By HANS DUVEFELT, MD

One of the things that can cause physician burnout is the arcane way information flows in medical offices. In essence, due to EMRs we are the recipients of increasing amounts of unfiltered data without context.

Pre-EMR, team members sorted incoming data, which allowed us to deal with it more efficiently. We would have piles of things that needed a signature just as a formality, other piles for normal reports, smaller piles for abnormal reports, or whatever system worked best for us and our practices.

Because EMRs were created by people who never imagined that doctors themselves knew anything about how to maximize their own efficiency, results and reports now fill our inboxes in random order and demand our attention and our electronic signatures more or less immediately.

There is a better way. It is standard practice in manufacturing. They call it “Just in Time”.

Continue reading…

By CRAIG KONNOTH

After the horrific shooting in in Orlando, the conversation has turned to homophobia—specifically, the homophobia of a man who sees two men kissing, buys an AR-15, goes to a gay nightclub, and killed 49 individuals.  But homophobia does not always come with a high capacity rifle—sometimes it comes with lab coats and syringes.  As the 53 individuals who were critically injured in the shooting receive medical care, we must come to terms with the anti-gay discrimination that pervades our medical system.

Continue reading…

By JOE FLOWER

Can’t. Won’t work. We’re stuck with this. We have to fix it.

But “Brexit” was a great logo/hashtag/campaign meme, with echoes of “Britain, break it, exit” all in one. Falls right off the tongue, it does. And it described fairly exactly the mood behind it, one of breaking, getting out.

So in healthcare? Time to FFSexit — exit the fee for service business model. Nah, doesn’t trip off the tongue. And it has echoes of “sex” and even “sexist.” Next!

Time to ITexit — exit the non-interoprative, non-communicative garbled EHRs and other information systems we have ended up with. Nope, nope. Sounds too much like inviting Texas to re-think this whole annexation thing.

Time to Vexit — exit the volume-based business model. Hmmm, no. Sounds vexatious, vexed.

Time to exit the fragmented, opaque, partial, byzantine, and outright cruel healthcare financing system we have now —FragOpParByzOutCrexit! Sigh.

Wait. Wait. Here’s the core problem of this meme-pondering: We don’t want to “exit” healthcare in any way.

Continue reading…

By JIM PURCELL

A message to health insurance CEOs, COOs, and CFOs.  I believe there to be a fundamental disconnect between typical health insurer provider reimbursement strategies and the long term good of our healthcare delivery system and its financing.

Let me give you some examples which I know, as a former health insurer COO and CEO, to be true.

• Insurers still pay primary care physicians far less than most specialists.  That perhaps was a function of the RBRVS system adopted by Medicare to “measure” the demands of specific physician activities and pay accordingly.  Specialist activities were rated higher than primary care activities.  They were deemed more complex, often involving surgery and fancy equipment with more training needed, etc.  The gap between primary care and specialist reimbursement grew and grew.  And what happened?  Predictably, the best and brightest are avoiding low paying primary care.  Consequences?

• Shortage and aging of primary care physicians who are needed to keep us from requiring the much more expensive specialist and hospital care

• Oversupply of specialists resulting in overuse, because if you build it they will come

• Keeping the focus on sick care, which is what most specialists specialize in, rather than well care

• Devaluing E&M (evaluative and maintenance) activity, which is the heart and soul of the practice of medicine, requiring observation, patient knowledge, and perception

Continue reading…

By DAVID INTROCASO

The intent of Title I of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) is to improve care quality and reward value. 1  Tying an increasing percent of Medicare fee for service payments to quality or value through alternative payment models such as Accountable Care Organizations (ACOs) is also Department of Health and Human Services Secretary Sylvia Burwell’s goal. 2  However, in the proposed MACRA rule published in May, CMS will measure and score quality and resource use or spending independently. 3  CMS will not measure outcomes in relation to spending.  CMS will not measure for value.  If value is left unaddressed in the final rule the agency can neither meet MACRA’s goals nor Secretary Burwell’s.  CMS cannot also reasonably expect providers to continue to enter into, and succeed under, risk based contacts if they do not know if they are incrementally improving quality or outcomes relative to spending. Continue reading…

By KIP SULLIVAN

One of the privileges of being a managed care advocate is that you never have to discuss the unpleasant question of how much your proposed intervention will cost. Whether your proposed intervention is HMOs, report cards, pay-for-performance, ACOs, “medical homes,” or electronic medical records, you never have to estimate what your bright idea will cost. With this privilege comes another: You are free to criticize doctors and hospitals for being “cost unconscious.”

Over the last decade, CMS has become a proponent of this double standard – cost consciousness for doctors and hospitals and cost unconsciousness for the health policy illuminati
. Beginning with the Physician Group Practice Demonstration, which ran from 2005 to 2010, and running through today’s ACO and “medical home” demos, CMS has assiduously avoided reporting the costs that clinics and hospitals incur to participate in these demos. Jeff Goldsmith and Nathan Kaufman  have described CMS’s behavior as “sunny obliviousness to provider economics.” [1]Continue reading…

By RONALD WYATT, MD

Civility is a system value that improves safety in health care settings. The link between civility, workplace safety and patient care is not a new concept. The 2004 Institute of Medicine report, “Keeping Patients Safe: Transforming the Work Environment of Nurses,” emphasizes the importance of the work environment in which nurses provide care.¹ Workplace incivility that is expressed as bullying behavior is at epidemic levels. A recent Occupational Safety and Health Administration (OSHA) report on workplace violence in health care highlights the magnitude of the problem: while 21 percent of registered nurses and nursing students reported being physically assaulted, over 50 percent were verbally abused (a category that included bullying) in a 12-month period. In addition, 12 percent of emergency nurses experienced physical violence, and 59 percent experienced verbal abuse during a seven-day period.²

Workplace bullying (also referred to as lateral or horizontal violence) is repeated, health-harming mistreatment of one or more persons (the targets) by one or more perpetrators.³ Bullying is abusive conduct that takes one or more of the following forms:³

Continue reading…