Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
HIStalk Practice Interviews Jennifer Hanscom, Executive Director and CEO, Washington State Medical Association
Jennifer Hanscom is executive director and CEO of the Washington State Medical Association.
Tell me about yourself and the association.
I’m the CEO of the Washington State Medical Association. I became CEO in February of 2013. Prior to that, I was the director of communications and membership. WSMA represents about 10,000 physicians, physician assistants, medical students, and residents throughout Washington State. They are of all specialties and all practice sizes. I have told people recently that about 60 percent of our membership is in practices or hospital health systems of 100-plus physicians. The landscape has certainly changed in terms of who we represent. I started at the association in 1996. At that point in time, we had about 38 percent of our membership in solo, small practices. Today, that represents 8 percent. Again, 57 percent and 100-plus practices, so there’s been a huge shift in terms of the practice landscape. Our vision is to make Washington the best place to practice medicine and to receive care.
What state and federal healthcare policies are Washington physicians keeping an eye on? Any specifically related to healthcare technology?
Payment reform is at the top of their list. How can we best transition from a fee-for-service world to one that rewards quality without placing a burden on or physicians? The future of value-based reimbursement really depends on leveraging health information technology. You may have heard that, in our state, we are moving forward with an initiative called "Healthier Washington" to transform Washington State’s delivery system by 2020. We’re really focusing on the resources that need to be dedicated to help physicians in their practices transition to the new system of care delivery in a way that is financially viable, doesn’t create additional administrative burden, and doesn’t impede their ability to deliver care in a safe and timely manner. We’re really focusing on how to help practices transform in the future to be set up to be successful.
With the launch of the Affordable Care Act, CMS had new numerous programs and models to help providers achieve that large-scale transformation. That certainly helps on the resource side. Then, for us as an organization, we’re really looking at anything we can do to eliminate unneeded expenses so that independent practices can redirect their limited resources. Looking at the ease of use with tools for quality reporting and methods that allow physicians and patients to find and use relevant information is critical. I think that stems into why we held the town hall with AMA – we need to really look at the time spent on navigating EHRs that can severely impact the physician’s ability to see patients and/or spend enough time with them to address all their concerns. This affects physicians in large systems as well as physicians in small practices.
Is Washington beginning to embrace telemedicine?
After several years of advancing the concept of telemedicine before our state legislature, as of last year, I’m happy to say, telemedicine is now covered in our state. It had some limitations as it originally passed; for instance, in-home telemedicine visits weren’t covered, but there have been some conversations in our state legislature this session to start having those services covered. We are starting to already see improvements to the original legislation.
How have Washington physicians reacted to the latest ups and downs of Meaningful Use?
I think there was certainly some confusion, but my sense is that our physicians have a lot of optimism that the pause button has been pushed. The Stage 3 requirements of Meaningful Use made it unreasonable to expect positive change in the next generation of EHRs unless significant program changes were made. Pushing that pause button may result in improved systems and tools, which is certainly something that will be embraced by the physician community. They see the advantages to EHRs. At our town hall event with AMA, one physician in particular shared that it’s revolutionized the way she provides care.
The majority of folks who attended the event said they absolutely do not want to go back to paper. They’re really committed right now to making EHRs and health IT work to improve patient care. They’re frustrated with the continuous interferences in workflow, the constant mouse clicks, and data entry. That’s something I hear over and over again: "Jennifer, just make the constant clicking stop." Interoperability, usability, the complex regulations that require a lot of time from our physicians really get in the way of patient care. When systems can’t exchange data, they demand too much of a user – that’s frustrating and hard for folks to embrace. Several physicians commented at the event that we really need to focus on separating the billing portion – again, the endless box checking – away from the clinical reasoning and the clinician portion.
How involved were you with the decision to bring that event to Seattle?
The AMA reached out to us. They had events in Atlanta and Boston, so we were quite pleased that they looked to us to have their third event. I think in part because the WSMA has advanced an initiative called "Healthy Doctors Healthier Patients" that really focuses on tackling the challenges and regulations that are getting in the way of a physician’s ability to practice good quality of medicine. It’s very similar to the AMA’s "Break the Red Tape" campaign. Although with us, we’re focusing on the Quadruple Aim in medicine and the notion that if we don’t have physicians who are professionally satisfied, it’s really hard to achieve the Triple Aim in medicine. Certainly, having a well-functioning EHR and IT tools is key to improving that professional satisfaction in the physician community, and I will say with their staff as well. Medicine is practiced as a team. Staff is critically important. If staff are feeling burned out and stressed, physicians are feeling burned out and stressed … it certainly doesn’t help them deliver good quality patient care.
What patient wants to go in to see a stressed individual? When you peel back that onion and look at the cause of this stress and burnout, we see it’s those administrative challenges. It’s working an EHR that they don’t feel is conducive to the patient care that they’re trying to deliver, not understanding why it takes 12 clicks to give somebody a flu shot. It’s, "Why do I have to sit on the phone for half an hour with an insurance plan to get pre-authorization when I went through all the clicks on my EHR and all the information is there?" The interoperability, the usability, it all contributes to that satisfaction. If we can spend some time there, I think we can really turn those physician satisfaction scores and practice satisfaction scores around.
What other takeaways did you get from the town hall event?
I was really pleased to hear that the physicians in the audience had some optimism that folks were willing to listen, and that they’re committed to making the change. It was very insightful to me that they did not come just to complain, but rather to offer ideas and solutions about how best to move forward to really improve efficiencies and provide patient care. I will say that won’t be good just for the physician in practice; it will also be good for patients. I think we all want better experiences in terms of capturing the information that we want to have access to as patients in a timely and efficient manner, much like we do when we’re on other websites, getting information or filling out forms. I think there can be some win-wins for both if we get focused on interoperability and usability rather than government regulations.
How is WSMA going to work with AMA to move forward and address these talking points?
At the national level, we’re already been engaged with the AMA and the other state and specialty societies offering detailed recommendations for moving forward to both ONC, CMS, and members of Congress. We’ll continue to collaborate on a grassroots campaign to advocate solutions to policy members or policy-makers, members of Congress, as well as industry vendors at that national level. Then, here in Washington State, whatever improvements we can make locally as our state moves forward with that "Healthier Washington" initiative will be key, so that we’re making improvements at the federal level and the local level.
Aside from EHRs, what other healthcare technology related concerns or even successes are your members experiencing?
I’m going to focus on the successes. I have to say that our members are really embracing strategies that provide them with relevant and useful information at the point of care. One thing we hear over and over again is, "How can I have this information at the point of care?" For instance, we’ve embraced technology such as the prescription monitoring program that allows physicians to access information before they prescribe or dispense drugs. That’s really critical, especially with access to opioids via emergency rooms. Being able to get in there and see if someone’s overprescribing narcotics is extremely important in reducing accidental death and overdose.
We’re looking right now at creating a central repository for advanced care plans including advanced directives in the POLST form. Again, so that at the click of a button, a physician in the ER, a physician who doesn’t typically see this patient, has that information on hand so that that patient’s information or wishes are being honored. We’re finding ways to incorporate Choosing Wisely tools into EHRs in order to guide and reduce overuse of unnecessary tests, treatments, and procedures as well as measure and track efforts to improve care. We’ve had several grants going on in our state where we’re working with some systems like Swedish and Group Health to see how to do that successfully, and then we’ll share those best practices with other practices.
One comment that was made at that EHR town hall the other day was from a physician who mentioned that she loves her EHR, but is struggling with how to incorporate population health referrals so that if she has a patient who needs some kind of service, that information pops up in her EHR so that she can get the patient to the right social services after the visit. Lots of good insight. I do want to be clear that we don’t want to layer on; rather, we want to just reorient the data and the measures away from a process-based task to focus on the goals that are useful to patients and physicians. Having physicians at the table voicing that and sharing that information will really be critical to success going forward.
Do you have any final thoughts?
Our healthcare system is in the throws of an unprecedented degree of change and disruptive innovation. As that transformation occurs, physicians and their practices must receive the support necessary to ensure sustainability so that they can provide the care needed by their patients. That’s the primary role of the Washington State Medical Association in helping our state physicians be successful going forward.
Jennifer, Mr. H, Lorre, Dr. Jayne, Dr. Gregg, Lt. Dan
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I’m really beginning to tire of the complaint that it is the EHR that is causing all the grief and stress for physicians.
Let’s face the facts, it has little to do with the software and a lot to do with the ever increasing administrative burden that physicians must go thru to justify their getting paid.
If you want to run a small business and get paid by other businesses (payers) then get use to the hassles.
If you don’t want the hassles find someone who will hire you and let them deal with it. Or…
Move to direct primary care model and be paid directly by the consumer.
With the advent of retail care, Telehealth, and other disruptive models to outpatient care, it certainly isn’t going to get easier. Tough times all around for physicians that really have nothing to do with software of any kind.
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