I had the opportunity to talk and learn about the future of office-based medical practice. The occasion was my participation in a panel discussion sponsored by a manufacturer of equipment for medical offices. A professional facilitator conducted a day-long interactive interview of 6 panelists, strategically selected from non-competing health care markets across the country. We talked about what was going on nationally, regionally and in our own organizations in order to provide a context for the sponsor's strategic planning.
Much of what we talked about centered on the transition from “volume to value,” the catch-phrase for the movement away from fee-for-service to some form of quality-based payment system. The content of the discussion reminded me of the saying, “The future is already here, it's just not distributed evenly yet.” Physician leaders from west-coast organizations described a landscape of capitated payments and “accountable care” that we talk a lot about but have not yet lived in a significant way. A representative of an institution in Boston spoke of a more highly consolidated provider community. Those stories were interesting, but not entirely novel. Here are a few things that were:
One organization was investing heavily in the standardization of all of their medical offices. They were going well beyond the familiar uniformity of signage, staff apparel and color schemes. They had invested in doing time/motion studies of staff members (even going so far as to “tag” them with RFID to understand their work patterns) and were applying Lean methodology to redesign the work space. The stated goal was to create a standard office suite, down to the layout of exam rooms, cabinetry, equipment and supplies, which they could then “replicate” as they grew.
Another provider was experimenting with the co-location of medical and dental services. This was described as a particularly important strategy for meeting the complex needs of a traditionally under-served population. It was a “bricks and mortar” recognition of the growing body of knowledge linking oral health with overall health, as well as a reflection of a capitated payment system that no longer forced providers to separate services according to payment stream.
The most intriguing innovation that I learned about was a pilot program of “real-time off-shore scribing.” The practice in question was experimenting with live audio sharing of office encounters with medically trained personnel in India. The distant scribe had access to the EMR, and was able to complete the documentation either at the time of the visit or within 24 hours. No word yet on how patients responded, or on the economics of the arrangement.
I think we are living in very interesting times.
What do you think?
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.