I’ve recently blogged about how the times are changing and the challenges of moving from a clinician-centric approach to care to a team approach to care. (See “Team Medicine” April 21, 2015 ACG blog post)
I’ve embraced this opportunity of “team medicine” focused on personalized care for individual patients. It’s become impossible for almost any clinician alone to navigate patients through the evolving health care system. It takes a team. The requisites for scheduling, documentation, authorization, referrals, and communication demand teams of schedulers, navigators, nurses, and advanced practitioners to facilitate care for patients with chronic or multiple conditions.
My recent move from a “traditional” academic center to a health system with an academic center has afforded me the opportunity to continue to evolve my own practice and to mentor colleagues on managing patient expectations around communications.
When I started in practice, my evenings were devoted to returning patient phone calls as my wife tutored our children after dinner. The concept of 24/7 availability that was engendered by my mentor, Joseph Kirsner, eventually contracted as patient volumes and complexities expanded. Over time, the communication evolved such that a nurse would review results with me (if needed) and then telephone results with the patients. Observing our current practices, telephoning has become onerous and inefficient (think phone tag).
In contrast, I have found that one of the benefits of the electronic health records (and mandates for meaningful use of EHRs) is the MyChart function for EPIC (and, I’m sure, similar systems in other EHRs), which offer the ability to review tests and communicate via a secure internet connection. Systems such as MyChart are greatly impacting the efficiency and quality of our practice.
The vast majority of our patients are now computer-literate and competent, and MyChart allows them to see their results. Because of the EHR, fewer results get lost or passed over. The facile ability to report and document the reporting of results without back-and-forth phone calls and undocumented communications improves patient involvement in their care. Furthermore, it has liberated our support staff from time-consuming and tedious telephone attempts at patient communications.
I was told by one of the practices incorporated into our health system that patients “expected” phone calls regarding routine results. That expectation needs to evolve. Secure, electronic communications are a much more efficient means of patient communications – a means that liberate team members’ time so they can handle more essential, personalized communications.
From day-to-day laboratory tests to pathology reports from procedures, I have embraced the EHR to enhance patient communications and facilitate the practice of personalized medicine.
Whether we like it or not, the Medicare Meaningful Use mandate is here to stay; these provisions have significant support at CMS and bipartisan backing in Congress. The College offers a suite of tools available on the gi.org site to help guide ACG members in satisfying CMS’ requirements to adopt meaningful use of EHRs while avoiding “negative incentives,” the term CMS gives to penalties.
Additionally, ACG is working actively with Congress and CMS to align and streamline the reporting requirements for both Meaningful Use and Medicare’s Physician Quality Reporting System (PQRS), a separate Medicare quality reporting program established under the Affordable Care Act (ACA), which now threatens to penalize those who do not comply. On behalf of ACG members, the College seeks to allow participation in a quality benchmarking registry such as the GIQuIC to satisfy all clinical quality requirements under both the Meaningful Use and PQRS programs.
A great example of the College’s advocacy is its recent success in helping to incorporate language in the so-called “doc-fix” law that passed April 14, 2015 and repealed the Medicare SGR formula. The law requires CMS to look to quality registries as a means to satisfy quality reporting across various Medicare programs.
Stephen B. Hanauer, MD, FACG
President, American College of Gastroenterology