Earlier this spring, the Centers for Medicare and Medicaid Services rolled out new parameters for the latest “doc fix” of the Affordable Care Act (ACA), called the Medicare Access and CHIP Reauthorization Act, or MACRA. MACRA is complex, but the main objective is to ease the transition to quality-based care standards required by ACA. Health Affairs summarizes:
MACRA creates a payment system for physicians that will accelerate Medicare’s transition from fee-for-service to payment based on performance metrics, patient experience, and patient outcomes.
Legislation like this creates a new business of medicine within which all physicians are undeniably tangled. The pressure to drive down costs while increasing quality of care requires an understanding that is beyond the scope of traditional medical school curriculum. Nearly half of U.S. medical schools offer a combined MBA program to their students. However, this adds significantly more work and costs to students who are already bleeding for time and money.
NEJM Catalyst discusses the need for medical schools to incorporate business school skills in an article re-released today. Its authors provide the concept of an interdisciplinary clinical rotation as a possible solution:
In our view, the best learning experiences would be project-based, combining components of didactic teaching sessions and hands-on experience. The goal of the four-week course would be for the student to identify and solve real problems facing the school’s hospitals and clinics. By the end, students would have developed the business skills needed to lead multi-disciplinary teams, serve as contributing team members, and apply data analytics to improve clinical practice.
Let’s take a look at each of these initiatives.
First, physicians are called on to be both team leaders and team contributors. Health care delivery from solo practice is disappearing in the United States. On the rise are larger hospital groups or small groups in an office setting with physicians leading mid-level providers. Thus, physicians must utilize team leadership strategies to survive. A group lives or dies by the physician leader’s ability to gain and keep patients, motivate and engage a team, understand its strengths and weaknesses, develop a culture of constructive feedback, and ultimately find financial success. These are just some of the skills that a business-orientated rotation could help teach medical students.
But a good leader isn’t the only important element of a team. Physicians should learn how to be a contributing team member:
Many business schools use simulated environments to teach team dynamics and help participants learn how to develop team culture, set clear expectations, and communicate effectively. These abilities require emotional intelligence and deep understanding of interpersonal dynamics — concepts and skills that are essential to maximizing quality, increasing patient safety, and improving clinical performance.
Transitioning from fee-for-service to value-based care in physician reimbursement also puts pressure on doctors to be better self-advocates. They can no longer expect a strong salary simply by providing a baseline of services or tests. Addressing salary and negotiating a contract with metrics, expectations, and incentives can take new doctors by surprise. Knowledge of business would help physicians transition better from medical training to the real world, where making money requires more than just clinical skill.
Finally, physicians must become experts in data, or operational analytics. Electronic medical records have allowed us to create warehouses of quality and performance data. It is now much easier to connect doctors to their performance in real-time. This is really the meat and potatoes of approaching value-based care. In order to improve quality and cut costs, physicians must first ask the right questions:
As reimbursements drop, physicians in the future will need to identify opportunities to improve performance by decreasing bottlenecks in their offices, reducing patient wait-times for the operating room, modeling alternative treatments to determine the most cost-effective option for a particular patient, and performing statistical analysis to identify trends in patient quality outcomes.
Providing care is expensive. Despite being the number one spender of health care in the world, millions of Americans struggle to get the care that they need. But when physicians are called on for solutions, they should be adequately prepared to answer. Luckily, the AMA and other groups provide resources on the business side of medicine.
Medical school teaches future physicians how to make the right decisions for their patients, but this isn’t enough. Combining clinical and financial decision-making into a student’s curriculum could be a first step in the right direction.
Four weeks would be similar in length to the majority of other rotations, and an adequate amount of time to identify and examine a real-world problem. Students working in groups could conclude how best to increase the rates of screening for cancer or how they might streamline the hospital discharge process. This program would not be a complete business and leadership education. Like other fourth-year elective rotations, it would develop the foundation for lifelong learning in this area.
Better financial decisions for health care are made when physicians are at the table, so let’s give them the confidence and ability to pull up a chair.
Image: Physician’s Weekly