It’s a time of turmoil for healthcare in general, and for small practices in particular. No one knows for sure whether new insurance products might steer patients away, or how these practices will be paid. As such, you can allow your organization to be buffeted by the turbulence — or chart a course to organize work and structure accordingly.
The strategy that makes the most sense is improving the value of healthcare from the patient perspective, and that means meeting patients’ needs as efficiently as possible. A winning combination under any type of contract, this approach helps practices maintain and increase their market share.
Under the fee-for-service model, the focus has been working hard and responding as well as possible to the issues of patients who are right in front of clinicians — and doing so rapidly so that the next patient can get in the door. Physicians have no reason to be wasteful, of course, but at the same time there has been little incentive to increase efficiency.
Those days are gone, and the marketplace is moving away from primarily rewarding clinical activity and the simple generation of relative value units (RVUs). It will be a long time before the dust settles and providers know exactly how they are being paid and what for, but one thing is certain: if you don’t have patients, the nature of your contracts will not matter much.
But how does that translate to meeting patients’ needs? More than checking off boxes on a list of evidence-based medicine practices, to truly meet patients’ needs, the focus has to be on reducing their suffering — from both their burden of disease and the dysfunction of the delivery system.
We are not just talking about physical pain. Suffering is also induced by the anxiety from waiting, the confusion caused by clinicians giving conflicting advice and the uncertainty when no one explains what will happen next.
Suffering can be reduced if we work better together. In this regard, small practices actually have a structural advantage: they know their patients and each other well enough that real teamwork is natural. But practice leaders need to rise to the challenge and recognize their strategic imperative. The next step is to commit to measuring their patients’ suffering, and then doing something with the data — organizing their personnel into real teams and participating in those teams themselves.
The practices that I see going down this road are happier for it. Non-physician personnel enjoy the teamwork — medical assistants and others suddenly feel that their jobs have become much more important. Patients praise the practices on the Internet and to their friends. And physicians get the satisfaction of knowing that they have really taken care of their patients.
Because state-of-the-science modern medicine requires the expertise of many types of clinicians, small practices inevitably need to develop collaborative relationships with other providers, including specialty practices and hospitals. But the complexity of modern medicine is the reason why patients desperately need coordination of care.
Small practices have a strategic opportunity to provide their patients with peace of mind that everyone is working together on their behalf and that their problems are not going to be lost in the shuffle. In doing so, they will simultaneously enhance the value of care they provide and reduce patients’ suffering.
Thomas Lee, MD, is chief medical officer at Press Ganey. He has more than three decades of experience in health care performance improvement as a practicing physician, a leader in provider organizations, researcher and health policy expert.