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The Rise of Urgent Care and Retail Clinics – Or Is It The Rise of Convenient Healthcare?

Posted on December 5, 2018 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

It doesn’t take a rocket scientist to see that primary care faces more challenges than it’s ever faced before. Not the least of which is being one of the lowest paid medical professions with rising medical school prices which encourages more doctors to choose specialty medicine and eschew primary care. What’s astounding is that this trend stands in stark contrast to what patients want from primary care. Patients want more convenience while the medical establishment is turning out fewer primary care doctors which creates a shortage of doctors and long wait times for primary care visits.

As Lydia Ramsey notes in her tweet below, urgent care offices are popping up everywhere. Combine that with retail clinics and the future of primary care is facing a lot of serious questions.

The reality is that most patients don’t want to go to urgent care or retail clinics. They’d much rather go to their PCP. Why don’t they go? The simple answer is convenience.

It’s much more convenient to hit the urgent care or retail clinic than it is to go to their primary care doctor. Some of this has to do with a shortage of primary care doctors which means long wait times to be seen. In other cases, it’s the really poor experience patients have had visiting their doctor in the past. I don’t need to list off the litany of bad patient experiences that we’ve all had when visting doctors. It’s like a universal PTSD experience that everyone has gone through.

Dave Chase offered his take on the rise of urgent care:

I’m not sure about his reference to the “devastation of primary care.” I’d be interested to hear why he thinks primary care has been “devastated.” Is he referring to over-regulation and underpayment? Is he referring to the shortage of docs I mention above? Is he referring to the rubber stamp PCP visits that are required to see a specialist in many insurance plans and in many ways ruined the PCP visit?

No doubt, primary care has been one of the least appreciated medical professions. However, primary care doctors didn’t do themselves any favors either. In many ways it reminds me of what Uber and Lyft have done to the taxi industry. Taxis could have embraced all the conveniences that Uber and Lyft provide, but they chose not to do so. Why not? Because they felt like they didn’t need to change since they had a virtually monopoly on the industry. Would I rather get a taxi? Yes, but I don’t because Lyft is more convenient. Sounds a lot like PCPs, doesn’t it? We’d rather go to a PCP, but an urgent care or retail clinic is more convenient.

Going back to Dave Chase’s comment that “If there’s proper primary care in a community and ethical hospitals, there’s no need for separate urgent care.” I might agree if he’d say there was less need for a separate urgent care. Urgent care does some really great work in off hours. However, the real problem is defining what he calls “proper primary care.”

I do think that if PCPs would have embraced better patient experiences, urgent cares and retail clinics would be much smaller. That said, does anyone think we can put that genie back in the bottle? I don’t think so. I believe our future healthcare system is going to have urgent care, retail clinics, and primary care.

The real question is what can PCPs do to make sure they thrive in this new mixed environment? I’d suggest that the first place to start is convenience.

A Vote In Favor Of Using Scribes

Posted on September 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Over the past few years, using scribes to complete medical documentation in EHRs has gotten mixed reviews. Some analyses have found that scribe services were too expensive to justify the investment, while others have concluded that the use of scribes can make a meaningful impact on revenue and improve physician productivity.

This month, a new paper has been published whose results fall into the plus column. The small study, which appears in JAMA Internal Medicine, looked at the use of scribes among 18 primary care physicians.

To conduct the study, researchers looked at physicians at two medical center facilities within an integrated healthcare system, gathering data between July 1, 2016 and June 30, 2017.

The research team assigned PCPs randomly to two groups, one with and the without scribes, for 3-month periods, switching physicians between the with and without groups every three months. At the end of each three-month period, the PCPs filled out a six-question survey which collected their perceptions of documentation burdens and visit interactions.

In addition to capturing PCP perceptions of scribe use, researchers also collected objective data, including time spent on EHR activity. They also surveyed patients of participating PCPs to gather data on the patients’ perceptions of visit quality.

When all was said and done, the research team found that scribed periods were associated with less self-reported after-hours EHR documentation work.

Researchers also found that when they used scribes, PCPs were more likely to report spending more than 75% of the visit interacting with the patient and less than 25% of the visit on the computer. In addition, physicians were more likely to finish their encounter documentation by the end of the next business day during scribed periods.

What’s more, 62.4% of patients said that scribes had a positive effect on the visits, while just 2.4% said they had a negative effect.

The researchers’ take away from all this was that the use of medical scribes could be one strategy for improving physician workflow and primary care visit quality.

As I noted previously, other research has drawn similar conclusions. For example, a study published in 2015 (which included the involvement of scribe provider ScribeAmerica) found that scribe use at the two hospitals was linked to an improved Case Mix Index which ultimately led to gains of about $12,000 per patient. Meanwhile, inpatient physicians were able to cut time spent the chart updates by about 10 minutes per patient on average.

Having been over arguments for and against scribe use, my personal conclusion is that working with them can be a worthwhile investment if doing so is a good fit for the physicians involved, but doesn’t work in all cases.

Ultimately, it seems that there’s too much variation between settings in which scribes could be used to make a single blanket statement about their benefits. I guess we won’t be drawing grand conclusions about scribe pros and cons anytime soon.

E-Patient Update: Clinicians Who Email Patients Have Stronger Patient Relationships

Posted on January 26, 2018 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I don’t know about you, but before I signed up with Kaiser Permanente – which relies heavily on doctor-to-patient messaging via a portal – it was almost unthinkable for a primary care clinician to share their email address with me. Maybe I was dealing with old-fashioned folks, but in every other respect, most of my PCPs have seemed modern enough.

Few physicians have been willing to talk with me on the phone, either, though nurses and clinical assistants typically passed along messages. Yes, I know that it’s almost impossible for doctors to chat with patients these days, but it doesn’t change that this set-up impedes communication somewhat. (I know – no solution is perfect.)

Given these experiences, I was quite interested to read about a new study looking at modes of communication between doctors and patients in the good old days before EHR implementation. The study, which appeared in the European Journal for Person Centered Healthcare, compared how PCPs used cellphones, email messages and texts, as well as how these communication styles affected patient satisfaction.

To conduct the study, researchers conducted a 16-question survey of 149 Mid-Atlantic primary care providers. The survey took place in the year before the practices rolled out EHRs offering the ability to send secure messages to patients.

In short, researchers found that PCPs who gave patients their email addresses were more likely to engage in ongoing email conversations. When providers did this, patients reported higher overall satisfaction than with providers who didn’t share their address. Cellphone use and text messaging didn’t have this effect.

According to the authors, the study suggests that when providers share their email addresses, it may point to a stronger relationship with the patient in question. OK, I get that. But I’d go further and say that when doctors give patients their email address it can create a stronger patient relationship than they had before.

Look, I’m aware that historically, physicians have been understandably reluctant to share contact information with patients. Many doctors are already being pushed to the edge by existing demands on their time. They had good reason to fear that they would be deluged with messages, spending time for which they wouldn’t be reimbursed and incurring potential medical malpractice liability in the process.

Over time, though, it’s become clear that PCPs haven’t gotten as many messages as they expected. Also, researchers have found that physician-patient email exchanges improve the quality of care they deliver. Not only that, in some cases email messaging between doctors and patients has helped chronically-ill patients manage their conditions more effectively.

Of course, no communication style is right for everyone, and obviously, that includes doctors. But it seems that in many cases, ongoing messaging between physicians and patients may well be worth the trouble.