Extended Hours 7/29/17

Welcome to the inaugural edition of Extended Hours! While the term “Extended Hours” may be an undesirable phrase in the lives of physicians, this series on the TheBossMD should prove to be a much better experience!

Extended Hours will be the weekly roundup post published every Saturday here on TheBossMD. As with all of my content, the purpose of this series is to help physicians manage their positions, whether it be personalfinancial, or professional.

These posts will be light on my thoughts and heavy on the best content I can find during my travels through social media and the internet. We might even have some fun along the way!

So sit back, relax, and enjoy this week’s Extended Hours!

Personal Position

Dr. Sonia Henry writes an excellent piece on KevinMD entitled Doctors:Don’t Lose Your Humanity. Highly recommended for anyone drowning in the world of metrics, reimbursement, and generally needing to remember why you’re doing this medical thing.

Looking to take your family on a sweet Hawaii vacation while paying next to nothing? The Luxe Strategist is here for you. Check out her tips for traveling to Hawaii for $45 in Travel Hacking:How I Booked Four Flights to Hawaii for $45. Sign me up!

Passive Income M.D. provides great perspective on managing work life balance and how to make the most of the time you have here on this Earth in his piece How Many Summers Do You Have Left? Will make you think deeply about your priorities.

Financial Position

White Coat Investor hosted one our lawyer colleagues, Joshua Holt of The BigLawInvestor, on his blog this week with a post entitled How to Save A Million Bucks Before You Become A Law Firm Partner. Don’t worry physicians, this is one lawyer you can trust. There is timeless wisdom here that can apply to any high income professional.

Physician on Fire recently ran an article featuring a physician that has taken saving money to a whole different level. Check out the man who earns $1,800,000 per year and only spends $70,000 per year in the first installment of Holy Stealth Wealth!

This next article features some personal mixed with financial. Michelle over at The Holistic Wallet has a good word that spoke right to my sometimes obsessive tendencies in True Life:I Was a Personal Finance Addict. I don’t know about you, but it probably would be more healthy to not check my student loans daily!


Professional Position

John Jurica over at The VITAL Physician Executive details the Top 10 Reasons to Pursue a Business Degree for aspiring physician leaders. Great points to consider for anyone seeking any type of leadership role from private practice to large healthcare organizations. I still say business degrees are not required in our current environment, but they are definitely more in favor than they used to be.

Everyone remembers some of those dark days during residency, right? Natashia Seemann delivers a nice article on her site More Than Scalpels and Sutures about Terrible Things You Will Think During Residency and Why Its OK. A good reminder that those in medical training should have a little leeway at times.

Heard much about medical quality lately? I have. Kjell Benson over at The Consolation of Philosophy writes about How to Create Medical Quality While Hardly Trying. I think you’ll find yourself nodding as you read, just like I did!

Just For Fun

Need a little laugh? A good pick me up? This section is for you. It’s hard to be a physician. You deserve some fun. Check this out.

Our friends over at GomerBlog deliver a wonderful new diagnostic tool in their latest masterpiece New Cheetos Finger Decision Rule for Abdominal Pain. Hospital administrators everywhere are lauding the improved costs and patient satisfaction scores. Any article with Dilaudid and Cheetos is sure to be a winner in my book.

For all of you personal finance types, the mecca of personal finance is at it again, The Onion. In their latest must read piece, they discuss their latest financial research entitled Study Finds Americans Do Most Financial Planning When Figuring Out How to Get Money’s Worth at Buffett. Truly insightful stuff.

Last but not least, I love you with one of my favorites, Brian Regan, talking about the emergency room. The clip is a little long, but if you’ve got 8:24 to spare and need a good laugh, then this video is for you.

Well that’s it for the inaugural addition of Extended Hours. I hope you enjoyed this week’s selections. Tune in next Saturday for another edition!

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We Need More Customer Service In Medicine

Customer service in medicine is important. I know many people don’t want to hear that, but it’s not going away. Patients are talking to each other more than ever. They’re leaving comments on Facebook, Twitter, and numerous physician review websites. Get a few bad reviews, and watch your patient volume drop. Your revenue won’t be far behind.

However, I believe the current focus on customer service is actually too narrow. Yep, that’s right. I think medicine needs more customer service, not less.

While much of the physician lounge discussion and staff meeting arguments stem from external customer service, medicine actually needs a larger focus on internal customer service.

The business world is already well versed in both internal and external customer service. Talk with any businessperson and you will hear them talk about their internal and external customers. It’s considered standard practice to extend the same level of customer service to your internal customers as your external customers.

The reason for this is simple. To best achieve your organization’s mission, everyone in your organization has to work together. Team work makes the dream work as we like to say.

Unfortunately, I have witnessed a lot of colleague interactions that were downright scary. Many times, they look something like this:

(video courtesy of Youtube and ZdoggMD.com)

While that video might be hilarious (this one is even better), these types of negative interactions not only throw a wet blanket on a everyone’s day, but they hamper patient care.

In my mind, there are three reasons that medicine, and physicians in particular, should focus on improving our collective internal customer service skills. Allow me to explain.

The Patient Is Still Sick


I use this phrase all the time when embroiled in some type of specialty turf war or argument. While we’re sitting here arguing about “whose problem” this should be, the patient is still sick. Think about the poor patient in the middle of this confrontation:

(video courtesy of Youtube)

I don’t know what the mission of each of your organizations is, but I’m willing to bet that taking care of patients is an integral part of it. As a profession that generally prides itself on caring for others, arguing and negative interactions takes the focus off the patient and onto ourselves. We should view this as countercultural and unacceptable.

I fully recognize that legitimate conflicts arise that need to be solved. However, my rule in my personal practice and those whom I supervise is to take care of the patient first, period. We will deal with the system issue, but step one is always to care for the patient in front of you.

By flexing our internal customer service skills, we can make these occurrences few and far between. I was involved in a great conversation on Twitter discussing the role of radiology and pathology in patient care, and specifically how both specialties desire to be more directly involved in the care of the patient. Here is one quote I think is poignant:

“Cannot tell you how many times I’ve gotten “I’m just covering” when calling back to ask more questions about a study.”

Good internal customer service recognizes that these types of conversations cannot happen and our relationships with our colleagues are essential to achieving our overall mission of caring for the patient. “I’m just covering” turns into “how can I help our patient today,” and the patients benefit at the end of the day.

Conflict Increases Your Workload


Can you afford to add more tasks to your day? Do you really want that routine case to take double the amount of time it should? No, right? Your day is already slammed.

Negative interactions with your colleagues not only hamper patient care, but they waste your time. First, there is the obvious. If you’re like me and you have an argument with a colleague, then its going to take you a few minutes to cool down. Are you going to do much productive during that time? Nope. Time wasted.

Second, are you going to work with that colleague in the near future if you need to? You might hesitate if you have a poor interaction with a radiologist and then need a quick chest x-ray interpretation. Might just wait for the report, right?

My previously mentioned Twitter conversation had someone that probably has lived out this reality. Check out this quote:

“Surgeons at my old institution referred to radiologists as “possums”. They lived in the dark and would bite if approached/provoked.”

Pretty sure you’re just going to wait for the report if you think the radiologists you work with are “possums.” Waiting for that report is probably going to cost you some time in the care of that patient. Instead of having the information you need and moving on, you’re going waste time because no one is practicing good internal customer service.


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Frustration Leads To Mistakes


Now its time for the rubber to meet the road. It’s one thing to have your schedule inconvenienced or to feel upset. It’s quite another to put patient safety at risk. Unfortunately, practicing poor internal customer service does just that.

Remember that example I just gave, where a physician and radiologist don’t want to talk because of a poor interaction? That lack of communication endangers patient safety. The patient safety literature already supports the idea that lack of communication amongst teams leads to medical errors.

As a community, are we OK with that? As a patient yourself, do you want your medical team to avoid communicating with each other? No! You want your medical team working together to provide care for you because you know that anything less is going to result in substandard care. If your medical team doesn’t communicate, then your care might look like this:

(video courtesy of Youtube)

So the next time you are frustrated at that specialist who is giving you a hard time about a consult or you’re nervous that the pathologist is going to bite your head off on the phone, remember we need more customer service in medicine, not less. Even Mr. Bean can figure it out.

Hopefully, I have convinced you that customer service inside of healthcare is actually the most important form of customer service. At the very least, I hope you got a few laughs watching the videos.

Just like we have resolved to provide excellent service to our external customers, patients, in our efforts to provide the best care possible, we must equally resolve to provide excellent service to our internal customers, our colleagues, so we can all provide excellent care to our patients. As professionals, we should demand no less from ourselves.

What do you think? Is customer service a bad word or do you agree we need more? Have you ever been assaulted by a colleague dressed as Darth Vader? Leave a comment and let’s talk about it.

Four Ways to Improve Physician Meetings

I often see physicians on my Twitter account bemoaning sitting through staff meetings. Some of the tales they tell are pretty harrowing. I silently grieved for one group as I read about how their meeting was three hours over time. I don’t like sitting through unnecessary meetings any more than the next guy, even when I’m running the meetings.

Based on my experience with colleagues in the business world and the medicine world, medical meetings typically lack in structure and organization. This meeting dysfunction makes many physicians staff meetings either ineffective or worse, unnecessary.

Physicians already have schedules that are highly compressed throughout the day. Calling meetings that accomplish nothing not only waste everyone’s time, but they erode trust between administration and doctors. Given our current climate of distrust in healthcare, I do not think this is something we can continue to do.

With this in mind, here are four tips that can help you run a better meeting with your colleagues. Feel free to use them at the next meeting you run, or print this out and anonymously leave it on the desk of your boss!

Negotiate the agenda before the meeting

 Staff meetings should not be mystery events where you show up to find out what the next bomb is going to be that will drop. No one trusts a leader that holds back all the information until they absolutely have to give it to you. Meetings are an excellent way to be transparent in this regard.

Meeting agendas should be posted prior to the meeting. Ideally, the meeting leader will request all attendees to send any items they wish to add to the agenda. The meeting leader will individually negotiate any items proposed that are outside the scope of the meeting.

Physicians can then actively participate in the structure of the meeting and not just have the meeting “happen to them.” Hopefully, physician participation leads to greater enthusiasm and a more productive meeting for everyone.

An added bonus of this process is that you will often find that some agenda items can be removed. This has happened for me many times. There may be an item that I think requires group discussion, but the barrage of emails that I get after sending out the agenda indicate that everyone already agrees on the solution. If everyone already agrees about an item, then don’t discuss it further and waste everyone’s time.

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Apply time limits


Meeting agendas should not only delineate what items to discuss, but they should state exactly how long to discuss each item. This practice will allow your staff to know what to expect during the meeting and get a general sense of the depth of each agenda item.

Using time limits will also shape how much discussion occurs about a topic. How many times have you been a part of a meeting where a minor point on the agenda railroaded the entire meeting because you talked about it for too long? This is much easier to avoid if the agenda already has the time listed next to each item. If something is only slated to be talked about for two minutes, then cut off the conversation at two minutes and move on.

Agenda time limits can take some adjustment for some groups. I recommend giving warnings at one minute or two minutes so everyone knows where you stand. You may have to even cut off a few conversations without making decisions at first. However, once your staff gets the hang of it, then they will be able to tell when it is time to make quick decisions and when it is time to discuss at length.

small meetingLimit meeting size


As meeting sizes increases, the productivity of the meeting goes down. This is true across all industries. Medicine is no exception.

I don’t like strong arm tactics, but this is an area where you should be militant. Do not invite people to meetings that don’t need to be there. If people are at a meeting unnecessarily, then ask them to leave.

There is no need to be rude about this. When I have to explain this to people that I am kicking out of a meeting, I explain it in terms of their personal productivity. What is the best way for them to use their time today? Sitting in a meeting where they are not going to participate or providing clinical care?

Most physicians will appreciate this gesture. I have never met a doctor that does not have some type of work to do. If it is a better use of their time to see patients or attend to clinical duties rather than being in the meeting, then that is what they should be doing.

Steve Jobs was famous for using this practice at Apple. There are some pretty entertaining stories of people being removed from meetings who had no idea it was coming.
His explanation, however, was directly in line with my thinking. I hired you to do a certain type of work. It is best if I do not distract you from doing it as much as possible.

Build in flex time


As good as you are as a leader and as well as you apply the above principles, unplanned things always happen in meetings. So…plan for that. I never run a meeting where the time limits on the agenda add up to the entire length of the meeting. For example, a 60 minute meeting always has 50 minutes worth of agenda items and 10 minutes of flex time.

You can use this flex time for any number of things. I typically use it for questions at the end of the meeting. This is a great way to give staff access to administration for any pressing matters. This will also give you time to discuss something that may have come up in the meeting, but it was not already on the agenda. If the questions that come up more of a personal nature, and don’t forget to cut the other staff members loose so they don’t have to listen to someone else’s personal questions.

The most popular use of flex time is to end the meeting early. Remember that ending a meeting early is never a bad thing. You will likely increase your popularity as a leader if you do this often.

Sometimes, it is even necessary to end a meeting early before all the agenda items are discussed, especially if you determine that you do not have the people or resources needed to make decisions about the agenda items. Never be scared to do this. As a leader, you need to respect both your time and the time of your colleagues. They will appreciate you for it.

I’m hopeful that following these tips will lead to fewer horror stories from my colleagues and honestly, less meetings doctors have to attend. Doctors really do tend to be happier when they focus on clinical care. That’s what they signed up to do. Let’s make staff meetings help them in this mission, not hurt them!

Let me know some of your best meeting stories below. Have you been a part of a particularly painful meeting? Do you have any funny stories about your staff meetings? Share in the comments!

Four Financial Tips For New Attending Physicians

So, you’re a new attending now, huh? The big money is rolling in. Your pager doesn’t go off as much at ridiculous hours of the night. Life is good. Life is going to be even better when we take our newfound riches and buy a Mercedes, right? Wrong.

Like other professionals that come into big paydays very quickly (professional athletes, lawyers, etc), physicians are highly prone to making very rash decisions with their money right out of the gate.

Nothing will set you up for misery more than tieing up your hard earned cash in petty things. New attendings tend to think they are invincible now that their paychecks have changed.

Your dream job you have now is perfect, right? No way it will go south and become awful. What if your job is actually terrible? What if you are ready to jump off a bridge six months in? It happens a lot, and the person that was smart with their money and can afford to make a change is in a much better position than the person driving the Benz.

So with that, I’d like to offer some free advice to the new attending crowd. Some of these tips I followed personally. Some I didn’t, and I have learned from the school of hard knocks. Heed my warnings so you can be in the best position possible.

Like any good boss, I don’t do all of the work myself, especially in the personal finance arena. There are a myriad of excellent blogs devoted to physician personal finance. Where applicable, I have linked to them so you can benefit from their wisdom.

Don’t Spend Differently

On the day you get your first attending paycheck, you should celebrate by eating out…at Subway. My first tip is don’t change your spending habits at all. If you bring your lunch to work every day, then keep bringing it. If you have a push mower to cut your lawn, then keep pushing (OK, maybe you can go self propelled here).

My point is don’t let your expenses grow with your new paycheck. When your expenses change with your paycheck, I call that living paycheck to paycheck. When your expenses are low and your paycheck is big, you are headed towards financial independence.

The temptation is so great in this arena that I propose literally hiding your money from yourself. Figure out how much you need to continue living your residency lifestyle. Keep that much in your checking account. Take the rest and put it in a separate account. Savings account, checking account, whatever. If your HR department lets you deposit your paycheck in multiple accounts, then do it that way. There is a bunch of free budgeting software out there that can help you keep track of your money across all your accounts. Pick one and use it. I use Personal Capital.

The White Coat Investor has many excellent articles about maintaining your residency lifestyle to grow wealthy. I recommend you check them out. Personally, I fell into this trap and then cut back my lifestyle after discovering my mistake. Don’t copy my screw-ups. Do it right from the beginning.

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Physician Finance Max Out Your Retirement Accounts

Do you want to retire one day? Do you want to become financially independent so you can just do the work you want to do? Both goals involve saving and investing money, so start doing it. The best way to save and grow your money in a tax deferred way is through your retirement accounts (401K, 403b, SEP-IRA etc).

If you’re making the average new attending salary in almost any specialty, then you can afford to max these out. The current maximum for those under age 55 in 2017 is $18,000 per year of employee contributions to a 401K. Divide that up by the number of paychecks you get per year and contribute that amount every paycheck.

There are multiple free resources available regarding the technicalities of retirement accounts and the different selections you need to make. For those already familiar with the numbers and terminology, I’ll say to set up your asset allocation with low cost index funds so you can reap the benefits of your contributions and your employer match. For those that have no idea what that sentence means, then read the following articles:

1. Index funds

2. Asset allocation

3. 401k basics

Clean Up Your Student Loans

If you’re like me, you came out of medical school with six figure student loans. You need to clean that mess up, pronto. You probably don’t have the free cash to pay all of those bad boys off immediately, so you need a plan.

This topic is very intricate, and there are a myriad of blogs and entire websites devoted solely to this topic. In a nutshell, here are the items you need to address:

1. Loan pay off vs. Loan forgiveness

2. Find any applicable loan assistance programs

3. Find the lowest interest rate

4. Variable vs. fixed interest rate

5. Identify the best loan term

For quick links that can give you great information on making these decisions, check out the following:

1. Student Loan Hero Guide for Doctors

2. Physician on FIRE Student Loan Resource Page

3. White Coat Investor

Public service loan forgiveness (PSLF) is the most popular loan forgiveness program. This applies to anyone working for a 501 (c) non profit or federal/state government. It is fantastic program that will allow your entire remaining loan balance to be forgiven tax free after 120 on-time, qualifying payments. This article gives you more in depth details regarding this.

Folks choosing PSLF should realize that your entire strategy changes if you are going this route. If you choose PSLF, then your entire focus should be on making your payments as low as possible. That way, you pay the smallest amount possible and maximize the amount that is forgiven. Pay close attention to what a qualifying payment is so you don’t wonder outside the bounds of the program in your search for the lowest payment.

Lastly, the subject of loan assistance programs is not well covered in the physician student loan world, in my opinion. You can negotiate with your new employer to write a check for your student loans for each year you’re employed with them. I have seen amounts ranging from $25,000/year to $50,000/year. You can also make sure they throw in enough to cover the taxes on that check.

Several government agencies also offer loan assistance above PSLF. The Department of Veterans Affairs will pay you up to $120,000 over five years through the Education Debt Reduction Program in some cases to work for them, just as an example. Don’t ignore these types of possibilities.

Physician Financial EducationEducate Yourself

There are enough resources available for physicians to be very successful with your finances without having to pay exorbitant fees to someone else. I have linked to several above, but here are links for the main sites of a few that will get you on your way.

1. White Coat Investor

2. Physician on Fire

3. Passive Income MD

4. Wall Street Physician

5. Rockstar Finance

If you follow my Twitter account as well, you will see me mentioning any new resources I find.

If you still want personal guidance after looking at these resources, then I recommend getting professional help in the form of a fee only financial planner. Fee only planners are financial professionals that will give you personal financial advice for a flat fee.

I mention this particular type of financial advisor specifically because they are the most likely to give you unbiased advice. Just like doctors that get paid by Pfizer are more likely to recommend drugs made by Pfizer, financial advisors paid by a certain services are more likely to recommend those services. You don’t want the services they get paid to recommend. You want the best ones. The National Association of Personal Financial Advisors is a great place to start looking for a fee only financial advisor.

So there you have it, my four financial tips for new attendings. Hopefully it prevents you from falling into some of the traps I fell into. I enjoy talking about money now that I’m starting to be responsible, and my life is always better when my financial ducks are in a row. I hope my tips help you do the same!

For those of you further down the line in attending world, leave a comment with your best advice for the younger crowd or maybe a personal story of something you did or did not do well financially. I’d love to share others’ experience in addition to my own. 

If any bloggers want to guest post on a physician personal finance topic, then shoot me an email or message me on Twitter.

Physicians Guide to Conquering Clinical Quality Metrics

I can think of no more well received topic amongst physicians than clinical quality metrics. Whenever I walk into a cafeteria or social event, quality metrics is one of my go to topics to lighten the mood and get everyone smiling.

OK, that’s a complete lie and all of you know it. However, that doesn’t diminish the importance of this topic. The number of metrics in healthcare has exploded over the past few years. They range from the essential to the absurd, and I’ve had a little fun on my Twitter account recently commenting on this.

The reality remains that metrics are not only increasing in our daily lives as clinicians, but they are starting to affect our wallets as well. I would venture to guess that a majority of you reading this now have some type of clinical quality metric that figures into your paycheck.

Once something starts affecting my paycheck, then you better believe it has my attention. As I’ve stated before, my goal is FIRN, so I cannot afford to have someone shaving pennies off my hard earned dollars.

My goal with this article is to give you some basic principles to apply whenever confronted with a clinical metric, not go through the ins and outs of all the different Medicare measures out there. I will readily admit that I am one of these weird physicians that enjoys this kind of stuff. Many of you are probably normal human beings that would be perfectly happy if this isn’t a part of your day. So, if you simply want to leave a snarky comment at the bottom as a means of taking out aggression, then please be my guest.

With that, let’s get started. I focus heavily on the mission whenever answering a question, so let’s start there.

Clinical Metrics

The Purpose of Quality Metrics

So, why are we doing this stuff? No, it is not as a means to pay doctors less money, despite what many may think. The reason we follow metrics is to improve the quality of care we provide. No improvement happens without first measuring what you want to improve. Clinical quality metrics are the first collective step in that process.

Most clinicians want to improve healthcare quality. On average, physicians are honorable professionals that want to do their best for their patients. They would gladly put in the work to improve their patients’ blood pressures or lower their patients’ collective risk of surgical site infections.

The disconnect occurs, however, in how the measurement process works and whether measuring things really leads directly to improving them. Many physicians feel that the steps required to collect and report clinical quality data are too onerous and take up inordinate amounts of their time (they’re right by the way and we’ll discuss how to spread the work around later).

Healthcare is still in the process of determining whether all of this measurement is beneficial to patients on a broad scale. From my vantage point, this depends heavily on what metric you pick and what resources are available to improve it. I think we are often guilty of trying to hit home runs in this arena when singles and doubles can score runs.

You can get tangible results by improving the colon cancer screening rate. A solid single. Cutting the thirty day readmission rate by fifty percent may be a home run but is a much tougher goal. This leads me to my next tip…

Picking the Right Metric

If you want to meet a metric, then pick one you can meet. It doesn’t get more obvious than that, but many fail to understand this. If you are already a physician administrator, then this is where you come in. You need to be able to explain to your non-clinical team that setting the goal of 100% of patients having a systolic blood pressure less than 130 is flat out impossible. Just like goal setting in any other realm of life, picking the right metrics to focus on should involve shooting for something that stretches you but won’t break you in half.

In addition, try to pick metrics that are actually meaningful. Picking some meaningless goal like “we will check blood pressures on ninety percent of our patients” is easy. Professionals want to be challenged, however, and will revolt against pointless work.

For those of you not directly involved in picking the quality metrics that your organization focuses on, you have two options to provide input. One is find the physician that does have direct input in the process so your voice can be heard. The other is to become the physician that gives input into the process. As I said before, your paycheck probably depends at least in part on this process. I prefer to be sitting at the table when the meal is served, and I suggest you do the same. I have done both of the above tactics in my career, depending on what my position in the organization was at the time.

Clinical MetricsKnow The Inputs

Once you have a metric picked, then you need to know exactly what the metric entails. Things seem very simple when sitting at a conference table, but they quickly become more complicated when you are back in the clinic seeing patients and trying to meet your goal.

Your electronic medical record (EMR) is intimately involved in this process, so plan to collaborate with your IT people or EMR vendor.

It’s probably easiest to use an example here so let’s suppose your clinic has decided to focus on your diabetic patients, and you want to get 80% of your diabetic patients to an A1c<9. Right off the bat, here are a few questions I would ask:

  1. Will ICD-10 codes identify diabetic patients or something else (i.e the EMR problem list)?
  2. If using ICD-10, which codes are we including (i.e what about the steroid induced diabetes folks etc)?
  3. Can patients be “cured” of diabetes? How will we figure that out?
  4. How do we track patients that have A1c’s done outside our healthcare system? Is someone going to manually enter these in the EMR or manually add them into the final calculations?
  5. Will both point of care A1c’s and serum A1c’s be included? Will the EMR capture both?
  6. Does the final A1c number of the year count or the average A1c?
  7. Will you be penalized if you go too long without measuring an A1c?
  8. Who are “your” patients? Is it the person that orders the A1c, the person that saw the patient last, or the person listed as the primary care?
  9. Do patients that move, change providers or get lost to follow up during the year still count?
  10. Do patients on hospice count?

A “simple metric” gets very complicated very fast, doesn’t it? Someone with a clinical background needs to be asking these questions, however, if you want to be successful. Knowing all of these details will allow you to take your next step in conquering a quality metric, building a systematic approach to success.

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Using Systems to Meet Metrics

Physicians cannot meet quality metrics by themselves. This concept is so important that I’ll say it again. Physicians cannot meet quality metrics by themselves. Systems of care meet quality metrics. Quality metrics are a means to improving systems of care at the end of the day. Physicians are essential to this system but are not the entire system.

This systematized approach happens at both an organizational level and an individual practice level. Let’s return to our A1c example from earlier. If trying to tackle this from an institutional level, I would address several items:

  1. Easy availability of A1c testing (lab availability or point of care testing)
  2. Technology transfer between health systems to obtain A1c data
  3. Working with EMR vendor to run periodic reports and ensure appropriate data capture
  4. Ensure appropriate diabetic referral resources available

As a provider in my daily practice, I would focus on different aspects of my individual system of care:

  1. Establish nursing staff protocol for nursing to test patient’s A1c’s automatically when due
  2. Establish or improve relationship with Endocrinology or clinical pharmacy to ensure quick patient access when needed
  3. Ask administration to give periodic updates on our numbers. Request real time data access if possible. Send the data to your staff so they can schedule appointments or deploy more resources for individual patients.
  4. Have front desk staff ask all diabetic patients if they have had labs drawn at other facilities. Get release of information on the spot for anyone that says yes.

As you can see, the scope of each approach is different but the concept is the same. You have to modify the system of care, not rely on one person (i.e the physician) to collect, analyze, and act on the data. The organization that can best implement systems at multiple levels instead of simply relying on doctors to do all the work will always win, and these doctors will not feel the onerous burden of meeting metrics by themselves.

healthcare administratorThe Evil Administrator Myth

Lastly, I want to tackle one common misconception that I constantly hear from physicians in regards to clinical metrics. I enjoy hearing physicians say things like,”This metric is just a way to cut into my paycheck,” or “I guess we’re not meeting the budget so they put in a few more metrics.” While I can’t speak for Uncle Sam’s motivation when it comes to implementing clinical quality metrics, I can tell you that the administration in your organization wants you to meet your metrics.

It is worth a lot more money to provide measurable, high quality care than to use metrics to deny doctors part of their salary. Number one, it makes for excellent marketing. If every primary care doctor you had controlled 100% of their diabetics, would you put that on a billboard if you were the CEO? You bet you would. More patients then come to your clinic, and everyone makes more money.

Second, meeting quality metrics produces improvements in staff morale.. There is a palpable improvement in the esprit de corps of a group when they meet a goal. Recognition for achievement will compound this effect even more in a group passionate about the cause. Healthcare professionals fit very well into this mold. Do these motivated groups then produce more? They do indeed. Every administrator on earth wants to improve the productivity of their people, so I promise, any administrator with sense is pulling for you (I hear you laughing back there!).

So, what do you think? Are you ready to conquer the clinical metric world? Do you still not care about this stuff at all? Does your boss need to read this article? Let me know what you think in the comments below. Remember that, at the end of the day, its still a great job to be able to take care of patients. Don’t let numbers on a page change that. But, if some numbers on a page can help you do a better job, then let’s do it!