Healthcare Talent Transformation

Transparency Inside and Outside Healthcare Walls – No one wants an “F”!

Jonena Relth, TBD Consulting

Promoting Transparency inside our walls:

How would you like your organization to be among the top 10 Places to Work?  Well, Fortune Magazine surveyed 259 firms and more than 277,000 employees to find out how they would rate their organization for management credibility, job satisfaction, camaraderie, pay and benefits, hiring practices, communication, recognition, and diversity, but only one healthcare company ended up in their top 10. 

The 10 most common answers were no surprise to any of us who follow transparent leadership methodologies, but my favorite “extra” was learning that one CEO posts his/her personal development plan for all employees to see and track results. 

This Leader ROCKS! (in my humble opinion...)

While the survey was aimed at all types of corporations, not necessarily healthcare, CHG Healthcare Services ranked third on the list of Best Companies to Work For. Wouldn’t it be great if several hospitals, especially those that have or are currently implementing Lean Healthcare, would be ranked in the top 10 for 2013?

To Read the Article: 100 Best Companies to Work For 

The facts are overwhelming that the most important asset we have is our employees and that all organizations should strive to hire the best candidates they can find to fill needed gaps. One process that is effective for building a best-in-class workforce is consciously hiring people who have skills and knowledge otherwise lacking in the organization - that of course includes hiring for IT and leadership expertise, as well.  By doing so, you build a solid company where everyone appreciates and learns from their peers and leaders.  It also fosters employee satifaction and patient satisfaction while grooming high potentials for leadership positions.

So healthcare leader, are you brave enough to post your personal development plan for all your employees and peers to see:

• What you don’t know now but are trying to learn? 
• How they are being led by someone who might not be as knowledgeable as they presumed?
• What you feel is important for you to become a better leader?

And, oh yeah…

• That you’re not perfect, all knowing, etc.?

Trust me, most leaders would be scared to death to let their employees and peers reach into their secret little minds and learn the real truth about them.  But folks, we need to step up to the plate and begin modeling transparent leadership so the people around us will feel free to do the same.

Once we all become transparent, we can begin the natural progression of everyone helping each other grow and our organizations and people will benefit socially, personally, professionally and financially. Can’t beat that! 

Promoting Transparency beyond our walls:

None of us wants the negative publicity of being linked to lack of transparency.  How is your organization rated for pricing transparency?  Patients want and deserve to know what they will be charged for procedures. As patients are becoming more informed, they are choosing to be treated at hospitals that willingly publish their fees. For healthcare organizations to be considered best in class, they need to swallow this poison pill and advertise their pricing.

You might want to read this article about Arizona state getting an “F” because price of services are hidden from the public: Arizona gets failing grade for healthcare transparency .  I have to believe that healthcare professionals in Arizona work hard to provide excellent patient care; but even so, their hospitals now have a definite black spot on their reputations.

Drum Roll Please:  Who will be the first person to step up and comment below:

• “Yes, I will post my personal development goals for my peers and employees to see.  I will begin the process of encouraging transparency within my healthcare organization.” 
• “Yes, we will change our pricing policies and post the cost of our services for easy access.”

I dare ya! Jonena

Suggested Reading:

Revolutionizing Healthcaare to Save Lives and Transform the Industry  By John Toussaint and Roger Gerard

 

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations as well as Lean Healthcare.

Drop by our EMR/EHR Clinical Transformation Group in LinkedIn to learn the latest news and opinions on electronic health records. 

Email Jonena or feel free to call our office today 602-263-1961. We'd love to hear from you!

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Do You Lead with Transparency or Power?

Training and Change Management Maximize Our Investment in Health Information Technology

Peggy Salvatore, MBA

I love a good think tank study. So here we go: a KPMG survey suggests training and change management are bigger barriers than technology implementation in achieving federal health IT standards.

Let’s look at this study in light of two other headlines this morning, February 11, from Healthcare IT News:

“Sebelius: ‘Speed up the rate of change’” and “EHRs top priority for CIOs”

We are partway there, but can we get there faster and work out the bugs?

Sometimes an analogy is helpful, so let’s break down the rapid, billion-dollar deployment of electronic patient records throughout one-sixth of our economy into a simple multi-million dollar story of a small company.

Let’s pretend you own a company, a few hundred employees, and your company is 40 years old. You make the hypothetical widgets, you are the Widget King. You’ve been operating your business – the books, the customers, the vendors, the employees – on a terrific old mainframe that has served you well. It’s not quite as old as Eniac but you are still printing out reports on tractor printers – and it’s getting darn hard to get the paper these days. The times, they are a-changing and so must you.

As your faithful, long-time machinists, bookkeepers, manufacturing assembly workers and shippers are retiring, you are bringing new people into this tightly held, well-run organization that has been your baby since you were in your 20s. Some of these freshly minted MBAs and IT whizzes say you can get a lot more done in a much quicker way with a fresh infusion of cash – say $5 million – in new technology to make your company more competitive and nimble in the new economy. It’s an easy sell. You’ve noticed that the market seems to be getting away from you. The MBAs and IT analysts say you can maximize your impact and increase revenue exponentially by collecting the data you have and analyzing it to segment your market, streamline your processes and create new connections among employees, customers and vendors. You’re sharp, you became successful because you can read the tea leaves.

So you spend the $5 million.

But your staff is still heavily populated by veteran employees. They are not very happy with the way the new technology changes the way they do their jobs. There is resistance to new hardware and software. There is reluctance among your older customers that you are changing some of the ways you invoice and market to them, and some of your long-time vendors just aren’t quite comfortable with the new way of relating to your company. Sure, some of your customers and vendors have been waiting for you to catch up to them, but there remains some resistance internally and externally. Newer might be better, but it’s different.

What’s a sharp CEO like you to do? You’ve spent $5 million, it was money well-spent IF the new technology is used well. If not, you can’t really go back to Son-of-Eniac. So you need to bring your people along with you.

Your MBA recommends bringing in an Organizational Development specialist. The OD person says:

• Sara in bookkeeping is complaining that she doesn’t understand the new screens and fields on her desktop – perhaps some software training for her?
• The shipping department is getting behind because they are spending an inordinate amount of time trying to figure out the new system – perhaps some process modifications
  supported by training shipping department supervisors in the new systems and teaching them how to coach their employees on the new processes
• Water cooler and lunchroom chatter is turning negative because the new system is slowing things down – perhaps some team building
•  And then there is the tension between the old guard and the infusion of new talent and ideas – how about some cross-generational leadership training

The inventor of the widget realized the $5 million in new technology was just the first step; now he needed to invest in the people who will make the $5 million technology work. Soon, the company was humming along again, and moving gracefully into the 21^st Century.

Take the story of the Widget King and extrapolate that a gazillion times over in dollars, complexity, products and people to one-sixth of our economy that is heavily populated by staff that has been used to doing business the old way rubbing up against people heavily invested in doing things a new way.

In health IT, the upfront investment in hardware and software is being made, much of it by our government so this is your tax dollars at work affecting the quality and cost of your healthcare. There is no turning back. So perhaps it behooves us to help this large and complex machine we call our health system move gracefully into the 21^st Century. Let’s throw good money after good and invest in training and change management to reap the benefits of the billions that we’ve spent, to get things running smoothly sooner – all for the better.

Sources:

KPMG Study: KPMG survey suggests training and change management are bigger barriers than technology implementation in achieving federal health IT standards.

Sebelius: 'Speed up the rate of change'. By Mary Mosquera, Senior Editor. 

EHRs top priority for CIOs. By Diana Manos, Senior Editor.

Lean Strategies Improve Healthcare Delivery while Lowering Costs

Jonena Relth, TBD Consulting

I'm encouraged to see healthcare leaders looking beyond the ways they have always done things in the past to implementing innovative solutions such as Lean to curb the industry's skyrocketing costs, poor quality, nursing shortages and employee dissatisfaction— all symptoms of deeper problems inherent in the system itself.

These forward-looking healthcare providers have realized the financial and moral imperatives for improving quality and safety and eliminating waste as strategies for responding to their pressing challenges.

Lean Healthcare (adapted from the Toyota Production System) is not just for manufacturing or another short-term fix: it’s a way to transform an entire organization into a safe and high-quality, high-performing healthcare delivery system. If implemented property, it can be the "how to" for managing change and creating continuous improvement.

Lean Healthcare is used to eliminate obstacles that prevent organizations from providing best-in-class healthcare by eliminating issues as vast as out-of-date technology systems, worker frustration and errors and oversights that can increase patient safety risks. Some "fixes" are complex, but lean methodology strives to find well-thought-out improvements that can be implemented quickly and
without costing a fortune, if at all possible -- thus the name Lean.

As a leader, it makes sense to at least research whether your organization would embrace the methodology and sustained results derived from lean implementation.

Take a peek and give me a call if you'd like to see how lean strategies can help your organization improve your care delivery while lowering your costs.

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations as well as overall process improvements. Whether you need assistance to create a Training Department or Lean Academy, or help your existing training organization meet the communication needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961    Email Jonena today!

Focus on Standards Not HIE Governance

We would like to welcome our newest blogger, John Tempesco.  John is the Chief Marketing Officer for Informatics Corporation America (ICA) and has 34 years of healthcare experience including 18 years of experience in HIT in both the civilian and government sectors. He has significant experience in marketing strategy as well as a strong background in implementation and support of healthcare information technology solutions at a local and regional level.  He is familiar with the political, workflow and organizational behavior aspects of the change management necessary for a successful deployment of clinical applications across the continuum of care. We look forward to John sharing his experiences with our bloggers.

In recent weeks, the American Academy of Family Practice (AAFP), eHealth Initiative (eHI), Health Information Management Systems Society (HIMSS) and others have responded to the Office of the National Coordinator’s (ONC) Request for Information (RFI) on health information exchange (HIE) governance.  Each of these and other organizations had differences, but the general consensus centered on advising the government to take a cautious approach to regulating an industry that is in relative infancy.  Although exchanging healthcare information can be traced back several decades with the emergence of Community Health Information Networks (CHINs), as well as a decade or so ago with the re-emergence of Regional Health Information Networks (RHIOs), it wasn’t until the HITECH Act within the stimulus package, and the even more recent proliferation of EHRs because of the Meaningful Use, that HIEs have really begun in earnest. With only a handful of HIEs mature enough to determine what works and what doesn’t, placing rigid governance standards in place could stifle this fledgling progress evolving across the country.

Nationally, HIEs are structured in many ways at the state, regional, community and hospital/IDN level. Each is having varying levels of success; some are thriving and some (as late as last week) are closing up shop (Health Information Plan of Tennessee).  There are also new models of HIE evolving.  AlliedHIE just recently launched in Pennsylvania as a for-profit, commercial HIE.  However, no initiative has emerged as THE model to emulate or replicate across the country.  With continued turmoil within the structure, sustainability model and value proposition of HIEs, I believe that placing any perimeters around governance, policy and procedures is far too premature at this time.

There are many reasons why HIEs have not historically thrived.  During the CHINs of several decades ago, there were four major barriers to success.  First, the prevalence and acceptability of the Internet had not emerged, and the infrastructure to connect healthcare organizations within the community cost as much if not more than the solution itself.  Second, there were very few clinical applications being adopted within the medical community to even capture clinical data, let alone share it. Third, there were not any standards designed to share the little data that was available.  And lastly, there really wasn’t a value proposition to commit the expense associated with on-going operation of a CHIN.

Fast forward a couple of decades and we have a ubiquitous, reliable, speedy and inexpensive Internet capability with connections literally everywhere including, untethered capabilities powering mHealth devices.  In addition, Meaningful Use has driven the fastest adoption of EHR in both the acute and ambulatory setting, astonishing even the biggest skeptics (including me).  However, standards are still in their infancy.  IHE and Direct protocols are being adopted within EHR products as rapidly as possible, but wide spread deployment of this new standard within operational products is just now starting to be realized.  But, that is only the tip of the iceberg. There are thousands of ancillary and diagnostic clinical systems in need of upgrades within the acute and ambulatory space for true interoperability to occur.  And, although EHRs are making progress complying with the latest IHE and Direct protocols, few have been able to incorporate this interoperability in a meaningful way within the workflow of their products. Stabilizing standards for interchange so that vendors have time to incorporate them within their deployable products in a way that is transparent to providers at the point of care will be required before HIE is neither costly nor time consuming for the provider community.

Accomplishing infrastructure, clinical system deployment and standards-based transfer among acute and ambulatory settings only solved half the equation.  As Paul Harvey would say, “the rest of the story” will evolve when the same progress is made in the post-acute setting.  Having rehabilitative, skilled nursing facilities, home healthcare and hospices all connected will be the next evolution in health information exchange necessary to meet the final challenge of value proposition. To date, HIEs were established in a “build it and they will come” mentality.  The Federal Government has been under the impression that there is an intrinsic value in health information exchange which everyone will not only recognize but will be willing to pay for.  In a paradigm of largely fee-for-service healthcare delivery, that value has not materialized. 

Wide spread adoption of a value-based reimbursement model with healthcare will be the final impetus for adoption of health information exchange.  However, it will require health information exchange to occur as a verb not a noun. Individual providers, especially in highly specialized functions, will belong to more than one accountable care organization requiring them to exchange information with multiple competing entities. If there are HIEs in the future, they must evolve into clinical data clearinghouses that support a paradigm of value-based
reimbursement rather than 501c3 organizations with an altruistic mission statement of improving the health of a community.  Once this occurs, all four barriers to HIE adoption will be overcome and there will be no need for a governance structure for obsolete community-wide or state organizations.

I believe that healthcare would be better served if the federal government did not waste time or money on governance and focus on improving standards and public-private collaboration efforts to drive adoption of technology, standards and payment reform.  

What are your thoughts? Should the federal government focus its efforts on improving standards vs spending time and money on governance?

Your People are Your Competitive Advantage

Jonena Relth, TBD Consulting

These days you can’t look at an industry magazine, cable business news channel, tweet or blog without bumping into an opinion about electronic medical records (EMR). Without question, a well-implemented health information technology system will help reduce human error, make it easier to access information, and increase efficiency. But your people are still your most valuable asset. The decision to automate processes is but one aspect of a well-planned talent management strategy.

Talent management is a never-ending process.

• Your people are your most valuable asset.
• Your people differentiate your organizational quality culture.
• Your people establish your competitive advantage.

As the healthcare industry continues to grow and seasoned talent concurrently reach retirement, most hospitals and healthcare providers recognize the need for analysis and direction from internal and outside consultants.  It's these professionals who have the expertise to help you prepared for changes and that will enable your organization to achieve its strategic business objectives.

To succeed in this wildly-changing environment, you MUST VHTD:

• View your organization's employee performance improvement from a holistic approach. Everyone needs training and continued education - not just physicians, techs and nurses.
• Hire the right people who will "fit" and even improve your organization's culture.
• Trust the expertise of organizational development experts to help guide you through the before-neglected aspects of HR.
• Demand that everyone be treated with respect and demand that of everyone in our organizations.  No one person or group can make our healthcare organizations successful -- it takes us all -- from physicians, techs, nurses, food service, maintenance, finance, etc.  No more allowing "Nurses that eat their own" or docs getting away with rude, demoralizing behavior.

Without everyone working for a common goal: providing best-in-class, state-of-the-art patient care, our organizations will be only memories in 5-10 years.  Yep, I said 5-10 years. It takes a lifetime to build a hospital system, but only a blink of an eye to tarnish its reputation and following.  The good 'ol days of being the only hospital in town is long gone.  If yours is the only hospital in town, same is true. There's usually a competitor's hospital or clinic in the next town or county that is happy to hire your employees and treat them with the respect they deserve.  And of course, they have beds ready for your patients, too!

To keep good people who truly want to work for you requires developing and implementing a talent management strategy that fosters organization-wide accountability, consistency from leaders, and increased productivity.  To accomplish this takes quality:

• Change management strategies: Proven processes will help you to prepare for, manage and reinforce change. Clinical and ancillary staff are prepared for changes in workflows and are fully readied to integrate the new technology in their every day work tasks.
• Training/coaching:  Research shows training is most effective when it happens in short, “just-in-time” snippets when the employee needs to apply the information. Time away from clinical duties is significantly reduced through the improved use of blended learning, online reference and workflow task training.
• Performance management: The quality of patient care is enhanced by a learning reinforcement and metrics tool that identifies needs for coaching. Low performers are addressed before quality metrics are impacted and the most valuable employees are given the opportunity for continuously learning.
• Leadership coaching and development:  Programs customized for your organization foster improved decision-making and identify potentials for promotion to senior management roles. A sound executive coaching model and use of tools such as the Myers Briggs and DiSC behavioral style assessment instruments help you build the emotional intelligence necessary for leaders to achieve the most out of themselves and others.
• New hire training: Learner-centered training that engages new employees and helps them align their talents with the organization’s vision and mission enables employees to do what they do best: provide quality patient care. It’s these programs that increase new employees' satisfaction and success and your organization’s productivity will increase as you build a healthier bottom line.

And REMEMBER:  Whether you’re just starting the process of selecting an EMR/EHR system or you’re a year or two into the integration process, it’s never too early or too late to bring in the experts to help you harness your change initiatives and all the emotions and behaviors that surround them.  With everyone "happily" working together to move your organization into the "EMR/EHR Age" means:

• Improved patient care
• Satisfied employees
• Supportive boards of directors AND
• Physicians clammering to bring their patients to your hospital!

Jonena

The Evolving Provider - The Other Side

Jonena Relth,
TBD Consulting

When I sat down to write about this month's topic, "The Evolving Provider," I must admit that I felt some empathy for my physician friends because of all the changes that are happening around them.  Let's be honest:  CHANGE SUCKS, especially for us 'ol cronies!  Not only are they expected to diagnose and treat their patients, now they are expected to manage their practices in a whole new way with computers and Lean/Six Sigma processes.  Their chosen career to heal people is now embroiled in an environment which is pressured by government bureaucrats, IT gurus and business, OD and training consultants telling them how they should do their job.  And for all of this, physician incomes are decreasing and their medical malpractice insurance is skyrocketing.  It's not a surprise that so many talented men and women are hanging up their white coats and retiring or becoming consultants!

We all know the "fortunate" docs that have been able to continue practicing medicine and fulfilling their life's dream.  These are folks that, for one reason or another, can go with the flow, adapt to the changes and/or simply stay out of the fray.  They are comfortable with change and working in and around change.  They will continue to thrive in the changing medical arena.

But what concerns me are three groups of docs:

1. The single practitioners who have merged their practices into the big clinics so they could still afford to practice medicine...those who:
   
   • Couldn't afford to implement EHRs and the other government mandates without going broke, or
   • Didn't have the computer or technology skills to manage the system implementation, MU, ICD-10, etc.
   • Refused to work a 50-hour week practicing medicine and give another 30+ hours to manage all the changes necessary for their practice's EHR implementation
2. The talented specialists who have given up treating patients because of all the red tape and have chosen to be consultants.  Don't get me wrong, I'm a consultant and have no problem with consultants!
   
   • We need those people with years of experience treating patients and mentoring younger docs.
3. The dedicated family practitioners who couldn't make enough money to justify the sacrifices of long hours away from their families and the OBGYNs that stopped practicing because it was made more sense financially to quit medicine than to continue paying their malpractice insurance premiums.

I've had some good and not-so-good physicians treat me over my lifetime, but overall, I've been very lucky to get good care.  But as I look back and realize that the majority of my primary docs have moved on, some retired and some just into new professions, I'd like to say:

"Thank you for helping me or my children when we needed a kind word or medicine in the middle of the night or on a holiday.  Thank you for holding your laughter and smirk when I asked a stupid question you just heard from other patients for the umpteenth time! Thanks for showing up for work even when you didn't feel like it.  That was the day I needed you the most!"

Jonena

TBD Consulting has a proven track record for ensuring staff and physician adoption of EMR/EHR system implementations. Whether you need assistance to create a training department, help your existing training organization meet the needs of the ongoing changes, or simply need "extra hands" to meet your deadlines or ROI goals, please contact Jonena Relth. She and her qualified staff are here to assist you with your organizational development, coaching and training initiatives.

Corporate Office 602-263-1961. Email Jonena today!

Speed and Efficiency versus Cost and Customization

Andrea Morgan, AndreaKnowsEMR.com

Most electronic medical records offer some ability to customize. Some providers take hours to learn about all the possibilities and design a system that replicates their current practices while others want to work with the software as configured by the vendor because that allows for a speedier implementation cycle. Of course there are advantages to each of these options.

The customization route allows providers to gain access to and familiarity with the selected system prior to implementation. That time is often used to examine existing workflows and determine how to best alter the system to reflect current practices. The ability to customize orders, letterhead, user interface and many other components can give providers a sense of comfort and confidence once the system is implemented since they have had some say in development.

Customization takes time. There is no way to avoid meetings, conference calls, analysis, interviews, emails and more meetings in order to get workflows clarified, software changed and tested, changed again and re-tested. Providers have to make the decision and commitment to spend time away from patient care to devote the necessary energy and attention to the process. The feelings of familiarity and comfort are garnered by spending time to get to the perfect balance of customization and cost effectiveness.

Skipping customization (or severely limiting it) has the benefit of speeding up the time between acquisition and implementation. The software can be installed on site with users trained and patients being seen within weeks rather than months. This approach gives users the opportunity to jump right in and begin seeing the increased efficiencies that electronic medical records can bring about. Patient information is readily available and can be utilized by staff to for medical decision making.

Lack of customization often brings about increased frustration however. The way medical practices work varies from office to office, speciality to specialty and in some cases, doctor to doctor within a practice. Using software that hasn’t been customized to address these differences requires that providers change the way they practice medicine. Processes that always seemed straightforward – placing a lab order or writing a letter – may have many more steps than they did previously. Taking the software “as is” means providers must learn to work DAW – dispense as written (in other words, to the software’s specifications as opposed to provider preference).

There are many changes inherent in the implementation of an EMR and even with customization there has to be the expectation that some adjustment and flexibility will be required for all involved. Getting guidance from others who have implemented electronic medical records can be helpful in deciding how much customization to pursue, and when. Spending on advice beforehand can save time, money and frustration during and after the implementation process.

Andrea Morgan is the founder and President of AndreaKnowsEMR.com As an EpicCare Ambulatory Certified technical trainer and consultant with over 15 years of pharmaceutical and EMR training experience, her areas of expertise include project management, curriculum development, and instructor led training as well as providing support to multiple medical specialities before, during and after EMR implementations.

Dear Mr. President

Kerry Willis, MD, www.aihinc.com

Dear Mr. President,

I sense that you are struggling with managing the budget and it seems that you and the MEDPAC committee are having trouble finding ways to save money and increase the value to the system of providing medical care. I have good news . It’s really not all that difficult, and it can be done without cutting the throat of doctors who are currently underpaid by Medicare for their services.

For many years now, healthcare providers have taken advantage of a loophole in the payment rules and allowed hospitals to bill for their services. These services are identical to services provided by other physicians except that they are reimbursed at rates varying from 20-150% or more than identical services provided to Medicare beneficiaries. Apparently a long time ago, someone convinced the government that services provided in a hospital-based clinic were worth more than services provided by private practice physicians and considerations such as regulatory compliance should be an allowable expense to the Medicare system. I personally think this is hogwash and we should have one fee schedule for all physicians. If I have done the math properly, a few hundred billion dollars a year are spent on physician services. If 50% of the physicians in this country now work for hospitals then stopping this horrible overpayment will result in savings of tens of billions of dollars each year and will be more than enough to plug the sustainable growth rates gap without cutting rates for physicians who more than earn their money.

I will admit to being a simple country doctor and high finance isn’t my forte, but I believe this would help fix one of the looming problems in medicine. I am a simple man and I like simple solutions. Another problem with the current Medicare system is the gaming of the observation vs. 1-day admission rules. The current system encourages hospitals to over-document and stretch the rules that are used to review 1-day admissions. Outliers on the high end of costs compose about 3% of claims at some hospitals, but approximately 12-18% of admissions in hospitals are single-day admissions. This low-end anomaly costs the Medicare system hundreds of billions of dollars each year. The RAC system seems to be having a major impact recovering these over-payments. Since I’m a simple guy , I would propose that we pay all hospitalizations under Medicare and Medicaid at observation rates if they last less than 48 hours. The savings will be large and immediate and again in the billions of dollars range.

A similar problem is patients who are readmitted within 30 days. Eliminate the first-day charge differentials for all these admissions and require a comprehensive plan for avoiding these admissions at all at each facility providing acute care hospital services to patients. The personnel who are charged with gaming the observation rules can be refocused on managing patients for a revenue neutral proposal for the hospitals. Again the savings would be substantial since 20-30% of Medicare beneficiaries admitted to the hospital are readmitted within 30 days. A more reasonable rate of 10% should be easily achievable and create large savings for the Medicare program.

As I suggested, it’s not all that hard to create savings for services that are over-compensated and continuing to pay other physicians at fairer rates. I might point out that we have studied and have established that medical homes provide higher quality and better valued services to Medicare beneficiaries than non-medical home practices. Perhaps rather than experimenting with someone’s pipe-dreams, we should establish criteria for being a medical home and establish a fee schedule with savings from the above suggestions to fund this change and create more savings for the Medicare system. I’m not against experiments but perhaps we should go with tried and proven rather than follow the drug-induced whims of policy wonks who have no clue about how to fix the problems in medicine.

Mr. President, I hope my suggestions are helpful to you and lead you to better solutions that some of the Alice in Wonderland suggestions that have been provided by other advisors to you.

Lastly, I’d like to point out that Medicare, as it has been modified and added to, is a failed system. We need to reexamine the system in terms of current research and alter the program to correct design flaws to prevent costs of not being able to afford quality primary care services. Instead of a confusing 20% after meeting a deductible after allowable charges scheme, perhaps we should adopt the Federal employees and Medicare Advantage model and move to a no deductible co-pay system so patients know how much they owe and offices can easily explain the charges and owed amounts to the patient. By increasing access to quality primary care we should eb able to manage conditions and avoid unnecessary costs to the system such as ED visits and emergency admissions for UTIs and problems that can be easily managed as an outpatient. This increase in quality primary care costs should lead to a decrease in avoidable medical procedures such as cardiac services and cancer care that are largely avoidable or have the ability to be much less than current incidence rates of these conditions.

I realize that we will never eliminate all problems but correcting design problems in our current system would go a long way to fixing the problems. I hope my suggestions have been useful to you. They are a result of a medical career spanning 26 years in a rural area that have exposed me to a number of experiences that have shaped my thoughts. If I can ever help you or provide further information on my thoughts to you, please feel free to contact me.

Sincerely yours,

Kerry A Willis MD

P.S. I’m still waiting to hear from you.

Dr. Willis is a practicing family physician in Beaufort, NC, where he founded East Carteret Family Medicine. He currently serves as Chairman and CEO of the largest and oldest self-sustaining physician-led network in NC, The Beacon Company, and Chief Operating Officer of Atlantic Integrated Health (AIH). A true believer in the need for healthcare reform, Dr. Willis believes that the best solutions will be community-based and provider-directed and are aimed at improving the affordability and accessibility of medical care by reforming the healthcare delivery. The need to consider new models that are patient-centered and eliminate many of the moving parts that cause waste are the driving goal for Dr. Willis and his organization.

Too Many Moving Parts

We would like to introduce our newest Healthcare blogger, Dr. Kerry Willis.  Dr. Willis is a practicing family physician in Beaufort, NC, where he founded East Carteret Family Medicine. He currently serves as Chairman and CEO of the largest and oldest self-sustaining physician-led network in NC, The Beacon Company, and Chief Operating Officer of Atlantic Integrated Health (AIH). A true believer in the need for healthcare reform, Dr. Willis believes that the best solutions will be community-based and provider-directed and are aimed at improving the affordability and accessibility of medical care by reforming the healthcare delivery. The need to consider new models that are patient-centered and eliminate many of the moving parts that cause waste are the driving goal for Dr. Willis and his organization.

Kerry Willis, MD, www.aihinc.com

I look at our government and realize there are too many moving parts to fix when there are problems. For several years I have wondered why we tolerate a tax code that includes enough words to fill up a large room with its volumes. I have considered the irony of a tax code that forces me to pay someone to tell me how much I owe the government and realized that our system has gotten way too complicated. Is it any wonder that healthcare has the same problems? We have too many moving parts and every solution is a brazintine collection of new programs and rules designed to replace the last mistake that was made by our government. If I express that I have little faith that the current experiments will provide improvement in a system that expends large amounts of money to provide care, would you call me cynical?

Recently I became enamored with the idea of examining the costs of our current system. I found that we spend billions of dollars to train people to become physicians like me. I also found that on average I spend 25% of my time on tasks that have nothing to do with taking care of patients that are usually related to the pipedreams of a somewhere MBA. He believes he needs more data or has convinced someone that his plan to control my behavior would result in a savings in healthcare expense. Funny thing, I’m smart enough to get into medical school but can easily be manipulated by a clerk with a 6-week training course in prior approvals. Healthcare is in need of proven models and the end of grand experiments. Healthcare needs a close examination of the costs and motivations for care to be provided.

We do have proven models that have demonstrated a cost savings while increasing the quality of care provided. It’s called the Patient Centered Medical Home (PCMH). We can reward practices for moving to this model and save money and improve the quality at the same time. We have trials and data and savings demonstrated everywhere the model has been tried. It’s portable, accessible and easy to understand and implement. And it’s being ignored in favor of ACOs where we have no data and no savings and no one is quite sure what they are or how they work. Why because the powers that are CMS didn’t think of PCMH.

Healthcare is in need of a dramatic simplification. We have too much expense tied up in claims processing and administrative tasks to properly restructure the system. The over-reliance on claims processing and large insurance systems/companies along with a lack of leadership for fixing the problems that exist have brought us to this place. Happily abandoning claims expense in favor of quality reporting from PCMH and leadership that demands real solutions to actually fix abuses of these system will lead us out of this place. All that is needed is the resolve to change.

Boomer Doc Put on Leave for Not Meeting EHR Performance Requirements

Jonena Relth, TBD Consulting

Dean Olson of the State Journal-Register in Springfield, IL, wrote an article recently about a 63-year-old family practice physician who has been put on paid leave because his performance does not meet Memorial Health's EHR use requirements.

While there appears to be other mitigating reasons for this physician being placed on leave for not keeping up with his patient load while using an EHR, I think this is the tip of the iceberg of legal issues that will surely follow the huge change from paper to paperless medicine.

This is not surprising, is it? We see this with all major changes in organizations. I'm guessing that there are many more docs and nurses retiring or finding work elsewhere rather than being fired.

Changing from paper to paperless is difficult for many healthcare professionals, especially if they have to choose between changing the way they've been practicing medicine for 30 years or learning a whole new way of doing their work. And yes, to some, using an EMR means learning to use a computer, etc. While this may seem incredulous to some, I see this in my EMR/EHR implementations all the time - enough so that we've written and conducted many training sessions on "Using a Mouse."

Sadly, if moving to EHR/EMR is not handled properly with proven change management strategies, we'll be losing many more docs and nurses by dismissal and/or retirement.

Jonena

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