EPtalk by Dr. Jayne 6/21/18

I was excited to learn that the Amazon-Berkshire-JPMorgan health care venture has selected Atul Gawande MD as its CEO. My first reaction was to wonder how he was going to fit this into his schedule, given his responsibilities as a surgeon, educator, author, and more. Although Gawande will assume the CEO position on July 9, he will be continuing in his roles at Harvard and Brigham and Women’s Hospital. He will, however, move from executive director at Ariadne Labs to the role of chair. Initially, Amazon-Berkshire-JPMorgan set a goal to identify technologies that would enable “simplified, high-quality, and transparent health care at a reasonable cost.” We don’t fully know what that will mean, other than we can probably count on checklists being involved. Given the scope of what it could mean, I hope he has some friends at Harvard working on a clone. I also hope someone comes up with a name for the company in short order.

Jeff Bezos, Amazon CEO, noted: “We said at the outset that the degree of difficulty is high and success is going to require an expert’s knowledge, a beginner’s mind, and a long-term orientation. Atul embodies all three, and we’re starting strong as we move forward in this challenging and worthwhile endeavor.” I’m a huge fan of Gawande’s work and recently finished his book “Being Mortal.” I found it to be thought-provoking, heart-breaking, and inspiring all at the same time. I’m looking forward to seeing how this progresses, and if he’s looking for a CMIO fan girl, I can be available at a moment’s notice.

Speaking of being a fan, the Honor Flight Network is right up there on my list. Its regional affiliates work tirelessly to enable our veterans to visit their memorials in Washington, DC. Unfortunately, space on flights is limited and many veterans are aged, ill, or otherwise unable to travel. Hospice provider Vitas Healthcare is helping bridge that gap, bringing the memorials to veterans in the organization’s care. These “Virtual Reality Honor Flight” experiences are pre-recorded visits led by retired military tour guides, and provide a 3-D tour of the WWII Memorial, Korean War, and Vietnam War Memorials, Women’s Memorial, and Arlington National Cemetery. The first virtual tour was conducted in Atlanta, and Vitas hopes to share this experience with its veteran hospice patients in Georgia and other states in the future. Kudos to Vitas for thinking outside the box and helping honor our veterans.

Given the tight margins in the healthcare industry, I’m surprised that patient-facing organizations don’t demand better solutions from their vendors, and that vendors don’t provide better options. One of my medical providers has separate portals for clinical information and bill pay, which makes very little sense from not only a patient engagement standpoint but from a practice management standpoint. Maybe there are contractual issues, maybe they think their vendor’s portal is poor on the collections side, or maybe they just don’t know better. I’d love to be able to ask in situations like that but don’t want to wind up enabling free consulting services while I’m freezing in a paper gown.

DrChrono has teamed up with Square to incorporate payment processing into the EHR. Practices can now save patient credit or debit card information, and can collect payments anywhere within the clinic workflow or remotely. Patient balances are automatically updated, which should improve cash flow with minimal labor cost. Existing Square customers can connect their accounts for a seamless transition. The ability to collect payment at various points in the workflow rather than just at the front desk or checkout is key, especially in smaller practices that may be maximizing staffing through cross-training or novel workflows. In my original solo practice, we didn’t have enough staff to have a check-out person, and the medical assistants often did the honors of booking follow-up appointments and taking care of labs and referrals before the patient left the exam room. Being able to have them collect and issue a receipt would be a plus, especially if you’re working with a system that can estimate patient portion due. I have used Square for various charity events and fundraisers and found it to be reliable. It’s also easy enough that a Cub Scout can set up the inventory and charge master functions.

Although I’m a clinician at heart, I love digging into financial and revenue cycle business problems. It’s amazing what goes on out there, particularly when a client doesn’t understand the power of their practice management system. I had one client that was processing refunds on individual patient encounters without checking to see if the patient had an overall patient balance. When the patient came in for a post-operative follow up and was erroneously charged a copay during the global billing period, they refunded the $25 (which incidentally cost them another $6.50 to have the check cut) once they received the communication from the payer. There wasn’t a process, automated or human, to identify the $900 balance the patient had outstanding on his surgery. It costs money to keep sending out paper statements, and the cost to the practice just grows. Those little things add up over time, and I’m always excited to be able to identify these opportunities for practices to fix their processes.

This week has been one of the more challenging travel weeks I’ve experienced in a while, with crammed airport parking lots, oversold flights, and weather delays that made me miss a much-anticipated dinner with a friend whose fair city I was visiting. It’s the height of family travel season, so as a road warrior I try to cut some slack to the families with fussy kids, people racing through the airport, and those who don’t know that your carry-on goes under the seat in front of you rather than trying to stuff it into the space below your own seat. However, there is no slack cut for healthcare vendor reps who act boorishly, fail to observe basic airport courtesies, or get sloppy drunk while wearing corporate-logo shirts and carrying logo backpacks. Be on alert folks – next time I’m going to name names. For now, we’ll just call it “bronchoscopy reps behaving badly.”

Does your company prohibit alcohol consumption while sporting the brand? Leave a comment or email me.

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