Re: Walmart Health: Just had a great dental visit this morning, which was preceded by helpful reminders from Epic, and…
Halee Fischer-Wright, MD is president and CEO of MGMA.
You’ve been with MGMA since 2015. What did you set out to accomplish, and how have your goals for the organization changed?
As I was being recruited in 2015, I recognized that MGMA – a remarkable organization with a fantastic brand – was really struggling to find its relevance in the healthcare world that had changed pretty dramatically in the five to seven years prior to my arrival. It’s one of those things where you can’t keep doing the same thing and expect the same results in a world that has undergone a dramatic shift. I knew I had to create a vision when I came in. I also knew the transition for a 90 year-old organization was going to take more than your standard 90 to 180 days. It’s really going to be between a three- and seven-year process.
The first thing that I focused on was actually finding relevance. Where is MGMA relevant in this day and age? That day and age was in March of 2015. I really spent the first year digging into that. Aside from that, there were other operational issues related to how you manage and operate a non-profit association and bring it up to speed with other industries. What I set out to accomplish that first year was to identify where our relevance is and really clean up the operations of the organization. I think we did an outstanding job with that.
Now, as we move into my third year, the goals have shifted. Year three is really looking at opportunities now that we’re clear on what our vision is, which is that MGMA wants to move from being the organization that reports on group medical practice to leading group medical practice. To do that, we have to shift some of our business functions, and we have to really change how we do business, which is, in full transparency, parallel to the growth processes going on right now at almost every other organization within healthcare. That’s what we’re focused on right now.
Let’s shift gears a bit and discuss MGMA membership, particularly small and independent practices. What do you perceive their biggest challenges to be, especially as they relate to technology?
According to our statistics, somewhere in the neighborhood of 40 percent of practices are in the small to medium-sized practice range, defined as less than nine providers. That’s quite a few practices across the country. We’re talking about practices that aren’t just in rural areas. These can be practices in urban areas as well. As we saw between 2010 to about 2015, there was a lot of consolidation with healthcare systems purchasing the small to medium practices. That has slowed down over the last two years. In fact, we’ve seen divestiture staring to occur. That begs the question, why do healthcare systems decide to divest practices and what do practices struggle with? I would say there are two really big things that practices struggle with, and they go hand-in-hand. First, it is the regulatory reporting burden and the shift of the payer landscape as far as how do physicians report on quality.
The other part is related to EHRs and the promise that it would make practices more efficient, and allow them to deliver higher-quality medicine and spend more time with their patients. We’ve actually seen them have the opposite effect. EHRs, because they’re not engineered specifically for the end-user, end up being really a business application. Because of that, it’s really interfered with the practice of the art of medicine. We’re seeing physicians becoming increasingly burnt out and patients becoming increasingly less satisfied. We’re now at a crisis point where physicians aren’t happy and patients aren’t happy. Our federal regulators can’t afford to pay any more money. Something needs to change. That really is the reason that I wrote the book Back to Balance.
Are you going to be signing copies of it at the conference?
Of course I am!
Speaking of the conference (which kicks off on Sunday, October 8), how will help physician attendees address those issues?
There are a couple of ways we’re doing that. First of all, I think our advocacy office is second to none. There’s no healthcare association that has better insight into how healthcare regulations affect the day-to-day operations of a practice. What the pros are. What the cons are. How to work within the regulations to still deliver high-quality, patient-centered care. We’ll be doing quite a few sessions with our governmental affairs office in DC. That’s number one. Those tend to be some of our most popular offerings at annual conference.
We’re also offering sessions on practice operations. There’s a lot that we can do in medical practice to streamline operations to make patients and physicians much more satisfied. If you don’t ever get the opportunity to leave your practice and think about how things should be different, you don’t get the opportunity to see how others can do it. We’re offering that. We have several educational tracks at our annual conference to really offer those insights that allow practices to bring something tangible home and put it into place. That’s probably what I’m the most proud of. We’ll also offer several CME sessions that really link the business of medicine to clinical practice as well.
Did you have any input into getting actress Viola Davis as a keynote speaker?
Yes. It’s really interesting. The topic of women in leadership has been a really hot topic over the last 18 months regardless of what your political ideology is. I think, in healthcare, we’re a bit down in the mouth. We’re really feeling victimized. There’s so much uncertainty. To bring in someone who can talk about how their circumstances really would have set them up to be unsuccessful, and even to be a victim, and how she triumphed in the face of great adversity, is really important for an organization like ours. I hope our attendees should really hear her story and come away inspired to move things forward, and to bring change into their own lives, even in a small way.
Circling back to technology, what has MGMA members excited?
Programs and software developed by end users are where people are focusing. We’re coming to a point in our technology that we’re moving towards interoperability. We believe that, within the next couple of years, we’ll see the government really regulate that interoperability, which will take care of a lot of the headaches that we currently experience. Where we have not seen a lot of improvement is in end-user design. We’re now seeing other players from other industries, i.e. Apple, starting to stick their toe into healthcare. That elegance of design focus and end-user focus, I think, is going to transform the relationship of technology in healthcare. I think it will require someone from outside of our industry to bring that expertise.
One of the things I talk a lot about is the fact that with healthcare, we expect incremental change. We’re happy with 2 percent, 3 percent, 4 percent. It really requires disruptive innovation. Who best to lead that than our partners in innovation in the Silicon Valley to really point out to us where we can be disrupted for the benefit of all? I do believe that’s coming.
Do you think companies like Apple and Amazon will either develop their own EHRs or partner with existing EHR vendors?
I’m going to say something completely controversial, and I’ll get pummeled for it. The aspiration of the EHR is fantastic. The application of the EHR has not lived up to anybody’s expectations. I’d like to see alternatives to an EHR. In a cloud-based system with sharing of data, maybe even some blockchain technology, it looks very different than what we’ve come to know as kind of a bread-and-butter EHR. That’s where I feel the disruption needs to occur. It’s something that we haven’t even envisioned yet that would come through and just, basically, everyone would say, “Yes, this is what we’re missing.”
Honestly, I think about my iPod. I didn’t know I needed an iPod, but since I got one I couldn’t live without it. Speaking as someone who had well over a thousand CDs, the idea of condensing all that into something that fit in the palm of my hand … At first, I thought this is ridiculous and it can’t be done. In all fairness, I can’t imagine what my life would be like without it. I think we’re going to have that same experience with EHRs and some of the new technology that’s being developed.
MGMA recently released its annual practice operations survey. Did any of the results surprise you?
I think they will surprise some patients. According to our survey, the wait time for patients has improved. I think, if you speak to any patient, that does not feel like the case. It’s actually down an average of 20 minutes between the waiting area and the exam room. The other thing is that, in scheduling, physician-owned practices see patients sooner than hospital-owned practices. I think that’s really interesting. That’s an insight that could be really useful for patients who are trying to decide how to choose their care.
What’s even more shocking are the results around patient portals. I went to a conference in 2005 where they talked all about patient portals and how they would give patients the ability to take their personal records with them anywhere they go. It hasn’t happened. Only 30 percent of patients who visit hospital-owned practices use the portal. Whereas, if you’re in a small physician practice, less than 10 percent use portals. The function that people like the most is online payments and communicating with providers. Less than 5 percent are using it to schedule appointments, which is really probably its biggest strength.
The other thing I found really interesting are the patient satisfaction results. Three-quarters of practices measure patient satisfaction. That’s quite a few, but I don’t see that commensurate with improvement in patient satisfaction. Clearly, the axiom of you get what you measure is not actually occurring in measuring patient satisfaction. Only about 27 percent of patients that go to a practice are satisfied with their experience.
How can physicians act on those survey results, especially when it comes to online scheduling adoption and patient satisfaction?
In the book Back to Balance, I point out that just because we measure it in healthcare doesn’t mean we actually do anything about it. I actually practiced medicine this way. I practiced for 19 years. The question I found myself asking was, if this test isn’t going to cause me to change what I’m doing already, I’m not going to order the test. In the same way, I would tell people, if you’re not going to do anything about patient satisfaction, stop measuring it. The irony in this is, let’s talk about quality measures in medical practice. According to our data, every physician, on average, spends about $37,000 measuring quality. Not to improve things. They just spend it to report it.
A better way to look at it is to ask physicians, what are you doing that is not adding value? I think a great place to start with things like this are patient satisfaction surveys or portals. They are tangible and there isn’t a lot of judgment around them. These are just things we have. Then physicians need to ask themselves if they’re doing anything with these results. If not, then stop doing it. Where can they invest their energy and effort that will move the bar on patient satisfaction or on enhancing portal usage? Those are the crucial things that I don’t think physicians have ever had the time to consider. Physicians are so burdened with all the things we need to do that we haven’t had the time to lift our heads up and ask those questions. If we stop doing things that don’t add value, we’ll find the time.
Finally, what advice do you have for conference attendees? Any tips and tricks for getting the most out of their experience?
I would advise people to really map out their strategy and be realistic. It’s one thing to take a look at our website and map out 14 sessions to attend. What I would ask people is, are you really going to attend 14 sessions over three days? If you’re not, then seek out the ones that you feel you can attend, engage in, and bring something back home to put in to practice. I think there’s always that balance between personal development and enhancing the practice. I’d ask people to really consider before they attend what they want to do for personal development, and then what they can bring back to their practice to really prove the value of attending the conference.