Driving Quality in Healthcare While Avoiding the Ditch

The second Tuesday of the month, practice managers and industry service providers gather for an educational Nashville Medical Group Management Association (NMGMA) meeting to hear from experts on a variety of topics to improve the efficiency and success of medical practices. In March, Paul J. Gentuso, MD, FACP, CPE, chief medical officer for Heritage Medical Associates, discussed the importance of driving quality in healthcare while managing to avoid the ditch.

Using an extended metaphor, Gentuso noted driving can be safe and easy when the road is newly paved, well-lit, well-marked and provides a wide, straight stretch for travel. Similarly, he continued, travel conditions also positively impact the trip when there are calm winds, a sunny day, low traffic and pleasant passengers. Unfortunately, Gentuso said, poor road and travel conditions have the opposite effect and can make driving quite dangerous.

The same types barriers that make driving dangerous also make the quality journey difficult. Gentuso outlined some of the factors that can take the trip off track:

• Poorly Lit Road: "What's difficult about the conditions of driving quality?" asked Gentuso. "It can be difficult to see the way forward," he continued of changing regulations, insurance parameters and governmental administration priorities.
• Unmarked Roadway: "Even knowing the way, it can be hard to stay on track and stay between the lines," he continued of switching between fee-for-service, value-based, shared savings and other constructs depending on the patient and carrier.
• Potholes: Gentuso noted missing the mark on risk-based contracts, shared savings and episodes-of-care payments represent potholes that are only increasing in size and frequency.
• Long & Winding Road: "We have to recognize preventive care is a long-term investment," he noted, adding changing HEDIS and Star measurements, along with varying recommendations, add curves to the road.

Similarly, he said 'road conditions' including heavy traffic from retail clinic competition and new payer/provider combos, along with slippery conditions that include vaccine and PPE shortages and rising overhead, all add to the distractions. On top of that, wind sheers from pandemics and constant calls for change are enough to rattle any driver.

Despite those dangers, Gentuso said there are many proactive steps practice administrators and providers can take to improve road conditions. "Let's move past what's bad and move on to what we can do," he stated. "Light the way: Study, learn, be a student ... you go to meetings like this and learn about healthcare," Gentuso noted.

"Mark the way: That's how you know the way forward. Get a good contract. Talk until you and the payer have a shared vision," he advised. When the larger rules don't work, he advocated for changing them though the legislative process, voting and advocacy.

Population management helps fill in the potholes, he said. "The potholes in healthcare are when we forget we should take care of every one of our patients every day." Educational materials, engaging family members, calling to check on patients and getting them scheduled for missed appointments and screenings all help fill in those cracks.

He also said it's critical to make the path straight so patients don't have to struggle to see a provider or get a question answered. "Remove the barriers to scheduling and access ... that's how you get people taken care of," he said. Gentuso added good patient portals and appropriate use of telemedicine are two steps to address those barriers.

To improve driving conditions, Gentuso said practices should strive for low overhead, lean staffing and high fill rates. "I know a bloated clinic when I see one ... rooms are empty and people are bored," he said. "If you aren't keeping your practice filled, you aren't maximizing the practice of medicine," he pointed out.

Gentuso also advised practices should "avoid heavy traffic." He noted, "Find your niche and avoid the places where you can't compete. Find what you do and do it well. You can't be all things," he said. "For example, Heritage doesn't do retail clinics." Finally, he said, it's critical to attend to the happiness of all passengers by keeping an eye on medicine's quadruple aim. For patients, he said safety should be the highest priority with best practices, accountability and peer review serving as their seatbelt.

Although driving quality isn't an easy task, Gentuso said there are steps and resources to make the journey less treacherous so that everyone arrives safely at the destination.

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