Fewer than five out of every 10 providers go to work feeling like they can do their jobs to their full potential, according to data from athenahealth. Physicians may not feel they have the latitude and autonomy to make decisions that drive quality, or they may not have the resources and tools necessary to provide proper care. This is a crisis.
When providers feel capable, they are less likely to leave their organizations, less likely to show symptoms of burnout and more productive in terms of driving volume. “There’s a notion of self-perceived capability from a patient and physician perspective. Without those two, it is difficult to drive outcomes,” Kevin Holst, athenahealth’s vice president of enterprise strategy, said at the Becker’s Hospital Review 9th Annual Meeting in Chicago during an executive roundtable discussion sponsored by athenahealth.
This content was sponsored by athenahealth.
Mr. Holst posed several poll questions to 27 senior-level healthcare professionals at the roundtable to better understand what holds care teams back from their full capacity, what leaders see as the top opportunities to improve and who they feel is responsible for leading the charge. The leaders in the room spanned across the C-suite, representing CEOs, CFOs, COOs, CMOs, CNOs, CTOs and various senior vice president level positions.
Their discourse revealed one of the greatest barriers to improving physician empowerment is misaligned financial incentives, but one of the greatest opportunities to improve it is optimizing IT and documentation workflows. And while most executives felt leadership and physicians were responsible for increasing care team capability, they realized throughout the conversation that several key stakeholders, including IT leaders, have been left out of the process.
Below are the key takeaways from the executive discussion.
Finding No. 1: While most executives believe misaligned financial incentives are the greatest barrier to helping physicians reach full capability, documentation and IT workflows emerged as a key issue.
The greatest barrier to capability for the physicians at my organization is:
- Misaligned financial incentives — 42 percent
- Suboptimal IT workflows — 29 percent
- Government regulations — 17 percent
- Prior authorization requirements — 8 percent
- Commercial payer quality program requirements — 0 percent
- Scheduling requirements — 0 percent
- Other — 4 percent
Discussion
Most executives said misaligned financial incentives were a top barrier to physician capability. Yet when the topic of IT workflows came up, participants had a lot more to say.
“The industry is burned out on IT. We are not using it like we thought we would,” said the president of large hospital based in the South. “If you mention your EMR in your hospital, sweat or anger will probably start coming out.”
Athenahealth CMO Kevin Ban, MD, agreed. “We are burned out by IT, regulations, quality — there’s another box to check and none of us feel it’s connected to the care we give our patients. That’s the problem. I’m a big believer that IT should be the thing that puts the wind in our sails.”
The director of strategy and operations from a major East Coast teaching hospital felt IT was more a symptom of the problem, and documentation requirements are at the core of the issue. “We blame a lot of the IT system,” she said. “[But] it’s because we have all these requirements below IT.” These requirements mean physicians see their inboxes fill up with items and tasks that others on the care team can address, keeping them from working to the top of their license.
Finding No. 2: Documentation workflows present the greatest opportunity to improve care team capability.
The greatest potential opportunity to improve capability is:
- Reimagined documentation workflow — 32 percent
- Compensation tied to something other than productivity — 28 percent
- Assumption of greater amounts of risk for total cost of care — 16 percent
- Physician wellbeing training and resources — 12 percent
- Commercial payer metric standardization — 4 percent
- Other — 8 percent
Discussion
The majority of executives in the room felt the physician documentation workflow could use a revamp. Some have opted to reduce the time physicians spend on documentation by leveraging scribes, producing mixed results.
The COO of a nonprofit health system in the Northeast said her organization used scribes and found they truly were the solution for many physicians, but for others the addition of scribes didn’t change anything at all. “It did open my eyes to our more mature physician population. Most of them never learned to type,” she said. “Most physicians are used to feeling confident, but if you ask them to type on a keyboard and they don’t know where the letters are, first of all. It’s infuriating and makes them feel incompetent. Second, it slows them down … there’s an emotional component, and I don’t think you can neglect it.”
The president of a large medical group on the East Coast said his system has also tried scribes, but to him scribe is a four-letter word. “It hasn’t made a difference in productivity. The doctor feels better, but all I’ve done is add $30,000 [for every scribe] to the cost,” he said. One executive in the room suggested circumventing this issue by setting a prerequisite level of productivity for physicians to receive a scribe and to set RVU goals for physicians to meet after working with the scribe.
Beyond scribes, other executives felt technology is largely responsible for reimagining workflow. “I’ve never seen or worked in an industry where the primary user of the product is so unhappy with the product,” athenahealth Executive Vice President and CTO Prakash Koht said. “All of these problems emerge from one fact: There is little standardization of metadata and data.” He felt this fact poses two solutions: Simply standardize the data and make it liquid so physicians can access data when they need it, or leverage AI to create an intelligent, computer-based scribe, allowing physicians to interact with patients in way that’s more organic.
Finding No. 3: Accountability for physician capability is shared, but IT departments and patients need to better understand their role in the process.
If capability were a standard performance metric, the following stakeholders should ultimately be held accountable for performance:
- CEO and CEO direct reports — 38 percent
- Physician leadership — 29 percent
- Physicians — 21 percent
- HR — 4 percent
- IT leadership — 0 percent
- Other — 8 percent
Discussion
As evident from the poll, the executives truly felt physician capability was an organizationwide effort. “It’s a shared responsibility,” the president of a regional medical center in the Midwest said. “No one component of the organization can do this on its own, and if the leadership doesn’t actively participate, that’s a problem.”
The COO of a children’s hospital on the West Coast said it is his responsibility to make sure physician leaders are empowered to manage capability. “I chose physician leadership because they are the ones we turn control over to … and they drive operations,” he said. He regularly evaluates what is working and what’s not working for physicians and ensures the organization offers resources, such as scribes, to equip physicians with what they need. “My job as COO is to put all those tools on the table and let them choose from that buffet.”
However, the executives noted two stakeholders are not engaged, although they should be. One participant questioned why none of the executives felt IT had a hand in capability. “It’s interesting nobody picked IT leadership, but at the same time we were kind of blaming the system,” said the chief digital officer and senior vice president of technology innovation and consumer experience at an East Coast academic medical center. “IT is seen as this group that can do some things or is supposed to do some things, yet they are not held accountable for that.”
Another executive, the COO of a nonprofit health system in the Northeast, noticed patients should be held responsible as well. “The whole point is to make sure we don’t harm patients and get the best outcomes we can, and [patient responsibility] is often the last thing we talk about,” she said. “I think it’s a problem.”
Dr. Ban agreed. “Patients have a job and we never talk about it,” he said. Providers need to help patients see “you have a job and you need to be proactive in your care. You need to be a partner in your care,” he added.
Finding No. 4: Executives believe patient access issues often stem from poor coordination, which can ultimately be improved by maximizing capability.
The top strategic priority in my organization is:
- Improving access for patients — 33 percent
- Improving and maintaining quality — 33 percent
- Developing a consumer strategy for low-risk members of my local community — 18 percent
- Creating an environment that allows physicians to focus on what they do best — 8 percent
- Improving healthcare affordability — 8 percent
- Other — 4 percent
Discussion
Access and care quality emerged as the top priorities for the executives present. However, many executives felt the industry needed to challenge how they think about access. The COO of a nonprofit health system said, “Access to me doesn’t mean going to a doctor’s office. I could sit here right now and order my groceries or new shoes. There is a ton of care that doesn’t require traditional access.”
The president of a large hospital in the South noted that access could also be improved by better coordination among providers. “There are access issues, but it’s the coordinating that we are looking for,” he said. For example, if a patient waits three weeks for an appointment, and then at the appointment the physician needs to order something from a specialist that takes an additional three weeks, the patient sees that as waiting six weeks to learn anything about their health.
The CFO of a midsized hospital on the East Coast agreed. “It’s amazing the amount of barriers that go into causing all these delays, but it creates that inefficiency at the end that you’re speaking of.”
A patient’s ability to connect with the right caretaker is often slowed by the fact that physicians are dealing with so many different responsibilities that could likely be passed off to another person on the care team. The lack of coordination bottlenecks physician capability and limits providers’ potential to transform healthcare delivery.
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