Curbside Consult with Dr. Jayne 6/8/15

I was visiting some friends this weekend and we drove past a niche primary care clinic. It advertised “Healthcare for Guys!” which certainly caught my eye. Although the location I saw was next to Costco, a quick Web search revealed that they apparently also have a location next to a home improvement store. I’m always interested in new models of care and thought I’d find out a little bit more. Unfortunately, their website was pretty sparse without even a listing of their physicians or the fact that they now have multiple locations. Their Facebook page had multiple posts with grammar errors and typos. Not exactly a vote of confidence, but a great example of why physicians need to pay attention to their social media presence and webpages.

On the flight home, I noticed that the ever-present SkyMall catalog was missing — apparently it’s gone digital-only. After some procrastination (check out the automated pill dispenser above), I was forced to read journals instead. An article in the Annals of Family Medicine caught my eye: “Health IT-Enabled Care Coordination: A National Survey of Patient-Centered Medical Home Clinicians.” The study set out to assess “the feasibility and acceptability” of some of the care coordination objectives in the proposed Meaningful Use rule for Stage 3. Specifically, they looked at referrals, transfer of care, clinical summaries, and patient dashboards.

Researchers surveyed primary care practices that had been recognized as patient-centered medical homes (by the National Committee for Quality Assurance) in addition to participating in Meaningful Use. They also surveyed community health centers with patient-centered medical home recognition. The survey looked not only whether the sites had implemented the proposed objectives, but also at whether the practice thought those objectives were important. The results were similar to anecdotal comments I’ve heard in the field. While 78 percent of the physicians thought it was important to be notified of hospital discharges, only 48 percent were using IT systems. Conversely, while 77 percent of practices were providing clinical summaries to patients, only 48 percent of them considered providing summaries to be “very important.”

Similar to what we know about vaccine delivery (namely that non-physicians do a better job of following protocols and ensuring vaccination), the study found that care coordination was more often done using IT systems when a non-physician was responsible. The practice’s “capacity for systemic change” was also positively associated with using health IT for care coordination as was being in a non-urban area. The study concludes that “health IT capabilities are not currently aligned with clinicians’ priorities” and that “many practices will need financial and technical assistance for health IT to enhance care coordination.”

Those aren’t earth-shaking conclusions for anyone who has been in the trenches during the Meaningful Use era. While those practices that had already transformed care coordination prior to MU will continue to do so, those arriving later to the dance are struggling. It’s hard to identify dedicated resources to manage patient panels without negatively impacting the bottom line of practices already on thin margins. Although there is the promise of future money for demonstrable outcomes, you have to demonstrate quality to get the money. It’s a somewhat perverse chicken-egg-chicken loop.

I also wasn’t surprised by the fact that the survey only had a 35 percent response rate. Additionally, the study found that the most commonly implemented care coordination processes were not those with the most IT involvement. Respondents cited the top barriers as time, money, and IT systems. There were several other interesting data points from the practice demographic data: approximately one-third of clinicians were concerned about practice financial health; more than three-quarters of practices received help improving care coordination; and referral tracking was less than 100 percent. My former risk/compliance department would have a field day with the latter statistic since everyone was expected to track 100 percent of referrals 100 percent of the time.

Now that we’re getting a critical mass of providers involved using IT systems, we need more surveys such as this to determine where physician priorities really are and whether we can align systems to support those clinical priorities rather than trying to drive clinicians based on what systems will support. Interestingly, the next article I read discussed the idea that payment reform isn’t the only factor turning medicine on its ear. The NPR headline caught my eye: “A Top Medical School Revamps Requirements To Lure English Majors.”

Having been a non-science major myself, I support approaches like this aimed at bringing more diversity into the field. Some of the problems we’re trying to solve are extremely complex with a high number of psychosocial factors. It’s going to take more than biochemists and fruit fly-counting biology majors to help solve them. There were a decent number of non-traditional majors in my entering medical school class, but it certainly wasn’t the norm.

What was your undergraduate major? Would you do it again or is it just good for cocktail party discussions? Email me.

Email Dr. Jayne.