Just Read: Fee-For-Service, While Much Maligned, Remains The Dominant Payment Method For Physician Visits

The title says it all. From the current issue of Health Affairs (@Health_Affairs).

Note that the study looked at actual visits booked by physicians so it doesn’t capture payments made to physicians for patients who didn’t visit.

It can be a confusing world when a health professional is trained and emotionally incented to be rewarded for health but not physically/financially. That confusion doesn’t exist in integrated care, where as Ezra Klein (@EzraKlein) so eloquently put it in the Weeds Podcast recently:

Thanks to Health Affairs for hosting the briefing around physician practice yesterday in Washington, DC

Fee-For-Service, While Much Maligned, Remains The Dominant Payment Method For Physician Visits0426
Fee-For-Service, While Much Maligned, Remains The Dominant Payment Method For Physician Visits0426 (View on Flickr.com)

MakerDocsDC January Edition

(View on Flickr)

Just adding this photo here so people can see the progression of MakerDocs. We are going to travel around to the most innovative places in Washington, DC in 2015. Always much to share about how to innovate in health and health care…

MakerDocsDC January: Left to Right, Denton Shanks, MD, MPH, Whitney Gray, PhD, LEED AP, Hassan Tetteh, MD, MBA, Emily Boss, MD, Nishi Rawat, MD, Kevin Maloy, MD, Me.

Just Read: Just 6 more seconds of listening needed to elicit the patient’s agenda

“…asking “Anything else?” repeatedly until a complete agenda has been identified appears to take 6 seconds longer than interviews in which the patient’s agenda is interrupted” Reference: Marvel MK, Epstein RM, Flowers K, Beckman HB. Soliciting the Patient’s Agenda: Have We Improved? Jama. 1999;281(3):283–287

Actually I read this a while ago; I realize I’ve never turned it into a slide, until now.

I’m using it to illustrate an artifact of physician culture, part of a keynote I’m preparing (Crowdsource Request: Keynote for Labor-Management Parntership all-hands – “Social innovation” | Ted Eytan, MD).

We tend to interrupt people. On average about 23 seconds into them telling us why they are here to see us. Good news is that it improved 5 seconds in between the 15 years it was studied (1984 and 1999). I can’t find a newer study, if anyone knows of one, let me know.

Interestingly, it was found that if physicians just listened for 6 seconds longer, by repeatedly asking “Anything else?” or “Tell me more?” they were able to know what the patient was concerned about. The opposite of this is not knowing up front, and the consequences of that – the door handle conversation, the “late concern,” the problem unexplored, and a less efficient encounter, and sometimes devastating health experience.

One interesting correlation is that physicians with fellowship training (training after residency) were more likely to exhibit listening behavior than those who didn’t have the training. These were all family medicine specialists so there’s no comparison of other specialties in this study.

This fits with what I have mentioned before in the world of listening, reducing conscious and unconscious bias, being there for the people we serve in and out of the exam room. The good news is it’s easy to move away from a “Yes I know what you’re asking for,” culture to a “tell me more” culture. I know because I do it all the time – “say more.” My colleague Danielle Cass (@DanielleCass) also taught me this one – “Go on..” Try replacing this response with the one you normally use and see what happens (and let me know what happens – magical!).

Listening is the hugest innovation in health in the decade of the patient.

6 seconds 🙂

Photo Friday: Change Reality, Talk about Magic, Learn Javascript. MakerDocs DC

This week’s photograph is of an almost electric (see the full set of photos below) ignite talk given by Kevin Maloy, MD (@maloykr) , Emergency Room physician and innovator at Medstar Institute for Innovation (@MI2Innovation), where he shows an audience how a simple web page, like, say the one for the Center for Total Health (@KPTotalHealth) can gently be edited to become a place to talk about magic.

A place to talk about magic? Maybe. View MakerDocs in DC 42798 on Flickr.com

MakerDocs is the super secret meeting of physicians that none of us wants anyone to know about(™), and includes doctors from across institutions who talk about the magic of innovation and are changing reality.

This is the second major meeting, the first was in San Francisco earlier this year (see: MakerMDs: Physician Intra/Entrepreneurs driven to innovate | Ted Eytan, MD)

Thanks again to Rebecca Coelius, MD (@RebeccaCoelius) and Connie Chen, MD (@ConnieChenMD) for organizing and our other igniter, Jacob Reider, MD (@jacobr), who’s also the Chief Medical Officer of the Office of the National Coordinator, AND Sandeep Pulim, MD (@Spulim) for being our DC facilitator.

Photo Friday: Faces of Innovation

Left to right: Lesley Levine, MD, John Mattison, MD, Ted Eytan, MD, Tad Funahashi, MD, Kaiser PermanenteView Faces of Innovation 39947 on Flickr.com

I took these photographs, except for the one above (I know a better camera when I see it) at Kaiser Permanente’s annual Innovation Retreat hosted by our Executive Vice President and Chief Information Officer Phil Fasano (@FasanoPhil).

In a recent Photo Friday (Photo Friday: Why aren’t more people asked about their goals? #TeamJess | Ted Eytan, MD) I said that I know some of the best doctors in the world. That’s still true, and it includes doctorates of Philosophy, Nursing, as well as other healers who innovate in an integrated care system less by building new things (they do that too), more by solving problems across the spectrum of health, as part of something bigger than our individual aspirations. Always a great reunion with the future. Rest of my photos below, enjoy.

Doctors, EHRs, and the Patient relationship on the Kojo Nnamdi Show, Washington, DC USA

It is the decade of the patient, when the local (Washington, DC) affiliate (@Wamu885) hosts a conversation about how electronic health records are affecting the relationship between patients and physicians (You, Your Doctor And A Computer: How Technology Impacts Personal Health Care | The Kojo Nnamdi Show).

There was a time when I would come to Washington, DC, and other physicians would say things to me like, “isn’t a patient e-mailing their doctor kind of like spam?”

I was joined by 3 (superstar) physicians:

  • William Yasnoff, MD, PhD, Managing Partner at National Health Information Infrastructure (NHII) Advisors; CEO and President at Health Record Banking Alliance
  • Nareesa A. Mohammed-Rajput, MD, Internal Medicine Physician and Physician Lead for Electronic Medical Records, Johns Hopkins Healthcare
  • Alice L. Fuisz, MD, Internal Medicine Physician, Washington Internist Group (DC); Governor, American College of Physicians, DC Chapter

as Nareesa Mohammed-Rajput, MD (@nmohamme) aptly stated, “across the spectrum from health care.” And guess what, we all want to perform well for our patients, which in 2013 includes using the best technology. The art, which is what the show was about, is making it work for our patients. The comments of the listeners confirmed that there’s optimism, and also some work to do.

You can view the transcript here, or if you are more about the audio, you can listen to the broadcast here.

I also personally enjoy being in a room with other doctors who like taking pictures – they’re the ones that celebrate the human spirit 🙂