Dr. Fashakin with his wife, Abby Fashakin, a nurse practitioner at the practice

Dr. Emmanuel Fashakin runs a family medicine practice called Abbydek Family Medical. The 22-year old practice has offices in Queens (Flushing and Richmond Hill), Nassau County (Elmont), and Brooklyn (East New York). Each location sees about 20  patients a day. They treat patients of all ages and accept all types of insurance. Their patients, who come mostly from underserved areas, have every type of chronic condition, but most commonly hypertension, diabetes, high cholesterol, and asthma. Most patients speak English or Spanish but many speak Yoruba, Dr. Fashakin’s native language, or Pashto, which Dr. Fashakin has learned over the years from an Afghan staff member and his many Afghan patients.

Dr. Fashakin has participated in a number of NYC REACH-supported programs including HealthyHearts NYC, Meaningful Use, and Patient-Centered Medical Home (PCMH). The practice is also connected to the Healthix Qualified Entity (QE).

We asked Dr. Fashakin how participating in these programs and connecting to a QE has transformed his practice.

Why did your practice become a PCMH?

The main thing, to be honest, is that the PCMH approach helps with patient care. The money is secondary. PCMH enabled us to practice medicine the way we want to practice it. The model’s approach is to do the types of things we already like to do – like calling patients for their labs, booking their appointments and referrals, tracking and getting results. Those are great things to enhance patient care. That’s why I love it and my patients notice the difference. They tell me other doctors don’t do these things and they really appreciate it.

How has operating as a PCMH improved patient care?

In the older days, so many people would fall through the cracks. You’d say “Ok, A1C is high,” and you try to get it under control, but then you don’t see them for another year, and when they come back it’s even worse. But now, we have workflows to track all our patients and they each have “care coordinators.” Anyone with a chronic condition has someone monitoring them: calling them every week, every month, to check on their medicines and referrals and labs and getting them in for appointments. It motivates the patients too and helps to keep their treatment plans on track. If they did a blood test and the results are good, we call and say “Whatever you’re doing is working; keep it up!”

How has operating as a PCMH improved your relationships with patients?

PCMH concepts improve the dialogue with patients. One big advantage is it’s helping us keep track of all of the patients better. Sometimes it’s a nightmare to reach a patient. Twice in the past we had to tell the police we couldn’t reach them because the patient had terrible glucose and we wanted the police to go to their house and make sure they were not in a diabetic coma. So it’s very, very important to have accurate information.

Now we can contact them easier – we can e-mail them through the patient portal, and our care coordinators make sure we have the right phone numbers and demographics…and if the patient can’t get through to the office, they have their care coordinators’ phone numbers, and the coordinators can help.

Has operating as a PCMH improved your relationship with specialists?

It does help. We’re doing PCMH together with MU – so the two programs sort of enhance each other and help with the electronic transmission.

Now specialists are reporting back me, thanking me for references. They’re sending electronic messages to me, I’m sending messages to them, and our practice is getting a lot more referrals. I tell them, “Because we’re trying to do MU and PCMH I need a reply back within seven days of your referral – and if you don’t reply back to me I’m not going to send you patients again.” That works! And then my staff is calling them to say “My doctor is very upset!” if the specialist is late in sending back reports.

How has being a PCMH and participating in MU impacted your staff?

Now as a PCMH and MU and everything, our medical assistants spend 10-15 minutes with patients in triage. They ask about colonoscopies, do screenings for smoking, STDs, drug use, a lot of things. Making all of this part of triage; that was a breakthrough. They are the bedrock of success: the MAs that cover gaps in care. Also, our care coordinators get a score card every month to

track how they are performing on different measures with their patients and they can see how the other coordinators are doing too. They are each assigned a list of patients and we pick a measure for the month, such as how many adolescents were seen or colonoscopy results are received.

Every month the care coordinators with the top three scores get bonuses. This month we are measuring mammograms. The care coordinator who has the highest percentage of patients who got mammograms gets $200, the second highest gets $80, and the third highest gets $40. It’s a way to incentivize them.
At the end of the year, if we meet our payer incentives for a measure, the staff get $1000. If we meet our target for 10 measures, staff get another $1000 bonus. Sometimes the coordinators have already reached their end-of-year goals by July.

This is even possible on hard measures like adolescent well visits because our staff starts in January and calls our patients until they come, sometimes 9 times! We take our incentive payments from these programs and give it back to our staff. Wages for our staff have gone up and we don’t have a high staff turnover. People stay. The sky is the limit for them now.

A lot of your patients are using the patient portal. How did you make that happen?

Number one: It is automatic signup. It is mandatory for every patient that walks through our door to be web-enabled; that we have an e-mail address for every patient. I check personally to make sure the patient’s email is there. Sometimes we print their username and password right at the onset. I tell them “I’m going to send you an email. Go to the site.” Number two: I tell them what the portal is all about. You have to be proactive. I say “Look, it’s not free, I pay good money to set up the portal for you, so make good use of it! You can see your records, results, you can make appointments, request refills – you don’t even have to call the office.”

How did participating in HealthyHearts NYC improve patient care?

Getting return appointments and blood pressure control were the two main things we derived from it.  NYC REACH helped us a lot. When they started with us, [hypertension control] was like 10 or 15 percent [of hypertensive patients].  Now it’s more like 80 or 90 percent. Believe it or not, many of the things we implemented in our practice then are still with us. We don’t accept bad blood pressure. My providers know you can’t just go through the motions. If somebody’s not controlled, you must tell me what you have done, what intervention, to give us a better outcome. The difference is glaring.

How do you make sure patients show up for return appointments?

After HealthyHearts NYC, we got up to about 60% for return appointments, and we were still trying to improve it. Took me two years to figure it out, and I finally nailed it down! If a patient has high blood pressure or diabetes, the MA gets them to make a three month return appointment in the office before they see me – that’s the key. So they already have the return appointment date when they see me. That day they get a message in the portal, and the day before a text, phone call, email.  It’s so strict now. Even in the absence of hypertension diagnosis, if the MA sees that their blood pressure is elevated when they are in triage, they make a return appointment.

Has connecting to Healthix been useful for your practice?

It is helpful in a lot of ways. Now and then patients go to the hospital, so we need that information, and we download information on new patients. It’s most useful for new patients. Some patients just walk in to our office with nothing. We have a good system now to check on all their medicine, download all their drug history and everything.

One patient told me “Never in my life have I had blood pressure.” But when I went to check Healthix, everything lit up like Christmas! I could see he had been taking medication for hypertension. We tell patients that consenting to join the QE is an advantage to them and it’s in their best interest. We say “if you’re in the hospital in the middle of the night, you have everything available. We get a call and can advise the doctor at the hospital. We can also make sure you come in to see us afterwards.” That education and rapport with patients is very important to us.

Is achieving PCMH Recognition worth the effort?

It’s worth it. Absolutely. My only regret is that we hadn’t done it years ago. It looks like an onerous thing to gather all this data, you know. We are busy clinicians! But later I realized many of the things they are asking us to do we are doing anyway, so it’s just going to enhance that. The extra payment is good because now we’ve got more staff. We have five people working permanently just as care coordinators.

To learn more about becoming a PCMH, contact pcmh@health.nyc.gov.