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EPtalk by Dr. Jayne 5/14/15

May 14, 2015 Dr. Jayne 3 Comments


First of all, I want to say thank you to all the readers who sent warm wishes after Monday’s Curbside Consult. Quite a few people shared their own stories of leaving positions they had been in for a long time. It’s encouraging to hear from people who have been there. Right now it’s nice to not be in overdrive for a change.

I also had questions from readers about my new perspective having used multiple different systems and having worked in some different provider environments. Here’s a bit of Q&A for those readers:

Are most EHRs universally disliked? Yes, but to different degrees. I don’t think the users dislike the EHR so much as they dislike the changes to their workflow. Although it’s popular to call for more disruption in the industry, physicians don’t like that their way of life has been disrupted. When you actually ask about the EHR system itself, some of the complaints are pretty small in the grand scheme of things. As a seasoned observer, I’d say 80 percent of the time there are unresolved operational issues rather than software issues. I see a lot of physicians blaming EHR for increased work when it’s really that the implementation didn’t redistribute work to the right people at the right point in the care cycle. I also see a lot of poorly configured systems and lack of knowledge on how to improve them. Most providers have only used one EHR (or maybe one in the office and one in the hospital) so they don’t have much of a frame of reference.

Are most EPs grumbling about all the CQM, PQRS, and MU hurdles? Yes, yes, a thousand times yes. Previously with PQRS, many providers had staff that did that behind the scenes with claims submission and now they’ve got it in their faces at the point of care. Some systems have CQM alerts that actively fire in the provider’s way and the measures don’t always match with their clinical priorities, so it causes frustration. Some systems handle alerts more gracefully than others. I was in a pediatric practice recently that was so tired of answering “the Ebola questions” that I thought they were going to go mad. The data-driven reason to ask about Ebola in a US-based suburban private practice is miniscule, but they’re on a subsidized software platform from their local mega-hospital, so they are stuck with the workflow. Providers are tired of MU and the attestation numbers reflect that. Specialty providers are significantly more exhausted by the MU CQMs because they don’t match practice priorities.

What about ICD-10? Lots of fatigue here and the delays didn’t help. Although large organizations seem to be doing a good job of being prepared, I’m not seeing enough grassroots training for end users. I’m also seeing some systems that have limitations regarding dual coding. Although having a seamless switch from one ICD to another on October 1 sounds slick, providers want to ramp up slowly and feel that working in a test environment is a waste of time or double work. Systems also vary on how well they will prompt users to enter all the information required for the more granular codes. Some are adding required fields and others are adding optional fields. My gut feeling is that it’s going to be messier than it needs to be, especially since we’ve had so long to plan.

Have EPs just given up on all these programs? The bloom is definitely off the rose. At the beginning of MU, it was clear that $44K was only a down payment on what it really costs to transform a practice, but a lot of people were seduced by the money or frightened by the future penalties. Some non-participants figured out along the way that they could see one or two more patients a day and more than make up for any penalties and they seem fairly happy with their decision. Others are just figuring that out now and feel pretty bitter.

I also received many recommendations for National Parks, including a plea not to overlook the state parks. I totally agree after visiting an obscure-sounding state park in Florida last year that was absolutely lovely and completely off the beaten path. Most of my previous National Park experience was on a Griswold-style family pilgrimage. There’s nothing like hitting the Grand Canyon, Sequoia, Yosemite, the Black Canyon, Mesa Verde, Bryce Canyon, and a host of other notable places in about a month’s time span. I didn’t fully appreciate it at the time, but do remember my mother being ready to throttle my adolescent self at the Glen Canyon National Recreation Area. Although no one was harmed during the trip, there were a lot of crazy stories.

For those interested in reader recommendations, here’s the score card. Bryce Canyon is leading Arches three to two with strong recommendations on Volcanoes, Grand Canyon, and Zion. Special mention goes to Yellowstone (which Weird News Andy calls “the king, queen, and court jester of National Parks”) and to Mammoth Cave, which I hear is breathtaking but also has almost 80 miles of trails that never get any use because everyone is underground. I also hear Glacier National Park is getting ready to emerge from winter and I haven’t yet packed away my fleece jackets. Plus I could hit the Black Hills on the way.

Do you prefer “Find a Car Bingo” or “The Alphabet Game” for your in-car entertainment? Email me.

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Currently there are "3 comments" on this Article:

  1. Glacier should be a top choice. Spent a 4 day weekend there in the 90s and the glaciers were starting to melt faster back then. You should go before they are a distant memory for all of us. It’s a fantastic park that the railroad lines started as a vacation resort before it was handed over to the National Park System. Wishing you the best in your next steps and in your summer travel decompression!

  2. I’ve managed our MU efforts since 2011, and we’ve had a few “philosophies” that I think have reduced, though certainly not eliminated, the frustration of our providers. For one, we do all registrations and attestations on their behalf. We also don’t push the reports to them and instead work through the practice managers for the ones who are struggling. Some providers don’t even know if they are MU-eligible, and it is likely the case that they are and are doing just fine on the objectives.

    We do NOT push the QMs, though that will change when IQR reporting changes from abstracted data to electronic submission only. So we have minimal alerts for the QMs and have certainly reported zero numerators for some EPs. Our goal is to minimize the entire MU effort for providers and do as much as we can without involving them as long as we get the incentive money.

    MU has been a big part of my life for almost five years, but I do agree that it has run its course and the penalty-only phase will certainly be unpopular.

    Good luck with the next phase of your life, and I hope you have some great trips this summer!

  3. There are other advantages to choosing Bryce or Arches in that you can make a big loop through southern Utah and add in Canyonlands and Capital Reef, plus a whole bunch of slot canyons not recommended for the claustrophobic. On the other hand, Glacier is stunning and leads right into Waterton Lakes on the Canadian side, which also then leads you up through Banff, Jasper, Kananaskis country and the glacier parkway (see those before they’re gone). Really good choices. Enjoy the time off!

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