Friday, July 20, 2018

Small Practice

Small Practice

The Doctor- Patient Relationship and the Outcomes Movement

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Screen Shot 2015-10-01 at 9.46.12 AMIn a recent Harvard Business Review article, authors Erin Sullivan and Andy Ellner take a stand against the “outcomes theory of value,” advanced by such economists as Michael Porter and Robert Kaplan who believe that in order to “properly manage value, both outcomes and cost must be measured at the patient level.”

In contrast, Sullivan and Ellner point out that medical care is first of all a matter of relationships:

With over 50% of primary care providers believing that efforts to measure quality-related outcomes actually make quality worse, it seems there may be something missing from the equation. Relationships may be the key…Kurt Stange, an expert in family medicine and health systems, calls relationships “the antidote to an increasingly fragmented and depersonalized health care system.”

In their article, Sullivan and Ellner describe three success stories of practice models where an emphasis on relationships led to better care.

But in describing these successes, do the authors undermine their own argument?  For in order to identify the quality of the care provided, they point to improvements in patient satisfaction surveys in one case, decreased rates of readmission in another, and fewer ER visits and hospitalizations in the third.  In other words…outcomes

ONC’s Interoperability Plan: a Day Late and $19bn Short

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Screen Shot 2015-10-21 at 8.40.34 AMEarlier this month, the Office of the National Coordinator for Health Information Technology released an update to Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap. The roadmap was first announced back in January, and the changes shared this month aren’t significant.

Ultimately, it calls for all healthcare providers nationwide to be able to send and receive electronic clinical information by the end of 2017.

This is a good plan on the surface, although it comes six years and millions of dollars late, and like other programs it may be more cumbersome that it first seems. Essentially, there are three facets:

1) Data standards to format and request/receive data

2) Incentives (again!)

3) Governance

Despite the intention to move data across the Union, each state will have the right to create its own unique rules on how to manage the exchange of information. This is a problem as we have seen before in the simple Case of e-prescription routing. A few states make it almost impossible to send e-scripts and layer on their own special form of bureaucracy. This inhibits the ultimate goal of reducing costs and errors and increasing Efficiency at the expense of both providers and patients.

How I Use P4 Medicine to Maximize Patient Engagement

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Molly MaloofThe healthcare industry is changing as new models of care and reimbursement emerge. One of these approaches is P4 Medicine. P4 Medicine stands for predictive, preventive, personalized, and participatory. This approach deeply resonates with me because the philosophy is aligned with how I have been developing my medical practice, which is focused on optimizing health and avoiding disease. In my opinion, P4 Medicine is one of the best models for maximizing patient engagement.

The earliest manifestation of P4 Medicine began eight years ago at the Institute of Systems Biology when Dr. Lee Hood, MD, PhD, a physician scientist and creator of the automated gene sequencer, recognized that the application of systems biology to medicine would fundamentally alter our understanding of health and disease. This model has merged three powerful aspects of science and technology:

Death By Documentation

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In my work with hundreds of over stressed and burned out physicians, one thing is constant. Documentation is always one of their biggest sources of stress.

In fact, if you ask the average working doctor to make a list of their top five stresses, documentation chores will take up three of the five slots.

1. EMR – especially if you use multiple EMR software programs that don’t talk to each other

2. Dealing with lab reports and refill requests

3. Returning patient and consultant calls and documenting them adequately and all the other places information streams have to be forced together by the sweat of your brow.

The average doc is walking the cliff edge of overload on a significant number of office days in any given month. Now comes ICD-10 and my biggest fear is the extra work of the new coding system will push many physicians over the edge into burnout.

How much more time will ICD-10 take?

A Powerful Tool For ICD9-ICD10 Conversion

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Prior to attending medical school, Parth Desai took a gap year to help his mom manage his dad’s small internal medicine practice.  She was worried about how she was going to handle the looming transition from ICD-9 to ICD-10.  Parth said he would help her out.

He looked at different consultants and programs, but they were all too complicated, too expensive, or both.  He also looked at a number of different ICD-10 training programs, but didn’t really find anything that he thought was that good.  He wanted help with code conversions, but everything he saw was slow, or required additional personnel, or was too costly.

So, he did what lots of entrepreneurs do, he decided to build what he needed himself.  He enlisted his former college roommate, Will Pattiz, a “tech whiz, outdoor enthusiast, and filmmaker” to help him and together they developed software that automates the conversion of ICD-9 to ICD-10 codes. 

Bridging the Gap between MUS2 and Patient Engagement Through Appointment Reminders

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MaloofMedical technology has undergone dramatic changes in the last 10 years. Right now, I make and cancel appointments, get prescriptions filled, look at test results, pay bills and email my doctor—all from my computer. I track multiple health markers on my cellphone, and am proactive about my preventive screenings. I am the definition of an engaged patient.

But, I know how the system works from the inside out. The question for most doctors is how to teach patients to be more engaged with the convoluted, fragmented, and confusing healthcare system. They are asking this because they are struggling to meet Meaningful Use Stage 2 requirements.

Most docs complain that the 5% patient portal requirement is unfair because it is out of their control. Maybe it is, or maybe there are smarter ways to work the system in their favor that they just don’t know about.

Doctors Going the Distance (In Education)

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We need more doctors.

Between older care providers retiring, and the general population shift that is the aging of the Baby Boomers, we are running into a massive demographic of more, older patients, living longer and managing more chronic conditions. This puts incredible pressure not just on the remaining doctors and nurses to make up the gap, but strains the capacity of schools to recruit, train, and produce competent medical professionals.

So how can schools do more to reach students and empower them to enter the healthcare field?

The increasing popularity of online programs (particularly at the Masters level, among working professionals looking for a boost to their career advancement) has called forth a litany of studies and commentaries questioning everything from their technology to their academics,compared to traditional, on-campus programs. More productive would be questioning the structure and measuring the outcomes of degree programs in general, rather than judging the value of a new delivery mechanism against an alternative more rooted in tradition than science.

In terms of sheer practicality, though, a distance education—yes, even for doctors and surgeons—makes a certain amount of sense. One of the hottest topics in the medical community right now is Electronic Health Records (EHRs) and the ongoing struggle to fully implement and realize the utility of such technology.

Independent Practice Equals Higher Satisfaction

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Tom Guillani

Thinking of starting a new practice?  Is the lure of independence calling to you?  There are more reasons than every why independent practice is a great option. Being your own boss is not only easier than it once was, it can actually make you happier.

Independent physicians have many more options available to help them today than they used to. Affordable technology has revolutionized private practice from EHRs to easy-to-use practice management and billing software, adding flexibility to staffing and simplifying paperwork needs. And, the increased availability and ease of outsourcing has further reduced the burden of running your own practice. Physicians can now choose to outsource inbound calls, reminder calls, pre-authorizations, marketing, and of course, billing. In addition, independent providers can transition to new agile practice models such as concierge and hybrid that can offer higher incomes and smaller patient census and reduce some of the headaches associated with traditional practice structures.

Added to the fact that starting and running a private practice is now easier than ever, is the higher level of happiness experienced by independent physicians. In fact, a study done by Medscape in March 2014 reported that 74% of self-employed doctors are satisfied in their practice and that of the physicians who left employment in favor of independent practice, 70% felt happier in their new practice while only 9% were less happy being self-employed. Seventy-four percent of these self-employed doctors also said that their opportunity to practice quality medicine met or exceeded their expectations.

There are many factors contributing to these high satisfaction rates in independent physicians but one of the biggest is the control these doctors have over their practice, their schedule, their treatment of patients, and their destiny. A survey in Hospital Topics on the impact of practice arrangements on physician’s satisfaction backs this up, reporting that physicians who work for HMO’s have much less autonomy and decision-making power than self-employed physicians. And, the report by Health Affairs found that 85% of doctors in private practice felt free to control their schedules compared to only 39% of HMO physicians.

Self-employed doctors also avoided the pitfalls of employment cited by the Medscape study while the doctors working for hospitals and group practices listed administrative headaches, added rules, and a more limited income potential as reasons for dissatisfaction in their careers. It’s easy to see why the 2014 Great American Physician Survey conducted by Physician’s Practice found that over half of independent physicians would do things the same way all over again. This isn’t to say independent providers done have regulatory challenges or administrative responsibilities. However, they have more control over the day-to-day operations and administration, eliminating frustrating bureaucracy.

Better, more affordable, easier-to-use technology, simple outsourcing options, greater autonomy and control, and higher levels of satisfaction…all of these factors make private practice a more attractive option than ever. So, if you are considering starting a new medical practice, now is the time. Just remember, doing it right from the beginning will save you from unnecessary stress, making the process of opening your new practice a much more enjoyable experience.

By joining the ranks of independent physicians, you will be in control of both your practice and your life. You will be free to set your own schedule, manage patient care to your standards, work with a staff of your choosing, and have the final control over your income potential. All new practices will face challenges along the way but you will find a wealth of resources to make your life easier and guide you to success in your new venture.

Tom Giannulli, MD, MS, is the chief medical information officer at Kareo. He is a respected innovator in the medical technology arena with more than 15 years of experience in mobile technology and medical software development. Previously, Giannulli was the founder and chief executive officer of Caretools, which developed the first iPhone-based EHR.