Galate observed that his clinic’s accounts receivable had been “climbing astronomically.” Said Galate, “Patients can’t pay. So you have to decide are you still going to give good care and take the hit, or are you going to force these people to pay what they’re supposed to.” He added, “It’s hard to be a doctor—I didn’t get into this to go chase people’s money. I got into this to take care of patients.”
Danette Wilson asked her colleagues whether physicians, hospitals and other providers had the ability to take on additional risk from the payers.
“I don’t think, if you were to make a generalization,” said Bruce Bagley, president and CEO at TransforMED, “that we’re ready for that.” There has been noticeable consolidation and integration among providers, but Bagley sees that as a kind of a foundation for the ability to manage performance risk. “We were so ingrained for so many years about creating revenue,” said Bagley, “and now we have to create value to patients, not value to a client organization.”
Bagley raised the issue of “excess.” Summarizing various studies, he argued that 30 percent of what physicians order for patients has no effect on outcomes, and yet, “nobody is talking about reducing the total amount of stuff that we buy.” Said Bagley, “We have created the patient’s expectation that more is better because it’s better for us.”
“It all goes back to the question,” said Kahle, “what does reimbursement need to look like from a provider’s standpoint to reduce waste to create quality outcomes?”
“Part of the problem,” said physician Eric Justin, chief medical officer and vice-president at Lockton, “is we don’t know the costs very well.” He cited the various studies that showed somewhere between 15 and 35 percent of all imaging was unnecessary. There would be a value to going back to the table with the payer and reviewing the numerous variables that affect cost and outcome.
Electronic Medical Records
Adding to the burden on physicians is the conversion to electronic medical records. “There’s no doubt that the EMRs are necessary,” said Jean Hansen. “They’re necessary for patient safety, to be able to integrate information, but all that workload has fallen to the physicians.”
Bruce Bagley noted that more than 80 percent of doctors use EMRs of some kind. “That doesn’t mean they do everything they’re supposed to do with them,” said Bagley. The real problem, he observed, is that the vendors have not kept up with the workflow changes. Vendors started off selling computers to doctors based on what the doctor wanted, and that was about billing and coding, it wasn’t about workflow or about communications. “It was about all the other stuff that we have to do every day.”
“From a physician perspective,” said Eric Justin, “the frustrating part is just the amount of time that [EMRs] have added to the end of the day.” Although his own background is in IT, Justin could spend two to three hours an evening on documentation. He argued for standardization of workflows on a national scale, not just on a local scale.
For all its burdens, the new technology has its upside. “We have always known we take fantastic care of patients,” said Hansen, “but now with technology behind us, we actually can track these outcomes to prove it.” According to Hansen, the tracking also helps keep the patients informed and educated. The problem remains, conceded Hansen, “the financing of it.”
Ryan Mullins, a physician with Liberty Hospital, suggested that the way providers measure quality may not be the way patients do. For many patients, intangibles like physician courtesy can matter as much as test results. “This has not been translated by ACA, and it’s causing mixed messages to the physicians and creating a little bit of burnout for them. That will be a continuing struggle as we define quality.”
