THE AMBULATORY CARE MODEL OF
THE FUTURE HAS ARRIVED AT VIRTUA
Virtua Medical Group / Richard Temple & Associates, LLC
Presented By:
Date:
Dr. Tarun Kapoor, Vice President/Senior Medical Director,
Virtua Medical Group at Virtua Health
Rich Temple, Founder/CEO, Richard Temple & Associates, LLC
October 29, 2015
Biography Slide for Dr. Tarun Kapoor
Tarun Kapoor, MD, SFHM is the Vice President, Senior Medical
Director for Virtua Medical Group (VMG), a 300+ clinician multispecialty medical practice. He has been a practicing hospitalist
with VMG since its inception in 2008. He joined Virtua’s Medical
Informatics team in 2010, helping to develop and implement its
inpatient electronic medical record, including full deployment of
CPOE and electronic Medication Reconciliation.
Prior to joining Virtua, Dr. Kapoor was Regional Director for
EmCare’s Mid-Atlantic Hospitalist Division. While at EmCare, Dr.
Kapoor developed 16 inpatient care programs for Clinical Staffing
Solutions, which was subsequently acquired by EmCare.
Dr. Kapoor trained in Internal Medicine at The George
Washington University Hospital, where he stayed on an extra year
to serve as Chief Resident and Clinical Instructor. He obtained his
medical degree from Rutgers Robert Wood Johnson and his
undergraduate degree in Government and Chemistry from
Cornell University.
In his spare time, he is an avid traveler, ice hockey player, golfer
and a fly-fishing novice.
Biography Slide for Rich Temple
Rich Temple has over 25 years of healthcare experience at
all levels. He is currently the Founder/CEO of Richard
Temple & Associates, a consultancy specializing in
healthcare advisory and strategy. In a recent engagement,
Rich led numerous strategic projects at the Virtua Medial
Group around physician-health system alignment, touching
on many current healthcare priorities. Prior to this, Rich
was the National Practice Director for IT Strategy for
Beacon Partners (now KPMG), an established consulting
firm dedicated to serving the healthcare provider
community. Before joining Beacon, Rich was a CIO at two
different major multi-facility health systems where he led
many system implementations, including a major “bigbang” EHR implementation which won multiple awards
from the EHR vendor for its overall success.
.
Rich is a former President, Secretary, and Board Member
of NJ HIMSS and has recently relocated to Philadelphia and
is becoming more involved with the DV Chapter of HIMSS.
About Virtua
 3 acute-care hospitals
 82 physician office locations
 9 ambulatory surgery center locations
Virtua Medical Group: A Multi-Specialty Practice
(287 Physicians + 87 NP/PA /OB Triage / Midwives)
9.2.15
Family Medicine
(84 Physicians,
18 NP, 3 PA)
Breast Surgery
(4 Physicians,
2 NP, 1 PA)
GYN Onc
(2 Physicians)
Infectious
Diseases
(11 physicians)
Dental
(3 Physicians)
Female Pelvic
(1 Physician)
Pulmonary
(12 Physicians,
3 NP)
Neurology
(2 Physicians,
2 NP,)
Surgery
(34 Physicians,
5 NP, 2 PA)
Urgent Care
(16 Physicians,
12 NP)
Maternal Fetal
Medicine
(6 Physicians)
Internal
Medicine
(7 Physicians,
2 NP)
Hospitalist
(59 Physicians
9 NP)
Women’s
Primary Care
(3 Physicians
1 NP)
Endocrinology
(7 Physicians,
2 NP, 2 PA)
Cardiology
(19 Physicians,
5 NP, 1 PA)
Podiatry
(7 Physicians)
Occupational
Health
(4 Physicians,
5 NP)
Community
6
Ob-Gyn
(7 Physicians,3NP)
OB Triage (12)
Midwives (2)
Women’s
Hospital/Specialists
Surgery
Virtua’s Overarching Vision for Ambulatory
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“Form Follows Function”
Everything revolves around the patient experience
Remove Wasteful Processes
Easy-in / easy-out – minimize waiting
Collaboration among caregivers is emphasized at all
points in the care continuum
 The office visit comprises only a part of the patient’s care
experience
Care Redesign & Delivery Strategies
 Access: Streamline Office Operations & functions. Optimize
types, number, functions of care team members. Build Access
Around the Patient’s Needs, not the Provider’s
 Patient Activation: Redesign patient encounter to maximize
patient activation. Patient activation means the patient self
motivates and sustains wellness activities outside of the
clinician office
 Evidence-Based Care: Highest quality care doesn’t necessarily
means the greatest amount of resource utilization
 Care Coordination: Redesign patient encounter to incorporate
care across multiple providers and across multiple episodes of
care
 “Wherever you go, we’re there to care for you”
Methodologies for Realizing the Vision at the
Virtua Medical Group
 Engaging ALL stakeholders at all points in the
process of opening a new ambulatory care center
 Larger exam rooms to accommodate family
members and make it easy for the doctor being able
to face the patient throughout the examination
 Overall office design to optimize the patient’s
journey through the entirety of their visit
 Utilizing the Six-Sigma expertise of Virtua’s “Business
Operations Excellence” (BOE) team to understand
workflow and overall patient throughput in
extremely granular detail
Methodologies for Realizing the Vision at the
Virtua Medical Group
 A “welcome center” to provide a warm environment
for patients upon their arrival
 Office layouts that facilitate easy collaboration
between physicians and all office staff
 Providing maximum appointment access to patients
through close coordination with Virtua’s Access
Center
 Offering a deep clinical support structure to ensure
the EHR is as information-rich as possible and that
doctors can have key information about potential
care gaps readily pushed to them in the exam room
Engaging All Stakeholders When Opening a New
Ambulatory Care Center
 This means ALL stakeholders:
• Physician leadership
• Physicians in the practice
• Office management and
staff
• VMG management and
staff
• Virtua leadership
• Virtua Facilities
department
 From the initial design session through to the opening of
the facility, meet with physicians, office managers, office
staff to understand what their current pain points are and
how the new center should be configured to address those
points
 Also engaged with Virtua’s Patient Family Advisory Council
to get direct “voice of the customer” feedback on our
ambulatory care concepts
Engaging All Stakeholders When Opening a New
Ambulatory Care Center
 Communicate, communicate, over-communicate

We sent out bi-weekly emails about progress on our key
projects to everyone involved in any project to create a sense
of ownership and skin-in-the-game
 Make sure the right people are communicating with
each other to avoid silos
• Physicians
• Medical Group leadership
• Facilities management
• Architects
 Speak at as many meetings as possible and solicit
feedback at these meetings
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Be prepared to be flexible when scheduling these meetings;
physicians often are most accessible very early or very late in
the day
Providing food helps drive attendance!
Engaging All Stakeholders When Opening a New
Ambulatory Care Center
 Having a common liaison to work with all parties to
shepherd new construction initiatives through the five
key project phases:
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Test Fit Planning
Program Verification and Schematic Design
Design Development
Construction Documents
Bidding and Construction Administration
 Facilitating direct discussions with all parties – reducing
the risk of miscommunication and ensuring the
architects clearly understood the needs of the practice
in the new locale
Going beyond the traditional “Exam” Room
 Inspired by the Advisory Board’s “Four Zone Exam
Room” model, but adjusted to address Virtua’s needs
Overall Practice Office Design to Optimize the
Patient’s Journey Through the Entirety of Their Visit
 “Welcome Center”
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The “gateway” to the (potentially) multiple practices located in
the ambulatory care center
Warm, inviting
The center will have a “greeter” always available to greet
patients and immediately answer any questions they may have
Check-in occurs here – via either kiosk or via human office
assistant – for all practices (exception: Urgent Care, since there
are no appointments for Urgent Care
 Instant communication to medical assistant that patient
has arrived and can be roomed
 Secondary waiting area for family members nearer to the
room itself (if they are not going to be in the exam room
with the patient)
Overall Practice Office Design to Optimize the
Patient’s Journey Through the Entirety of Their Visit
 Strategic placement of functions relevant to the
patient encounter
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Scales / vital-sign collection – right near the entrance to
the office suite – on the way to the room. Provide privacy
but “keep the flow going”
Point of care testing (“POCT”) blood draws or urine
samples – lab right next to patient bathroom
Clean and soiled utility areas easily accessible but
sufficiently far from typical patient paths
Placement and angling of exam tables
Placement of sinks
Set-up of advanced technology to share key information
with patients
Overall Practice Office Design to Optimize the
Patient’s Journey Through the Entirety of Their Visit
 The team pod: the collaborative area right at the
heart of the practice!
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All caregivers work closely together in a common place
with frequent interactions with physicians
Full line-of-sight to all exam rooms so everyone can know
what is going on and when they are needed
Physician “touch down areas” right in the pod and also
along the perimeter of the pod
Strategic placement of printers and scanners within the
pod area
 Shared physician spaces with very comfortable
surroundings – optimize clinical and revenuegenerating areas
A Rendition of a Team Pod
The “Business Operations Excellence” Team (“BOE”)
and Six Sigma Best Practices
 Virtua has a team of Six Sigma experts who played a
hugely valuable role in allowing best practices to be
facilitated in the new ambulatory spaces
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Fleshed out exact processes
Identified chokepoints at various points in those
processes, along with potential resolutions –
• Rigorous attention to "reality" during the design
process.
Detailed time-and-motion studies to look at patient
volumes, calls handled by Medical Assistants per hour,
peak periods, potentially uncomfortable high-traffic areas
Some Process Areas Examined by BOE
 Pre-registration process
 Arriving patients
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Scanning scripts
Providing med lists, ACO packets (where appropriate), new
patient welcome kits, collecting copays and other outstanding
balances
Printing receipts
Getting necessary HIPAA and other forms signed
 Handling walk-ins
 Handling patients who need to speak to the office staff
but don't have an appointment that day (a surprisingly
large percentage)
 Alerting medical assistants to patient arrival
Some Process Areas Examined by BOE (continued)
 Rooming the patient - involves non-obvious things like
making the walk from the main Welcome Center to the
room and the shared practice waiting area as quick as
possible; also need to figure out what types of hardware
(e.g., tablets) should be used by the MAs to make this
process easy
 Prepping for medical assistant initial discussion
 Prepping for the physician visit itself
 Communicating any next steps / referrals to appropriate
staff
 Printing necessary materials for the patient (referrals,
educational collateral, etc.)
 Check-out (in-room where possible)
In-Room Check-Out – New Concept
 Studies have shown that patients appreciate not having
to make an additional stop on their way out after their
visit has completed
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That said, there are circumstances where the check-out process
is sufficiently complex and time-consuming that a separate
room is necessary
Want to balance patient happiness with not locking down a
room that could throw off a physician’s schedule
 Pilot studies showed that patients liked it and it wasn’t
unduly cumbersome on physicians, though physicians
had – and to some extent, continue to have - concerns
 Questions: who does the check-out, what types of
technology do they need to do it effectively, how to print
off additional information for patients while they are in
the exam room?
A Major Imperative: Providing As Much Access As
Possible While Maintaining High Clinician Utilization
 Virtua maintains a well-staffed “Access Center”,
using CRM technology to help patients get
appointments and coordinate referrals
 This Access Center handles a great deal of the
scheduling for the Medical Group and reduces this
burden for the individual practices
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The dedicated focus on this with the Access Center allows
for a terrific array of metrics showing improvements in
patient satisfaction
 This is one more way that processes are getting
streamlined in the new model of ambulatory care at
Virtua
Clinical Support Services
 New and revolutionary concept being rolled at
Virtua to:
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Proactively perform outreach to patients prior to an
appointment to ensure whatever tests were supposed to
be present, in fact, are
Aggregating data from a multitude of sources to provide a
clear picture to the physician – right in the exam room - of
key quality indicators and potential care gaps
Relieve the practices of much of the burden of ongoing
patient follow-up, medication refill processing, etc.
Final Thoughts
 Key success factors for success in the increasingly
ambulatory-centric healthcare provider model:
 Vision
 Leadership
 Communication
 Collaboration
 Execution
 Work closely with your Marketing departments, service-line
coordinators, and others to make sure that you are deploying
services in a market where those services are needed and that
you can do it in a manner that supports organizational
strategy
Thank you for your time!
Questions?