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From the Consultant’s Corner 8/3/17

Crossroads Between Physician Productivity and Burnout
By Nancy Gagliano, MD

The scenario is all too common. Practice expenses are rising while physicians are asking for reduced clinical sessions and productivity requirements. Everyone is worrying about physician burnout. Increased and shifting regulations have dramatically increased the complexity of delivering patient care. MACRA, EHR adoption and usage, coding compliance, quality monitoring, and prior authorizations have all amplified the administrative burden that has fallen disproportionately into the hands of physicians. Physicians, particularly, primary care doctors, are spending close to half of their time performing administrative tasks including documentation. This article reviews physician motivators and dissatisfiers, and provides concrete suggestions for improving physician satisfaction while setting up a foundation to enhance productivity.

Physician burnout has three core components – emotional exhaustion, depersonalization, and a low sense of personal accomplishment. It is estimated that close to half of physicians today are burned out. Burnout is associated with depression, substance abuse, suicide, and divorce, as well as reduced patient satisfaction and quality.

Understanding core motivators that affect physician satisfaction is essential to enhance the work environment to support physicians. We all have intrinsic and extrinsic motivators that contribute to our job satisfaction. The intrinsic motivators for physicians are the “Why I went to medical school.” A typical physician finds satisfaction in providing high quality care, learning and discovery, delivering excellence and “making a difference.” Certainly, all healthcare organizations value these core elements, which are often highlighted in mission statements. However, is it possible that these values are not communicated and reinforced frequently enough to providers? Instead, is communication from business lines focused on regulations, revenue, quality reports, and the multitude of demands facing healthcare today? Organizations should step back and commit to a balance of communications focusing on business imperatives and embracing, highlighting, and recognizing its core mission.

In addition, business units should be aware of these attributes when working with physicians. For example, the revenue cycle team may think of EHR documentation as a tool to support compliant coding and charge capture. However, physicians value their documentation as a mechanism to share clinical information with their colleagues to enhance patient care, and view coding and charge capture as a burden. It is important for coding experts and the billing staff to acknowledge and reinforce documentation’s core purpose when working with physicians.

Let’s move on to external motivators that affect physician satisfaction. These factors include autonomy, resources, community, leadership, and appreciation.

Autonomy

Autonomy should be broken into three areas – financial, environmental, and clinical. We have come a long way from the independent physician running their own practice, determining how hard they want to work, where they work, who works in their practice, and the care that they deliver. Today, many physicians work in practices managed by administrators and arrive for their assigned session hoping that the same medical assistant is there to support them. Standardization is essential for efficiency. No longer are diplomas or family pictures hanging in exam rooms. Physicians have lost their environmental autonomy.

Although physicians can impact their earning potential through specialty selection, many physicians are now salaried with only minimal ability to control their earnings. Overall, they have lost their financial autonomy as well.

Finally, they are losing their clinical autonomy in having to deal with quality programs reports, guidelines protocols, and prior authorizations. We are telling physicians that the quality of care they provide, without these programs, is inadequate. Given that a typical physician spends a decade on education and training, we should be careful when communicating these programs and requirements, as they can be perceived as insults. When working with physicians and asking them to change behavior, it is important to be aware that autonomy is important and standardization is not cherished. Prioritizing those activities that truly require standardization and presenting the value of standardization is critical.

Resources

Unfortunately, with the complexity of healthcare increasing, tasks falling onto physician shoulders have increased. In addition, the EHR, because of increasing documentation requirements and inbox tools, has increased the time physicians spend doing tasks previously done by others. There are numerous opportunities for organizations reduce the administrative burden and increase productivity, including:

  • Clinical workflow and EHR optimization.
  • Virtual scribes.
  • Centralizing access.
  • Appropriate use of clinical support staff.

Community

Although many physicians are independent by nature, the importance of community is often overlooked. Gone are the physician-only lounges and lunch rooms, which were eliminated for political correctness. Dining with colleagues has been replaced with catching up on notes and paperwork before the afternoon session. We have lost sight of the fact that these venues gave physicians opportunities to discuss emotionally and intellectually challenging cases. Physicians no longer have easy access to their colleagues to unburden themselves from the weight of patient responsibility, which, arguably contributes to burnout.

Look for opportunities reinforce physician community. Consider holding physician team meetings to share information, whether it is coding review, financial reports, or other administrative issues. It provides an opportunity to support physician community as well as learning from one another. While a physician group meeting may be viewed only as opportunity for venting and could potentially be difficult to manage, the venting may, in the end, result in greater buy-in.

Leadership

While organizations acknowledge needing excellent physician leaders and champions, many physicians do not excel in leadership roles given their autonomous and independent nature. Typical challenges include consensus building, active listening, inspiring, dealing with conflict, and mentoring. Organizations should resist putting the “physician IT geek” in technology roles or solving a productivity reduction request by giving a leadership position. Another common mistake is selecting a physician leader based on how their peers perceive them. While it is vital that their peers respect their clinical leaders, being respected for high quality care, research, or productivity are not necessarily the attributes that make the physician an excellent leader.

Once physicians are selected to be leaders, organizations need to focus on leadership development through external and internal programs. There are numerous external programs available that can provide a boost in learning. However, for larger healthcare organizations, it is advantageous to develop an ongoing internal leadership forum that will provide physician leaders with skills reinforcement and an opportunity to interact with peers in leadership roles across the organization.

Appreciation

Physicians are similar to others in valuing appreciation. Although a full waiting room provides a sense of satisfaction, appreciation from colleagues is very gratifying. While balloons, candy, and flowers may not be appropriate recognition tools for physicians, peer and colleague recognition programs are. Regularly highlighting and celebrating clinical excellence, compassionate caring, teaching, and research should be an integral part of an organization’s culture.

In summary, physician burnout is a real phenomenon that we should all take seriously, particularly in an era of physician shortage. Understanding internal and external motivators of physicians is important when working with physicians. We should reflect on how we work with physicians to make sure our approach taps into their intrinsic motivators. In addition, there are numerous opportunities to create a positive environment to maximize physician productivity and satisfaction.

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Nancy Gagliano, MD is CMO at Culbert Healthcare Solutions in Woburn, MA.


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News 8/2/17

August 2, 2017 News No Comments

Top News

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Telemedicine e-prescribing vendor EazyScripts closes a $2 million Series A investment round led by private equity firm Bluff Point Associates. BPA Managing Director Kevin Fahey will join the EazyScripts Board of Directors.

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BPA worked with EazyScripts CEO Reed Liggin during the funding and acquisition of his previous company, RazorInsights, which was sold to Athenahealth in 2015 for an undisclosed amount. Liggin did a relatively short stint at Athenahealth after the acquisition as VP of hospital sales.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Announcements and Implementations

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EWellness will add AI-powered tools and predictive analytics to its physical therapy remote monitoring technology by the end of 2017.

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Cedar Valley Medical Specialists, an 90-provider independent medical group in Waterloo, IA, replaces Allscripts and GE Healthcare technologies with EHR and population health management software from EClinicalWorks.

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The New York-based Greater Buffalo United Accountable Care Organization will offer its Medicaid patients free rides to and from appointments through a new partnership with Lyft, which was recently approved to operate in the western part of the state.

As part of its efforts to achieve Meaningful Use Stage 3 certification, Drchrono enables its EHR for FHIR, meaning patients can access health data via the company’s FHIR API-enabled Onpatient PHR.


Acquisitions, Funding, Business, and Stock

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Document management company Spectrum Information Services launches a service line for retiring physicians looking to archive health records.


Research and Innovation

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Minnesota Community Measurement releases the results of its third annual Patient Experience of Care Survey, which highlights the experiences of over 180,000 patients at 767 clinics across the state. Patients were asked about care coordination for the first time, with rural clinics beating out urban facilities on satisfaction. “In the metro area you have lots and lots of providers, so I think we have the potential for more miscommunication,” says Julie Sonier, executive director of the nonprofit. “That’s one theory — as opposed to a rural area where you are seeing the same provider for all or most of your care.”


People

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Healthcare compliance and credentialing software company Symplr hires Amie Teske (Topline Advisory) as VP of Sales.

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Arun Mohan, MD (WellStar/Radix Health) joins healthcare review site CareDash as medical advisor.


Telemedicine

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Employer-focused telemedicine company WellVia gets into the genetics game, offering DNA testing to employees through a new partnership with Predictive Medical Solutions lab. WellVia Genetics will initially help employees determine how they might respond to certain medications in order to prevent adverse reactions. Cancer risk analysis and newborn genetic testing are in the works.

Arkansas loosens up its telemedicine regulations, prompting Doctor on Demand to roll out its virtual consult services in that state, where patients in some areas wait an average of 18 days to see a PCP.


Other

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Coming soon to a crosswalk near you?: Honolulu Mayor Kirk Caldwell announces the city will start fining pedestrians who cross a street while looking at a mobile device. Fines will range from $15 to $99 depending on the frequency of offense.


Sponsor Updates

  • Healthwise will exhibit at Allscripts ACE 2017 August 8-10 in Chicago.

Blog Posts


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Jenn, Mr. H, Lorre

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News 8/1/17

August 1, 2017 News No Comments

Top News

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Athenahealth CEO Jonathan Bush announces that he will give up his roles of chairman and president as part of $100 million in cost-cutting moves that will be undertaken to improve profitability. The plan, which will include finding replacements for Bush’s vacated roles and a new independent board director (not to mention the still vacant CFO position), comes just three months shy of activist investor Paul Singer taking a 9.2 percent stake in the company.


Webinars

None scheduled in the coming weeks. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Announcements and Implementations

Provider enrollment and credentialing services company Stat MedCare Solutions selects Delivery Trust secure email services from Identillect Technologies. (Interesting fact: Stat is not an acronym as I initially believed, but rather is from the Latin word statim, which means “instantly” or “immediately.”)


Acquisitions, Funding, Business, and Stock

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New York City-based Fruit Street Health raises $3 million in a round led by board member Jeremy Tucker, MD. The company, which has raised $8.4 million over the last three years, will use the capital to continue development of its Diabetes Prevention Program-focused digital health offerings, hire additional dieticians, and grow its commercial health plan business.

Patient relationship management vendor Solutionreach joins Athenahealth’s More Disruption Please program.

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VillageMD launches in Northern Indiana, counting Family Medical and Wellness Center among the initial members of its new primary care practice management network. The company expanded its services in Georgia earlier this month.

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NextGen will acquire population health management-focused analytics company EagleDream Health for $26 million. Expected to close this quarter, the agreement marks the second acquisition for NextGen this year; it acquired mobile physician documentation vendor Entrada in April for $34 million. Prior to founding EagleDream in 2014, CEO Betty Rabinowitz, MD served as medical director of the University of Rochester’s Center for Primary Care. EagleDream will maintain its headquarters in Rochester, NY and Rabinowitz will play a key leadership role in the blended organization.


People

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Remote vision monitoring company Notal Vision hires Susan Orr, OD (Janssen Pharmaceuticals) as CMO and VP of medical affairs.


Research and Innovation

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Massachusetts, Washington, Maryland, California, and Delaware take the top spots in a new think tank report highlighting states best positioned to encourage and enable data-driven innovation. The Center for Data Innovation looked at each state’s publicly available datasets, digital infrastructure, and number of open data companies and number employed. The top states have all demonstrated a commitment to promoting the implementation of health IT, among other benchmarks.

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Cochlear updates its hearing-aid implant processor to give users wireless access to their iPhones, meaning that whatever sound is coming from the device is now streamed directly to the ear. Users can also control and customize the sound from their phone without having to download a separate app.


Other

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Women’s Health Care Group of PA notifies patients of a May security breach caused by a computer virus on a server at one of its 45 locations. The ensuing investigation revealed that hackers had access to the server as far back as January. The breach seems to have had a ransomware component, though WHCG’s notification only refers to virus-encrypted files. The group restored records from back ups and has found no evidence of compromised PHI.

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I love this: The local paper covers the growing popularity of Reach Out and Read programs at clinics in North Carolina. The national program partners with pediatricians to encourage them to “prescribe” books to improve literacy, encourage kids to put down devices, and engender a love of reading. The prescription includes reading and talking about a book during appointments, after which the patient gets to take the book home.


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Jenn, Mr. H, Lorre

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News 7/31/17

July 31, 2017 News 1 Comment

Top News

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Modernizing Medicine plans to add 838 jobs and double its office space when it moves into new headquarters in its hometown of Boca Raton, FL. The EHR vendor, which employs 550, will use $6 million in government incentives to create the jobs by 2022 in exchange for investing $15 million in the region. Founded in 2010 by Dan Cane and Michael Sherling, MD after they met at a local physician practice, the company’s news comes just two months after news of a $231 million investment from Warburg Pincus. “Now our big focus is around the patient,” says Cane, “on mobile devices [to] access records and telemedicine experience; more information and power down to the patient.”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information on webinar services.


Acquisitions, Funding, Business, and Stock

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EClinicalWorks says 1,000 providers selected its EHR in June, its strongest month so far this year.

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Amazing Charts users are temporarily unable to e-prescribe due to technical difficulties at NewCrop, its e-prescribing software vendor.


Announcements and Implementations

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California Retina Consultants rolls out email security services from Identillect across its 10 locations in Central California. I’m honestly surprised I haven’t seen more press releases from vendors touting new cybersecurity customers – though perhaps new customers don’t care to broadcast their latest security measures to hackers waiting to pounce.


Telemedicine

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Doctor on Demand looks to grab a hold of the now more telemedicine-friendly state of Texas with $10 video visits for citizens of the Lone Star State through September 3.


People

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Miriam Paramore (Lucro Solutions) joins EHR-integrated prescription savings software company OptimizeRx as president.

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TeamHealth hires Philip McSween (Baker Donelson) as EVP, general counsel, and corporate secretary.


Government and Politics

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CMS releases pediatric core measures – one of eight sets that comprise the Core Quality Measures Collaborative, which aims to streamline quality measures across providers, payers, and other stakeholders.


Research and Innovation

Coordinated Care Organizations in Oregon seem to be making headway when it comes to ensuring mothers-to-be on Medicaid receive timely prenatal care. A look at CCO effectiveness in that particular area found that more women began receiving such care in their first trimesters as opposed to the year before the model began. There’s still more work to be done, however. Researchers also found that improvement in timeliness was more pronounced in white and Asian women, and those living in urban areas. The CCO model for Medicaid was launched in 2012, providing incentives to providers who meet benchmarks related to ED visits, EHRs, cancer screenings, and prenatal care.


Other

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The New York Times looks at the developing world of empathy gadgets like the SymPulse, a blood pressure cuff-like device that enables the wearer to feel tremors akin to those experienced by Parkinson’s patients. Devices are also being developed to mimic the symptoms of emphysema, psychiatric conditions, and diabetic nerve disease – all to help caregivers and even physicians better understand and empathize with patients.

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This takes multitasking to an entirely new level: Amanda Hess, DO delivers Leah Halliday Johnson’s baby despite being prepped for delivery of her second child (and clad in a hospital gown to boot). Hess heard from her own hospital room that Halliday’s baby was in distress, threw a cover over her gown, and went to help out while the on-call physician made his way to the hospital. Hess’ contractions started just after she helped Johnson give birth to her daughter. Hess said that “It was a perfect way to get my own labor started.”


Contacts

Jenn, Mr. H, Lorre

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Population Health Management Weekly Wrap Up 7/30/17

July 30, 2017 News No Comments

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Siv Raman, MD (Anthem) joins ZeOmega as chief analytics officer.

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Privis Health hires Craig Jones, MD (ONC) for the role of CMO.

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Cottage Health, a nonprofit health system based in Santa Barbara, CA, develops a Population Health Learning Lab that includes an interactive county mapping and data tool, and an evaluation toolkit to help community and clinical stakeholders assess needs and collaborate on programs.

Allscripts will offer Conversa’s Conversation Platform as the patient-facing portion of its CareInMotion population health management platform to engage patients between visits. Allscripts will also make an unspecified investment in Conversa.

Hexaware will add Zynx Health’s evidence-based care plans and order sets to its CarrotCube population health management solution.

A Connance survey on the importance of SDOH data finds that nearly 100 percent of those surveyed want the data before a patient is released from the hospital so as to ensure they have all the resources they need (transportation, power, food, etc.) to make a full recovery. Many respondents noted that the type of SDOH data available today via EHRs and population health management programs is not enough – often arriving too late in the care process to make a real difference.

Three Florida-based ACOs — Central Florida AVO, Next ACO of Nature Coast, and Space Coast ACO – select the population health management solution of EClinicalWorks.


Sponsor Updates

  • Nordic opens a 6,000 square foot expansion of its Madison, WI office.
  • GE Healthcare names Catherine Estrampes president and CEO of GE Healthcare Europe.
  • Frost & Sullivan recognizes EClinicalWorks with the 2017 North American Frost & Sullivan Award for customer value leadership.

Blog Posts


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Jenn, Mr. H, Lorre

More news: HIStalk, HIStalk Connect.

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  • Tony Moir: To think that this process began with a simple idea many years ago and has evolved into a truly helpful and dynamic plat...
  • : Just loved this story and hats off to Amanda Hess, DO who delivers Leah Halliday Johnson’s baby despite being prepped fo...
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