EPtalk by Dr. Jayne 6/2/16

I was talking to one of my colleagues today, who reminded me that June 1 was the registration deadline for the Clinical Informatics Board Exam. The so-called “practice pathway” for clinical informaticists who haven’t completed fellowship training closes in 2017. I would encourage anyone who thinks they might want to be Board Certified and who falls under the grandfather provisions to give it a shot. Although we’re past the cutoff, you can still register (although the late fees climb from $400 to $1,600 over the next several months). AMIA is offering their Clinical Informatics Board Review Course live in August and September.

CMS held a webinar on Wednesday to talk about the Quality Performance category, which will account for 50 percent of the MIPS score in the first year of the new program. This will replace the Physician Quality Reporting System (PQRS) for Medicare physicians. The blurb advertising the session talked about the goals for the category of simplifying administrative and reporting burdens for physicians. Frankly, whenever I see anything from CMS talking about so-called “administrative simplification” I have to laugh. The complexity of getting paid in our current environment has just become absurd. I’d like to see those in power truly consider what it would take to create a simple program that actually helps physicians deliver better care rather than creating more hoops to jump through. Whatever it might be, it’s certainly not 800+ pages long.

The ONC Annual Meeting also took place this week. Sessions were to focus on “three core commitments” of improving consumer access to health information, combating information blocking, and implementing national standards. They did live stream the sessions but I decided to instead spend my free time working on a project that actually made me feel fulfilled rather than just generally frustrated. I’ve taken up a new craft and it was great to engage my brain in something completely different from what I do most of the time. In addition to a finished project, I also walked away with some great new ideas for work – powerful evidence that getting away is a good thing.

Most of my Memorial Day weekend was spent seeing patients. I never know what my travel schedule will bring, so I often schedule myself for the holiday weekends so that my clinical work doesn’t interfere with consulting engagements. My partners don’t mind me working the holidays, that’s for sure. I was pleasantly surprised on Monday when our executive responsible for physician satisfaction showed up with barbecue. Although my team definitely appreciated it since we were extremely busy, the real tone of the day was set by the fact that most of my support team members were veterans with fallen comrades on their minds.

For the fifth or sixth time in the last several months, I had a patient ask me what I thought about concierge medicine. This particular patient was in her 80s and said she was tired of “getting the run around” from her doctor’s office and never being able to get in. She has been seeing us fairly often for various acute illnesses, so her care is already a bit fragmented. I know her physician and know that their practice certainly has struggles with staffing and capacity. For patients of means, concierge or other direct care models are definitely attractive. As much as people talk about not wanting to move to a two-tier health system like Canada and the UK, every time I have one of these conversations I feel like we’re moving in that direction.

It was in that frame of mind that I came across this NPR piece in which a young physician longs for the time “when physicians were ‘artisans.’” The interviewer mentions that the physician “must have known at the outset that wasn’t the way medicine worked anymore.” I’m not that much older than the physician in the story, and I can say without a doubt that when I went to medical school, I had no idea that clinical practice looked more like a hamster wheel than anything else. Fast forward and students have tens (if not hundreds) of thousands of dollars in student loans, which makes some students drawn to higher-paying specialties for fear they won’t be able to get by in primary care.

The interviewer likens the pull of concierge or direct practices to the slow food movement. I do enjoy an heirloom tomato, but I think the analogy is a difficult one. The costs and complexity of healthcare have gotten so out of control, it’s nearly impossible for the average patient to be able to choose rationally between providers, facilities, and procedures. I know my practice leans heavily towards patient satisfaction scores for determining provider compensation, and the idea that giving patients what they need (rather than what they want) can impact me negatively is always a consideration. Sometimes we have to send people away unhappy, and I did have one of those situations this weekend. Fortunately, our physician leadership handles patient dissatisfaction with compassion and tries to help the patient understand why we advised a course of care different than what they wanted, but it’s never easy.

What’s your favorite artisanal or heirloom food? Email me.