In his column for The Wall Street Journal, Benjamin Brewer, MD, contemplates the value of overbooking patients to avoid no-shows. Brewer notes that his practice depends on patient visits as the main source of revenue so any missed appointments cost him money. In a busy practice, patients who don't show up take away a slot that someone else could use, he adds.
Practices aren’t always successful with electronic medical record (EMR) implementation. Some have even abandoned attempts to implement an EMR system, reverting back to the old way of doing things—a waste of valuable time and money.
The reason projects fail is often not about the software but about practices not wanting to change, says Susan Ordway, senior director of HIT services and manager of the Quality Information Technology program at Masspro. Project failure may be caused by:
A resistance to change (e.g., no operational design)
A lack of preparation (e.g., budget, communication plan, appropriate resources)
Selecting the wrong partner
To get a failed project back on track, first determine the reason for the project’s collapse. Before recommitting to your implementation, make sure your practice is equipped with the right tools. Start by creating an assessment form that includes questions about what you want to accomplish this time, Ordway says.
During the assessment phase, Ordway suggests groups draft a project that includes their renewed strategic vision, goals, and objectives. Also, take a closer look at your practice from an operational standpoint.
“Do you have regular meetings, and is there a definite leader responsible for these tasks?” Ordway says. “What are the practice’s initiatives, and does your practice have enough time to focus on saving the EMR project based on these initiatives? Do you have any standard documented policies and procedures in place?”
EMR projects often fail due to a lack of leadership. If you didn’t previously have a champion for your implementation, get one. If your former leader isn’t up to the task, make it a priority to find the right person to motivate and lead your team. “This person needs to be someone who can lead through change and be a part of the project beyond the go-live phase,” she says.
But an implementation is far from a one-person job. Make sure you have a dedicated implementation team that includes both clinical and executive leadership, Ordway says. “It’s not just the business manager; there needs to be physicians discussing this too. You also need people that are not so much [technically] educated, but folks who want to spend extra time on this project and are open-minded to other people’s input,” she says.
Finally, make sure your group is culturally ready for change. “There are practices that say we’ve been doing the same things for 20 years and there is no need to go paperless,” Ordway says. Your leader needs to help the group do away with this attitude before you proceed.
Shannon Sousa is the editor of The Doctor's Office. She may be reached at Ssousa@hcpro.com. This story was adapted from one that first appeared in the March edition of The Doctor’s Office, a publication by HealthLeaders Media.
It's not uncommon when I'm interviewing a physician—and the topic could be just about anything related to healthcare—for the conversation at some point to turn to the state of the reimbursement system and the need for some type of healthcare reform. Increasingly these days, that means we're talking about universal healthcare.
Some think it is a necessary next step, particularly physicians whose reimbursement suffers because they treat a lot of underinsured and uninsured patients. Others take a look at the bureaucracy of Medicare and the current healthcare system and consider a movement to universal coverage the equivalent to throwing gasoline on a fire. But with the election in full swing and healthcare one of the key issues of the campaign, universal healthcare is on many physicians’ minds.
Which is why I found a survey released last week regarding physicians’ attitudes about universal healthcare particularly interesting. The verdict? Fifty-nine percent of the more than 2,200 physicians surveyed say they support legislation to establish national health insurance. This represents a 10 point increase from a similar survey conducted in 2002.
A second question was asked about whether physicians support achieving universal coverage through more incremental reform, which is essentially what the major presidential candidates are proposing, and support actually dropped to 55%. Aaron Carroll, MD, MS, a pediatrician who was lead researcher on the study at the Indiana University School of Medicine, thinks this reflects physicians’ impatience with previous reform efforts that didn’t go far enough in addressing the problems of the uninsured and rising healthcare costs.
“Everything seems to be going downhill, and all the incremental reforms over the last five, 10, 15, 20, 30 years are not doing a good job,” he says. “If anything, most people feel that everything is getting worse, and I think physicians are recognizing that we need to have much more radical reform.”
But some physicians still have reservations. Another survey came across my desk this week from the physician recruiting firm Jackson & Coker. It found that 47% of physicians think patient care would probably be worse under a universal healthcare system, and 60% think patient wait times would increase dramatically.
Many questions still linger as universal healthcare looms on the horizon. Is healthcare a right or a commodity? Will our healthcare system become less efficient? How will we pay for universal coverage? How can we offer universal coverage without limiting patient choice? Will physician reimbursement suffer? Senior editor Les Masterson poses some additional questions in this week’s Health Plan Insider.
Though these questions range from the philosophical to the practical, physicians’ answers may be more predictable than we think. Female physicians and younger physicians tend to be more supportive of universal healthcare, Carroll says. And the specialty breakdown may be most revealing. Only three groups in Carroll’s survey had less than 50% support for universal coverage—radiology, anesthesiology, and surgical subspecialties—all of which earn well over $300,000 annually.
In fact, self interest may be the strongest correlate to support for national insurance. The specialties that most strongly supported it—psychiatry, emergency medicine, pediatrics, and primary care—all make less than $200,000 (MGMA median levels) and often have patient panels with a lot of uninsured or Medicaid patients.
But it’s important to remember that these are only patterns. I know primary care physicians who strongly oppose universal coverage and surgical subspecialists who favor it. This is a very contentious issue, and as is the case in the general public, physician opinions about universal healthcare are far from universal.
Metairie, LA-based East Jefferson General Hospital has established a partnership with the University of Texas' M.D. Anderson Cancer Center in Houston. East Jefferson officials called the move a boon for cancer care in southeast Louisiana, and that the pact extends the range of M.D. Anderson's expertise to the New Orleans area. Under the three-year agreement, East Jeffeson will pay M.D. Anderson $500,000 annually, with an option to extend the relationship.
Under a major reform of Cuba's vaunted free healthcare system, President Raul Castro's government will close more than half of Cuba's family doctor offices and boost staffing at the rest. The overhaul of one of the pillars of the health system came in response to public complaints, according to sources.
It takes patients at Philadelphia health centers an average of more than five months to get an appointment to see a doctor, according to a report released by the city controller. It took 15 days to get an appointment in New York City and only seven days in Baltimore, according to the report. There are eight public healthcare centers throughout Philadelphia, and data shows most of the 85,000 patients who visited them last year were impoverished African American and Hispanic adults. About half of their 320,000 visits were uninsured.