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HD Download: Top Questions From Physicians About Clinical Integration

Posted by Matthew Smith on Aug 21, 2014 4:14:00 PM

FAQ, Clinical IntegrationClinical Integration programs unite physicians for the purpose of delivering higher quality health outcomes. Payers in certain markets reward systems with Clinical Integration programs due to the savings created by better population health management. Physicians are sometimes reluctant to join Clinical Integration programs and appropriately ask “What’s in it for me?” 

While our previous article, titled "5 Incentives for Enlisting Physicians in a Clinical Integration Program" examined the "What's in it for me" question, we received some great feedback asked for more answers to commonly received questions. This FAQ will help you communicate the value and details of clinical integration and a clinically integrated network to your physicians. If you're a physician, these questions and answers should help you with some recurring and nagging questions.

Top Questions Include:

  • What’s driving the movement toward clinical integration?
  • What is the purpose of the clinically integrated network?
  • What are the benefits of joining?
  • Who can join?
  • Do physicians join as individuals, or do all the physicians in a practice need to join?
  • What type of data is monitored?
  • How will clinicians submit data to the network?
  • What is the difference between a Clinically Integrated Network and an Accountable Care Organization (ACO)?
  • and more.

Do you have a question that is not included in the FAQ? Feel free to share your question in the comments section and we will address these in a follow-up document.

To download the FAQ, simply click on the button, below:

FAQ_Button_Orange.png

Topics: ACO, Clinical Integration, Hospitals, Clinically Integrated Care, FAQ, Physicians

New Infographic Examines Physicians’ Salaries in 2014

Posted by Matthew Smith on Aug 13, 2014 3:37:00 PM

Physician Salary, Affordable Care ActThere are a lot of great take-aways in Medscape's 2014 Physician Salary Report and resulting infographic, including data related to:

  • Ways doctors are managing their income
  • The impact of the Affordable Care Act
  • Income gender disparity
  • Career satisfaction

Many physicians are becoming more proactive in managing their incomes by being more selective about insurers and patients and providing ancillary services. In addition, a small but growing number of physicians are moving toward cash-only practices.

To view a larger version of this image, please click here.

Physician Compensation, Medscape

Topics: Infographic, Affordable Care Act, Salaries, Salary, Medscape, Career Satisfaction, Physicians

Building the Four Pillars of Clinically Integrated Care

Posted by Matthew Smith on Jul 28, 2014 1:19:00 PM
By Daniel J. Marino,
President/CEO, Health Directions

4 Pillars of Clinical Integration

Government and private insurers are gradually moving away from encounter-based reimbursement and rapidly developing new payment models that reward coordination of care and population health management. How should healthcare leaders respond? As always, there are options.

The first option is to do nothing. Both hospitals and physicians can maintain current strategies based on fee-for-service payment, avoid the up-front costs of care coordination — and tolerate declining reimbursement. Physicians will take home less pay, and hospitals will see their margins shrink.

The next option for hospitals and physicians is to work on improving care coordination, but within their respective silos. A hospital could use quality methodologies and technological tools to improve coordination of inpatient care. A physician group could develop a medical home model to coordinate care within its practice population. "Siloed coordination" will enable each party to leverage gains in payor contracting. Hospitals will be able to point to cost reductions, and physicians will be able to tout better chronic disease outcomes. The problem is that neither the hospital nor the physicians will realize the benefits of fully coordinated patient care. Their opportunities for success under value-based contracting models will be limited.

That brings us to the last option: clinical integration between hospitals and physicians. Clinical integration offers both parties the opportunity to coordinate patient interventions, manage quality across the continuum of care, move toward population health management and pursue true value-based contracting.

Unfortunately, the path to clinical integration is far from clear. The best strategy is to build a platform for hospital-physician collaboration that is flexible enough to support a broad range of possible futures. Right now, leading healthcare organizations are creating this versatile platform by focusing on the four "pillars" of clinical integration.

Clinical Integration Collaboration1. Collaborative Leadership

The first pillar of clinical integration is a shared governance body with strong physician leadership. Getting governance right is critical for three reasons.

First, if a clinical integration initiative will include independent physicians, it needs to have a legal structure for contracting with payors and, in turn, paying physicians based on outcomes, not referrals. To be acceptable under Federal Trade Commission standards, a clinically integrated organization must be an independently governed entity with the objective of improving population health through coordinated programs and interventions.

Second, clinical integration requires collaboration on payor strategy. The scope goes beyond the typical Physician-Hospital Organization. The focus is on achieving clinical outcomes that can serve as value drivers within risk-based and pay-for-performance contracting models. Only a strong physician-led governance body will be able to create the clinical strategies required to pursue risk-based or value-based contracts with commercial payors, develop innovative care contracts with employers and take advantage of accountable care opportunities in the Medicare Shared Savings Program.

Third, clinical integration requires a strong physician-led governing structure for driving cultural change. For a clinically integrated organization to be successful, physicians must transition away from the fee-for-service mindset. This includes adopting new behaviors that align with outcomes-based reimbursement, such as collaborating across specialties, sharing information, managing utilization and providing proactive care. Educating providers on clinical integration concepts, including innovative care delivery models and tracking of clinical quality outcomes, is what allows community physician members to understand the value of participation.

2. Aligned Incentives

Hospitals and physicians share many goals, but their priorities often diverge. It is essential that clinically integrated organizations develop structures that align goals and incentives across the entire spectrum of providers.

Clearly, physician compensation is an important tool. Clinically integrated organizations must design incentive plans that not only encourage productivity, but reward physician efforts to achieve shared goals in care, quality and cost control.

But compensation design is not enough to ensure strong performance. Organizations need to create support structures to help physicians understand and work toward performance objectives:

Develop a plan for communicating strategies and decisions to the entire organization.
Assign staff and resources to physician education and office staff training.
Develop a provider scorecard that keeps physicians oriented toward improving clinical outcomes and controlling costs.

Supporting all of these efforts, leaders need to build a financial infrastructure to guide overall decision making. One key priority is to develop a risk-based cost model that links patient care costs to interventions and quality outcomes. Finance leaders will also need to begin engaging with payors to explore and negotiate risk-based contracts and develop a physician performance incentive fund.

3. Clinical Programs

The heart of clinical integration is care coordination. Greater coordination between providers will improve patient outcomes and wring costs out of the system by optimizing care transitions, reducing redundant testing and providing better management of patients with multiple complex co-morbidities and diagnoses.

To launch a care coordination strategy, begin by creating clinical programs that target major opportunities in care improvement. Initial areas of concentration may include:

High-risk patients (for example, diabetics with multiple co-morbidities such as hypertension or heart failure)
Cost-control opportunities (like generic prescribing and MRI utilization review)
Key public health initiatives (such as smoking cessation and depression screening)

The next step is to develop appropriate clinical performance measures. For example, an asthma care program could track asthma control rates, screening frequency and percentage of patients with an up-to-date asthma action plan. The program could also track cost measures such as drug expenses, physician visits and emergency room visits.

Clinical programs should also develop care plans that define care protocols for various conditions. Program leaders can use process mapping to create care pathways that encompass ambulatory, inpatient, post-acute and home health interventions. Care gaps reports can be created to identify opportunities to enhance delivery of patient care according to care protocols and measure clinical care performance by care setting.

Physicians who are used to encounter-based reimbursement need guidance on how to be successful within a clinically integrated initiative. Support should focus on helping physicians manage patients within care plans through the use of care coaches and care coordination tools. Many physicians will also need coaching on how to incorporate nurses, dietitians and other support providers into care efforts aimed at managing the patient outside the traditional office setting.

Proactive medicine is key. Traditionally, a physician knows that a patient has a problem only when the patient comes in for an appointment. The success of clinical integration will hinge on physicians' ability to anticipate and prevent patient problems. To do this, physicians will need to incorporate care gap reports into clinical care and adopt new processes — for example, assigning a nurse to call patients with high-risk diabetes to ensure hemoglobin A1C is reported according to the defined diabetic clinical treatment protocol.

4. Technology Infrastructure

New connectivity and point-of-care tools make hospital-physician collaboration more possible than ever. The risk is overspending on technology and under-delivering on functionality. The key to avoiding these problems is to create a focused IT investment strategy.

The first priority is to invest in technologies that support coordination of care. One approach is to develop a health information exchange that connects ambulatory electronic medical records (of both employed and independent physicians), the hospital EMR, pharmacy information systems, labs, etc. The goal is to create a patient longitudinal record that allows physicians, nurses and other providers across the care community to track patient care in every setting.

Next, begin investing in technologies that support population health management. A clinically integrated organization needs to be able to aggregate and analyze clinical data so it can identify performance shortfalls and strategize improvements. Stage 1 meaningful use data from the ambulatory EMR and Physician Quality Reporting System can serve as a starting point, but to achieve significant gains in quality and cost, the organization needs comprehensive clinical and claims data from disparate information systems. The solution is to create a disease registry, a database that enables an organization to capture information from various provider systems and sources. The key is to incorporate a tool that allows the clinically integrated organization to run performance analytics on clinical programs, care settings, provider performance and cost utilization.

Clinically integrated organizations should also invest in technologies for connecting patients. Patient electronic engagement — via patient portals and secure messaging — is a requirement under stage 2 meaningful use. Beyond the requirements, organizations should explore patient portal and personal health record technologies for involving patients more deeply in clinical programs.

Tying it all Together

The overall goal of the four-pillar platform is to link clinical outcomes to cost management with the aim of negotiating value-based payor contracts. In light of this goal, clinically integrated organizations need to be able to aggregate data for the entire network and compare outcomes to community performance.

For example, a clinically integrated organization might set the goal of reducing high-risk diabetic patients from 12 percent to 8 percent of its patient population, compared to a community-wide rate of 10 percent. If the organization can achieve this outcome and demonstrate it with valid data, it will be in a position to negotiate favorable risk-based or shared savings performance contracts that enhance revenue and drive patient volume.

Looking Ahead

While both hospitals and physicians have several options for taking advantage of new payment models, clinical integration represents the best opportunity for both parties. The key to success is a flexible strategy that emphasizes effective governance, aligned incentives, clinical programs and appropriate technology.

None of these pillars can be built overnight, but leading organizations are making steady headway in each area. Clinical integration is not a project with a defined endpoint, but an evolution that will require ongoing attention, quality improvement, resources and leadership.

 

Clinical Integration, Health Directions, Population Health

 

Daniel J. Marino, CIN, Clinically Integrated Networks; As President/CEO of Health Directions, Daniel J. Marino shapes strategic initiatives for healthcare organizations and senior health care leaders in key areas such as population health management, clinical integration, physician alignment, and Health IT. With a broad background in all aspects of practice management and hospital/ physician alignment, Dan is nationally recognized as a strategic leader in Accountable Care Organizations and clinical integration development. He frequently speaks at national conferences and regularly authors articles for the nation’s top healthcare industry publications related to current transformations in healthcare delivery. Dan may be reached via email at [email protected] or by phone at 312-396-5400.

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians

Infographic: Can the EHR Save Private Practice?

Posted by Matthew Smith on Oct 30, 2013 12:52:00 PM

EHR, EMR, Medical practiceIn the past few years, some studies have suggested that private practices--especially those with fewer than 10 providers -- are on the way out. One study reported in JAMA Internal Medicine suggested a steady decline of 2% a year. However, other recent surveys show that this isn't the direction that providers want to go in, and it isn't what patients want.

Undoubtedly, there are many challenges that stand in the way of maintaining practice autonomy, but with the right tools it may be possible to thrive and grow--and part of the solution is technology. While many physicians in practices with five providers or fewer are still hesitant to adopt and EHR (only about 50% have an EHR today), the potential benefits are indisputable as shown in this infographic.

EHR, Private Practice, EMR, Electronic Medical Records

Source: Getting Paid

Independent Practice, Independent Physician, Physician Practice, Allied Physician

Topics: EHR, EMR, Electronic Health Records, Patient Records, Physicians, Independent Practice

Ten Benefits Resulting from Clinical Integration

Posted by Matthew Smith on Aug 29, 2013 9:00:00 AM

Clinical Integration, Top 10, TenIn today's health care landscape, there are a wide-range of approaches and strategies employed to achieve successful clinical integration (“CI”). Regardless of the strategy, when designed and implemented correctly, CI offers tremendous potentials for efficiencies and improvements in health care quality and patient satisfaction.

Here are 10 identified benefits of CI to consider when exploring your CI options and feasibility:

  1. Increased Collaboration: The use of care teams to implement a CI program addresses gaps in the care continuum while reducing ineffective or unneeded process steps. This approach allows hospitals and health care providers to learn to operate as a team to better align, or realign, their efforts to improve quality, patient safety, and patient and family satisfaction.
  2. Improved Efficiency: CI eliminates health care waste and redundancy, making it possible for hospital systems to provide patients focused seamless systems of care across and between health care providers.
  3. Integrated Systems: CI programs provide hospital systems with many more monitoring and enforcement tools than through a typical medical staff organization, including the payment of financial incentives for physicians who actively participate in the program and penalties for those who do not.
  4. Payer Partnerships: As CI improves the quality of patient care and clinical processes and reduces costs, hospitals are able to achieve market differentiation. This type of differentiation is attractive to health plans and can serve as the catalyst for payer partnerships.
  5. Improved Care Management: Organizations that are successfully clinically integrated benefit from improved care management. Patients who see multiple doctors are well aware of the fragmented and redundant services and care they receive. Case management serves as the foundation to accomplish coordination of care across traditional health settings. Its goal is to achieve the best clinical and cost outcomes for both patient and provider and is most successful when case managers are able to work within and outside organized health systems.
  6. Integrated Continuum of Care: At the center of CI is teamwork among health care providers working to ensure patients get the right care at the right time in the right setting. CI care management teams collaborate with adult day care, independent living, assisted living, and skilled nursing facility partners. Together, with infrastructure focused on supporting caregivers and patients to efficiently assess, document, communicate, and meet patient needs enables hospital systems and health care networks to achieve this core objective.
  7. Clinical Data Systems: An integrated technology (“IT”) platform that supports continuity of care and enables access to medical history and critical patient data for all stakeholders is imperative in CI, easing communications across the care continuum and providing information that measures service, performance, quality, and outcomes on an individual provider and network-wide basis.
  8. Patient-centered Communication: In many networks, communication skills training is provided to physicians and health care providers with the goal of establishing clear channels of communication as a vital part of the CI program. The Joint Commission has cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. The CI emphasis on timely and clear communication is key to influencing patient behavior, resulting in cost/quality benefits.
  9. Improved Pharmaceutical Management: Most medication errors are not caused by individual carelessness, but rather by faulty processes that lead people to make mistakes or fail to prevent the mistakes. CI improves pharmaceutical management allowing hospitals to identify gaps in the medication management process and allow them to take actions to help make patients safer.
  10. Improved Health of the Community: CI emphasizes wellness initiatives such as outreach programs and classes to empower the patient with tools, knowledge, and practical solutions to participate actively in their care, ultimately leading to a healthier population. Extensive research in the past three decades indicates that receiving wellness and prevention advice and care from trusted local hospitals and physicians resonates with individuals.
Clinical Integration, Health Directions

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

Study Shows Growth of Primary Care Provider Pay Tied to Quality

Posted by Matthew Smith on Jul 5, 2013 10:34:00 AM

Physician CompensationWhile a new survey indicates that a small percentage of both primary care and specialist pay is tied to quality and patient metrics, it could be growing in the future.

For the first time in over 35 years of surveying physicians, the Medical Group Management Association (MGMA) included questions on quality and patient satisfaction metrics on its latest annual compensation survey, according to MGMA director of data solutions, Todd B. Evenson.

"Obviously, under the ACA and other value-based reimbursement that we see in the future, we'll see [quality metrics] as increasingly important components of physician compensation models," said Evanson. "So we felt that it was very important to begin that process to highlight how compensation plans are being changed based upon those changes to reimbursement models."

The "Physician Compensation and Production Survey: 2013 Report Based on 2012 Data," which surveyed over 60,000 physicians and nonphysician providers, found that primary-care physicians reported 3 percent of total compensation tied to quality metrics, while specialists reported 2 percent of compensation.

While this number is relatively small, MGMA president and CEO, Susan L. Turney, MD, said in a statement, "It's encouraging to see physician practices invested in patient-centered care and continuing to seek ways to better incorporate quality and experience into compensation methodologies."

Mary Barber, vice president of physician recruitment and retention firm, Cejka Search, agrees.

"We do see signals that these components [patient satisfaction and quality measures] will be growing in significance and proportion to total compensation. Primary-care physicians will be positioned as the care quarterback for their patients from an outpatient basis. And, in fact, physicians are positioned to lead and their compensation will reflect that reality," said Barber in an e-mail to Physicians Practice.

In the Physician Retention Survey 2011, the American Medical Group Association and Cejka Search asked physicians "what minimum percentage of incentive compensation is required to drive desired changes in practice outcomes for [quality measures]." Fifty-one percent of respondents felt that 3 percent or 5 percent of incentive compensation was sufficient to drive quality measures in their practices.

Evenson noted that while practices are already moving in the direction of patient-centered care and reimbursement contingent on quality measures, e.g. PQRS and e-prescribing programs, very often they are limited by the amount of funds available for that purpose. However, through the expansion of government initiatives like the EHR Incentive Programs, physicians are being paid for meeting quality measures like meaningful use, which, he said, could help them expand their own quality programs.

So while these metrics directly affect physician compensation, it will be a practice-wide effort, added Evenson, driving stronger relationships between physicians and staff.

"The administrative and support staff team will have a larger role ultimately in delivering that satisfying experience for the patient," he said. "As a result, it will be critically important for the physician and the administrator to develop a stronger relationship to be successful at that."

The MGMA survey also reported that the growth of physician compensation was relatively flat during the period 2011-2012, with a modest 5.6 percent increase for select primary-care specialties. Annual median compensation in 2012 was reported for selected specialties.

• Family Practice (without OB/GYN) — $207,117

• Pediatric/Adolescent Medicine ― $216,069

• Internal Medicine ― $224,110

• Obstetrics/Gynecology ― $301,737

• Cardiology Invasive ― $532,269

Topics: ACA, Primary Care, Physicians, Specialists, Accountable Care Act

Study Cites EHR Meaningful Use Challenges; Praises Adoption Progress

Posted by Matthew Smith on Jun 10, 2013 1:24:00 PM

EHR, EMR, Meaningful Use, Annals of Internal MedicineThe task of automating America's health care system via physicians' use of electronic health record (EHR) technology is progressing but far from finished. That's the conclusion offered by authors of a new study in the June 4 issue of Annals of Internal Medicine.

According to the article, "Meeting Meaningful Use Criteria and Managing Patient Populations: A National Survey of Practicing Physicians," U.S. physicians are embracing EHRs in increasingly high numbers, but as recently as 2012, few physicians could meet the objectives set forth in stage one of the federal government's EHR meaningful use (MU) program. 

In fact, of 1,820 primary care and subspecialty physicians in office-based practices who responded to the survey, 43.5 percent reported having a basic EHR, but only 9.8 percent said they had achieved MU. Fewer than half of the respondents said their EHR systems were capable of performing any of the patient population management tasks included in the survey. 

The results didn't surprise study co-author Michael Painter, M.D., J.D., a family physician and senior program officer at the Robert Wood Johnson Foundation, which partnered with the Commonwealth Fund to fund the independent assessment of the nation's progress in adopting EHR technology. "Transformation is incredibly hard, but our family docs -- and everybody else -- are doing a heroic job at adopting and then learning to use this new technology," said Painter. 

EHRs are a tool that can be used to automate America's health care system -- an absolutely necessary process, according to Painter. Pulling an EHR out of a box is just the first step, said Painter. The real magic is in learning to use EHRs to perform key tasks, such as managing patient populations and generating quality metrics. 

"Yes, we're having steady sustained increases in adoption, and that's exactly what we wanted to see," said Painter. "But what we really want is the transformation process."

Study Highlights

In addition to answering questions about national trends in EHR adoption and determining how many physicians were able to meet MU criteria, researchers also wanted to know which MU measures were most difficult for physicians to meet and whether physicians were able to use their EHRs to manage the health of their patient populations. 

According to survey results, physicians most commonly used their EHRs to

  • view lab results,
  • order prescriptions electronically,
  • view radiology and imaging results, and
  • record clinical notes.

On the other hand, physicians were least likely to use an EHR to

  • exchange patient clinical summaries and lab and diagnostic test results with clinicians outside the office,
  • generate quality metrics, and
  • provide patients with post-visit summaries and copies of their personal health information.

As for meeting MU criteria, 11.2 percent of primary care physicians had done so compared with just 7.6 percent of subspecialists. 

Among primary care physicians, 40.5 percent had between eight and 10 MU functions available via their EHRs compared with 36.5 percent of subspecialists. Nearly equal proportions of primary care physicians and subspecialists reported having no MU functions (14.6 percent and 12 percent, respectively). 

The authors noted that "computerized systems for patient panel management and quality reporting do not seem widespread, and, where they are implemented, physicians reported that they are not always easy to use." For example, fewer than half of physicians could generate lists of patients by diagnosis. Furthermore, only about one-third of physicians could

  • track referral completion,
  • generate reports on quality of care,
  • send patient reminders for preventive or follow-up care,
  • pull names of patients who missed appointments or were overdue for care,
  • create patient lists by lab results, and
  • provide patients with after-visit summaries.

Physician responses regarding ease of use of patient-management functions varied, but nearly half of physicians said they could not, or found it very or somewhat difficult to, perform many of the above functions.

Moving Forward

Researchers concluded that the study results held implications for federal policy, particularly in light of MU bonus payments doled out to more than 145,000 health care professionals and totaling more than $3.9 billion through September 2012. 

"The pace of adoption of basic EHRs seems to be increasing, and findings around availability and perceived ease of use of systems that can help to manage patient populations should be of concern to policymakers," said the authors. "Using EHRs as simple replacements for the paper record will not result in the gains in quality and efficiency or the reduction in cost that EHRs have the potential to achieve." 

However, Painter focused on the positive. He pointed out that although just 10 percent of physicians in the study had met MU criteria, "the number who are really close is really big -- almost 40 percent. It's 40 percent for primary care physicians and almost 40 percent of (sub)specialists, and that's a big deal."

In addition, Painter said he would expect that a good number of physicians would have "tipped over" into actually meeting the criteria if they were surveyed now. He predicted that when the already written and approved MU stage two rules take effect in mid-2014, physicians would "blow right past those because they're going to need -- and want -- to use those population tools and quality metric tools." 

Painter, who saw patients in private practice from 1995 to 2003, urged his family physician colleagues to beat back discouragement. "It's really hard to practice primary care right now. It's slow going, but we are making progress," he said. "The best developers are going to try to develop things that physicians just love to use, but we're not there yet. We can't go back, because we can't get to where we need to be with health transformation without automating all these information processes." 

However, physicians can help move things along by being very vocal with health information technology developers about what they need in EHR systems to get the greatest results possible, he added.

Electronic Health Records EHR Assessment

Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians, New Study

New Studies Explore How EHR Use Influences Physician Behavior

Posted by Matthew Smith on May 30, 2013 3:02:00 PM

NewStudyJPG resized 600Two separate studies published this week examined the effect of electronic health record systems use on physician behaviors.

EHR Alert Fatigue Study

Clinicians might ignore positive alerts from EHR systems because of a deluge of repetitive, inappropriate alerts, according to a case report published this week in PediatricsMedscape reports.

Researchers from Stanford University Department of Biomedical Informatics and Harvard Medical School examined the case of a two-year-old boy who died after clinical staff overrode EHR alerts about potential drug allergy cross-reactivity. Prior to inappropriately administering a diuretic to the patient, the clinical staff overrode more than 100 alerts over the course of one month.

"Excessive electronic alerts warning clinicians of potential but rare adverse drug cross-reactions result in increased patient safety risks by rendering these alerts meaningless," the authors wrote, adding, "The threat of missing a rare event must be balanced with the dangers of burdening clinicians with unnecessary and interruptive electronic alerts."

In an accompanying editorial, Stephen Lawless -- with the Nemours/Alfred I. duPont Hospital for Children -- wrote EHR alerts "should neither replace nor minimize accountability that occurs through daily physical examination and reassessments."

Lawless concluded, "If the reliance on alerts results in either the purposeful or fatigue-induced deterioration of clinical assessment and decision-making skills, then alternative messaging techniques should be sought and studied" (Brown, Medscape, 5/28).

Provider Reliance on EHRs Study

Physicians might rely less on EHRs because they accept medical uncertainty as part of their practice, according to a separate study published in the Journal of the American Medical Informatics AssociationInformationWeek reports.

Based on interviews and observations of 28 doctors at a Texas multispecialty group, researchers organized physicians into three categories:

  • Reductionists: Clinicians who believed that the more information they put into an EHR the less uncertainty felt by physicians and the better care outcomes are;
  • Absorbers: Clinicians who spent less time documenting information and more time talking to patients; and
  • Hybrids: Clinicians who had characteristics of both reductionists and absorbers.

Reductionists used EHR systems the most, while absorbers used EHRs the least, the study found.

Those seeking to reduce uncertainty believed documentation through the EHR could help other providers who might care for the same patient.

In comparison, absorbers believed their conversations with patients were the most important tool for diagnosis and treatment.

Whether a physician was tech savvy did not necessarily predict his or her use of EHRs, study authors noted.

Lead author Holly Lanham--assistant professor of medicine at the University of Texas Health Science Center at San Antonio--said, "Uncertainty reduction is helpful, and IT is already designed to help us with that. What I'm hoping is that the finding of this paper will encourage EHR developers and policy makers to recognize that uncertainty is inevitable and figure out how to help doctors and nurses cope with that uncertainty" (Terry, InformationWeek, 5/28).

Topics: EHR, EMR, Electronic Health Record, EHR Adoption, Physicians, New Study

Launching Your Clinical Integration Program: 10 Defined Benefits

Posted by Matthew Smith on May 15, 2013 3:46:00 PM

Clinical Integration, Program LaunchIn today's healthcare landscape, there are a wide-range of approaches and strategies employed to achieve successful clinical integration (“CI”). Regardless of the strategy, when designed and implemented correctly, CI offers tremendous potentials for efficiencies and improvements in healthcare quality and patient satisfaction.

Here are 10 identified benefits of CI to consider when exploring your CI options and feasibility:

1. Increased Collaboration: The use of care teams to implement a CI program addresses gaps in the care continuum while reducing ineffective or unneeded process steps. This approach allows hospitals and healthcare providers to learn to operate as a team to better align, or realign, their efforts to improve quality, patient safety, and patient and family satisfaction.

2. Improved Efficiency: CI eliminates healthcare waste and redundancy, making it possible for hospital systems to provide patients focused seamless systems of care across and between healthcare providers.

3. Integrated Systems: CI programs provide hospital systems with many more monitoring and enforcement tools than through a typical medical staff organization, including the payment of financial incentives for physicians who actively participate in the program and penalties for those who do not.

4. Payer Partnerships: As CI improves the quality of patient care and clinical processes and reduces costs, hospitals are able to achieve market differentiation. This type of differentiation is attractive to health plans and can serve as the catalyst for payer partnerships.

5. Improved Care Management: Organizations that are successfully clinically integrated benefit from improved care management. Patients who see multiple doctors are well aware of the fragmented and redundant services and care they receive. Case management serves as the foundation to accomplish coordination of care across traditional health settings. Its goal is to achieve the best clinical and cost outcomes for both patient and provider and is most successful when case managers are able to work within and outside organized health systems.

6. Integrated Continuum of Care: At the center of CI is teamwork among healthcare providers working to ensure patients get the right care at the right time in the right setting. CI care management teams collaborate with adult day care, independent living, assisted living, and skilled nursing facility partners. Together, with infrastructure focused on supporting caregivers and patients to efficiently assess, document, communicate, and meet patient needs enables hospital systems and healthcare networks to achieve this core objective.

7. Clinical Data Systems: An integrated technology (“IT”) platform that supports continuity of care and enables access to medical history and critical patient data for all stakeholders is imperative in CI, easing communications across the care continuum and providing information that measures service, performance, quality, and outcomes on an individual provider and network-wide basis.

8. Patient-centered Communication: In many networks, communication skills training is provided to physicians and healthcare providers with the goal of establishing clear channels of communication as a vital part of the CI program. The Joint Commission has cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. The CI emphasis on timely and clear communication is key to influencing patient behavior, resulting in cost/quality benefits.

9. Improved Pharmaceutical Management: Most medication errors are not caused by individual carelessness, but rather by faulty processes that lead people to make mistakes or fail to prevent the mistakes. CI improves pharmaceutical management allowing hospitals to identify gaps in the medication management process and allow them to take actions to help make patients safer.

10. Improved Health of the Community: CI emphasizes wellness initiatives such as outreach programs and classes to empower the patient with tools, knowledge, and practical solutions to participate actively in their care, ultimately leading to a healthier population. Extensive research in the past three decades indicates that receiving wellness and prevention advice and care from trusted local hospitals and physicians resonates with individuals.

Clinical Integration, Launching a CI Program

Topics: Clinical Integration, Hospitals, Clinically Integrated Care, Physicians, Population Health Management

10 Reasons Your Organization Needs a Clinical Integration Strategy

Posted by Matthew Smith on Apr 29, 2013 1:08:00 PM

Clinical IntegrationIn today's healthcare landscape, there are a wide-range of approaches and strategies employed to achieve successful clinical integration (“CI”). Regardless of the strategy, when designed and implemented correctly, CI offers tremendous potentials for efficiencies and improvements in healthcare quality and patient satisfaction.

Here are 10 identified benefits of CI to consider when exploring your CI options and feasability:

1. Increased Collaboration: The use of care teams to implement a CI program addresses gaps in the care continuum while reducing ineffective or unneeded process steps. This approach allows hospitals and healthcare providers to learn to operate as a team to better align, or realign, their efforts to improve quality, patient safety, and patient and family satisfaction.

2. Improved Efficiency: CI eliminates healthcare waste and redundancy, making it possible for hospital systems to provide patients focused seamless systems of care across and between healthcare providers.

3. Integrated Systems: CI programs provide hospital systems with many more monitoring and enforcement tools than through a typical medical staff organization, including the payment of financial incentives for physicians who actively participate in the program and penalties for those who do not.

4. Payer Partnerships: As CI improves the quality of patient care and clinical processes and reduces costs, hospitals are able to achieve market differentiation. This type of differentiation is attractive to health plans and can serve as the catalyst for payer partnerships.

5. Improved Care Management: Organizations that are successfully clinically integrated benefit from improved care management. Patients who see multiple doctors are well aware of the fragmented and redundant services and care they receive. Case management serves as the foundation to accomplish coordination of care across traditional health settings. Its goal is to achieve the best clinical and cost outcomes for both patient and provider and is most successful when case managers are able to work within and outside organized health systems.

6. Integrated Continuum of Care: At the center of CI is teamwork among healthcare providers working to ensure patients get the right care at the right time in the right setting. CI care management teams collaborate with adult day care, independent living, assisted living, and skilled nursing facility partners. Together, with infrastructure focused on supporting caregivers and patients to efficiently assess, document, communicate, and meet patient needs enables hospital systems and healthcare networks to achieve this core objective.

7. Clinical Data Systems: An integrated technology (“IT”) platform that supports continuity of care and enables access to medical history and critical patient data for all stakeholders is imperative in CI, easing communications across the care continuum and providing information that measures service, performance, quality, and outcomes on an individual provider and network-wide basis.

8. Patient-centered Communication: In many networks, communication skills training is provided to physicians and healthcare providers with the goal of establishing clear channels of communication as a vital part of the CI program. The Joint Commission has cited communication breakdown as the single greatest contributing factor to sentinel events and delays in care in U.S. hospitals. The CI emphasis on timely and clear communication is key to influencing patient behavior, resulting in cost/quality benefits.

9. Improved Pharmaceutical Management: Most medication errors are not caused by individual carelessness, but rather by faulty processes that lead people to make mistakes or fail to prevent the mistakes. CI improves pharmaceutical management allowing hospitals to identify gaps in the medication management process and allow them to take actions to help make patients safer.

10. Improved Health of the Community: CI emphasizes wellness initiatives such as outreach programs and classes to empower the patient with tools, knowledge, and practical solutions to participate actively in their care, ultimately leading to a healthier population. Extensive research in the past three decades indicates that receiving wellness and prevention advice and care from trusted local hospitals and physicians resonates with individuals.

Clinical Integration, Strategy Development

Topics: Clinical Integration, Clinically Integrated Care, Attestation, CI, Coordinated Care, Physicians

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