In part two of a three-part interview, James Hartert, MD, MS, Chief Medical Officer for MinuteClinic, discusses the nurse practitioner model and the physician-staffed model for convenient care clinics.
A recent analysis by PricewaterhouseCoopers concluded that more than half the dollars in our $2.2 trillion healthcare system are wasted, says USA Today columnist Kevin Pho. Pho notes that while medical errors, inefficient use of information technology and poorly managed chronic diseases were all cited as factors, dwarfing these reasons is doctors practicing "defensive medicine." In this practice, doctors order (often unneccesary) tests to avoid the threat of a malpractice lawsuit.
The number and rate of serious disciplinary actions against physicians has decreased for the third consecutive year, according to Public Citizen's annual ranking of state medical boards. The trend indicates many states are not living up to their obligations to protect patients from bad doctors, according to the report. The top 10 states at disciplining doctors were Alaska, Kentucky, Ohio, Arizona, Nebraska, Colorado, Wyoming, Vermont, Oklahoma and Utah.
Primary care physicians treating large minority populations tend to earn less and see more patients, leaving them ill-equipped to address racial and ethnic treatment disparities, according to a study by researchers at the Center for Studying Health System Change. If Medicaid payments were on par with those paid by Medicare, more practices would have the resources to reduce treatment disparities, say the study's authors.
For years, medical schools and residency training programs avoided the topic of emotions. Doctors learned the facts about cancer and other serious diseases, but when it came time to reveal grim diagnoses, they were largely on their own. These days, all medical schools have some type of education in topics like the physician-patient relationship and breaking bad news. But knowing how to respond to personal emotions due to stress or sadness remains a major challenge.
Physicians have the highest suicide rate of any profession-between 300 and 400 doctors take their own lives every year. A new documentary, "Struggling in Silence", aims to shed some light on the topic, and this Newsweek article offers a brief preview of the film.
The Centers for Medicare & Medicaid Services has announced steps to encourage physicians and other eligible professionals to take part in the Physician Quality Reporting Initiative. The program is designed to improve the quality of care provided to Medicare beneficiaries. The steps, including a variety of new reporting options, will make it easier for eligible professionals to participate and receive feedback on their performance, said CMS representatives.
The current U.S. healthcare discussion misses a key variable—that providers will succeed or fail based on the quality of their customer service—says a recently released report from Katzenback Partners, The Empathy Engine: Achieving breakthroughs in patient service. Jenny Machida, one of the report's authors, explains how good customer service can increase the quality of care a patient receives.
Because the No. 1 reason for physician turnover is poor cultural fit with the practice, engaging physicians and ensuring compatibility should be a primary goal any practice's retention plan. This isn't always easy, since cultural fit can be intangible and can vary depending on the physician.
However, there are some universal challenges to ensuring a proper fit. Physicians desire a sense of belonging and value both autonomy and accountability, says Kevin Donovan, FACHE, FACMPE, vice president of physician and ambulatory services at Elliot Health System in Manchester, NH. He has implemented mentoring and networking programs--both networkwide and within a physician's specific specialty--to help physicians assimilate within Elliot Health System. To develop advanced strategies for engaging physicians and instilling a sense of loyalty, he recommends asking the following questions from the physician's perspective:
Do I have what I need to be successful?
Do I receive recognition for my contribution?
Is there someone encouraging my professional development?
Do my opinions count?
Have I been asked to help solve a problem in the group?
Has someone talked with me recently about my progress?
Am I presented with opportunities to learn and grow?
Do I feel proud to be a member of this group?
Would I encourage others to work here?
"We try to get people involved in our quality committee or physician management council or even on smaller projects just so they feel like they've got some skin in the game or some ownership in the practice even if they are an employee," Donovan says.
This story was adapted from one that first appeared in the April edition of Physician Compensation & Recruitment a publication by HealthLeaders Media.
The announcement earlier this month that physician groups were joining forces with major insurers to establish a national set of standards to measure physician performance was a big first step in resolving the dispute over the accuracy of physician ranking systems. But standards-based reform has drawn criticism in the education sector, and reformers should expect to see critiques similar to those leveled against No Child Left Behind, the law that established national testing standards for rewarding and ranking public schools.
We may be talking about two different industries, but bear with me on the analogy—the dialogue is very similar. After all, physicians are regularly getting report cards and being graded on their performance—sometimes with the same letter grades used in schools—and reform efforts are based on providing incentives based on a national standardized benchmark.
Now consider the two major criticisms that have been made against the No Child Left Behind approach: That national standards don’t accurately measure local variations in resources, student populations, and staffing challenges, and that focusing on standards can actually reduce the quality of education by providing incentives for schools to “teach to the test” in order to boost rankings.
Similar criticisms can and probably will be made about national ranking standards applied to physicians. It will certainly be difficult to reach a consensus on a national set of standards that takes into account variations in resources, patient populations, payer mix, costs, and other externalities that aren’t directly related to a physician’s skill but may affect his or her final ranking. And perverse incentives are always a concern in healthcare. Will physicians be too focused on improving their rankings, so much so that it comes at the expense of patient care and quality?
Not that the alternative is any better—the lack of uniform standards is making physician rankings one of the most contentious issues between insurers and doctors, and that’s saying a lot. Physician groups have even taken the issue to court, arguing that insurer ratings mislead consumers and are based more on cost than quality.
Without some standardization, physicians receive mixed signals about their performance and may take an unjust financial hit. A recent Newsweek article offered the example of a physician treating patients from different health plans. “If a physician has 100 patients, but only 15 of them are on a given plan, then only those 15 patients will contribute to that plan's rating of that doctor. The result: a physician can end up with drastically different rankings from one plan to the next.” Add in factors about sample size (How much information do you need to gauge physician performance?) and insurers’ incentives to focus on costs rather than quality, and it’s no wonder docs don’t trust the ratings system.
But the concept is here to stay. Though some physicians might debate the need for rankings in the first place, insurers have latched onto the idea and independent physician-rating Web sites, which typically lack accountability and accuracy, are popping up regularly. Patients are going to rank and research their doctors, most likely online, so it’s time to move onto the question of how to do this most effectively.
Establishing a national set of standards is movement in the right direction, but it’s important to keep in mind the shortcomings of national standardization systems and keep the process as transparent as possible.
