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Developing physician leaders in the new healthcare world


Caryn Lerman, Ph.D.,  and J. Larry Jameson, M.D., both of the University of Pennsylvania, write in NEJM Catalyst about leadership development in the new world of medicine.

Among their remarks:

“We believe it is time for a critical assessment of the ways in which health systems develop, select, and support emerging physician leaders….”

“Physician leaders were traditionally selected on the basis of their national prominence and excellence as master clinicians, star researchers, and revered educators. These credentials remain important, but they aren’t sufficient in the current health care climate. Given the high rate of turnover among physician leaders such as department chairs and deans, we can no longer afford to neglect the skills that are essential for leaders to succeed. We believe there is a need for a new generation of leaders who can promote strategic and cultural alignment in the face of rapid change. … We suggest that health systems focus on three key strategies for promoting the effective development of physician leaders.”

“First, such systems could build a diverse pipeline of future physician leaders from within the organization. This approach would expand the pool of potential leaders, allow emerging leaders to take on progressively increasing responsibility, and ensure that leadership strategies are aligned with the organization’s culture and priorities. …”

“Second, health systems could implement a deliberate process for rigorously mining talent pools, whether internal or external. The most promising leaders are those who not only have experience and a compelling vision but also exemplify the core values of the institution and can engage and inspire others to rally around a shared vision. Physicians are understandably passionate about their own clinical specialties and research areas, but leaders need to understand, respect, and support the diverse interests of their teams and the institution in a balanced way. Physician leaders also need to partner effectively with nonphysician colleagues, including business leaders, administrators and nurses.”

“Third, health systems could implement structured processes for ‘onboarding’ and methods for gathering feedback. For example, listening tours that allow newly appointed leaders to solicit viewpoints from current leaders, faculty, and staff are invaluable for learning cultural norms and strategic priorities for the new role. This process also serves to establish new collaborative partnerships and build credibility for the new leader.”

To read the article, please hit this link.

Hospitals not using drug-discount-program savings to improve care for the underserved

A new study says that hospitals that have been saving money through 340B program discounts have generally not been been using  those savings to improve care for low-income and  other underserved patients, although that’s been one of the program’s missions.

Researchers at Harvard Medical School and the New York University School of Medicine studied data on Medicare beneficiaries from hospitals with 50 or more beds that were just above or below the 340B program’s 11.75 percent disproportionate share hospital threshold.

According to FierceHealthcare, “They found that hospitals eligible for 340B discounts administered more drugs, and also increased their ability to administer more drugs by absorbing physician practices, particularly in oncology. The study, which was published in the New England Journal of Medicine, found that 340B participation was linked to an increased number of hematologist–oncologists, ophthalmologists or rheumatologists working in the hospital.

“The study also analyzed the impact of the program on quality improvements and mortality rates for low-income patients and found little evidence that hospitals were investing the 340B savings in these areas. ”

“We found evidence of hospitals behaving in ways that would generate profits, by building their outpatient capacity to administer drugs,” Sunita Desai, Ph.D., an assistant professor in the Department of Public Health at NYU School of Medicine and the study’s senior author, said in a public announcement.  “But we did not see any evidence that hospitals are investing those profits in safety-net clinics, expanding access to care for low-income Medicare patients or improving mortality in their local communities as the program intends.”

To read the New England Journal of Medicine article on the study, please hit this link.

To read the Fierce report, please hit this link.


The health-system gaps within rural areas

In the Texas Hill Country.

Shao-Chee Sim, Ph.D., vice president for applied research of the Episcopal Health Foundation, writes in Health Affairs that a major problem of American healthcare is not just the “health gap widening between urban and rural areas. There’s also a growing gap between the way systems of health work in different areas of the country” — including gaps between how hospital systems work within the same rural areas.

For those who need to understand this, Dr. Sim pointed to the recently released   report by the Rural and Community Health Institute (RCHI) at Texas A&M University called “What’s Next? Practical Suggestions for Rural Communities Facing a Hospital Closure.” He calls it  “a powerful narrative on the opportunities for rural communities to optimize their healthcare delivery systems in the face of hospital closures.”

“The RCHI team challenges conventional policy conversations and goes beyond solely focusing on a community losing a hospital. Instead, the authors look at the problem through a geographic lens and focus on what are the available health resources in the affected areas. The report finds that a regional approach is key to developing healthcare alternatives for rural communities, such as expanding telemedicine options, converting a former hospital into a freestanding emergency department, or establishing new rural health clinics.”

To read the piece, please hit this link.

Canada’s healthcare issues seen less daunting than in U.S.

“In the U.S., financial issues dominate the patient experience. Care is very often excellent, but unexpected crises and even everyday care can break the bank, and in many cases continuing medical care is simply not available.

“In Canada, patients regularly face delays in care, although seldom in urgent or emergent situations, but they do not face bankruptcy from medical bills. And for the most part they get continuing everyday healthcare without needing to compromise other aspects of their lives.”

“And evidence suggests that healthcare outcomes are pretty much equivalent, if not slightly better in Canada.”

Yale University’s Ted Marmor, Ph.D., an expert in comparative health systems, told Mr. Smith: “Canada is doing overall better than the U.S. in distribution, financing, and regulation of medical care…. ”

It would be a “gross misunderstanding to think that Canada’s areas of trouble are comparable to the areas of trouble in the United States,” he added.

 To read more, please hit this link.

Psychological safety and physician teams

Jessica Wisdom, Ph.D., and Henry Wei, M.D.,   writing about a project they did at  Google, discuss the importance of psychological safety in physician teams.

They note at the start that “Physicians may enter training drawn to the autonomy of medicine, but effective health care delivery — particularly in the era of Accountable Care Organizations and patient-centered medical homes — will likely be driven by effective teams, not individuals working solo.”

“But what is the secret to creating an effective team? Over two years, Google conducted 200+ interviews and a series of analyses of over 250 attributes to understand what drives team performance. What emerges is not the who, but the how: the attributes of the team members matter less than how the members interact, structure their work, and view their contributions.”

“For healthcare, this may mean that individual clinicians’ technical excellence is necessary, but insufficient to improve team-driven patient outcomes.”

“We’ve learned that there are five key dynamics that set successful teams apart from other teams at Google:

  1. Psychological safety: Can team members take risks by sharing ideas and suggestions without feeling insecure or embarrassed? Do team members feel supported, or do they feel as if other team members try to undermine them deliberately?
  2. “Dependability: Can each team member count on the others to perform their job tasks effectively? When team members ask one another for something to be done, will it be? Can they depend on fellow teammates when they need help?
  3. “Structure & clarity: Are roles, responsibilities, and individual accountability on the team clear?
  4. “Meaning of work: Is the team working toward a goal that is personally important for each member? Does work give team members a sense of personal and professional fulfillment?
  5. “Impact of work: Does the team fundamentally believe that the work they’re doing matters? Do they feel their work matters for a higher-order goal?”

“It may surprise people to learn that psychological safety is the most important of these five dynamics by far. In fact, it’s the underpinning of the other four.”

In their piece, they outline six steps to improve team performance and psychological safety

To read their piece, please hit this link.


Program coordinating diabetes, cardio and depression treatment is touted


A nationwide initiative called COMPASS (Care of Mental, Physical and Substance-use Syndromes) is being touted for successfully coordinating patients’ diabetes and cardiovascular treatment with mental-health care to both reduce depression and improve patients’ glucose and blood-pressure numbers.

Patients  in the initiative talked at least once a month with  care managers, who worked with the patients and primary-care physicians to address  patients’ depression and medication for diabetes, hypertension or both.

Forty percent of patients with uncontrolled disease at enrollment achieved depression remission or response; 23 percent achieved glucose control, and 58 percent achieved blood-pressure control during an 11th-month followup.

Care managers had either behavioral health or  regular medical training.

The Center for Medicare and Medication Innovation funded the $18-million, three-year initiative.

“This was a successful wide-scale implementation of a collaborative care model that demonstrated it can be used in a variety of health care settings with positive effects for providers and patients,” Karen J. Coleman, Ph.D.,  of Kaiser Permanente Southern California Department of Research & Evaluation, said.

She added said that the study indicates that patients with mild and moderate depression can be cared for in a primary-care setting.

“Depression is a chronic disease like diabetes,” she  said. “Healthy behavioral changes like sleep, exercise, and better eating can improve diabetes and depression.

To read an article on this program, please hit this link.

Consistency of ties with physicians said to reduce their patients’ visits to ERs


Seniors who consistently see the same physicians in  outpatient settings are more likely to avoid  emergency-room visits, according to a study  by CMS and Dartmouth researchers and published in the Annals of Emergency Medicine.

The researchers measured continuity of care based on two risk scores and found that patients who saw the same physician consistently were 20 percent less likely to go to the ER.

Those who did go to the ED were slightly more likely to be admitted to the hospital. The study suggested that  patients with more continuity of care receive more appropriate ED referrals.

“Visits with the same physician or a small number of physicians fosters long-term relationships for Medicare patients, which is ultimately good for their health,” said David Nyweide, Ph.D., a researcher with CMS and lead author of the study,  said in an announcement from the American College of Emergency Physicians (ACEP).

FierceHealthcare noted that the  number of ER visits has grown considerably in the past several years, blamed partly on an increasing number of non-emergency patients showing up there.

“Previous studies have shown that improving continuity of care could save Medicare as much as $600 billion each year by reducing frequently overused medical procedures, and limiting the rate of mortality linked to cardiovascular events,” Fierce reported.

To read the study, please hit this link.

To read a Fierce overview of the study, please hit this link.

Why Clinton and Trump are wrong about Medicare and drug-price negotiation


Two health-policy experts — Geoffrey F. Joyce, Ph.D., and Neeraj Sood,  Ph.D. — discuss why they think that Donald Trump and Hillary Clinton are wrong about Medicare’s ability to negotiate drug prices.

To read their essay, please hit this link.

ACA said to mostly block new physician-owned hospitals


Affordable Care Act (ACA)  regulations effectively halted the creation of physician-owned hospitals, researchers say.

But the trade association Physician Hospitals of America (PHA) says that conclusion is largely incorrect.

Elizabeth Plummer, Ph.D., a professor in the Department of Accounting, Neeley School of Business, Texas Christian University, Fort Worth, and William Wempe, Ph.D., an associate professor in the department, studied 106 physician-owned hospitals in Texas, where about 20 percent of the hospitals have this model. They compared them with a control group of hospitals not owned by physicians to see their response to ACA rules.

Medscape noted that proponents of physician-owned hospitals say that patient satisfaction is high and that “they are well-positioned to improve care and population health and reduce costs; critics say they have incentives to order excessive tests and improperly refer patients to facilities in which the physicians have financial interests.”

The researchers wrote: “Moreover, physician-owned hospitals may cherry-pick the marketplace to secure patients with good general health who seek specialized and highly profitable medical treatment, reducing other hospitals’ bottom lines and their ability to provide indigent care.”

To read the Medscape article on this, please hit this link.


How to live with MIPS


Many physicians are asking whether they can opt out of Medicare’s Merit-Based Incentive Payment System (MIPS), which is replacing the Sustainable Growth Rate formula.

Well, probably not. But in any case, suggests Medscape, physicians can reduce  their MIPS reporting burden by reporting with other physicians together in single submission.

“It would be administratively simple to report as a group,” says , founder and CEO of SA Ignite, a Chicago company that helps organizations manage value-based programs, told Medscape. Of course, this would be easier for  a large practice or group of hospital-employed physicians with the staff and IT capabilities to centralize reporting.

The Centers for Medicare & Medicaid Services (CMS) defines a clinical group as having at least two “eligible clinicians”. That could be a physician and a nurse practitioner or physician assistant in one practice.

Under its  proposed rule, CMS would let solo and small practices to get together in “virtual groups,” but owing to the difficulties of implementing such arrangements, this wouldn’t be possible in the first year of MIPS reporting.

Dr. Lee told Medscape that a downside of reporting in a group is that “you would have limited ability to choose specific measures. You may be forced to accept measures for activities where you don’t perform that well.”

To read the full article, please hit this link.

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