Friday, August 2, 2013

The Obamacare Health System-Physician Computer Game
“Let’s play a game. Today we are going to pretend you are a Vice President for Medical Affairs, or a Chief of Staff, or a health system CEO about to announce a collaboration with a major health insurer like CMS or a regional Blues Plan. You’ve done your homework, read the journals, listened to the experts, anticipated the future and haven’t applied enough skepticism in reading all those pro-EHR and pro-bundled payment posts on THCB. You really believe payment reform and the EHR are the way to go.
You’ve called a meeting of your organization’s physician staff – the professionals you are counting on, caring for all those patients – and your job is go to the front of the auditorium and convince them that the success of your new venture relies on lowering health care costs with new payment arrangements that align incentives, in tandem with the launch of a new EHR.
Jaan Sidorov, MD, “Managing Physician Skepticism About the Affordable Care Act,” The Health Care Blog, August 1, 2013

This morning I awoke and read the above words of Jaan Sidorov, MD. Sidorov is a primary care internist and former Medical Director at Geisinger Health Plan with over 20 years experience in primary care, disease management and population-based care coordination.
Sidorov’s blog drew 20 responses – some negative, some positive – as befits the controversial Affordable Care Act (ACA) and its emphasis on computerization.   Practicing physicians  often view the ACA witht its computer requirments with skepticism. 

Which is understandable since we all resist change. Also some of its provisions, e.g. electronic health records and Accountable Care Organizations,  transform  their usual way of doing things,  threaten their autonomy, and, in effect, transfer much of their authority to a parent organization, be that hospital employers,  health systems, or a new computer system that disrupting their usual practice patterns.     
With regard to the new computer system, the question becomes,  as Alice in Wonderland said,  “Which is to be master, that’s all.”  
How does one play the Obamacare computer game when talking to physicians within your organization?
Here is a couple of takes on how to play the game.
  1. John Irving, a principle in the Health Care Blog,  one of America’s most widely read health blogs.
Great question. Here’s what I wouldn’t do. I wouldn’t sit those physicians down in front of me and say “we’re doing this with you or without you. you can come along for the ride or not. we don’t really care which” which when you get right down to it is the approach a lot of large organizations are using.
I wouldn’t insult their intelligence with canned management talking points about quality and efficiency and evidence. They’ve heard them before. I wouldn’t wave my hands in the air and talk about the “magical things that EMR is going to do for us.” These are smart people. They’ve turned on their EMRs. They get it. But talking about technology like we’ve just discovered the Internet and entered the Golden Age of Happiness and Joy isn’t going to do it .
I’d talk to them like human beings. And I’d show some degree of empathy. I’d say, look – this is going to hurt. Actually, it is going to hurt a lot. However, by the time we’re done, we’re going to have a better system and most of the problems we’re facing will have gone away. Ten years from now, the things we’re talking about now will sound laughable to you. You’ll forget there was a time when you couldn’t email a patient – or get an instant lab result – or call in a specialist at a major academic medical center using Google Glass …

2.      Richard L. Reece, MD, Medinnovation blog

John: If I were addressing a group of skeptical physicians about the changes taking place, I would say it differently. I would say things are going to be different, perhaps better because of organizational and technological support, and coordinated team care, but maybe worse if you are wedded to the concept of personal autonomy for physicians.

Technological changes  will come in the form of diagnostic support, instant access to historical information, data about drug interactions, and electronic connections to patients and colleagues. The underlying idea behind these changes, advocated by both private sector and government , is to make care better and more cost-effective. But achieving these outcome will not be easy.

This is an era of experimentation, a search for a better way of doing things. Sometimes experiments fail, like ACO “savings,” EHR “efficiencies,” pay for value,” but these xperiments  are gropings for better ways of doing things. Sometimes things get worse before they get better.

Will the change to a new computer system be hard? Yes. Change is always hard.

Let’s face it. You will have to become skilled and comfortable with entering, absorbing, and interpreting data electronically. Some of you will not like with computer system-driven care. You will find it lessens your personal productivity. It will be awkward to use and to digest. Some of you, particularly older physicians, may drop out, retire, form concierge practices, or join physician-driven groups.

But most of you will hang in there, welcome organizational transformation, and understand the need for management systems that promise better, more cost-effective care. We hope you will be leaders in this transition. There is a better world coming. Accept it. Help shape it.

Adjusting to Obamacare,  if one assumes it will go forward, is basically a computer game.    Computerized data will be the basis for paying doctors for performance,  for the evidence judging that performance, for the use or non-use of electronic health records,  for prescribing,  for allocating “savings” from Accountable Care Organizations, for communicating with patients and colleagues,  for following guidelines.  

As a modern Sherlock Holmes might say if he were referring to Watson, IBM's supercomputer now being applied to healthcare, " Come, Watson, come! The game is afoot."

Tweet:   If one is VP of medical affairs,  how does one persuade skeptical doctors the  new EHR computer system will benefit both them and patients.





No comments: