EPtalk by Dr. Jayne 7/28/22

I was exited to see a Tweet from my favorite bowtie-wearing crush Farzad Mostashari @Farzad_MD as he shared information about the Aledade FIRST program, which is designed to support medical residents pursuing family medicine. FIRST stands for Fostering Independence, Readiness, Sustainability, and Togetherness. The program strives to better educate new physicians about value-based care and to equip them for successful careers. Aledade will offer the program to up to 20 second-year family medicine residents who will receive additional training in value-based care and practice management while receiving one-on-one mentorship. Residents can also opt to participate in a subsidized clinical experience. In exchange for agreeing to serve for 3-5 years in an Aledade member practice, clinic, or Community Health Center of their choice, residents will receive monthly stipends, signing bonuses, and more. The program is open to those who intend to practice full-time in North Carolina after completing residency. If we truly want to transition to value-based care, we need clinicians who understand the model and how to maximize patient outcomes. I’ll be looking forward to following it over the next several years.

Lately, I’ve been receiving some random faxes intended for other providers, which I can only assume is from crossed wires deep in some database somewhere. My practice has been trying to correct it, but I suspect it will take some time. Given that context, I was interested to see this Kaiser Health News piece about the challenges of inaccurate provider directories. The article’s introduction is painfully true: “If you have medical insurance, chances are you’ve been utterly exasperated at some point while trying to find an available doctor or mental health practitioner in your health plan’s network.”

As an urgent care physician, I saw hundreds of patients in that situation who ended up in front of me because they didn’t know where else to turn after finding out that the wait was too long,  in-network providers weren’t taking new patients, or providers no longer participated in their insurance plans. Many of these patients needed specialty care that we were not equipped to provide, and they became even more frustrated when they learned that we couldn’t help.

Despite regulations that require accurate provider directories, they’re often a mess. The article cites a study from the Journal of Health Politics, Policy, and Law that found that in a best-case scenario, patients could only schedule timely appointments for urgent issues with about half of the physicians listed in a directory. The worst-case scenario was 28%. For general medical appointments, best case was 64% and worst was 35%. The article notes the challenges in getting providers to update their files with each payer, but from experience, even when providers do provide updates, they are often not incorporated.

Case in point – my previous employer sent termination notices to all plans when I left the practice. I was copied on all the communications. Even as recently as last month, one payer sent me multiple notices that I needed to update their directory and didn’t respond to my attempts to clarify that I hadn’t been a participant in well over a year.

The article closes with some good advice for patients who might find themselves fighting an out-of-network charge despite thinking that a provider was in-network. It recommends taking a screenshot of the provider directory showing the provider’s name, calling the physician office to confirm, and taking notes of the name of each person that was spoken to. That’s more work than the average patient is going to do, even assuming they know that it’s a good idea, which most don’t. Despite recent “no surprises” legislation, fighting unanticipated out-of-network bills is still an irksome task even for those with experience.

The American Academy of Family Physicians was on fire regarding healthcare technology topics in the recent issue of its FPM Journal (previously known as Family Practice Management). One article looked at strategies for reducing documentation burden through EHR simplification. It called out the fact that changes to documentation require buy-in from leadership, appropriate resource allocation to make changes, and adequate support for implementing change.

The author provides an example of institutional policies not keeping up with government simplification of Evaluation and Management guidelines. Their project team engaged subject matter experts to identify ways in which documentation could be simplified, used clinician surveys to identify problematic workflows, and worked with technology teams to identify the best solutions. The authors also noted the need for providers to take advantage of basic EHR functionality such as templates or exam defaults, along with time management strategies such as completing notes throughout the day rather than saving them for the end of the day. I continue to see physicians who will complain endlessly about EHR templates that don’t meet their needs, but who are unwilling spend the time to update them to better suit their needs. If the article spurs even a handful of physicians to take steps to improve their workflows, it has value.

The second article that caught my eye listed five administrative tasks where technology could improve physician workflow. The list includes some features that are readily available in EHRs, including the calculation of patient risk scores and synthesis of data needed to facilitate pre-visit planning. The list also features technology-assisted workflows, such as using voice recognition for visit documentation and using digital solutions to assist with prior authorization tasks. Although many practices are using EHRs, I would wager that a minority are fully optimized and there is still much for clinicians to incorporate into their day-to-day workflows.

The third article addressed quality metric reporting and why practices are struggling to rebound from the impacts of COVID-19. It highlights three burdens impacting practices: the emotional burden, the workload burden, and the payment burden. Technology can help with workload through automation and delegation, allowing diverse members of the care team to assist in closing care gaps and recommending services for patients. It can also help with the payment burden through solutions that promote improved charge capture, demonstration of higher quality in the face of risk-based contracts and ensuring that incentives are maximized. As noted in the previous articles, these efforts take time and resources, but it’s important for organizations to understand that making the effort now will pay dividends in the future and to provide leadership to make changes a reality.

How is your organization using technology to bolster struggling primary care practices? Leave a comment or email me.

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