Practice Performance Index 2017: Not Standing Out is the Same As Being Invisible

By Andis Robeznieks

Making Technology Work for Your Practice – The Way Forward In The New Medical Economy

“Information technology is a big part of the Greater Rochester Independent Practice Association – IT and care management. Physicians can go online and find new data every day — most systems can’t do that. Our IT system can show gaps in care, and physicians are able to act on reports pretty darn quick,” said Mark Belfer, D.O., Chief Medical Officer, Greater Rochester Independent Practice Association.

Uncertainty surrounds the new medical economy, but one thing that does appear to be certain is that technology is emerging as a differentiator between high-performing practices and those that are falling behind.

That was a major thread running through CareCloud’s 2017 Practice Performance Index that studied the opinions of 2,020 physicians and practice administrators who participated in an interactive online survey this past March and April.

The report, developed with UBM Medica, highlighted how healthcare is being driven by changes such as value-based reimbursement, the consumerization of medicine, and the changing business climate.

“Thriving in the New Medical Economy” was the theme of the report, which showed how high-performing practices differentiated themselves by improving in at least three of the following categories:

  • Practice collections.
  • Number of practice locations.
  • Number of providers.
  • Total patient volume.
  • Provider satisfaction

Almost a quarter of practices (24 percent) met this definition, while 15 percent were described as “falling behind.”

High Performers are being rewarded for embracing change with higher growth, a more loyal patient base, and more satisfied providers

The High Performers are being rewarded for embracing change with higher growth, a more loyal patient base, and more satisfied providers, according to the report. The satisfaction is derived from bringing providers “closer to their original motivation for entering medicine: more engagement with patients, a stronger relationship between provider and patients, and better outcomes for all.”

High Performers are twice as likely to adopt new technologies such as health analytics, telemedicine, and check-in kiosks than those falling behind, according to the report. And, as a result, they are creating an experience that is “more convenient, modern, and enjoyable for patients.”

Conversely, representatives from the Falling Behind practices made comments about how “innovations have destroyed medicine” and that they are using technology only because it is “being forced by government against our wishes.”

Bob Wachter, M.D., who chairs UCSF Health’s department of medicine at the University of California, San Francisco, touched upon these attitudes and the promises and disappointments of IT in his book The Digital Doctor, Hope Hype and Harm at the Dawn of Medicine’s Computer Age.

Wachter acknowledges the current problems providers face with clunky interfaces, too many alerts, and a lack of interoperability, but he predicts these issues will be “largely solved” in 10 years.

“Not tomorrow, not perfectly, not everywhere, and not without pain or political dogfights, but incrementally and, ultimately, in a relatively satisfying way,” Wachter wrote, IT will be improved in a way that “truly makes healthcare better.”

One organization that is already on this path is the Greater Rochester Independent Practice Association whose motto is “Healthcare could look like this.”

GRIPA was launched 21 years ago as a partnership between New York’s Rochester Regional Health system and area physicians. Today, it is almost 1,400 physicians strong with about another 900 advanced practice providers operating an IT-facilitated care-management delivery model.

In 2007, it was only the second organization to receive Federal Trade Commission clearance to operate a clinically integrated program and, in recent years, has entered into risk-based contracting in a big way. It has 190,000 patients covered either by Excellus Blue Cross Blue Shield, MVP Health Care, or a Medicare Shared Savings Program accountable care organization.

“Information technology is a big part of the Greater Rochester Independent Practice Association – IT and care management,” said Mark Belfer, D.O., GRIPA’s Chief Medical Officer. “Physicians can go online and find new data every day — most systems can’t do that.”

Belfer adds that there is a “halo effect” in which the patients who are not covered by risk-based contracts benefit by receiving the same quality of care as those that are. GRIPA primary-care physicians, for example, are scored on 23 quality metrics — most of which are outcome- rather than process-based, he noted.

“We have a tremendous data warehouse,” he said. “Our IT system can show gaps in care, and physicians are able to act on reports pretty darn quick.”

While it started as an IPA, Belfer explained that GRIPA is now a hybrid organization that is part IPA and part physician-hospital organization. About 55 percent of its physicians are employed by Rochester Regional Health, while 45 percent are independent of the system.

Belfer said he was in general agreement with the findings of the PPI report but said he would’ve liked to have seen a breakdown of technology adoption between employed and independent doctors because adoption rates vary so greatly within his own organization.

The employed physicians use the built-in EHR patient portal while independent physicians may or may not use it — if they have a patient portal at all. Belfer estimated more than half of the independent physicians are making use of portals.

GRIPA is just now implementing online scheduling and doing so with some trepidation because of a perceived loss of control.

“Patients can make an appointment for a 15-minute visit but can come in with a list that will take an hour to cover,” Belfer said. “That’s what happens.”

Most high-performing practices collect patient feedback and, again, Belfer said that all of GRIPA’s employed physicians survey patients “frequently,” while the independent doctors do it somewhat at random — but they do do it because “we get graded on that by payers.”

About 17 percent of the High Performers surveyed have implemented telemedicine technology compared with only 7 percent of the Falling Behind group.

“I think it’s here to stay on a national basis,” Belfer said, adding GRIPA has physicians and other providers in five hospitals and several skilled nursing facilities across seven counties. Telemedicine helps GRIPA cover a lot of territory.

And while Belfer sees its value particularly with dermatologic and psychiatric consults, he said telemedicine is also utilized in the intensive-care unit of one of its more distant facilities, United Memorial Medical Center in Batavia, N.Y.

“We’re also seeing where payers are pushing it for after-hour visits instead of urgent care or the emergency room,” Belfer said.

In his book, The Patient Will See You Now, The Future of Medicine is in Your Hands, Dr. Eric Topol, M.D., noted that insurance companies and dissatisfied patients are driving telemedicine adoption.

Topol, the director of the Scripps Translational Science Institute in La Jolla, Calif., cited a survey in which 70 percent of 1,500 American respondents said they preferred virtual visits over going to see their doctor in person.

“That’s not too surprising, given that the average return visit in the United States lasts seven minutes and new consultation twelve minutes, and that only after an average wait of 62 minutes to get into exam room and be seen,” Topol wrote. “Or not being seen because the doctor is predominantly looking at the keyboard to type into the electronic medical record.”

Matthew Thorne, Chief Operating Officer and vice president of finance, for Carena, Inc., a Seattle-based provider of telemedicine services, said that many healthcare organizations view telemedicine the wrong way

“Telemedicine is more than technology — it’s care delivery, It truly can extend a practice. You’re able to reach patients you may not otherwise be able to see.”

“Telemedicine is more than technology — it’s care delivery,” Thorne said. “It truly can extend a practice. You’re able to reach patients you may not otherwise be able to see.”

He agreed that telemedicine has proven its value with dermatology and psychiatry — especially in rural areas where physicians are scarce. But Thorne emphasized that telemedicine also has a place with managing the care of high-cost patients in “post-discharge scenarios.”

Thorne disagreed with the suggestion that these often elderly patients are not a good fit for technology-driven healthcare innovation, adding that these same consumers are also frequent users of communication technology such as Skype and FaceTime.

“In value-based care, providers are more and more at risk with these patients, so they need to activate and engage with patients in ways they don’t now,” Thorne said. “Without engagement, you’re really struggling. There’s no way of preventing them from leaking toward an urgent care center or a competing facility.”

Carena works with systems and provides them with the technology and platform that can be customized with the partnering system’s own brand. They can also supply Carena providers who Thorne refers to as “virtualists.”

The report concludes with a warning that “what used to work in the past is necessary but no longer enough.” Providers will have to adapt and embrace the new medical economy to succeed.

Not surprisingly, Thorne sees telemedicine as a critical element of a practice that thrives in the new healthcare environment.

“I’m bullish,” Thorne said. “It will only increase.”

Belfer said the organizations that meet the PPI’s “high-performing” definition “will do better” and see more patients — in part by meeting the millennial generation’s demand for care “right then and there.”

He added that healthcare is not as slow to adapt as some critics charge.

“Healthcare has truly changed, I’ve been around for 30-plus years, and I’ve seen so many changes — most have been good.”

“Healthcare has truly changed,” Belfer said. “I’ve been around for 30-plus years, and I’ve seen so many changes — most have been good.”