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EPtalk by Dr. Jayne 4/2/15

April 2, 2015 Dr. Jayne 2 Comments

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I’ve been struggling to get through the Meaningful Use Stage 3 proposed rule, but finally reached the end. I’m not sure how much of it I’ve retained, although I did take good notes.

I also skimmed the certification document to get an idea of new things my vendors may be offering. A couple of them struck me as interesting additions: the family health history pedigree; expanded social, psychological, and behavioral data; and consolidated care plans. CIO John Halamka, MD and Micky Tripathi posted an excellent analysis last week that should be required reading for all hospital and software vendor executives.

My favorite section of their write-up (appropriately subtitled “The Ugly”) encapsulates my frustration as a primary care physician:

If a clinician has 12 minutes to see a patient, be empathetic, document the entire visit with sufficient granularity to justify an ICD-10 code, achieve 140 quality measures, never commit malpractice, and broadly communicate among the care team, it’s not clear how the provider has time to perform a “clinical information reconciliation” that includes not only medications and allergies, but also problem lists 80 percent of the time. Maybe we need to reduce patient volumes to 10 per day? Maybe we need more scribes or team-based care? And who is going to pay for all that increased effort in an era with declining reimbursements / payment reform?

Most of my primary care peers could deliver truly excellent care if I we only saw 10 patients per day. However, primary care physicians in my organization are expected to perform at a certain percentile based on MGMA data. The majority are seeing 30-35 patients daily, yet revenues are still declining. They’re also working longer hours with increased burnout. One of my favorite colleagues just “retired” from practice at the tender age of 48 and will be doing part-time urgent care instead.

I’m grateful to those who actually selected primary care residencies during the recent National Resident Matching Program process. Over 1,400 fourth-year US medical students selected family medicine and I salute them. To consciously choose this life given current market forces, you are either called to serve or you are a risk-taker. Fortunately, we can benefit from having more of both in the trenches. There were a total of 3,195 positions available and graduates of non-US medical schools will typically fill the remaining slots.

I mentioned last week that I had received some pre-HIMSS mailings with butchered addresses and titles. Not to be biased in reporting only questionable print media, I’ll share that this week I received three emails that fell into the category. When preparing mass communications, first make sure you’re selecting the right field for the last name. I guarantee my real name is not “Dr. O’Day,” so I didn’t read your piece. Second, “Dear Chief Nursing Executive” isn’t going to make CMIOs want to continue reading. Third, don’t call out my mostly-inactive consulting company as needing your services because my “organization is bustling and case managers are overwhelmed with ineffective ways of contacting and tracking patients.” Nothing like serving up an insult to an entity that doesn’t even have contact with patients.

While I’ve got my crankypants on, let’s talk about vendor events at HIMSS. On one end of the spectrum, we have sponsors like Divurgent who offered all HIStalk readers the opportunity to attend their HIMSS event.  On the opposite end, we have Nordic. Their event was advertised in a CHIME bulletin, but after an initial acceptance email, I received a follow up email stating I’m now declined “due to the lack of space and focus on our clients.” I guess the fact that I’m on the IT committee at one hospital who has been a client and on staff at another Epic hospital is moot. I’ll be reporting on other social events instead, but they might want to update their website since it says guests are welcome and suggests forwarding the invite to colleagues.

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I always enjoy hearing about sponsors and their philanthropic efforts. NextGen announced its Eighth Annual NextGen Cares Golf Tournament to benefit the Jayne Foundation. The scholarship fund is in memory of former client Dr. John W. Jayne, but for obvious reasons, it caught my eye. Opportunities are available for both golfers and non-golfers, including a cocktail hour and silent auction.

Have a charitable event and want to get the word out? Email me.

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Currently there are "2 comments" on this Article:

  1. “Most of my primary care peers could deliver truly excellent care if I we only saw 10 patients per day. ”

    I’m not sure most primary doctors would know what to do with so much time. They’re so use to treating just the presenting issue, that with all the time they would have to retrain on how to treat the whole patient and not just the presenting issue. That’s more social work than it is medicine and so I wonder how many doctors could make the transition.

  2. Social work? I think not. There’s a very good reason we used to call it “a visit to the doctor.” No longer. Too many others in the room, LOL







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