I had the honor and pleasure once of sitting in on a broadcasted conversation with Faisel Syed, MD on the Sacred Patient-Physician Relationship. (Faisel and Friends) That discussion got me thinking more about the special rapport needed between the Person we call the Patient and the Healer for healthcare to be effective and to optimally create value.

One of the first and most important challenges an organization faces when moving from strictly fee-for-service (FFS) healthcare delivery to value-based care (VBC) is aligning physician and provider compensation to the new priorities of VBC. If this gets left to be done “later” or not at all, the disconnect between incentives will make VBC success very difficult. 

Here’s another article in the medical literature that was needed to verify common sense – an all too frequent occurrence in healthcare, as we seem to often forget it (e.g., handwashing). This one deals with a well-known social risk.

A good proportion of healthcare delivery in the US happens on the fly. Even when an office visit is scheduled in advance, many practices don’t start any work on a patient until they see the whites of their eyes. Mrs. Jones shows up, and we look through the chart to see what needs to be done in the moment. This approach opens the door for inefficiency, ineffectiveness, missed opportunities, poor experience, and low-quality outcomes.

Throughout this series of articles, we’ve discussed value-based care (VBC) drivers of gross income – attribution, risk coding and activities-based bonuses – and spent a good amount of time on drivers of net income, those that lower medical expense. Of these, we have looked at access, Annual Wellness Visits, and managing patient care. These six levers get pulled by most all organizations and practices to some degree regardless of their position on the VBC spectrum.

First impressions have always gotten a lot of attention, but I’m going to push back a bit and suggest that what happens after that first impression (aka unconscious bias) might need more focus. This MA, I’ll call them “Bleu,” was able to create a safe space for the patient and family member that overcame their initial judgment. Let’s explore how they did that, and how you and your team can focus on this too.

The New England Journal of Medicine recently published a paper titled “Digital Minimalism - an Rx for Clinician Burnout.” The article points to a recent study that found the amount of time spent in electronic health records (EHRs) correlates with declines in face-to-face time with the patient, computer-based work after hours and increasing rates of burnout. Digital minimalism could be a new way forward for physicians.

Noncompete clauses may become a thing of the past as the Federal Trade Commission (FTC) is expected to vote on its proposal to ban noncompete language in employment contracts in April of 2024.

National Nurses Week is upon us! Officially going from Saturday, May 6 to Friday, May 12, 2023, with the 2023 theme being “Nurses Make a Difference: Anytime, Anywhere – Always”. According to the American Nurses Association, there are currently over 4 million Registered Nurses in America. 

With cold and flu season winding down, now is a great time to schedule classes, webinars, or conferences that will count towards the CEU and CME requirement for the providers and staff in your practice.

CMS issues an updated Advance Notice document each year, officially titled for 2024 “Advance Notice of Methodological Changes for Calendar Year (CY) 2024 for Medicare Advantage (MA) Capitation Rates and Part C and Part D Payment Policies”.

The CMS Innovation Center (CMMI) has produced many directives recently, many of which deal with the future of value based care. A 2021 strategy statement summarized the vision of CMMI, with these two statements showing how to measure progress.

The Dictionary defines leadership as “the action of leading a group of people or an organization”. There are a variety of interpretations of what it means to be a leader but I would like to expand on this and create a definition of the word specific to the primary care setting. Leadership in primary care is “the action of inspiring, encouraging, and empowering a team of people to work together to provide high quality care to their patients resulting in positive outcomes and strong interpersonal relationships”.

With the public health emergency and the impact of Covid on the overall workforce, we’ve all become even more familiar with terms such as “The Great Resignation” and “toxic culture”. Especially in the overburdened healthcare industry, with many clinical and support areas experiencing shortages of employees or shifts in employee responsibilities, the topic of workplace culture has become even more critical.

Does the culture of a practice impact the quality of care a patient receives? Research shows it does. It is well known that engaged employees are more productive and have greater job satisfaction. Let's look at how culture can help an organization achieve higher quality care for their patients. According to Merriam-Webster, culture is "the set of shared attitudes, values, goals, and practices that characterizes an institution or organization". If a practice is solely focused on volume and revenue with no regard for the providers and team, the result is likely a negative culture with burnout and high turnover rates.

The Centers for Medicare & Medicaid Services have advanced value based care significantly in the last several years, and in a somewhat expected, yet bold move in October 2021, specifically said that they expect all traditional Medicare beneficiaries to be treated by a provider in a value-based care model by 2030. CMS rarely uses such superlative terms (all traditional Medicare beneficiaries), and the Centers for Medicare & Medicaid Services Innovation Center (CMMI) has five stated strategic objectives to achieve this massive undertaking.

The patients at your practice, your staff, the physicians, vendors and other support partners - these are all critical to your success. But when it comes to self care, the most important person at your practice is … you!

Primary Care Providers (PCP) are problem solvers trained to learn as much as they can about the entire human body. As soon as the patient begins to describe their concern, the PCP is processing the information and evaluating possible solutions or treatments. It is often difficult to determine how much time is needed for a visit because they are trained to not just look at a single problem, but the whole person. Value-based care and mandatory quality measures (or risk losing money) have made the primary care visit even more complex. If a provider runs late, patients become irritated and upset but expect the provider to give them the amount of time needed for whatever “oh by the ways” they mention even if it wasn’t included in the reason for visit.

It’s the beginning of a new year, so you’ll be hearing a lot about Medicare risk coding and the importance of risk coding. You’ll most likely hear the same story from many different sources - beginning January 1, those patients with amputations suddenly have limbs grow back and patients with certain conditions no longer have those conditions. You as practice leaders and physicians are told by multiple sources about how important capturing appropriate condition coding for your patients is.

You as a primary care leader are responsible to your practice and yourself for financial performance. As value based care evolves for your Medicare patients, this performance is becoming more directly linked to stars performance. There are value based care programs available from CMS directly, as well as payer-specific value based care incentives that your practice might qualify for. There are also basic, upside-only contracts from both entities and more advanced, risk-bearing contracts as your practice matures and can gain through these more advanced contracts.