Common areas of medical misinformation are related to childhood vaccinations, natural remedies, and dietary supplements.
Medical misinformation, which was rampant during the coronavirus pandemic, continues to be a significant issue in healthcare, says Frank McGillin, MBA, CEO of The Clinic by Cleveland Clinic.
Medical misinformation is one of the hallmarks of the pandemic. Medical misinformation was spread about coronavirus vaccines and treatments.
Now that the crisis phase of the pandemic has passed, medical misinformation has returned to areas subject to misinformation before the pandemic, McGillin says.
"What we are seeing is that the misinformation is in areas that were present before the pandemic. Vaccines in general continue to be the subject of misinformation, particularly around childhood vaccines, which is leaving many populations unprotected. There is also misinformation about natural remedies and dietary supplements. People are looking for alternatives. Sometimes, there is a belief that pharmaceuticals are not the best route forward. Unfortunately, there are a lot of people in the natural remedy space who are making unsubstantiated claims. They are tapping into people's fears and desires," he says.
When you look at the typical healthcare consumer who is trying to understand the health journey that they are facing, they are confronted with misinformation, McGillin says. "They are confronted with a lack of quality information. If you look at online health trackers, there is research that has shown that only a third of the responses that consumers have encountered for online symptom trackers have pointed them in the right direction. It gets back to healthcare is complex, and the quality of the questions that are asked help define the quality of the answer."
Online sources of information can lead patients astray, he says. "While Google is a wonderful resource, and our data shows Google is a go-to source for patients, often they do not have the expertise to ask the right questions when confronted with an overwhelming amount of data. It helps to have experts to parse that data."
Misinformation plays a role in misdiagnosis, but part of this problem is just access to quality information, particularly for rare or complex conditions, McGillin says. "In these cases, when you are talking with a physician, you want to access someone who has a lot of experience with your specific condition. That is part of the value of tapping into academic centers such as Cleveland Clinic. We see those kinds of patients regularly."
In addition to clinical consequences, the economic impact of medical misinformation is significant, he says.
"There are more than 10,000 conditions that can be potentially diagnosed and only about 250 symptoms. Some small variability can lead to one conclusion versus another. Our data shows that on average there could be savings for misdiagnosis of about $12,000 per occurrence. Some of that is over-utilization of unnecessary procedures. For example, there are people with back pain who may not be a good candidate for back surgery, but they have been led to believe either through their own research or from a physician that back surgery is appropriate. In reality, physical therapy is the frontline treatment for back pain, and it not only saves money but also spares patients the pain and suffering from recovering from an invasive procedure."
How clinicians can work with misinformed patients
When working with misinformed patients, trust is crucial for clinicians, McGillin says. "You need to establish a level of trust with the patient. Clinicians need to listen to their concerns. If you think about the typical interaction between a physician and a patient, there is not a lot of face time. So, the quality of that face time is important. Is the healthcare provider listening to you? This involves soft skills."
The clinician-patient interaction is pivotal, he says. "It begins with the interplay with the patient and listening to the patient. If a patient comes in and says, 'I printed out this information from the Internet about a condition.' Instead of dismissing the patient out of hand, the clinician needs to understand the patient's concerns. Facts alone are insufficient. People want to be listened to. People want to make sure you are addressing their concerns and their needs. If you do that, then patients will open their eyes to the facts and the scientific research. The worst thing a clinician can do is shut a patient down. They will think their views are not important, and they will not trust the physician."
More than half of medical groups report that workforce shortages are the biggest barrier to productivity growth.
Physician compensation has not kept pace with inflation, according to a Medical Group Management Association reportbased on 2022 data.
The 2023 MGMA Provider Compensation and Production report features data collected from nearly 190,000 clinicians at more than 6,800 healthcare organizations. The report provides insights on the evolving financial circumstances for clinicians.
"Despite physician and advanced practice provider (APP) productivity continuing its post-pandemic recovery, compensation gains are being outstripped by the most severe inflationary growth in decades," the report says.
For example, increases in median total compensation for primary care physicians in 2021 (2.13%) and 2022 (4.41%) were far lower than rates of inflation for 2021 (7%) and 2022 (6.5%), according to the report. "Primary care, surgical specialist, and nonsurgical specialist physician compensation all saw modest gains from 2021 to 2022; however, none of these benchmarks rise to the elevated levels of inflation," the report says.
The report has several key findings:
APPs experience the biggest change in median total compensation from pre-pandemic levels, but growth dipped slightly from 3.98% in 2021 to 3.70% in 2022
More than half (56%) of medical groups reported that staffing is the biggest barrier to productivity growth
A November 2022 MGMA poll found varying performance on productivity at medical groups, with 29% reporting that they had exceeded their productivity goals for the year, 36% reporting that they were on target, and 36% reporting that productivity was below expectations
Physicians with supervisory responsibility over APPs reported earning 7% to 15% more in total compensation than physicians without supervisory responsibilities
Primary care physicians working night shift hours reported earning $70,000 more than colleagues working the day shift and nearly $23,000 more than colleagues working afternoon-to-evening shifts
From 2020 to 2022, there was a "steady shift" to salary-based compensation models for clinicians away from production-based compensation models
MGMA Stat polls found a significant increase in medical groups incorporating quality metrics into their clinician compensation models, with 47% of medical groups linking quality performance metrics to physician compensation in May 2023 and 42% of medical groups linking quality performance metrics to physician compensation in May 2022
According to an October 2022 MGMA Stat poll, only 28% of medical groups reported adding an ancillary service in the previous year, with many organizations citing labor recruitment difficulties as the barrier
An April 2023 MGMA Stat poll reflected a trend toward hiring APPs to offset shortages of physicians and nurses, with 65% of medical groups planning to add new APP roles in 2023
The April 2023 MGMA Stat poll found nearly half (47%) of medical groups had added or created part-time or flexible-schedule physician roles in the past year in response to physician shortages
MGMA recommendations
Jessica Minesinger, an MGMA consultant and founder and CEO of Surgical Compensation & Consulting, made three recommendations for medical groups in the report.
Medical groups need to respond to "rampant" physician burnout, which is decreasing productivity, she said. "Taking a customized, positive, and proactive approach to identifying the causes and finding effective ways to reduce the impact of burnout on your physicians is critical. This includes recognizing the challenges unique to female and male providers. A one-size-fits-all approach won't suffice."
Minesinger identified several components to addressing turnover, disruption to staff, lost revenue and productivity, and recruitment costs, including retention, promotion, staff engagement, and well-being initiatives.
Caring for physicians and other staff members responsible for patient care is critical to financial sustainability, she said. "Establish and invest in leadership roles and departments tasked explicitly with increasing provider recruitment, retention, and well-being. Address the well-documented gender wage gap in medicine and the ongoing challenges female physicians face with openness and transparency. The ultimate goal is to provide the best possible patient care, experience, and outcomes."
The report calls on medical groups to establish retention committees to help ease workforce shortages.
The first step to establishing a retention committee is to create an electronic survey to poll physicians on their feelings about practicing in the medical group, the report says. "The survey should ask physicians: What one or two issues create the highest level of dissatisfaction in practicing with us? What one or two things are responsible for your highest level of satisfaction? What one or two issues would cause you to leave for another opportunity?"
A findings report should be developed from the electronic survey and presented to senior leadership, including CEO, chief operating officer, chief medical officer, chief financial officer, and chief human resources officer. "Discuss all issues, evaluate recommendations, and determine what can be agreed to in this initial meeting. Leave the final report with recommendations for attendees to review on their own, and schedule a second meeting for the following week with expectations that each category will be discussed and addressed," the report says.
Scripps Health has physician operating executives at the health system's five hospitals and about 80 medical directors.
Physician operating executives and medical directors are crucial players in healthcare administration at Scripps Health, says Ghazala Sharieff, MD, MBA, corporate senior vice president of hospital operations and chief medical officer at the San Diego-based health system.
Sharieff has held her current role since January 2020. Her previous experience includes serving as Scripps' chief experience officer and emergency department division director at Rady Children's Hospital.
HealthLeaders recently talked with Sharieff about a range of issues, including addressing healthcare worker burnout at Scripps, her learnings from being a command center leader during the coronavirus pandemic, and the primary elements of a positive patient experience. The following transcript of that conversation has been edited for brevity and clarity.
HealthLeaders: At Scripps, you serve as CMO for inpatient care and Anil Keswani serves as CMO for outpatient care. What are the benefits of splitting the CMO role?
Ghazala Sharieff: Our president and CEO, Chris Van Gorder, is incredible. He always thinks ahead of the curve. He split the role in January 2020, right before COVID hit. So, I was the coincident commander of our COVID response in addition to working on quality, patient experience, and all the regular CMO duties. Splitting the CMO role into two pieces has been crucial. Given what we went through over the past few years, particularly with patient experience and quality, it would have been difficult for me if I was manning everything. We have about 30 clinics and five hospitals—it would have been too much. With 17,000 employees, 3,000 physicians, and 2,000 volunteers, having one person man all of that would have been extremely difficult given the challenges over the past three years.
Dr. Keswani and I work very well together. When we started, we were unsure how we were going to work together—we each had a column and some areas that overlapped like a Venn diagram. Now, it is not like a mine-and-yours situation. The Venn diagram is getting bigger and bigger because we realize there is a spectrum of responsibilities. Most of the things that you do in inpatient care affect ambulatory care because you must have a handoff for patients who have been admitted and discharged, then need care on the ambulatory side.
So, it is working very well, and I highly recommend this structure for other organizations as large as we are.
Ghazala Sharieff, , MD, MBA, corporate senior vice president of hospital operations and chief medical officer at Scripps Health. Photo courtesy of Scripps Health.
HL: What are the main ways you are addressing healthcare worker burnout at Scripps?
Sharieff: During COVID, we launched the RISE program—Resilience in Stressful Events. This is a peer-to-peer responder program, and it has a physician component. Physicians do not like to speak with others about their concerns or crises. When they have another physician to talk to, that is a safe place, and it does not have any stigma attached to it.
We have employee assistance with psychologists. So, if a healthcare worker feels they need more than a peer responder, we have a psychology team that can meet with them.
We also have some simple things such as one-on-one coaching. And we have reminders about mental health such as a webpage for physicians with resources that are available to them.
It is important to have open communication about the burnout that many of us are feeling.
HL: What role do physicians play in healthcare organization administration at Scripps?
Sharieff: We have an amazing infrastructure. One of the first things our CEO asked me to do on the inpatient side when I became chief medical officer was to align my physicians. We have five physician operating executives—one at each of our hospitals. They are dyad partners with chief operating executives because you need physician leadership as well as administrator leadership to run daily operations.
We also have about 80 medical directors across the health system. The medical directors report to the physician operating executives, who report to me. So, we have clear accountability for the metrics that we are trying to improve with this infrastructure. Physicians have a huge role not just in patient experience but also in daily operations. That is our secret sauce.
HL: In general, when you look at the healthcare system, do you think physicians are becoming more involved in healthcare organization administration?
Sharieff: In general, there are a lot more physicians going into administration because they want to make a difference in their organizations. It is also because of the financial climate we are facing, with hospitals struggling with finances. We need physician leadership to help us prioritize. Everybody wants new equipment—there is so much new technology coming out that physicians want to have, but we need them to help us prioritize. What do we need today? Is new technology truly more effective or is it just something you want to try?
You are going to see much more physician involvement in hospital operations as well as on the ambulatory side.
HL: You co-led command center operations for Scripps during the coronavirus pandemic. What were your primary learnings from this experience?
Sharieff: I learned about situational leadership. There was a sense of panic. Among physicians, there was sincere concern not only about their patients but also about themselves and their families. Some of them were not going home because they were afraid they were going to bring the virus home to their families. They were living in hotels. We had to be more directive with our leadership. We would say, "This is the path we are going to take." Eventually, we were able to be more collaborative—bringing in more physicians and staff to help us design our policies. But at first, we had to take control of the situation, which was important. Somebody had to be that voice.
What I have learned is there is a cycle to leadership in a crisis.
We have also learned that we can pivot quickly when we need to. We learned that we could be organized, pivot quickly, and try things that are different. One example is our Sprint Teams—we identify a problem then put a team around it so we can move quickly. With the Sprint Teams, you may not have a solution totally mapped out. Nothing is going to be perfect when you roll it out, but you must start an initiative and pilot it, then you make adjustments as you go.
HL: You previously served as chief experience officer at Scripps. What are the primary elements of a positive patient experience in the inpatient setting?
Sharieff: The key drivers are nursing communication, physician communication, and the environment of the hospital. Patients want to be heard.
We have a unique patient experience effort that we call The One Thing Different campaign. What that means is that I do not want to script anybody. It is horrible when everybody says the same thing because the patients know that somebody has told them to ask questions. Scripting your staff does not work. The One Thing Different campaign started with me thinking about what I can do differently. We ask patients about their greatest concern. It has changed my practice and it has changed the practice of many of our staff as well.
HL: You have a clinical background in emergency medicine. How has your clinical background helped you to serve in leadership roles such as CMO?
Sharieff: For emergency physicians, situational leadership is important. When you have a critical patient come into the emergency department, you must be in charge. One person must be the captain. So, when we have rocky times or there is uncertainty, it is easy for me to slip into that role as CMO.
There is also a lot of camaraderie in the emergency department. After a night shift with the nurses, we would all go out for breakfast. There is that side of leadership as well. You cannot always be directive—you have got to be seen as collaborative.
You must roll up your sleeves as an emergency physician and work with your colleagues. There are leaders who I have seen who do not get in the field with their people, and that does not resonate with me. If my staff is doing something, I like to be there with them. That is the ER doctor in me, and it has affected how I am as a leader.
Emergency physicians need to be transparent with their colleagues and share the "why" behind what they are doing. I tell my staff, "Here is what we are doing for this patient. Here is why I am ordering tests." That naturally translated over to my CMO role. I explain to people what we are doing. It cannot be bossing people around. You must explain the process and why we are going a certain route.
The Mountain View, California-based health system's initiative features a partial hospitalization program and an intensive outpatient program.
The Maternal Outreach Mood Services (MOMS) program at El Camino Health has a significantly positive impact on new mothers experiencing psychiatric conditions, according to data presented last weekend at the American Psychiatric Association Annual Meeting.
The perinatal period is associated with the risk of psychiatric disorders, including depression, anxiety, and post-traumatic stress disorder (PTSD). During the perinatal period, the prevalence of depression is 19%, the prevalence of anxiety is 13%, and the prevalence of PTSD is 8%, the research presented at the American Psychiatric Association Annual Meeting says.
The MOMS program features a partial hospitalization program and an intensive outpatient program, says Nicole Tarui, MD, an El Camino Health psychiatrist and medical director of the MOMS program.
"At the partial hospitalization level of care, it is generally five days a week and six hours per day. Folks are usually in that level of care for two to three weeks, depending on how they are doing and how they are progressing through treatment. Once a patient is doing better and symptoms are reducing, they step down to the intensive outpatient program. That program is similar to the partial hospitalization program, but it is fewer hours. It starts at five days per week for three hours per day, then gradually goes down to four days per week and three days per week as folks get close to graduation," she says.
The MOMS program features a multidisciplinary team, with social workers, psychologists, perinatal psychiatrists, and nurses who deliver the care. The program offers group and individual therapy as well as medication management. New mothers are treated with their babies present. The types of therapy provided include cognitive behavioral therapy, dialectical behavioral therapy, and infant-parent psychotherapy.
The main sources of referrals into the MOMS program are other mental health providers, obstetricians/gynecologists, pediatricians, and the inpatient women's specialty unit at El Camino Hospital.
The research presented at the American Psychiatric Association Annual Meeting focuses on Edinburgh Postnatal Depression Scale (EPDS) scores for 88 mothers who participated in the MOMS program from July 2020 to June 2022. The patients ranged from 22 weeks of gestation to two years postpartum. The EPDS is a screening tool with 10 questions generating a score from 0 to 30. A score of 10 or higher indicates possible depression, according to the University of California-San Francisco.
The study includes two key findings:
For all diagnoses among the 88 patients, the mean EPDS score was 15 at admission to the MOMS program and 6 at discharge
For the 57 patients who were diagnosed with major depressive disorder, the mean EPDS score was 17 at admission to the MOMS program and 7 at discharge
Unique aspect of care
One of the unique aspects of the MOMS program is that mother and baby are together while the mother is in treatment, Tarui says. "On a daily basis, we are getting to see them interact in a group setting as well as in individual sessions. This is where I help parents understand that there may be some challenges that they are facing and how to overcome those challenges to develop a secure attachment with the baby."
Infant-parent psychotherapy is one of Tarui's areas of expertise.
"I work individually with the parent and their baby to be able to talk about their history, relationship dynamics, and the impacts on bonding with baby. … We use the information about someone's history to be able to understand whether there are challenges in the bonding. We also get a lot of information in real time—being able to see the interaction between mom and baby. We can see whether the mom is responding to the baby's cues and how the baby is responding to mom," she says.
In infant-parent psychotherapy sessions, the goal is not to be directive, Tarui says. "It is more about encouraging the parent to be able to understand how their past or their symptoms might be impacting the bonding. I just gently point out interactions that I am seeing. For example, if the baby is crying and mom is feeling particularly distressed at that moment, I am curious about what is happening for her and how she can tolerate that level of distress. I want to help her become attuned to the baby and his or her cues. That is what helps build reflective capacity in mom and develop a secure attachment to the baby."
Advice for health systems and hospitals
Tarui offered three pieces of advice for other health systems and hospitals interested in launching initiatives similar to the MOMS program.
First, collaboration is essential the MOMS program, she says. "There are many different aspects to the care and treatment, on the group level, the individual level, and in medication management. Being able to talk with colleagues who have done this work and have this expertise is crucial to understanding the barriers to treatment and other challenges."
Second, ongoing education is important, Tarui says. "Even for myself and the staff that we have in the MOMS program, the field of perinatal psychiatry is vast and there is so much to learn on an ongoing basis. I educate myself on developing treatments and new therapeutic modalities. That is key to delivering the highest quality of care."
Third, seek out education on infant-parent psychotherapy, she says. "Recently, we have been doing a lot of work with infant-parent psychotherapy, and we had an expert in the field from University of California-San Francisco come to train us. We have been able to integrate that education into the care that we are providing both on the group and individual level."
A New Jersey-based hospital has repurposed emergency department staff to improve efficiency.
An initiative launched in January has significantly improved efficiency at Cooperman Barnabas Medical Center's emergency department.
For patients, lengthy wait times are common at emergency rooms across the country. The result is a poor patient experience, with some patients choosing to leave emergency rooms to seek care at other facilities.
Since the efficiency initiative was launched, the emergency department at Cooperman Barnabas Medical Center has posted impressive wait time statistics:
The average wait time from patient arrival to being placed in a room is under 10 minutes.
The average time to talk to a healthcare provider is about 10 minutes.
The median turnaround time for patients to be seen, treated, and discharged was 160 minutes during the most recent month for which data is available.
The front-end process at the Livingston, New Jersey hospital's emergency department moves patients quickly, says Maria Aponte, MPA, BSN, RN, administrative director of emergency services.
"As soon as someone comes in, they are greeted by a security guard, who finds out whether they are a patient or a visitor. If you are a patient, you are seen by the first nurse, who does not conduct triage. The nurse does a quick assessment by asking a couple of questions. Then the patient is quickly registered with five registration questions. A full registration is not done on the front-end, which cuts down on a lot of the time. Five questions get asked and the patient gets directly bedded to the back," she says.
Clinicians see patients as quickly as possible, says Eric Handler, DO, chairman of emergency medicine. "On the provider side, not too much has changed other than we are really happy to have the patient in the room and being able to see them there instead of having to bring that process up front."
Rooms are available in part because the hospital is working hard to make sure patients are not boarded in the emergency department after they are admitted, Aponte says. "One of the biggest factors in efficiency is patient boarding. In the past, we had patients waiting for a bed upstairs for three or four hours. We have made sure that we have good throughput throughout the hospital. That means, when a physician puts in an order to admit a patient, the patient is bedded in the hospital as quickly as possible. We want to move patients out of the emergency department so we can see other patients. Becoming more efficient in the emergency department is a hospital-wide initiative."
Similarly, the emergency department is getting timely service when tests are ordered for a patient, Handler says.
"We have been having a bi-weekly throughput committee meeting, where we get together with all of the stakeholders and hold everybody accountable in a collegial way. We have stakeholders such as laboratory, transport, logistics, and radiology, and we make sure everybody is on the same page and being as efficient as we can. … With the throughput committee meeting, we are making sure that radiology does X-rays right away, and CAT scans, ultrasounds, and lab tests are done right away. We are making sure that these other stakeholders are onboard with the new process. We look at the metrics, and we look at the times, and we see how we can improve. We make sure all of the stakeholders are making us more efficient."
An innovative aspect of the efficiency initiative is that the emergency department was able to improve without hiring more staff, Aponte says. "What we did was repurpose staff. Before, we were sending resources to the front such as a provider in triage and getting lab work on the front-end. We were able to become more efficient and bring patients directly into a room by repurposing staff. A provider who was seeing patients in the front was freed up to see patients at the bedside. The nurse who was doing the triage in the front became a floating triage nurse who can provide triage at the bedside and assist the primary nurse who is providing care."
The emergency department also has an efficient discharge process, Handler says. "Once we get the results of tests back, we can make the determination whether it is safe to discharge the patient home. Our goal from there is to get the patient out the door with their discharge instructions in less than 30 minutes."
Advice for other emergency departments
Teamwork is crucial to improve emergency department efficiency, Handler says. "Maria and I speak frequently throughout the day. We observe what is happening in the emergency department into the early evening to make sure things are going smoothly. There is a HIPAA-compliant text service called TigerConnect that we use with all of our stakeholders. If there is a delay in one area, we get a message out and the person responsible for that area—whether it is lab, radiology, transport, or logistics—does their best to rectify the problem. Without teamwork and an eye on the ball, things can fall apart quickly."
Emergency department teams need to care about efficiency and their patients, Aponte says. "You need to care about the initiatives that you are doing and care for the people doing the work. You also need to provide patient-centered care. When someone comes to the emergency room, it can be scary for them. They are very anxious when they arrive. You need to care about the efficiency model and care about what is right. We cared enough that we knew that our time numbers were not meeting our expectations."
Patient satisfaction can be a powerful motivator for emergency department staff when conducting efficiency initiatives, Handler says. "One of the things that got us the biggest buy-in and gave us momentum was when the staff saw how happy the patients were and how much easier the encounter became because the patient was not upset, frustrated, or disappointed. Patients get dissatisfied if they sit in a waiting room for hours before being seen. The encounter goes so much more smoothly when you have a happy patient in front of you instead of an angry one."
The survey found 73% of adults feel that the healthcare system fails to meet their needs in some way.
Two-thirds of U.S. adults surveyed by The Harris Poll reported that managing healthcare is "overwhelming" and "time-consuming."
The survey was conducted by The Harris Poll on behalf of the American Academy of Physician Associates (AAPA). The survey, which features data collected from more than 2,500 adults, was conducted from Feb. 23 to March 9.
The survey was conducted to get the patient perspective on U.S. healthcare, AAPA CEO Lisa Gables, CPA, said in a prepared statement. "So much has changed in healthcare since the pandemic, and the focus has largely been on the strain that healthcare teams are experiencing. Certainly, we have to address that as we know it impacts the resiliency and strength of our healthcare workforce. However, AAPA wanted to understand from the patient perspective what is and isn't working in healthcare today."
The survey generated several key findings:
Survey respondents reported that they spend the equivalent of an eight-hour workday per month coordinating healthcare for themselves and/or loved ones
The survey found 73% of adults feel that the healthcare system fails to meet their needs in some way
The survey found 71% of adults are concerned that the demands on healthcare providers are onerous
The survey found 68% of adults worry that healthcare workforce shortages will impact patients
The survey found 66% of adults reported that healthcare providers appear to be more rushed than in the past
The survey found 47% of adults believe their healthcare providers are burned out or overburdened
Nearly one-third of survey respondents reported feeling rushed during a healthcare appointment
The survey found that 61% of adults only seek healthcare services when they are sick
The survey found 44% of adults have skipped or delayed care in the past two years, with 40% saying the reason was concern about cost
The survey found 64% of adults want healthcare providers to spend more time understanding them, with 49% of survey respondents reporting that healthcare providers do not always listen to them
The survey found 67% of adults reported that their health would improve if they worked regularly with a healthcare provider they trusted
The survey found 54% of adults would feel more comfortable working with a healthcare provider who shares their background
The survey found 54% of adults reported that their health would improve if healthcare providers helped them figure out the healthcare system
The survey shows patients are struggling with the healthcare system, which can impact health outcomes, John Gerzema, CEO of The Harris Poll, said in the survey report. "What struck me from the research we conducted on behalf of AAPA is how clearly the findings demonstrate how the system itself is getting in the way of people being able to take care of themselves as well as the ones they love. The system is costly, confusing, and it takes too long to get needed care. The result is that people want to engage with it less which can lead to even more health problems—both physical and mental."
Difficulty engaging with healthcare providers has negative consequences, the survey report says. "Most adults admit that they only seek care for themselves when they are sick and delaying care or skipping it altogether is an all-too-common occurrence. This often comes with consequences: Many adults who have skipped or delayed care say they experienced negative impacts as a result. Forgoing care is not only detrimental in the case of a major health concern, but also prevents people from undergoing routine preventative care. In addition, the negative impacts often extend beyond patients themselves: Many of those who have helped someone coordinate care say their life was negatively impacted in some way as a result of helping someone navigate the healthcare system."
Strong medical groups function as a network, with clinicians knowing and talking with each other.
Leading a large medical group requires careful listening, understanding the issues, and achieving alignment on key priorities, says RWJBarnabas Health's Andy Anderson.
Anderson has been executive vice president, chief medical officer, and chief quality officer of the West Orange, New Jersey-based health system since May 2022. He previously served as president and CEO of the Combined Medical Group of RWJBarnabas Health and Rutgers Health. Prior to joining RWJBarnabas, Anderson served as executive vice president and system chief medical officer of Aurora Health Care in Wisconsin.
Anderson recently talked with HealthLeaders about a range of issues, including the challenges of leading clinical care at RWJBarnabas, the keys to generating a positive patient experience, and the primary elements of physician engagement. The following transcript of that conversation has been edited for brevity and clarity.
HealthLeaders: What are the primary challenges of serving as CMO of RWJBarnabas?
Andy Anderson: The opportunity is to truly build an integrated health system, and our health system is interested in being one system and one family. Having all of our individual pieces and parts come together for a seamless experience for our patients while we are serving our communities and having our communities become healthier is key.
The challenge is having a common vision and mission as well as achieving good outcomes together. The biggest levers we are pulling are having system incentives and having everyone rally around the most important things: the patient experience and quality outcomes. If everyone is centered on those important things, we will be able to come together as an integrated health system.
HL: How are you rising to the challenge of being a fully integrated organization?
Anderson: There are three important levers. One is making sure that we have the right culture. We need a culture where people can speak up for safety, people are working well together on teams, and people are working on continuous quality improvement. The second lever is having strong leaders who are engaged and accountable, with engaged team members who are working together to achieve the best outcomes. The third piece is transparency of data. We need to make sure people know how they are doing. We need to make sure people know how the health system is doing and whether we are making progress on key initiatives. It helps create positive energy when you are making progress.
Andy Anderson, MD, MBA, executive vice president, chief medical officer, and chief quality officer of RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
HL: What are the primary challenges of serving as chief quality officer of RWJBarnabas?
Anderson: Part of that challenge is making sure there is focus because there are a lot of different areas that can be worked on at once. If you do not focus on the most important areas, then it is hard to move things forward. We have picked some areas where we know we have opportunities to improve based on the data such as prevention of hospital-acquired infections.
So, having focus, clear priorities, goals, and incentivizing everyone around those goals creates alignment, where the whole health system is moving forward together to improve outcomes.
HL: You served as president and CEO of the Combined Medical Group of RWJBarnabas Health and Rutgers Health. What are the keys to success in leading a large medical group?
Anderson: Leading a large medical group requires careful listening and an understanding of what the issues are; then you need to achieve alignment on key priorities. In the work we are doing on patient experience and quality, having clear direction on the key outcomes that we are trying to achieve is crucial. You need to create the vision of where we want to go, set common outcomes such as having a great patient experience and making sure care is coordinated, and make sure that you have created an integrated network within the medical group.
One of the most powerful motivators for a medical group is to have your clinicians be interconnected, know each other, and trust each other. You need a network that is centered around the patients. A high-functioning medical group is going to be tightly interconnected, and it is going to coordinate and integrate care for patients.
HL: How do you establish a network within a medical group?
Anderson: Some of that is people truly getting to know each other, seeing each other, and talking to each other. Clinicians need to have a comfort level to pick up the phone and call a colleague. It also goes back to the common outcomes that we are all trying to achieve together—great patient experience and great quality outcomes. Having everyone centered on those common outcomes brings everyone together. Having a network of positive and trusting relationships is critical. You must foster that and make sure that people are comfortable talking with each other.
HL: What are the primary elements of physician engagement?
Anderson: Physicians are very interested in being leaders. Allowing them to take on leadership roles, then coaching and developing them is very engaging. You need to create career paths for physicians to take on roles, whether it is leading a committee or an initiative, or moving up into an administrative role.
The other important part of physician engagement is two-way communication. You need to make sure physicians understand the priorities of the health system, then listen to them. You want good feedback, and you want to understand the issues at the front line. Sometimes, it comes down to an individual practice and the pain points in that practice, and how you can help solve those pain points. Effective two-way communication is very engaging for physicians as well as the knowledge of the health system, what the priorities of the health system are, and how the physicians can contribute to those priorities.
HL: What are the keys to generating a positive patient experience?
Anderson: Listening to the patients very purposefully and understanding what their priorities are is important. We need to listen to any issues that they may identify while they are in our hospitals or other facilities. Then you need to close the loop. If there is an issue that we hear about with an individual patient, we need to close the loop on that issue right away—it makes a big difference for that individual.
I was rounding recently, and we had a patient who was not sure who their doctor was going to be because their current doctor was retiring. After rounds, we talked immediately with the care team, who went back to the patient and helped the patient understand the transition to a new doctor.
So, closing the loop with an individual patient makes an enormous difference for that person. More broadly, we need to understand what the themes are by listening to patients. We need to find out if there are themes emerging about the environment, the food, how much patients know about their day in terms of procedures or tests they are going to have, and whether their doctor and nurses are communicating appropriately. Just getting that information by listening to our patients is impactful to improve the patient experience.
In addition, employee engagement is the underlying way you can improve the patient experience. If your employees are excited to be at work, they are happy to be at work, and they are centered on mission and purpose, then they are going to deliver the best possible care to our patients. So, focusing on our employees is a critical part of being successful with our patient experience.
HL: What is the role of clinicians in organizational administration at RWJBarnabas?
Anderson: It is very important to have the voices of physicians, nurses, and other clinicians—those who are doing the work and delivering the care. It is much better when there is communication, understanding, and coordination with those clinicians. To have a health system that is truly effective and efficient, that clinician voice is critical.
We have purposefully engaged our nurse leaders and our physician leaders. They typically co-lead our quality, safety, and patient satisfaction projects with dyad nurse leadership and physician leadership driving initiatives. It is powerful and great role-modelling.
Part of how we have organized ourselves is through service lines such as cancer, neurology, cardiovascular, and pediatrics. The model for those service lines is to have a dyad leadership team with an administrator and a clinician. Having a clinician be a co-leader of a service line is one of the examples of how we have clinicians involved in administrative leadership.
Another example is that each of our hospitals has a chief medical officer and a chief nursing officer. They are very much at the table and often leading initiatives, particularly quality, safety, and patient satisfaction. They are the leaders for those initiatives and make sure that we are making progress.
The overuse of antibiotics has been linked to antibiotic resistance and antibiotic-associated adverse effects.
A multifaceted antibiotic stewardship initiative for respiratory conditions at Intermountain Health urgent care clinics resulted in a significant reduction in antibiotic prescribing, a new research article found.
Most antibiotic prescriptions in the United States are made in outpatient settings and as many as 30% of those prescriptions may be unnecessary. Antibiotic overuse has been linked to antibiotic resistance and antibiotic-associated adverse effects.
The research article, which was published by JAMA Network Open, is based on data collected from nearly 500,000 urgent care encounters at 38 urgent care clinics and one telemedicine clinic operated by Intermountain Health. The data was collected during a 12-month baseline period from July 1, 2018, to June 30, 2019, a 12-month intervention period from July 1, 2019, to June 30, 2020, and a 12-month sustainability period from July 1, 2020, through June 30, 2021.
The intervention was based on the Centers for Disease Control and Prevention (CDC) Core Elements of Outpatient Antibiotic Stewardship. The intervention incorporated all four of the CDC core elements, including the following:
1. Education for clinicians and patients: Education for clinicians included an urgent care antibiotic stewardship champion who served as a peer-to-peer resource for clinicians, a handbook that included guidelines, and monthly update lectures at regional urgent care meetings. Education for patients included a symptomatic therapies checklist and a patient-facing antibiotic stewardship webpage.
2. Electronic health record tools: Clinicians had EHR tools such as receiving azithromycin prescribing justification alerts in the EHR and the addition of delayed antibiotic prescriptions in the EHR.
3.Clinician antibiotic prescribing dashboard: This dashboard included all clinicians and clinics, which allowed for peer comparison.
4. Media campaign: Intermountain Health launched a media campaign that included television and radio interviews, print media such as newspaper articles, and Facebook and Twitter posts.
In addition to the four CDC core elements, Intermountain Health designed a quality measure financial incentive for urgent care clinicians. The financial incentive gave clinicians increased compensation if they prescribed antibiotics in less than 50% of respiratory illness encounters.
The study generated several key data points:
Clinicians prescribed antibiotics for respiratory conditions for 47.8% of encounters in the baseline period and 33.3% of encounters in the intervention period.
In the first month of the intervention, antibiotic prescribing decreased 22% and antibiotic prescriptions fell 5% monthly during the intervention.
Among clinicians who were working in both the baseline and intervention periods, 95% decreased their prescribing of antibiotics for respiratory conditions.
During the baseline period, 38.5% of clinicians prescribed antibiotics for more than 50% of respiratory condition encounters. During the intervention period, 10.2% of clinicians prescribed antibiotics for more than 50% of respiratory condition encounters.
There was no statistically significant decrease in patient satisfaction when comparing the baseline and intervention periods.
The was no statistically significant increase in hospitalizations within 14 days of an urgent care encounter when comparing the baseline and intervention periods.
"The findings of this quality improvement study indicated that an [urgent care] antibiotic stewardship initiative was associated with decreased antibiotic prescribing for respiratory conditions. This study provides a model for [urgent care] antibiotic stewardship," the study's co-authors wrote.
Interpreting the data
The research shows that outpatient antibiotic stewardship programs can be successful, the study's co-authors wrote. "This study adds to growing evidence about effective outpatient stewardship programs, including those focused on [urgent care] settings. Features of successful programs include the use of audit and feedback, clinician and patient education, EHR tools, and peer comparison or benchmarking."
The urgent care antibiotic stewardship initiative made gains beyond the reduction in prescribing for respiratory conditions, the study's co-authors wrote. "In addition to reductions in the overall rate of antibiotic prescribing for respiratory conditions, several other areas of antibiotic prescribing improved, including the use of azithromycin and delayed prescriptions. Because these areas were explicitly targeted by components of our intervention, they likely represent changes in clinical practice and were sustained beyond the intervention period."
The finding that there were no statistically significant changes in patient satisfaction and patient safety is noteworthy, the study's co-authors wrote. "This is important because of the relatively large reduction in antibiotic use for respiratory conditions that occurred with the intervention. Our observation that patient satisfaction scores were stable may provide reassurance to clinicians that practicing antibiotic stewardship is not associated with unintended consequences in patient satisfaction and other important dimensions of clinical care, including visit duration, both of which have been cited as barriers to mitigating antibiotic overuse."
The Cancer Equity Project will initially focus on three initiatives.
Total Health, the largest provider of free oncology continuing education in the United States, has launched the Cancer Equity Project, a nonprofit organization designed to promote health equity in cancer care.
Cancer disparities include incidence, mortality, morbidity, and stage at diagnosis, according to the National Cancer Institute (NCI). Contributing factors to cancer disparities include social determinants of health, behavior, biology, and genetics, the NCI says.
The overall mission of the Cancer Equity Project is to promote health equity in cancer patients, so everyone can live their lives to the fullest, says Sharon Gill, executive director of the nonprofit. "We want to elevate the voice of underrepresented groups in cancer care. We will be looking at the disparities in cancer care and bringing them to the forefront. We want everyone to have a fair shot."
There is a need for an organization such as the Cancer Equity Project because there are many serious cancer disparities, she says. "Black women are 40% more likely to die from breast cancer than White women. Black men have a prostate cancer death rate that is more than twice the rate for White men. Hispanic children are 20% more likely to die of leukemia than non-Hispanic White children. Men living in the poorest U.S. counties have a colorectal cancer death rate that is 35% higher than men in affluent counties."
Total Health is well-positioned to help address cancer disparities, Gill says. "We have access to data and information. Total Health works with the medical community, and the Cancer Equity Project is going to be focusing on the patient community. We want to impact healthcare disparity numbers."
Initiallly, the Cancer Equity Project will be focusing on three initiatives.
1. Healthcare Provider Certificate Program
The SEEK Color Certificate Program will provide training to healthcare providers focused on inherent biases, Gill says.
"In terms of the disparities in cancer care, one of the things we know is that there are inherent biases in the healthcare system, and what we are trying to do is educate healthcare providers on the inherent biases. These are not malicious—just inherent. The certificate program is working in tandem with diversity, equity, and inclusion (DEI) experts and DEI speakers to talk about some of the barriers. It could be unconscious bias or unconscious microaggression," she says.
The Cancer Equity Project will be bringing DEI speakers who can help draw attention to how doctors are interacting with patients and how patient questionnaires are written, Gill says. "We want to expose to the medical community that there are differences in how a Black patient may respond to a doctor. There are differences when Black patients are asked about their medical history—they may not have those answers based on cultural and economic status. We are going to train doctors to understand how to work with underrepresented groups."
Healthcare providers can earn a certificate by participating in three workshops, she says.
2. Patient education
The Cancer Equity Project has developedCompass Cancer Journey Mapsto help cancer patients have educated shared decision-making conversations with their healthcare teams, Gill says. "When you go to a doctor, you often only have 15 minutes to talk—whether they are an oncologist or a primary care physician. You have a limited time to speak with your doctor. What we have found is that if you are an uneducated patient about your condition, the doctor will make decisions for you."
The Compass Cancer Journey Maps will arm patients with information about next steps and expectations, she says. "So, when you go to your doctor, you can have an intelligent and educated conversation. At that point, you can make decisions together with your doctor because you will be more informed. Doctors do not have the time in their office visits to give you much information, so we are trying to give patients the information that they need."
3. Clinical trial
The Cancer Equity Project is launching the EBONY-B001 clinical trial, which will focus onyounger Black Women with early, hormone receptor-positive clinically high-risk but genomic low-risk breast cancer. The goal of the clinical trial is see whether this patient population can avoid chemotherapy by using ovarian function suppression in combination with endocrine therapy.
The EBONY-B001 clinical trial will address an unmet need in cancer research, Gill says. "Of the people who are taking part in clinical trials, a small percentage of those people are Black women. Many Black women do not have access to cutting-edge medication that is coming out; or, worse, medications are developed that are not necessarily suitable for Black women or other patients from underrepresented groups."
"Even the most highly qualified and competent physicians in the U.S. may face a medical liability claim in their careers," the AMA president says.
A new analysis from the American Medical Association (AMA) shows that 31.2% of physicians have been sued for medical liability claims.
Most lawsuits for medical liability claims do not result in the finding of a medical error, according to the AMA. From 2016 to 2018, 65% of claims were dropped, dismissed, or withdrawn; and for the 6% of claims decided by a trial verdict, 89% were won by the defendant.
Many physicians will face lawsuits during their careers, but they practice medicine despite the risk, AMA President Jack Resneck Jr., MD, said in a prepared statement. "Even the most highly qualified and competent physicians in the U.S. may face a medical liability claim in their careers, however, getting sued is not indicative of medical errors. All medical care comes with risks, yet physicians are willing to perform high-risk procedures that offer hope of relief from debilitating symptoms or life-threatening conditions."
The new analysis is based on the AMA's 2016-2022 Physician Practice Benchmark Surveys. The benchmark surveys are nationally representative and include paid and unpaid claims.
The new analysis features several key findings:
The longer physicians practice medicine, the higher their risk of a medical liability claim. For physicians over the age of 54, 46.8% have faced a lawsuit. For physicians under age 40, 9.5% have faced a lawsuit.
Medical specialty accounts for the largest variation in lawsuits, with surgical specialties generally facing the highest risk and internal medicine subspecialties generally facing the lowest risk. The specialties at highest risk of lawsuits include obstetricians-gynecologists, with about 62% of physicians being sued during their careers, and general surgeons, with about 60% of physicians being sued during their careers. The specialties at lowest risk of lawsuits include allergists and immunologists, with 7% of physicians being sued during their careers, and hematologists and oncologists, with 8% of physicians being sued during their careers.
Lawsuits also vary by physician gender. Female physicians are at lower risk of being sued than their male counterparts. About 24% of female physicians have been sued during their career compared to about 37% of male physicians having been sued during their career. Female physicians had 42 claims per 100 physicians compared to 75 claims per 100 physicians for male physicians.
Medical liability claim reform is needed, the AMA said in a prepared statement. "Given the heavy cost associated with a litigious climate and the significant financial toll it takes on the nation's healthcare system, the AMA continues to work with state and specialty medical associations and other stakeholders in pursuit of both traditional and innovative medical liability reforms that strike a reasonable balance between the needs of patients who have been harmed and the needs of millions of Americans who need affordable, accessible medical care."
Interpreting the data
There is a strong association between longer-term claim frequency and physician age, the new analysis says. "Physicians under the age of 40 are 15.6 percentage points less likely and those over 54 are 21.9 percentage points more likely to have ever been sued than their age 40-54 counterparts. These differences are almost identical when controlling for other factors. This age-risk relationship is not surprising given that older physicians have been practicing for a longer period of time and thus have had more exposure to risk."
Specialty is a key factor in the likelihood of a physician being sued, the new analysis says. "In both the short and longer term, the widest variation in liability risk comes from specialty. Among the strongest and most consistent results is that OB/GYNs, general surgeons, orthopedic surgeons and other surgeons have a much higher incidence of claims. Of OB/GYNs, 62.4% have been sued in their careers, followed by 59.3% of general surgeons. Controlling for other factors, OB/GYNs and general surgeons are 33.6 and 28.6 percentage points more likely than general internists to have ever been sued."
In the short term, female physicians have been at lower risk of being sued than their male counterparts, the new analysis says. "Women were less likely to have been sued in the prior year than men. Notably, this gender differential grew over time. In the 2016-2018 period, 2.8% of men were sued in the previous year, compared to 1.6% of women. There was no change over time for men in 2020-2022, but the likelihood that women received a claim fell to 0.9%. … There are a number of reasons why women are less likely to be sued. In terms of short-term risk, they tend to practice in less risky specialties and provide fewer hours of patient care."
Ghazala Sharieff, , MD, MBA, corporate senior vice president of hospital operations and chief medical officer at Scripps Health. Photo courtesy of Scripps Health.
Andy Anderson, MD, MBA, executive vice president, chief medical officer, and chief quality officer of RWJBarnabas Health. Photo courtesy of RWJBarnabas Health.
