EPtalk by Dr. Jayne 5/10/18

Primary care physicians continue to look for ways to get off the hamster wheel that our profession has become. The Direct Primary Care (DPC) movement is the answer for growing numbers of physicians who engage with patients on a cash or retainer basis, cutting the insurers and health systems out of the equation. The 2018 DPC Summit will be held in Indianapolis in July, welcoming both existing DPC practices and those looking to explore their options.

I have several good friends with DPC practices. The movement is something that health IT companies should start thinking about if they’re not already. These practices often embrace electronic health records and technology that better enables connections with their patients along with comprehensive and high-quality care, but they don’t want the distractions of convoluted workflows to support billing requirements or other regulatory content.

My practice’s EHR has a setting that allowed us to completely turn off all of the Meaningful Use content, which was a great physician satisfier when we made the change. There are niche vendors such as Atlas.MD whose product is designed for DPC practices, but physicians often look for ways to transition their practices without a system switch. If your products can’t handle monthly recurring credit card billing, telemedicine, and plug-and-play interoperability, you’re going to miss out on these practices.

I’m often asked if I would ever go back to the primary care trenches. Informatics is definitely my first love, but I do miss the ongoing patient relationships I had previously. Given the stresses to the system and the level of burnout that many physicians are experiencing, I think the only way I would do it would be to either be part of a direct-type practice or part of a relatively closed system such as a civilian contractor to the military. Of course, there is a magical salary number that would take me back into the trenches tomorrow, but I have better odds of winning the PowerBall than I have of seeing a typical primary care physician hit that number.

I was somewhat puzzled by the headline on this CMS press release: “CMS Announces Agency’s First Rural Health Strategy.” Correct me if I’m wrong, but hasn’t CMS had a rural health strategy for a long time through the Rural Health Clinic (RHC) program? I’m a big fan of the idea that words mean something, so it’s kind of disheartening to think that people who have been working in the Rural Health arena for years might be hearing that their hard work wasn’t part of any strategy. CHS formed its Rural Health Council in 2016 and the Health Resources and Services Administration’s (HRSA) Federal Office of Rural Health Policy (FORHP) was created in 1987. I guess they didn’t have any strategy either. But maybe we’re just now calling it a strategy?

I’m unimpressed by the level of rhetoric coming out of CMS lately, which seems more political than patient focused. I’ve searched through some press releases I kept from previous years and I don’t see “this Administration” or “the X Administration” mentioned nearly as often as I see “the Trump Administration” mentioned. Of course, this is strictly anecdotal and has no statistical power – maybe one of my AMIA colleagues will consider doing an analysis of the content of HHS, CMS, and ONC press releases to see if the language really is that different.

Speaking of AMIA, the organization is introducing a new program to recognize applied informatics professionals. Fellows of AMIA will demonstrate education, commitment to the practice of informatics, contributions to the field of applied informatics, and a sustained commitment to AMIA. The organization plans to begin recognizing Fellows at the AMIA 2018 Annual Symposium and will begin accepting applications by July. I’m not sure I’ll qualify since my practice of informatics is far from typical, but I’ll check it out nevertheless.

CMS recently updated its Hospital Compare website with new Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) data on patient experience. The new data was collected between July 2016 and June 2017. The patient experience ratings are separate from the overall CMS quality star ratings and cover 11 publicly reported measures. One available map I found listed hospitals in the wrong place, so I hope patients using the map look carefully at the legend to ensure they’re getting the right information. My 4-star hospital was replaced on the map by a 2-star hospital, so I had to do a double take.

The 11 patient experience measures are: cleanliness; nurse communication; doctor communication; staff responsiveness; pain management; communication about medicines; discharge information; care transition; overall hospital rating; quietness, and willingness to recommend the hospital.

I’ve spent quite a bit of time on aircraft over the last decade and continue to be amazed by the level of self-centeredness of some of the passengers. Despite recent in-flight incidents, people continue to ignore safety briefings and defy flight attendant instructions. Usually I sit in the exit row, but was near the front due to a tight connection, and watched four people try to use the lavatory while the seatbelt sign was on and the plane was on its initial climb. The flight attendant sent each of them back to their seats, but no one seemed to pay attention to the person in front of them being turned away or the multiple overhead announcements.

On another flight where the row in front of me didn’t recline, I had an irate woman (who had already been told by the flight attendant that the seat didn’t recline due to being in front of an exit row) lift herself up in the seat and try to force the seat to recline with her whole body weight, almost breaking my laptop screen. We had people jumping up and out of their seats while we were still taxiing, requiring the flight attendants to unstrap themselves and force people to sit down.

It’s not just the lack of following published rules, but the general lack of civility. I watched a woman berate a flight attendant for not putting enough cream in her coffee, even after the flight attendant carefully verified how many units of cream and sugar the passenger wanted. The coffee was almost white and I had to resist the urge to remind the passenger that this was a Southwest Airlines flight, not a Starbucks.

Right now, I’m watching a woman give a full-on back rub to a man with no shoes, using a massage tool that she pulled out of her carry-on. I also saw someone rubbing liquor on the lips of his sleeping companion, trying to wake her up. I had to look around and make sure I wasn’t on some episode of a prank TV show. If you’re a ground-based employee and interact with road warriors, give them a little slack if they seem grumpy. They may have just gone through three hours of wondering what crazy thing would happen next.

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