The Healthcare Industry is in Desperate Need of Healing
By Halee Fischer-Wright, MD
Medical Group Management Association (MGMA)
Nearly every industry in the United States has become part of the on-demand economy, where consumers can get what they want, when they want it, and sometimes before they even realize they want it. Media, banking, grocery shopping—just about everyone has had to adapt to the Amazon effect.
Healthcare is slowly being pulled into this vortex of convenience and effectiveness. Within the last year, 71 percent of all medical practices have reported making changes to reduce patient wait times, according to a poll the Medical Group Management Association did last year. That is a good thing.
But it is not nearly enough. We are not close to getting the outcomes we say we want: better care and more satisfied patients at lower costs.
I know healthcare is a notoriously complex system with costs nearing 20 percent of our total GDP. Somehow, some way, healthcare needs to get a lot more efficient, and that means reimbursement will be tied to delivery of actual outcomes.
The frontline players—patients and physicians—will have to be bigger drivers of the change we need. Patients are going to have to demand more and doctors are going to have to deliver more on outcomes and accept that part of their compensation is going to be tied to that.
In fact, I would suggest that physicians build their data analysis and communication skills to articulate what measures and metrics actually do promote better health and better outcomes, long before those benchmarks are set for us. After all, big tech, payers, and investors are perhaps more incentivized than we are to manage costs. Healthcare is a big, juicy market to “disrupt.”
Here’s what the industry needs to keep in mind through this transition:
Focus on outcomes
In the search for quality, are physicians asking the right questions? We stuff our EHRs with data, but is it the right information and is it being used to the greatest effect? Data does not inevitably create discernment.
We need to reverse engineer the process. Let’s start with the desired end result and work backward from there to build processes and compensation models that reinforce the desired outcome, rather than what we’re doing now. My fear is that we’re waiting for someone else to do it for us. Or, perhaps more accurately, to us.
According to a 2016 MGMA poll, “Only 26 percent of physician compensation plans are tied to quality metrics.” That makes us sitting ducks in the eyes of efficiency players in the technology and logistics world.
Even as there is this disconnect, physicians are asked to manage too many metrics—4,000 data points at our last count, which doctors are forced to enter manually into EHRs after each appointment. Yet, we haven’t stepped back to ask whether or not these metrics are actually helping us to deliver the outcomes we want. I believe doctors want to influence clinical outcomes, but that’s hard to do when spending twice as much time on paperwork than with patients.
When organizations create compensation plans that base 5 percent or 10 percent of physician payments on myriad metrics that might not be ultimately relevant to patient health, the entire process becomes top heavy and difficult to manage. Of course, business people want to build compensation plans around what can be measured, but as physicians, we need to call for a focus on the measures that truly indicate patient health as our true yardstick of success.
There is no single solution
Every insurer, every physician, and every patient has their own idea about what constitutes quality. That’s OK to an extent, as the definition will and should vary. It’s not neat, but we have to accept that this will be the case and move forward from there.
Adding more quality markers won’t help, but that doesn’t necessarily mean that removing the ones we don’t agree with either. We must enable physicians to determine for themselves what quality looks like, stop spending time and money trying to define it with too much granularity, and instead focus on what can be done with the available tools.
To achieve mass customization in healthcare, we must accept fluidity and flexibility. Compensation plans will be a dynamic blend of base pay, production, and then enhanced compensation or a bonus tied to achieving certain patient outcomes that are unique to each organization’s and individual’s need.
And that’s where metrics come in. Once those outcomes are determined, doctors should work within their systems to discern what measurable metrics truly indicate how they are delivering on those outcomes compared with other physicians.
Build a better model
As much as we hear about the move from quality to value in healthcare, we are still a fee-for-service compensation industry (with a few exceptions). There are lot of different players making a lot of money with the current system, and it’s all based on the same productivity model of compensation. The more patients you see, the more money you make.
It’s the model we have, whatever we might think of it, and it’s not going anywhere anytime soon. But we cannot rest on our fee-for-service laurels. We can begin by using the tools at our disposal to accelerate change.
We know that healthcare can’t be run on algorithms. Health technology is not going to save us, although it can fill in much-needed gaps. The human element is essential to achieving better patient outcomes. We have to think our way out of this, putting the patient at the center of our efforts, not the technology.
When you’re sick and vulnerable, you want the intimacy of human interaction, and that is impossible to reproduce with digital tools. Our compensation models need to reinforce this. Better care with better satisfied patients at lower costs can be achieved if we put patients first and incentivize our doctors—and frankly the rest of the system—to make those outcomes paramount.
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About the Author
 Halee Fischer-Wright, MD, is a healthcare leader, physician, speaker, author, and president and CEO of MGMA.
Thank you Business Resource Sponsors
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By Brian Courtney, RPLU, AAI
The Safegard Group, Inc.
Originally publish on The Safegard Group, Inc. website
Regardless of whether you operate from a high-rise building or an industrial complex, or you rent, own or lease your property, your first priority is to protect the health and safety of everyone in your facility. One common means of protection is through the use of an Emergency Evacuation Plan.
Planning for emergencies is critical in assisting you in assigning responsibilities and procedures when responding to fire, chemical, weather, utility or medical emergencies. A plan will also further assist you in developing preventative actions.
If you already have an evacuation plan, make certain your plan has accommodated any changes. If you don’t have a formal plan, we urge you to develop one. Plans compel you to think through the best course of action in an emergency.
Develop your Emergency Evacuation Plan
Here are some items that should be included when developing your plan:
- Determine conditions under which an evacuation would be necessary.
- Establish a clear chain of command.
- Designate who has the authority to order an evacuation.
- Designate specific areas where personnel should gather after evacuating. Take a head count.
- List the names and last known location of personnel not accounted for. Confusion in the assembly areas can lead to unnecessary and dangerous search and rescue operations.
- Establish procedures for assisting non-English speaking workers and those with disabilities.
- Post evacuation procedures and clearly identify primary and secondary escape routes.
- Conduct training. Failing to practice can undermine even the best plans. Practice increases the likelihood of a confident and orderly evacuation. Coordinate plans with your local emergency management office.
The details involved in evacuation planning range from major to minor, but decisions have to be made, written down, presented and practiced regularly.
Employees need to know what to do, and know it so well that they can put the plan into action even when they are rattled. Being prepared for a catastrophe lessens the potential for injury, lost lives and property damage.
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About the Author
 Brian Courtney joined The Safegard Group, Inc. in April 2005 and serves as a Producer for the company. He is primarily responsible for the direction of client services to the professional services industry.
Brian began his career at the height of the medical malpractice crisis. Working with a large regional insurance broker, Brian served clients in the professional service industries placing various coverages, such as Malpractice Liability, Directors & Officers Liability, and Employment Practices Liability. Prior to joining The Safegard Group, Brian joined a large national insurance brokerage firm where he gained considerable experience in risk management serving the needs of large professional organizations. Currently, Brian is helping many of his clients with Risk Management initiatives, such as Risk Assessments, Data Breach Incident Response Planning, Contractual Risk Transfer, Insurance Protection, Loss Control, Claims Management and a host of other related services. Brian has conducted seminars on topics, such as Cyber Security, Disaster Recovery Planning, Sexual Harassment, Workplace Violence and Group Captive Insurance.
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Barriers to Effective Communication
By Mallory Earley, JD
ProAssurance
To
ensure an effective physician-patient relationship and provide quality
care, you must be able to communicate with your patients.
Physicians
may encounter difficulties in three situations: when a patient is hard
of hearing, has limited English proficiency, or is illiterate. Federal
law requires physicians to make reasonable accommodations for hard of
hearing and Limited English Proficiency (LEP) patients. If proper
accommodations are not afforded to these individuals, serious
consequences, including medical professional liability lawsuits, can
occur. Here are some risk management strategies which can be applied to
reduce miscommunication with hard of hearing, LEP, and illiterate
patients.
Hard of Hearing Patients
The
Americans with Disabilities Act (ADA) strictly prohibits any
discrimination against individuals who are hard of hearing in places of
public accommodation. Under Title III of the Act, a physician’s office
is defined as a place of public accommodation.1
As such, it is required to make reasonable accommodations for hard of
hearing patients. Since the standard is reasonable accommodation, there
is not a bright-line rule which states what each practice must do for
each patient. Appropriate accommodations will vary based on the
circumstances of each patient’s case and his or her needs. For example,
one patient may want to write notes to facilitate communication with the
provider while another may require a qualified sign-language
interpreter for every visit.
Discuss
communication preferences with hard of hearing patients in advance.
Their options can include: a qualified interpreter on site, note taking,
computer-aided transcription services, or devices such as telephone
handset amplifiers and Telecommunications Devices for the Deaf (TDDs).
If you have a large number of hard of hearing patients it may be
effective to hire an interpreter. Then set aside a block of time when
the interpreter will be present to accommodate these patients.
Regardless
of the method of assistance your patient chooses, ensure the type of
aid to facilitate communication is accurate, effectively conveys medical
terminology, and maintains the patient’s confidentiality of protected
health information.
Limited English Proficiency (LEP) Patients
Another
breakdown in communication can occur with LEP patients. Title VI of the
Civil Rights Act prohibits discrimination on the basis of race, color,
or national origin. This Act requires physicians to ensure that
non-English speaking patients have equal access to healthcare.2 You and your office staff need to take reasonable steps to make sure LEP patients have meaningful access to care.
Once
you determine your office’s need for language or interpreting services,
choose the services that best meet your patient’s needs and office’s
resources. Your practice may also want to include a preferred language
section on office intake forms so patients can tell your practice if
they require accommodation.
Your
options for communicating with LEP patients can include: hiring
bilingual staff if English is not the dominate language in your area;
using a telephone or video conferencing interpretation service;
contracting with companies to provide qualified interpreters who will
come to your office; or written translation services.
Some
patients ask their family or friends to translate which can be helpful.
However, it remains the physician’s responsibility to ensure that the
communication is accurate and effective. For example, if minor children
translate for a parent, they may lack the knowledge or maturity to
effectively convey the medical information. An adult family member or
friend may not be comfortable telling the patient certain information or
could fail to tell the patient important items. In certain
circumstances, referring the patient to a physician better suited to
communicate with the LEP patient could be an option. However, this does
not need to be the sole method for accommodating LEP patients in your
practice.
As
with any patient, the doctor must ensure accurate communication of any
medical terminology. When using an interpreter, the physician should
stress the importance of confidentiality and document in the medical
record the type of interpretive services used.
Minimally Literate Patients
Minimally literate patients may be difficult to identify in your practice.
One
article defines health literacy as “the degree to which individuals can
obtain, process, and understand the basic health information and
services they need to make appropriate health decisions.”3
If patients cannot understand their medical information, they may be
unable to follow their treatment plans, take medications as prescribed,
or make educated decisions about their care. Some may turn to litigation
to resolve their issues.
According
to one estimate, nearly half of Americans have some type of limited
ability to understand medical terminology and have difficulty
understanding and acting on health information. Nearly forty million
Americans cannot read complex medical texts, and ninety million have
difficulty understanding them.4
With training, your front office staff may be able to help identify and
assist minimally literate patients at check-in. Patients who avoid
filling out new patient information, miss appointments, or mishandle
medications may have literacy challenges. They also may bring a family
member along to read their paperwork, or say they have poor eye sight
and forgot their glasses.
There
are a few risk management tips when caring for minimally literate
patients. Physicians and medical staff should avoid using complex
medical terms. Instead of assuming a patient understands what has been
said, physicians can ask questions and have the patient explain the
instructions or care plan. Physicians can help minimally literate
patients by using pictures or illustrations to assist patients in
understanding treatment plans. If a patient brings a family member or
friend to the appointment, enlist the help of the other person to aid in
the patient’s comprehension. As with any patient, ask if he or she has
questions at the end of the appointment. A little bit of extra time
during the appointment could help prevent follow-up appointments or
subsequent treatments and improve the health of the patient. Ensure that
your educational materials and forms are easy to read and understand.
Use plain language in short sentences and avoid medical jargon.
Noncompliant Patients
Noncompliant
patients also can pose a risk management risk to a physician practice.
These patients may miss scheduled appointments, not follow treatment
guidelines, or ignore medical recommendations for further testing or
scans. Although there can be many reasons for noncompliance, open and
honest communications with the patient may help you reach a compromise.
Some patients may not follow through due to financial limitations.5
Others may not understand the importance of compliance in their
treatment goals. Regardless of the reasons, physicians and office staff
must document any noncompliance in the medical record. Proper tracking
and follow up procedures for missed appointments will indicate a
potential problem with a patient that must be addressed. If the patient
continues to be noncompliant with appointments or treatment options, the
practice may consider dismissing the patient.
Sources:
1 Americans with Disabilities Act of 1990, Pub. L. No. 101-336, 104 Stat. 328 (1990).
2 Civil Rights Act of 1964, Pub. L. 88-352, 78 Stat. 241 (1964).
3
Nielsen-Bohlman et al., Health Literacy: A Prescription to End
Confusion, Institute of Medicine (Eds. National Academies Press 2004).
4 Ibid.
5 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2912714/
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About the Author
Mallory
B. Earley, JD, is a Senior Risk Resource Advisor for ProAssurance. She
researches legal and professional liability issues for insured
physicians and other healthcare providers. Mrs. Earley is a licensed
attorney who litigated domestic and civil cases in private practice. She
obtained her BA in History and Psychology from Samford University and
her Juris Doctorate from Cumberland School of Law at Samford University.
She is an active member in the Birmingham Bar Association and the
Alabama Bar Association.
email: mearley@proassurance.com
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A Good Practice Leader is a Good Listener
By Lisa Grabl
Originally posted on Physicians Practice
Lisa Grabl is president of the locum tenens division of CompHealth, a division of CHG Healthcare.
One of the greatest attributes a leader can have is the ability to listen. Listening to your staff and peers and then taking action on what you hear is often the key to keeping an engaged and happy workforce. I have found in my own work a few things that have made listening easier and providing feedback on that listening more effective.
Be Approachable
The easiest way to receive feedback is being in a position where employees trust you and are willing to share. For most leaders, this may take some work. Many think they are very approachable but spend most of their time locked away in meetings or their office. Don’t expect approachability to mean people will naturally come to you. You need to go to where the people are and strike up conversations.
Let people see you as not just the supervisor or boss, but rather a real person. Setting aside a regular time to get out and just talk with employees is key to building approachability.
Be Transparent
If you are open and honest with your employees, they are more likely to be open and honest with you. Generally, unless there are legal or privacy issues keeping you from sharing something, let employees know what is going on with the practice.
Whether it’s the current state of the business, plans for a future expansion, or new goals, share them. Employees want to feel like they are part of the company so don’t leave them in the dark.
One-On-Ones
Regular one-on-one meetings with employees are a great way to get direct feedback. However, just meeting with an employee doesn’t necessarily mean they will be engaged. Instead of taking charge of the one-on-one, let the employee drive the conversation. These meetings are a great opportunity for employees to lead the discussion and bring up topics they have questions about, are concerned about or are passionate about.
Focus Groups
Focus groups are another way to receive immediate qualitative feedback. Identify a problem in your facility and bring together a small group of employees to find out how they would solve problems and other ideas they have for improving your work.
Employee Surveys
Another good way to get feedback from employees is through surveys. This is especially true for those employees who feel more comfortable submitting their feedback anonymously.
However, the key to a good survey is making it realistic. Don’t ask questions if you have no intention of acting on the feedback you receive. Also, make sure you are ready to report on and share all the results.
Act on Feedback
The key for all of these listening tools is acting on the feedback you receive. Whether in a one-on-one meeting or in a big employee survey, you need to outline how you are going to respond. You also need to share with your employees the things you are doing to address their comments. Whether it’s something as simple as installing a pebble ice machine or something bigger like expanding maternity and paternity leave, let your employees know that you not only listened to their feedback but implemented it as well.
When we were trying to decide the location of our new headquarters, we surveyed our employees to find out where they wanted it located. We then used that feedback to decide on our final location. We used similar means to determine what amenities the building should include and added things like standing desks, a cafeteria, and a health clinic—all due to employee feedback.
Listening and acting on what you hear is key to engaging your employees and knowing what you need to do to keep them happy and productive.
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Tom Powers currently serves as President & CEO of StrataDefense, a cybersecurity firm headquartered in Wausau, WI focused solely on securing financial networks. With more than 24 years in the technology arena, 20+ years in the financial and healthcare industries, and several technology industry certifications Tom has developed a passion for developing solutions to protect the critical networks that StrataDefense serves. He has a passion for securing his client networks, driving penetration testers insane, pina coladas, and getting caught in the rain.