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Curbside Consult with Dr. Jayne 8/8/16

August 8, 2016 Dr. Jayne 3 Comments


I started my consulting work assisting small practices and that’s still the sweet spot for a lot of my consulting business. My partner does much more revenue cycle work than I do, so he sees more large clients than I do.

Based on what I hear from my clients and their needs, there are numerous areas where our current incentive programs have missed the mark. While they’re encouraging providers and organizations to try to improve clinical quality and reduce costs, they’re not providing much support to organizations who are struggling to actually get the work done.

It feels like we need a second push for organizations like the Regional Extension Centers. The RECs were initially aimed to assist practices through the EHR adoption process, including vendor selection, implementation, and achievement of Meaningful Use. Although the larger healthcare organizations and larger provider groups are doing well, many smaller groups either stalled along the way or failed outright. In working with practices over the last several years, I see some themes. Although some are technology related, many are related to a lack of business and operational skills among quite a few physicians.

Of course, this doesn’t mean all physicians – many are quite savvy and run highly-functional practices. Some of my best physician friends are MD/MBA type individuals who can tell you the exact cost of the services they provide and can closely predict what their profit margins will be prior to adding a new service or expanding their practices. They are successful at managing their employees and developing staff to be able to adapt to the changing healthcare environment.

Others need a tremendous amount of help, and maybe something like a REC to assist with the non-technology needs could be of benefit. Although some of these services are already provided by state and local medical societies, risk management vendors, and of course consultants, practices often feel like they are having to cobble things together to meet their needs. Then again, there are the needs they don’t even know they have, which aren’t necessarily recognized by assisting organizations with a narrow discipline.

Physicians don’t inherently know how to take members of a clinical or operational office staff and turn them into technical support or technical assistance resources. Even though practices could hire consultants or use vendor resellers or other third parties to fill that gap, often the perception is that the cost is prohibitive. Groups then try to use their own in-house resources to manage complex projects such as Meaningful Use, PCMH, PQRS, and accountable care participation. Often these assignments are under the “other duties as assigned” category that staff members struggle to achieve on top of their regular job functions.

Adding to the problem is the increasing turnover that we’re seeing in many primary care practices – often these offices are running on a shoestring, and may choose their resources based on cost over quality. It’s hard for any business to balance this, but when you have a physician-owned practice where the business skills are lacking, this becomes increasingly difficult. Owners may have difficulty explaining expectations and may underestimate the complexity of what they’re asking their staff to do, or the skills required for success. This can lead to cycles of failure when staff members become frustrated and leave, so the process starts over and over again.

Although some vendors offer support and assistance in these areas, the quality of help provided varies dramatically. Even with the best vendors that offer free staff training and ongoing learning opportunities, I see practices struggling to help their employees find the time to even attend sessions, let alone master the skills needed to change how a practice operates. This process is challenging enough when the practice is committed to a certain course of action, but when you have practices that are fractured in their approach, it becomes even more difficult. Maybe the partners don’t agree on how quickly or fully the practice plans to transition to value-based care; maybe there are members of the staff that openly sabotage efforts; or maybe everyone is just not on the same page about how things should be accomplished.

I’m happy to be part of the solution to the problem and have held the hands of many providers as we have moved into this journey. As a small consultant, I’m a lot more reasonable from a cost standpoint than some of the larger firms, but I can also only assist so many groups at a time. I take the primary care approach to helping offices solve their problems – serving as quarterback to get it all done, while looking out for the overall health and well-being of the practice. Similar to the original intent of the RECs, maybe we could benefit from a public health approach to solving the problems practices face as they try to transform how we deliver healthcare in the US.

Most of the incentive programs place the burden on the providers – perhaps they assume that physicians are smart enough to figure out how to make it happen. The reality is that everyone has different skill sets and some of us are better than others at putting all the pieces together and driving change. Some know to reach out for help (and can afford good help) but others continue to struggle.

I would hope that as rulemaking processes continue and we continue to make the process more and more complicated, that someone would think it would be a good idea to put additional resources behind helping providers make it happen, not just telling them what needs to be done. There may have been an assumption that vendors would assist, but that hasn’t fully been borne out for smaller practices. As the old saying goes, Rome wasn’t built in a day. Massive undertakings like transforming the healthcare system require an enormous amount of resources as well as strong leaders who are willing to help people be successful rather than just telling them to get to a destination.

What’s the solution for helping providers achieve success? Is there more we can do? Email me.

Email Dr. Jayne.

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Currently there are "3 comments" on this Article:

  1. I am in complete agreement with your assessment. I work for a mid-sized practice but also consult with a handful of others on compliance and HIT related issues. While I support the idea of “kaizen” in the delivery of healthcare, the government gets a big fail on their execution. In my opinion, they forced medical practices to adopt technology with a carrot and stick approach but ignored the fact that the bulk of the workforce is untrained in basic computer skills (not to mention business skills). As you mentioned, it appears the government made the assumption that physicians and clinical staff are smart enough to figure it out on their own. The issue is not one of intelligence, but bandwidth. Independent medical practices have neither the time nor the resources to accomplish all of the government mandated initiatives being pushed down their throats. Sadly, many practices have given up and have been absorbed by larger health systems that have more resources, but are far more fragmented and bureaucratic. Does anyone think for a minute these large health systems are delivering higher quality care?

  2. I agree with your observations and Greg’s assessment. But maybe, just maybe, the consolidation is exactly what the feds wanted. And isn’t that what ACOs are all about?

    I said from day one of ARRA /HiTech that it was the death knell for independent practices. I believe the feds finally realized after 50 years that setting up Medicare Part A and B as separate payment entities was a big mistake. Problem is from a political standpoint they could not just slam them together, but by creating ARRA /HiTech / ACOs /Bundled payments / PP4/ MIPS, etc…they could get there via an end runs and by the time the AMA realized it, it would be way too late..

  3. I agree with you and Gregg. As I said when ARRA was passed in 2009 maybe, just maybe the feds want to kill the concept that docs and hospitals s/b separate as originally promulgated in the passing of Medicare in 1966. In the eyes of today’s feds that was a big mistake and is a significant part of their reasoning for uncontrollable of health care costs.
    But they knew that just slamming the two together was politically unfeasible. So create a bunch of payment incentives/penalties that force them together to survive. Regs like MU, ACOs, PP4, VBP, Bundles, MIPS, etc..

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