EPtalk by Dr. Jayne 1/19/23

Most workers in the healthcare IT trenches are familiar with the US Meaningful Use program and its successor, the Medicare Merit-based Incentive Payment System (MIPS). A new study in the Journal of the American Medical Association says that MIPS gets it wrong by penalizing physicians who care for patients with complex medical needs. Researchers from Weill Cornell Medical College noted that “MIPS scores were inconsistently related to performance on profess and outcome measures, and physicians caring for more medically complex and socially vulnerable patients were more likely to receive low MIPS scores even when they delivered relatively high-quality care.”

If there’s one thing I learned as a CMIO, it’s that the team needs to be top notch at collecting the right measurements, which may or may not align with what is really important to patients and their care teams.

I’ve watched patients be treated in ways that aren’t necessarily appropriate for their situation, in the name of satisfying measures. I’ve seen physicians trying to maintain tight control of blood sugar in elderly diabetic patients because they didn’t understand how to exclude them from the measures and the physicians didn’t want to get dinged on their clinical quality metrics. The sometimes-mindless devotion to metrics just illustrates how misaligned the incentives in the US healthcare system can be.

For the love of all those elderly patients who are being overtreated due to poorly implemented clinical decision support in the EHR, if you’re in clinical informatics, please make sure your clinicians know how to properly exclude a patient to whom the recommendations do not fully apply. It will be interesting to see what comes after MIPS – I know clinicians are sick of it and primary care practices waste countless hours on the program every year.

Speaking of primary care physicians, many of my colleagues have come together for regular conversations about how to prevent burnout and promote wellbeing among physicians and office staff. When I started in solo practice, I had 2.5 full time support staff just to run the office, and I paid for a central business office to handle the back end of the revenue cycle. Most of the primary care physicians in my area are employed by one of three large health systems or a large investor-owned provider group, so they’re no longer in charge of their own destinies.

Due to the staffing crisis everyone is seeing, most of them are down to 1:1 support with a medical assistant. One of the doctors I recently spoke with is allocated 40% of a medical assistant’s time to support her 3,000-patient primary care panel. It’s frankly absurd, and she’s looking to leave when the school year is over. She has to give 90 days’ notice, so she will be resigning soon, and I can’t imagine how they are going to be able to recruit a replacement if they let the candidates visit the office and see what’s happening.

She has one child in college and one who has been in the workforce for a couple of years. One of the hot topics with her family over the holidays was the idea of a “slow work” mindset. Her eldest child works at a company that has adopted a four-day work week, which evolved after a couple of years of “focus Fridays,” where employees were encouraged not to have meetings but to give their effort to priority projects or personal development. At that employer, meetings have been either compressed into 20-minute check-ins or expanded into multi-hour collaboration session where people are encouraged to get the work done as a team rather than individually push things along an inch at a time.

Her youngest is interviewing with companies that have been deliberate in their communications about workplace flexibility and how they don’t want to be in the business of babysitting their employees. Despite stories in the media announcing the death of remote work, it seems like a lot of companies are still offering it. I know from experience that I’m more productive in a remote environment. I have fewer interruptions and can use break time productively, whether it’s rotating loads of laundry, baking a loaf of bread, or knocking out a little yard work on my lunch break. Once I’m back at my desk, I’m more focused and it seems like time flies compared to when I was in an office and had constant face-to-face interruptions from co-workers. Sure, there are interruptions, but I can manage a Slack message and respond in 1-2 minutes when I’m finished with my current train of thought versus having to immediately turn to an in-person contact and let that train run right off the tracks.

I get a ton of unsolicited emails and calls, mostly from people trying to sell me services I don’t want or need. Pro tip for those folks responsible for composing corporate communications: starting your email with “Dear Dr. HIStalk,” will at least keep me reading, where “Hey Jayne,” is going to be a direct trip to the “Block Sender” button. Sales and marketing people everywhere, please take a look at your templates and let’s all agree to make professional communications a part of general business discourse again.

Frankly, the Girl Scouts coming to my door with their much-awaited cookie order forms are doing a better job than some of the sales reps who’ve approached me lately. If you’re wondering, Samoas (Caramel deLites ) are my favorites, followed by Tagalongs (Peanut Butter Patties). Depending on which baker services your region, names may vary. And if you’re interested in appropriate wine pairings for your cookies, may I suggest this handy guide.

Several of my friends are in academics, and we recently got into a discussion about sabbatical leave. I was telling them about the sabbatical programs at some well-known tech vendors and they were surprised that sabbaticals exist outside the university world. It’s an interesting idea for companies that want to differentiate themselves and who want to make a clear statement that they want employees to be with them for the long haul. A recent opinion piece talked about the lesser-known effects of sabbaticals, including providing an opportunity for coworkers and teams to shine. The author had spent 10 years at a marketing agency and received an eight-week paid sabbatical upon reaching that milestone. She notes that in addition to providing “a proactive hedge against employee burnout, an antidote for attrition, and a protection from career wanderlust” her time away made her more passionate about her work and workplace than before.

In observing that those who managed her workload while she was out, the writer found that upon her return, those co-workers had increased confidence and willingness to provide leadership for projects. Experts agree, and she cites several studies that have reaffirmed the benefits of sabbaticals. Proponents of the practice find that sabbaticals are an investment in employee wellbeing. According to sources cited in the article, only 5% of employers offered paid sabbaticals with 11% offering unpaid leaves. When you consider how much it would cost to replace a valued employee, two months’ salary seems a relatively economical investment.

There’s a lot of discussion about the value of time away from work, particularly with recent announcements from Microsoft that it is expanding its unlimited time off policy to all US-based employees. For many, such a policy makes it tempting to take days off here, which may lead to fewer employees taking longer vacations. Research from the travel industry indicates that many individuals need at least three days away from work to de-stress, which is nearly half of the traditional week off. For most of my friends, having several four-day holiday weekends in close succession made people feel a little spoiled, and it will be hard to have only two-day weekends for a while.

Does your employer offer sabbatical leave? How has the experience been, not only for the person on leave but those left behind? Leave a comment or email me.

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