Cooperating for better care.

Robert Whitcomb

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Many organizations lag in physician-leadership training programs

An article in NEJM Catalyst by Gary S. Kaplan, M.D., and Stephen Swensen, M.D., about training physician leaders, says that “Leadership is teachable, and leadership development and training are important, according to NEJM Catalyst’s recent Insights Council survey on the topic. Yet the same survey reveals that more than half of respondents think their organizations’ efforts to develop and train leaders are lacking in quality and time commitment.”

Dr. Gary Kaplan, chairman and CEO at Virginia Mason Health System in Seattle, finds these results concerning, especially as the complexity of delivering health care continues to increase. ‘Leadership doesn’t just happen,’ he says. ‘We need strong leaders for greater focus and to execute improvement work in organizations and the health care industry overall.”’

“Internal leadership training programs are the top approach used at Insights Council members’ organizations, by a wide margin, ” the article says.

To read the article, please hit this link.


More ACO’s, fewer small practices

From FierceHealthcare:

“Researchers examined changes in physician practice sizes associated with ACO market penetration three years after the launch of the Medicare Shared Savings Program, which began in 2012 and is one of the country’s largest ACO programs. In counties with more ACOs, they found more large practices and fewer small practices, according to a study published in Health Affairs.

“And they found evidence suggesting that ACO-driven physician consolidation is accelerating. ‘These patterns suggest that the consolidation concerns initially raised regarding ACOs were warranted and that gains from care coordination facilitated by ACOs will have to be balanced against higher prices and possibly lower-quality care that could result from consolidation,’ the study authors said.

“The catch is that while ACOs are associated with higher quality and lower costs, consolidation of physician practices is associated with lower quality and higher prices in some settings.”

To read the whole article, please hit this link.


How will AI affect health-care delivery?

Authors of an article in NEJM Catalyt look at how artificial intelligence will affect health-care delivery. Among the conclusions:

“{H}umans still will be required to sustain the core doctor-patient relationship, and several universal obstacles could hinder the pace of AI adoption in health care delivery for the foreseeable future. For example, development of AI technology requires access to data sources that accurately and equitably reflect the general patient population. However, medical AI is likely to emerge in high-resource settings, such as academic medical centers, leading to contextual bias when it is deployed in lower-resource settings such as community health centers or rural areas. Additionally, developers must attain physician and staff buy-in regarding using AI in clinical practice. Despite great promise, some digital health tools have faltered at the stage of clinical adoption and diffusion.

“Finally, questions remain about reimbursement, liability, and regulation. In the U.S., the FDA has been establishing regulatory policies and guidelines around software and digital health. The agency has, for example, built a pre-certification program aimed at making sure consumers have access to high-quality digital health products.”

To read the article, please hit this link.


Should systems buy or build?

An NEJM Catalyst article looks at whether health systems should buy or build to expand. Among the comments:

“As in many industries, health care has experienced waves of consolidation in the name of growth. Hospitals have bought physician practices, doctors are opening ambulatory surgical centers, and there is a buy free-for-all across all parts of the continuum of care (and new forms of payment) as never before. Such vertical integration purportedly drives financial efficiencies with scale, improves clinical quality by reducing problems of care transitions, encourages teamwork, and calibrates scope of practice to services provided. Yet the jury is still out. Costs continue to rise as the market power of health systems grow (with lots of finger pointing), readmissions and problems in patient handoffs persist, anticompetitive practices emerge, and quality remains highly variable.

“Perhaps this lack of progress toward the Triple Aim suggests that we should reconsider our assumptions that vertically integrated systems will achieve productivity, patient-centeredness, and will deliver on a scalable version of Kaiser Permanente. Perhaps we should revisit the so-called rules of health care.”

To read the article, please hit this link.


Peer advice on managing a practice

Physicians Practice surveyed 943 practice owners, managers and physicians to ask them about their staffing challenges and solutions. To read the report, please hit this link.


How to respond as new tech invades health care

Picture: Visualization of some Internet routes

— The Opte Project

Namita Seth Mohta, M.D., David Blumenthal, M.D., MPP, president of The Commonwealth Fund, and Robert Galvin, M.D., MBA, chief executive officer for Equity Healthcare discuss why and how big private-sector health-care organizations are responding to the onrush of technology into the sector.

One of Dr. Galvin’s observations:

“Sometimes the unintended consequences exceed the benefits, to be honest. When you get into a system as big as health care, as resistant to change in health care, and inherently much more complicated, this is not buying goods and services over Amazon; this is not getting an Uber or using Lyft. These are in many cases very sick people with complicated diseases in a system that’s already very complicated.

“One unintended consequence is you make it more complicated for people, so the number of choices they have — and the array of opportunities they have to access these apps — can be overwhelming. The misinformation is another unintended consequence; I’m not sure how good Alexa is going to be, or whether there’s going to be any clinical judgment in Alexa. If you go onto the Web and look for health care information, it’s as likely to be inaccurate as it is to be accurate.”

To read and hear the full discussion, please hit this link.


Warning about ‘medical directors’

An article in Physicians Practice warns practices and hospitals:

“There are often situations where a physician holds the title of medical director. The physician, however, does not necessarily perform any substantive roles or functions, but the title is sometimes given to induce patient referrals to the facility. These types of situations can — and do — give rise to liability under the False Claims Act….”

“Sham medical director agreements to induce patient referrals violate the Anti-Kickback Statute and Stark Law. Doctor’s Choice also allegedly paid some employees in a manner that accounted for the volume of referrals by their physician spouses, in violation of the Stark Law….”

“Physicians, medical professionals and facilities should appreciate the legal liability for not performing the requisite functions. They should also ensure they are meeting an Anti-Kickback safe harbor and a Stark Law exception.” 

To read the whole article, please hit this link.


Four tenets for physician incentives

“Incentives are there to try to change behavior, to try to move things along,” noted John Jenrette, M.D., executive vice president for Cedars-Sinai Medical Network, during a talk on physician incentives, as reported in NEJM Catalyst.

His four tenets of physician incentives and behaviors, reports the NEJM article and video:

  1. Follow the money. ‘Physicians like money and financial incentives, yes, but they’re not at the core, at all. They aren’t. They maybe have this kind of incremental impact if you can put them in the right direction, but I truly believe that if physicians are compensated appropriately for the work they’re doing, the incentives become that icing on the cake, that top performance, the things that we want to pay attention to, want to try to focus on, and reward physicians for that type of behavior.’”
  2. Produce meaningful data. ‘That data has to be accurate, it has to be reliable, it has to be meaningful. If you have walked into a room with a bunch of physicians with data, and they begin to poke thousands of holes into it, you walk out of the room with your tail between your legs, completely discredited, and you will spend so much energy trying to get back there, and even have another conversation. The reliability and meaningfulness of the data and how that applies is important to the why I take care of patients and do the work that I do.”’
  3. Involve physicians. ‘Physicians want to be a part of the process. They want to be in the conversation. ….They want to help guide that and direct it, and make sure the data can be meaningful and helpful to their practices and the work that they do. …”’
  4. Ask why. Jenrette stresses that this fourth tenet is the most important. ”’It goes to the core of why we are physicians, in taking care of our patients, in taking care of families, in creating great outcomes and seeing people live healthy and happy. That’s why we become physicians, and why we need to continue to focus in that direction.”’

TO read/hear the article, please hit this link.


Breaking down health-care silos

Four staffers at Boston’s Brigham and Women’s Hospital write about breaking down health-care silos in this case regarding treatment of patients with end-stage renal disease.

Among their observations:

“{I}n 2016 we launched a coordinated ESRD program within Partners Healthcare, based at Brigham and Women’s Hospital (BWH) in Boston, one of the first to bring the care-coordination principles that are increasingly common in primary care to disease-specific specialty care. While other programs, like the CMS ESRD demonstration projects, have piloted care-coordination models with large dialysis organizations, ours is the only such program that we’re aware of that coordinates care across all stakeholders (dialysis units, hospitals, primary care providers, and others) rather than focusing on care within the dialysis unit itself. Further, unlike other programs, ours extends beyond dialysis-based care to facilitate transplant evaluations and, when needed, palliative care.”

To read the whole article, please hit this link.


Severe shortage in residency slots

FierceHealthcare reports:

“There’s more medical school students than ever before, but there’s still a big obstacle to solving a predicted physician shortage.

“While U.S. medical school enrollment has increased, averting a physician shortage now depends on more residency training slots, according to the results of an annual survey from the Association of American Medical Colleges (AAMC).

“The number of residency positions has increased only 1% a year, far lower than the 52% growth in medical school spots since 2002, the AAMC said. Federally supported residency training slots have been capped by Congress for more than 20 years, limiting the spots for medical school graduates to undergo additional training in a residency program before they can practice medicine….”

“The survey found that medical school deans are worried about the lack of residency slots: 75% expressed concern about the availability of residency slots nationally, and 44% expressed concerns about their own incoming students’ ability to find residency positions of their choice after medical school. Over half of schools reported they experienced difficulty in finding clinical training sites for obstetrics/ gynecology and pediatrics.”

To read the whole article, please hit this link.


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