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Curbside Consult with Dr. Jayne 2/8/16

February 8, 2016 Dr. Jayne 3 Comments

Last week I talked about physician understanding of the economics involved with a transition to value-based care. This week I’d like to entertain the idea of opportunity cost, which is the loss of potential benefit from alternatives not selected when a choice is made. In explaining it to my niece, it’s missing out on buying a cool pair of boots in three months because you’re buying too many lattes and not saving anything from your part-time job.

I’ve had a series of events lately that make me think that healthcare leaders don’t understand the concept of opportunity cost. I know I have a penchant for working with organizations that tend to be fairly troubled, but this is a pretty basic concept. Let’s take a look at a few of those scenarios:

Hospital A had a very strong IT analyst who had been working in a physician liaison role, meeting with new hires and personally setting them up with various credentials, their VPN tokens, etc. She would meet them either at their offices or in the physician lounge and do whatever it took to get them activated and make sure they felt supported for the first few months of employment. She was dearly loved by everyone. 

When her husband developed an ongoing medical issue and she asked to reduce her hours, it seemed like a done deal. Instead, the IT department informed her that they had no part-time positions available. She was forced to take early retirement in order to care for her family.

Subsequently, they contracted out the position to a third-party desktop support group, who immediately hired the staffer part time. She earned close to her previous full-time salary as a part-time contractor while the hospital ended up paying more than her full-time salary.

It’s bad enough to not do the right thing for an employee who has been with you for 30 years, which is unheard of in the working world today. To make such a poor business decision on top of it, though, is just mind-boggling. They’re now essentially paying twice as much for her services. Making it even more bittersweet, her husband’s condition turned out to be not as dire as predicted. She’s now back in a full-time position, performing project management services in addition to the desktop support.

Hospital B had been trying to hire a CMIO for some time. They engaged me to help put together the job description and evaluate candidates since they had never had a CMIO and wanted someone to help sort the wheat from the chaff.

We first ran into trouble when they created the job posting and its accompanying salary range, which was less than what most physicians make fresh out of training. Yet they expected to hire a board-certified clinical informaticist who had been working in the field at least five years with their specific platform.

They were surprised that no one was interested in the job. Only a handful of folks who had lost their licenses or had other suspicious gaps in their employment history had applied in several months. None of them were board certified. They changed the salary range, but by then the organization had lost momentum. After engaging an external recruiter, they were able to finally get some good candidates. 

The human resources department processes of running the background checks and making the offer sent the first-choice candidate running for the hills. Why would someone want to work for an organization who can’t even get the hiring process right? I’m not sure, and neither was he, apparently.

As time elapsed, their second-choice candidate had already accepted another position. Their third choice turned them down with inadequate compensation as the reason. They were unwilling to respond to a counter-offer. 

The newly-created position has now been vacant for six months. Had they been able to get themselves in order, how much could a new CMIO have accomplished over the last several months? How many opportunities for improvement were missed? How much money have they lost in recruiting after trying to “save” it on salary?

They’re now back at square one, cobbling the role together with a host of physician champions who are trying to fill in on top of their regular jobs and hiring me to do tasks that are beyond their capacity or skills.

Hospital C had an employed physician group that was preparing to change EHRs. They hired me to shepherd their data migration. After looking at the quality and quantity of the data (which was really pretty appalling), I recommended against trying to extract the data to to seed their new system.

As an example, most of their blood pressure values were unusable since their previous vendor didn’t have adequate control of data fields. Nonsense characters and inappropriate abbreviations filled tables where only numbers should have been.

In looking at the overall poor quality of the data, the specialty mix, the volume of truly “repeat” patients vs. those that were episodic, I recommended they use a third party to abstract and load the data so they could have a clean start. It looked costly on paper, but I thought I made an adequate argument for the return on investment given the risk to patient safety of poor data quality.

The IT team felt my concerns were “ridiculous” despite my experience and decided to go it on their own. They now have spent nearly a quarter of a million dollars trying to get the data to a point where the incoming vendor will accept it. They’re paying their own physicians (who aren’t informatics trained) to work on the data. They have done so much manipulation that now they’re questioning the data integrity themselves.

I was asked if I am willing to come back and help. Of course there is no way I’m touching it at this point. I referred them to the abstraction firm and hope they can take a rush job. Their go-live is in a few weeks and the physicians are at risk of starting on the new system with nothing.

Figuring out the money wasted is easy. But how do you put a value on all the stress that has been generated and the growing negative feelings about the transition?

I have friends that work in all kinds of industries and we always swap war stories. It seems like mine are always the most outrageous as well as being most plentiful. It’s like no one is watching the store. Healthcare organizations hire someone to give them advice, then ignore it, then act surprised when things turn out badly. I’m very much concerned that the move to value-based care will only make a broken system more dysfunctional.

Where do we go from here? Email me.

Email Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. Funny, as an IS Analyst, I thought it was just us IS folks that had this problem. I was hired with 10 years of experience in Hospital IT experience, including conversions.

    After seeing the lay of the land in my new organization and know that the “old” EMR rarely went “down” for more then 20 minutes a week or even month. I recommended that the organization hold a mock downtime to ferret out problems before our planned go live to a new EHR. This hospital had been on the old system since moving from typing insurance claims.

    The best I could get agreement on was asking the departments to review their downtime procedures and forward them to the Project Manager.

    Needless to say our go live did not go well. We were down for over 24 hours. This was 5 years ago. Downtime occurs more frequently on the new system then it did on the old, so the practice is good.

    I just wish the organization would have listened in the first place.

    Rumor has it that we maybe looking for a new EHR again….I can only hope that we have learned from past mistakes.

  2. Re: Hiring a P-T analyst for the cost of a F-T analyst

    These situations are caused by a policy or process that is on the books, and cannot be changed. At least not without the proverbial Act of God. They are also signs that said policy or process needs to change… but won’t until the negative outcomes are so great they can no longer be ignored.

    The decision-makers doing the hiring are often aware of the consequences. However if they aren’t in control of the P&P it makes no difference. So they do the part that is in their control and hope the negative side-effects sends a message. And if the message isn’t sent (or received, or understood, or…) well, that’s not in their control either.

    To be fair, employees in companies often warn of dire consequences for various decisions. And the decisions’ consequences can turn out to be less important than feared (see ICD-10). It’s all part of the political tug-of-war going on every day. You don’t need malice or stupidity either; just an incorrect assessment of the relative merits of Choice A or Choice B.

  3. Simple economics and basic math are no match for organizational politics, arrogance, and the drive for self-preservation. The providers who survive the transition to value-based care will be those who recognize that the paradigm of healthcare has changed, the targets are new, and learning from the experience of others is essential.

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