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How to lure and keep Millennials in medicine



In a Med Page Today article, Colin Zhu, D.O., discusses how to lure and keep Millennials in medicine to deal with the oncoming physician shortage.

Among his observations:

“Society associates Millennials with negative connotations like entitlement and selfishness, but I beg to differ. My generation is known for our tech savvy, flexibility, and eagerness to produce results. We crave constant feedback and seek out continuous opportunities to improve. We find culture to be a greater attraction than compensation, look for new experiences in life, and want to pursue passions outside of our chosen fields.

“As more doctors cut back their hours or plan to retire, practices and hospital administrators will need to look in new directions to increase retention among young doctors. Keeping talented people within the practice of medicine will ultimately benefit everyone. Organizations that build strong cultures by providing career opportunities and encouraging people to pursue outside passions will be more likely to attract and keep Millennial physicians. ”

Dr Zhu is the creator of TheChefDoc and author of Thrive Medicine: How to Cultivate Your Desires and Elevate Your Life.


To read the article, please hit this link.

The value of multidisciplinary teams in cancer treatment


An article in NEJM Catalyst touts the value of multidisciplinary teams in cancer treatment. The group of authors conclude:

“The long-term cost of care needs to be further investigated, but the treatment changes based on multidisciplinary team recommendations likely led to improved outcomes or reduced cost, including lower downstream costs from complications or poor disease outcomes, based on studies in other institutions. True cost of treatment is difficult to quantify in a retrospective fashion in our study and would require further prospective study. Though the precise value of multidisciplinary team discussions may be difficult to quantify, multidisciplinary team discussions result in improved disease outcomes and better coordination of care, and may decrease cost of cancer treatment.”

To read the article, please hit this link.


Providers warn Feds about proposed changes to MSSP



FierceHealthcare reports:

“Provider groups had plenty to say about the proposed changes to the Medicare Shared Savings Program (MSSP) that are likely to drive out a portion of Accountable Care Organizations (ACOs) if finalized.

A new survey by the National Association of ACOs (NAACOS) released this week shows that 60% of ACOs currently in the MSSP wouldn’t enter the program under the proposed structure, which includes reducing shared savings from 50% to 25% and shortening the amount of time ACOs can remain in a one-sided risk model from six years to two years.

Nearly half of the ACOs surveyed said they are likely to continue even if those changes take effect. More than one-third (36%) said they were unlikely to continue under the proposed structure, and 16% took a neutral stance.”

To read the whole article, please hit this link.


Changing executive behavior in healthcare

“The behavior of senior executives, and especially the CEO, is known to be directly related to an organization’s performance. In 2017, we reported on five behavioral dimensions required to build a culture of continuous improvement: willingness, humility, curiosity, perseverance, and self-discipline. Does changing leader behavior to embody these qualities lead to better patient outcomes? The leadership team at Zuckerberg San Francisco General Hospital (ZSFGH) has been studying this question over the last year and has determined the answer is yes. We will describe the outcomes ZSFGH has achieved since creating specific behavioral expectations for its leaders.”

“One step toward developing an improvement management system is defining what people should be working on. This is called True North, a handful of metrics that allow everyone to know what’s most important and whether the organization is making needed progress. ZSFGH adopted six True North goal areas — equity, safety, quality, care experience, workforce care and development, and financial stewardship — and decided how to measure each performance category. These measures are ZSFGH’s must do, can’t fail metrics for organizational performance.”


To read the entire piece, please hit this link.



Renaissance in independent practices seen



4 categories of ‘providers of the future’


FierceHealthcare reports that Researchers at PricewaterhouseCoopers  have found that “the providers of the future’ will likely fit into one of four categories, based on the areas where each excels: product leader, experience leader, health manager or integrator.”

The four categories are, as paraphrased by Fierce:

  1. “Product leaders. According to PwC, these health systems will take the lead on providing the most advanced care and positive patient outcomes. These facilities will be investing in telemedicine, and care for complex conditions to new markets.
  2. “Experience leaders. These providers will need to put a focus on analyzing the communities they seek to serve to achieve high customer satisfaction. Another piece to this, according to the report, is ensuring that the market has access to diverse care settings to improve the experience.
  3. “Health managers. These providers will especially focus on population health and social determinants of health, according to the report. This will require a robust data infrastructure and direct contracts with employers to manage health.
  4. “Integrators. These providers will devote much of their effort to expanding and building scale, according to the report. Having a large network—potentially even beyond U.S. borders—will create value for patients. ”

To read more about the report, please hit this link.

What a new healthcare-delivery system might look like

Deborah Walker Keegan, Ph.D., president of Medical Practice Dimensions Inc., discusses in Medical Economics how to restructure the U.S. healthcare-delivery system. Among her observations:

”Pharmacy and retail blockbuster chains, having already embarked on retail and express clinics, are now proposing partnerships with commercial insurers to expand their reach, improve their bottom line, and reposition themselves as the new ‘front door’ of primary care.”

She asks:

  • “Do we want to have pharmacy/insurer monoliths wield power to steer patients to specific facilities and providers for care, services and medications?  Beyond primary care, patients need access to specialty care and care coordination across the continuum of healthcare services. Except for the small number of proposed mergers that involve multispecialty provider groups … is this on the companies’ radar?  If so, what are their proposals for a comprehensive delivery system of care?
  • “Will we be fracturing an already dwindling provider supply?  It is doubtful that economies of scale will be realized by placing one or two clinicians in a retail pharmacy and replicating this model over tens of thousands of sites as they compete on every corner. Primary care clinicians may become an even more endangered species than they already are, with many seeing only a handful of patients per day.”


She says that an  innovative healthcare delivery system could look like some of the following:

  • “Patients living or working within a defined region receive care from a designated healthcare delivery system.
  • “Patients receive primary care services locally and specialty care services regionally. The most complex procedures are performed in a few, well-established centers of excellence located throughout the country.
  • “The regional healthcare delivery system is incented to improve and/or maintain population health and wellness; financial incentives and/or subsidies are paid to the systems themselves (rather than to patients or commercial insurers).
  • “Patients purchase health insurance directly from the regional healthcare delivery systems, thereby effectively integrating the financing and delivery of healthcare and thus aligning incentives.”

To read her whole essay, please hit this link. 



ACOs denounce CMS’s proposed changes


FierceHealthcare reported:

“Proposed changes to the federal Accountable Care Organization (ACO) model—namely, a cut in the shared savings rate from 50% to 25%—would cut the knees out from under the program, board members of the National Association of ACOs said on Thursday, Oct. 4.

“Speaking with reporters at their annual conference in Washington, D.C., ACO leaders said they supported many of the proposed changes that the Centers for Medicare & Medicaid Services have brought forward regarding ACOs.

“But proposed rules that would speed their path to risk and reduce the reward they would reap in return for any savings they realize are ‘deal breakers’ for new entrants to the program, said Clif Gaus, NAACOS president and CEO.”

To read the entire article, please hit this link.


Bundled payments and ACOs side by side

In an NEJM Catalyst piece, Poonam L. Alaigh, M.D., executive vice president for corporate development at Remedy Partners, writes about how to make Accountable Care Organizations and bundled payments work side by side. Among Dr. Alaigh’s conclusions:

“Federal policymakers have recently indicated that they expect far greater returns on their investment in payment reform and they are prepared to hold stakeholders’ feet to the fire. They’ll likely do so by eliminating Medicare value-based care participation options that lack downside risk, which fail to hold organizations accountable for negative performance.

“Provider organizations must become adept at delivering care under both of these models as we shift from volume to value-based care. This approach provides an innovative platform for primary care and specialty care integration. ACOs and bundled payment systems are an opportunity for health care providers and payers to work in unison toward improving health for patients and better managing costs. Leaders should be seeking to build on the last several years of experience and momentum by aligning these initiatives and mobilizing these complementary programs while internally leveraging economics of scale and driving increased return on investment.”

To read the whole piece, please hit this link.


How to develop healthcare teams with grit

In an NEJM Catalyst video and text piece, Thomas H. Lee discusses the need for health-care teams with “grit” in today’s every more complex healthcare environment.

Lee describes four key elements of what it means for a group or an organization to behave like a gritty individual. The text below is from NEJM:

Have a goal hierarchy:

“In a goal hierarchy, the lowest-level tasks are akin to daily to-do lists, with things like going through one’s inbox on the electronic medical record, answering pages, and sending in prescriptions. ‘Those are tasks that if that was the only thing I focused, on I’d have a burnout issue,’ says Lee.”

“Middle-level goal tasks are designed to help clinicians accomplish things like coordinated care and preventing complications for patients by addressing their current symptoms.”

A Growth Mindset

“‘A growth mindset is the idea that you can get better and change — even if you are already the best. ‘That drive for improvement, that restlessness with the status quo, that is part of grit,’ says Lee.”

Two Types of Resilience

“One type of resilience is the willingness and the ability to bounce back from setbacks, acknowledging that things didn’t go right and trying to learn from the experience and be better as a result.”

“A second type of resilience is the flexibility to deal with the unexpected. When taking care of patients, the unexpected happens all the time — unexpected medical conditions or other circumstances. ”

Identification with Growth

“Individuals must feel pride in being part of the Parkinson’s team or the cancer team, and pride in being part of their institution. ‘That has to be something that motivates them, gives them pride, makes them feel better about themselves,” Lee says, ‘so that when the inevitable stresses of the unpredictable come along, they’re ready to shoulder them and not fall apart.”’

“‘These elements of a gritty team are essential competitive differentiators for health care organizations that are going to thrive in the marketplace that lies ahead,’ he adds. Grit is strategic and will help organizations thrive in the face of competition.”

To access the piece, please hit this link.


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