Michael Hunt, MD, isn’t down on health technology or the movement toward rewarding higher quality, lower cost care. But he believes that the healthcare industry needs to be more realistic on current IT capabilities and the targets physicians are being asked to meet.
And he also wants to shine some light on how difficult the current direction of the industry has made it to practice medicine.
“Research shows that physician burnout is at an all-time high, and that even with all the analytic platforms and tools and infrastructure and incentives we’re putting in place, the majority of accountable care organizations don’t hit their targets and qualify for shared savings,” he says.
”Does anyone think those ACOs and physicians aren’t trying their hardest to hit those clinical and financial goals? If you assume, like me, they are making the best effort they can, than you have to think about the barriers to success,” Hunt adds.
Hunt is the interim CEO and president, and chief population health officer, at St. Vincent’s Health Partners Inc., a Bridgeport, Conn.-based physician-hospital organization with more than 275 local primary care and specialist physicians. St. Vincent’s is the first organization to earn clinical integration accreditation from URAC, so Hunt is steeped in what it takes from IT and clinicians to design a network that can succeed in a risk environment.
And in his opinion, the new models just aren’t working because of the mind-boggling complexity of shared-savings programs and the relative infancy of the tools required to manage them.
“We are suffering from a plague of metrics that don’t really have anything to do with outcomes,” he says. “Just use mammograms as an example. It’s easy to find the patients in a certain age range that need mammograms, but those mammograms have to be administered in a very specific time frame, and then you have to identify exclusions, such as mastectomies, and then you have to ensure your IT can log that you ordered appropriately with all those specifications, and then you have to result it and show that it was all done according to the inclusion and exclusion criteria. Now expand that complexity to a large patient population, and to the 27 different metrics under the Medicare Shared Savings Program that you have to run every time you see a patient, and you have a real conundrum.”
The fundamental issue, Hunt believes, is that the industry is trying to push technology in a direction the current infrastructure simply doesn’t support. The data and computational intelligence required to help physicians make the exact right decision, in terms of quality measures and shared savings, is just not there yet, and perhaps will never be if the requirements aren’t more realistic.
“Just shaving 2 percent off costs seems like such a simple thing,” he says. “But how do you tell a physician exactly, at that point of care, how much has been spent on a patient, especially those with multiple conditions, from a widely disparate number of care settings and information systems, and have them make decisions on utilization and the efficacy of multiple treatment options, and do that while they’re seeing a different patient every 15 minutes?
Quote"Physicians are being beat up like this every day—is it really any wonder they’re feeling burned out?"
“The fact is that physicians are working their butts off, and in many settings they’re being asked to do what I just described, and they’re being told to use multiple tools to gather that kind of information, because it’s not in one place because EHRs don’t have those capabilities. And if you’re a physician trying to remain independent, every tool you add is a cost and a new complexity, even as your reimbursements are falling and workloads are going up. Physicians are being beat up like this every day—is it really any wonder they’re feeling burned out? These requirements and technology complexities are alienating the one group of people that can deliver the changes we need in the industry.”
St. Vincent’s tries to take the pressure off its physician members by doing detailed profiling and risk assessments of physicians’ patient panels so they have the information before and after—not necessarily during—patient encounters. “We are doing the physician’s homework for them and identifying the patients they need to watch very closely, as well as who needs what treatments based on all the available data we have. That way, they can get ahead of the curve and get patients the right care before they see them, and track them after they see them.
“We have backed off at trying to insert this into the real-time workflow—that would be the Holy Grail, but we’ve found that if you try to ask a clinician to add that type of value at the point of service, you cannot do it effectively and efficiently through the EHR or other tools, and even if you try to incentivize them with a pot of gold to use those tools, it doesn’t overcome the time restraints they’re working under. We figure that focusing on getting the right care, at the right time, in the right environment will yield those cost savings we’re aiming for, instead of directly focusing physicians on cutting costs.”
The bottom line, Hunt says, is that national progress on cost and quality are achievable, but HIT leaders need to appreciate how much pressure is being brought to bear on front-line physicians, and focus their IT efforts on providing them the support they need to push the industry forward.
“I think we’ve underestimated the complexity of the Affordable Care Act as well as the complexity of getting to where shared-savings programs want us to go. The practice of medicine is much more complex than it was a few years ago, and by not using IT to take some of that pressure off, we are disenfranchising physicians.
“In my case, I don’t need the best analytic platform ever built, I need the capability to take data and make it into actionable information to support physicians who are taking care of patients. I think we sometimes forget these shared-savings program and our technology are designed for the purpose, to benefit our patients.”
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