An Interview with Dr. Michael Jongerius

View Dr. Jongerius' 2009 Performance Summary
Visit his website

Please describe your background in medicine.

I'm originally from St. Louis and I went to college and medical school at the University of Missouri in Columbia. After that, I did my primary care residency in York, PA. I then started practicing medicine in Peoria to fulfill a commitment with the Health Service Corps. When I completed that, I intended to go back to St. Louis to practice, but there was an opening that appealed to me for a physician in a Methodist rural practice in Princeville, that included a large migrant health population. Following some time there, I had the opportunity to help start a practice on an expanding edge of Peoria. Several years down the road, I decided to take an administrative position, but before long, I missed the clinical work. I wanted to return to practicing medicine, but do it differently than before, in my own way. That leads me to where I am today, in my Junction Medical practice which I opened in January 2009.

What made you want to get back to patient care?

After three years of serving in administration, I decided to return to clinical medicine. But I was only going to return to practicing medicine if I could do it a different way, based on what I had learned patients wanted from a medical practice and their relationship with their physician. The practice is set up based on a medical home model and Gordon Moore’s model of an Ideal Medical Practice (IMP), which focuses on highly-positive patient-physician relationships, increased face-to-face time with a physician, low physician overhead, and elimination of wasted healthcare dollars.

How is your practice set up?

I have two main goals that drive my practice: improving patient service and improving the clinical care I provide. There are several questions a patient can be asked related to their doctor’s access, competency, coordination of care, and continuity.

• Can I get care when I need it?
• Does my physician know me as a person?
• Does my physician take care of the bulk of my needs?
• Does my physician coordinate my care within the healthcare system?

If the patient can answer yes to all these questions, he or she is probably in a medical home or IMP. What I am running is closer to an IMP because it has financial structure so that I can independently run my practice without having to be burdened to see 20-30 patients a day in order to cover costs. In regular primary care practices, overhead can take as much as 50-60% of every dollar. The IMP greatly reduces that amount.

How many total patients do you have and how many do you see in an average day or week?

Right now the practice is hovering around 850 patients and I average 10-12 visits on a full day. When I started this practice, my goal was 750 patients. Now it is up to 1000. Every time the goal is met, I assess my situation to determine if I am still fulfilling the model and providing the necessary services to my patients at a high quality. If I think I am, I’ll set a new goal for the number of patients.

When did you start tracking your patients’ diagnoses, health measures, and outcomes?

From day one of my practice, it was my goal. I use a basic electronic health record, so I primarily track information I can pull from that. I want to look at data that makes sense to measure, has a direct impact on patient care, can drive change, and is of interest to my patients. It’s all part of a movement to transparency; people can look at my data, compare it with other physicians, and see if they want to come to my practice. That’s why I measure both clinical and service outcomes - to allow people to see how I perform in both patient outcomes and patient satisfaction. Then when I became involved with Quality Quest, I saw the opportunity to volunteer for the Patient Registry team and be more robust with my measurements.

How have the measures of interest improved or changed since you first started reporting? Are you pleased with the current levels?

I published my first report at the end of 2009, emailing the results out to my patients with data from my first year. The report is also posted on my website. Comparing those results with the current levels just one quarter into 2010, I can see improvements anywhere from a couple percentage points to maybe 10% improvement, and all the measures seem to be trending in the right direction. So far, the results are far from my goals and nationally recognized benchmarks, and there is always room for improvement, but it will take time to see big changes. I also have some measures of patient satisfaction and those are positive. From a clinical aspect, the trend must be upward or else there is a problem with the practice. I’m not doing these measures to promote my practice as much as I am to drive performance improvement. Measuring the data is rewarding to me and it motivates patients to be part of the improvement process when you can share the data with them.

Have you received feedback from your patients? What do they think of the report?

Yes, I send out a monthly e-newsletter and the one with the report generated the most feedback, which was mostly positive and encouraging. My patients appreciated my effort in putting the information out there and gave constructive criticism. Overall it was very good feedback.

Do you think reporting this information leads to patients taking more responsibility in increasing their health over patients that don’t receive the same data?

I certainly hope it drives patients to be more interested in being a part of the improvement process. Obviously, I don’t publicly report anything other than aggregate data, but in a one-on-one interaction with a patient, I can show my practice averages in comparison with the patient’s values and use it as an avenue of discussion on what others do differently that is more effective. One patient won’t make a significant difference in the overall numbers, but it does allow patients to be more active and engaged, which is key to my model and one of my goals in practicing in an IMP.

What is the next step for you in terms of making your practice better, improving transparency, or getting better results?

I have two main goals for this year. One is to improve my registry and patient care for diabetic patients, to make it more complete. The other is related to my service and that is auditing my referral process. I’m going to look at how long it takes for the patient to see the doctor I refer, the timeliness of response from the consulting physician, and the patient’s perception of the referral’s value. Studies have shown that as many as one-third of patients referred to specialists are dissatisfied and would rather not have gone through it, but the primary care physician may never hear that. Now, I am keeping a checklist for every referral I make to evaluate the quality of the referral. I can also talk to other physicians about improving communication flow. It’s all a part of my drive to continually improve efficiency.

Do you think your model represents the future of medical care?

I like to think that bits and pieces of it do. The model will not appeal to every physician.

What do you think of the current healthcare reform effort in Congress?

Like many people, I think the plan contains some good and bad elements. On the positive side, I support extending healthcare coverage to all Americans, closure of the doughnut hole in prescription benefits, and the proposed health insurance reforms. Major issues regarding cost containment and funding do not appear to be addressed by this bill.