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Quality & Governance News

Patient Adherence, Evidence-Based Care Top Priority for Docs

By Jennifer Bresnick

- Increasing patient adherence and delivering evidence-based treatment programs are top priorities for the vast majority of physicians, according to a new survey from the American Association for Physician Leaders (AAPL) and the Navigant Center for Healthcare Research and Policy Analysis.

Patient adherence and evidence-based care

Ninety-two percent of physicians believe that patient adherence is a critical issue for improving the quality and effectiveness of the healthcare system, while a similar number added that reducing unnecessary care that does not meet evidence-based guidelines is a key activity for cost-cutting and better patient outcomes.

“Physician leaders have the clinical insights on what constitutes good, strong patient care. They have the insights on how to make the system work effectively to deliver that care,” said Peter Angood, president and CEO of the AAPL, formally known as the American College of Physician Executives (ACPE).

“As a result,  compared with non-physician leaders, physicians who are well-educated with leadership and management training have the better insights on health care and how to run it better.”

“Doctors hold more sway over patient behavior than any other force in the health care system, and yet they do a lousy job of both measuring and monitoring adherence,” added Paul Keckley, Managing Director at Navigant. “If we really were serious about adherence, there would be no question when an individual leaves the office that they know precisely what they are supposed to do.”

But the constraints of time and organizational conflicts often make it difficult for physicians to monitor their patients effectively while meeting the strategic objectives of executive leaders, Keckley noted.  As executives face their own pressures during the complex transition from volume to value, health systems operating with one foot in each world face difficult choices to balance reimbursement with quality.

“The minute the chief executive officer of an organization – MD or not – challenges the medical decisions made by doctors, that’s fightin’ words,” he said to Lola Butcher. “Historically administrators have taken the position that ‘doctors make clinical decisions. I’m not in that business,’ but now they have to be. They have to affirm to the community and to their lenders that the only thing being done in the organization is what should be done based on the evidence.”

This potential disconnect between the C-suite and physicians may be contributing to rapidly decreasing levels of provider satisfaction, the survey indicates.  Ninety-three percent of providers responding to the poll stating that improving provider satisfaction should be a central objective for healthcare organizations.  

These same providers added that they do not feel equipped with the right education or knowhow to cut unnecessary services while still delivering high-quality care.

“The resistance is typically not to the idea that there is waste, but the tactics that are used to hold clinicians accountable,” said Neel Shah, MD, founder and executive director of Costs of Care, a non-profit dedicated to patient education and empowerment. “The frustration is feeling like we are being blamed for it without the knowledge, skills and support we need to deliver” the evidence-based care expected of them.

“A significant amount of waste is driven by inefficient workflow, not by reimbursement or malpractice,” he continued. “If I am an emergency physician who feels under siege, it is easier for me to order five tests at once than to wait for the results of the first one before ordering the second.”

As value-based reimbursement and accountable care arrangements continue to gain traction across the industry, executive leaders will need to find more effective ways to collaborate with their physicians if they wish to reduce spending without compromising patient care and provider satisfaction.  

Raising the bar on chronic disease management and improved patient adherence will help healthcare organizations succeed in a quality-focused financial world as organizations do their best to reduce detrimental variations in care while keeping physicians focused, satisfied, and motivated.

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