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EPtalk by Dr. Jayne 12/15/16

December 15, 2016 Dr. Jayne No Comments

Lots of vendors are sending holiday greetings. Although I appreciate the sentiment, there’s a lot of noise this time of year and I think a lot of the messages get overlooked. I’d like to recommend that vendors consider sending friendly greetings throughout the year. Perhaps cardiovascular solution vendors might consider National Tap Dance Day on May 25. Geriatrics vendors may want to consider As Young as You Feel Day on March 22, where storage vendors may want to consider World Backup Day on March 31.

I was glad to have a couple of extra days off the road this week since several of my clients are still struggling with how they’re going to wrap up their reporting for Meaningful Use attestation and other quality programs. I know organizations are busy and healthcare is a crazy changing place, but there’s no reason for leaving things until the last minute. I have two clients who have yet to select their clinical quality measures for the year. They can’t seem to understand that if their numbers haven’t improved throughout the course of the year, there is no magical force that is going to get them to the desired threshold with only 10 patient care days left.

I mentioned this phenomenon before. A reader shared his experience with using LogicStream to measure adoption of workflow best practices down to the clinician level. Designed to reduce unnecessary variation in care, it sounds like a great way to track compliance with specific clinical protocols and alerts. However, there are a lot of physicians out there who still struggle with the idea of “variation in care,” especially in the ambulatory space.

Let’s face it, we have a lot more compelling studies from the inpatient arena, and given volumes at many acute facilities it’s much easier to see when a specific clinical pathway is superior than it is at the average physician office. I have a lot of physicians that fight me about the EHR workflow being “contrary to how I practice medicine” and it’s always a battle to try to explain that the way they are practicing might just not be best practice. Most of the top-tier EHRs are designed with best practice and evidence-based workflows. I know I’ve mentioned in the past the physicians who argue about reconfiguring preventive care guidelines to match their own personal practice that isn’t supported by the US Preventive Services Task Force, the American Cancer Society, or anyone else who actually has data.

I feel for the organizations that have to try to rein these physicians in. On the other hand, the organizations are to blame because they allow this to go on. I’m not going to say it’s easy to get rogue physicians under control, but it can be done. Sometimes they will respond to targeted interventions and sometimes it takes a change in their contract to elicit the desired behavior. But if you can’t get a physician in line even with a contractual agreement, I would argue that it’s better for the practice to consider making them available to the workforce. In the new world of transparency around quality, the viability of keeping someone around because they’re productive or popular is less every day, especially if they’re doing something squirrely related to established protocols for patient care.

Another project taking a lot of my time this week is a strategic planning engagement for a midsized, hospital-owned provider group. For the past couple of years, they have been running on fear and adrenaline, acquiring as many small practices as they could in hopes of solidifying their referral base. Now they have a provider organization that looks like the Wild West. The only referral metrics they’ve been tracking are hospital admissions and surgical cases, leaving physician-to-physician referrals completely unaddressed. I’m not even sure the physicians know who their peers are since the acquisition strategy didn’t include much internal marketing to other members of the group. Some members have been migrated to the enterprise ambulatory EHR and some were allowed to stay on their own office systems, so interoperability isn’t what it needs to be, either.

Because they were so focused on building their provider base, they lost focus on other key projects such as staying current with EHR upgrades and making progress towards patient-centered medical home recognition. The coding and compliance staff was focused on onboarding the new providers and stopped their regular audits of existing physicians. Rather than having quarterly audits like they’re used to, some physicians haven’t had a coding audit for more than a year. If someone’s gone off the beaten path with their coding, that’s not the kind of thing you want a delay in uncovering.

I had several calls with them this week, trying to prepare an agenda for a strategic planning retreat in January. They’re struggling with their end-of-year ACO and PQRS reporting, however, and all they wanted to talk about was the perceived issues they’ve having with their vendor. I say “perceived” because I have other clients working with the same vendor who are doing just fine. They say they can’t give the quality reports to their providers because they’re not granular enough and the providers don’t understand them. I’ve seen the reports, and they’re extremely clear – they have the name and number of the measure and a brief synopsis. The providers can drill down into the individual patients to see why someone is passing or failing. It turns out the organization has been printing them out, so of course they’re not as impactful as delivering them electronically so they can be used interactively.

The reason for the printed reports is so the office managers can use highlighter on them and sit down and discuss them with the providers. I’m not sure why the red-yellow-green display in the EHR report package isn’t good enough or why they can’t sit down in front of a screen instead of a piece of paper. This is a classic case of “blame the vendor” for an operational problem. I said as much, trying to steer them back to the agenda at hand, but they continued to try to return again and again to their “pressing issues.” I’ve been working for months to help them understand that they have to get out of the weeds and start looking at the bigger picture and not continue to be ensnared in “pressing issues” because it’s simply a classic case of avoidance behavior.

They need to decide who they want to be when they grow up. Do they want to be a big fish and keep growing? Or are they happy where they are and ready to make the most of their provider membership? Are they ready to start working on quality in earnest and remediating any poor performers? Until they set some direction, they’re going to continue to struggle.

I’ve got another call with them tomorrow to try to continue to nail down the agenda, but it’s slow going. They “forgot” to invite the CFO to today’s call and I wasn’t willing to move forward without the right players on the call. I’m planning to bring a second facilitator with me to the onsite planning meeting because I can see already that it’s going to take a village to keep them corralled. Sometimes these clients make me want to give up, but once in a while, one starts to really get with the program and those bright spots keep me going.

Does your organization have a strategic plan for 2017? Email me.

Email Dr. Jayne.

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