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'It's the Caring'

Analysis  |  By Debra Shute  
   September 01, 2016

These insights may not have been on point, but they revealed physicians' takes on MACRA, telehealth, and other key challenges.

Physicians' time is precious, so while interviewing, I do my best to stay on topic. But some of the best conversations I have with physicians flow more like a winding river than a highway, with bumps and currents that may not pertain to a particular article but make the ride more memorable.

Here are the highlights from some recent side trips to visit various subjects.

On Caring

"After all these years, I've gotten back many personal letters from patients, not about what I've done for their cancer, though that's been part of it, but about the things I've done to make people feel better—the kind words, the time," says George Raptis, MD, executive director of Northwell Cancer Institute, in New York.

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"The people who write will always note the people who were kind. It's not always providing the cancer care that really endures and makes an impression on patients. It's the caring."

On Telehealth

"Telehealth is a good thing," says Charis Eng, MD, PhD, chair and founding director of the Genomic Medicine Institute of the Cleveland Clinic.

Considering that there are only 500 or so practicing physician geneticists in the country—fewer than there are professional astronauts—virtual access makes sense. But while practicing telemedicine within the Cleveland Clinic is relatively seamless, challenges outside the system remain.

"What's wrong with telehealth?" Eng asks. Licensing, for one thing. "I think it will happen one day that there will be a telehealth license that covers physicians nationally," she says.

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"And reimbursement is almost nonexistent. The third-party payers absolutely know that telehealth gives access and drives costs down. So these are things that need to be solved and can be solved."

On Collaboration

"It's a time of so much instability for all of us, and we don't even know what the rules are yet," says Sarah E. Streett, MD, chair of the American Gastroenterological Association Institute Practice Management and Economics Committee.

Streett, a clinical associate professor of medicine at Stanford Medicine, was referring to MACRA. But this time of instability also presents new opportunities for collaboration to occur.

"It's like you're in the middle of a game and the board keeps moving around," she says. "But my hope—and really the direction that I see—is that as the rules become more fixed, all of the different partners in healthcare really are going to need to collaborate.

"We often have so many layers of committees and not enough opportunities for people to come together, share information, come up with some goals, and actually enact them," she adds.

On Communication

In recounting the process of creating a new cancer center and changing its model of care, the logistics were not the hardest part, says Randall Oyer, MD, medical director of the oncology program at Lancaster (PA) General Health's Ann B. Barshinger Cancer Institute.

"I don't think any one step was individually challenging. The challenge is to find the time, attention, and focus to get all of the right people to the table at the same time," says Oyer.

"You're essentially creating new teams, new work flows, new imperatives. It takes vision. It takes operational diligence and it takes follow through. It takes ongoing, vigilant communication with the many different people who work in many different parts of the organization."

Debra Shute is the Senior Physicians Editor for HealthLeaders Media.

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