EPtalk by Dr. Jayne 10/27/22

Hospitals and health systems are often sponsors and supporters of various sports teams. Although I understand the reasons and how marketing works, I’m always annoyed since deep down all that spending is fueled by patients.

One of our local surgeons, who is frankly embarrassed at his organization’s sports sponsorships and luxury suites at the local ballpark, shared this piece about a shakeup in stadium naming rights for one of the newest Major League Soccer teams. Health insurer Centene has backed out of a deal to be the naming sponsor for the newly constructed stadium in St. Louis, where the aptly named St. Louis City SC is set to play. The stadium will now be called Citypark while the team hunts for a new naming sponsor. Centene had previously inked a 15-year deal for the naming rights, but a recent statement to local media said it would be realigning partnerships to create “long-term, tangible value for local communities.”

Millions of taxpayer dollars flow through Centene every year via government programs such as Medicaid, so I’m glad they’re reassessing the use of their funds. Not to mention that recent reports indicate that their Medicare Advantage quality scores have been worse than expected, which places its 2024 revenues at risk. The organization recently announced it plans to hire a chief quality officer. I’d much rather see money spent on that role than to name a sports facility. At the same time, Centene noted that quality improvement will be “a compensation metric by which all employees’ performance will be measured this year.” I hope they set things up to truly incentivize the employees as opposed to making it a way to squeak out more cash for the shareholders.

I admit that I’m suckered in by clickbait headlines as much as the next person, so I felt compelled to click on the recent Medscape feature on “Physicians Behaving Badly: US vs. UK.” I had literally just come off a call with a colleague where we discussed various patient misadventures, including misdiagnosis, failure to receive informed consent prior to a procedure, fraudulent patient care documentation, and more. The survey looked at 2,800 physicians in the US and UK. In case anyone is curious, the US ranked higher in several unseemly behaviors, including being verbally or physically aggressive; disparaging others; using racist language; and bullying and harassment. UK physicians ranked higher in public intoxication. “Making unwanted advances” was a choice in the US survey but not in the UK version, and conversely sexist behavior was a choice in the UK but not in the US, so it was hard to compare the two.

When faced with physician misbehavior, US physicians were more likely to complain anonymously to the employer or human resources, where UK physicians were slightly more likely to do nothing. For both groups, the leading demographic for misbehavior was age 40-49, with men outnumbering women twofold. As far as how those surveyed think physicians should behave, data was almost identical for both the US and UK, with two-thirds thinking that physicians should be held to higher standards than the general public due to their role. I dislike seeing healthcare professionals behaving badly, regardless of their title, role, or geographic location. I’ve seen more training programs addressing professionalism in their curricula, so let’s hope things improve.

If primary care physicians spend more time in the EHR, does that lead to improved clinical outcomes? A study published this week in JAMA Network Open looked at this question. Researchers performed a cross-sectional study of 300 primary care providers at two large academic health centers. They found that each additional 15 minutes of daily use of EHR messaging led to improvements in glucose control for diabetic patients, improved management of hypertension, and higher breast cancer screening rates. Of course, that amount of time sounds small, but over the course of a year, 15 minutes a day adds up to an additional week and a half of work for a clinician who is more likely than not to already be burned out and stressed.

The authors noted that “these results underscore the need to create team structures, examine PCP and office workflows, and enhance EHR-based technologies and decision support tools in ways that enable high quality of care, while optimizing time spent on the EHR.” Since so much of EHR messaging work is not part of a clinician’s visit-based, revenue-generating work, they also note that “the associations we have identified between increased in-basket time and enhanced ambulatory quality of care highlight the importance of continuing to develop and expand value-based reimbursement systems that adequately reward outside-of-visit care delivery.”

They note that both academic health systems in the study have dedicated population health teams that support primary care physicians in tracking quality performance. They’re also both located in the same geographic area that has a relatively heterogeneous patient population, and as such, they may not represent the majority of primary care physicians in the US.

My favorite quote from the piece is this: “Our findings suggest that although increased EHR time, particularly after hours, has been associated with increased emotional exhaustion and burnout, it may represent a level of thoroughness, attention to detail, or patient and team communication that ultimately enhances certain outcomes. This finding is consistent with recent research reporting a trend toward better outcomes for measures of health care use for family physicians who reported some level of burnout, suggesting that the extra attention given to clinical problems and extra communication that may occur during additional time spent by PCPs may be valuable for patient outcomes.”

Primary care physicians are living in a way that most are counseled against. Time and again, we have seen their willingness disregard the phrase about “not setting yourself on fire to keep others warm.” In the US, they’re among the most hard-working of physicians with the best opportunity to intervene in chronic conditions and lifestyle issues, yet they’re at the bottom of the pay scale and often with the least support staff. The failure of policymakers to align payments in a way that will best serve patients and reduce overall costs will continue to haunt us for decades.

Do you have a primary care physician, and can you actually get a timely appointment? Leave a comment or email me.

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