Special Guest “Dr Jayne Histalk MD”
This months episode of “News you can Use” on HealthcareNOWRadio features news from the month of January 2022
This month Craig Joseph, MD (@CraigJoseph) and I delighted to be joined by Dr Jayne (@JayneHIStalkMD) who writes “Curbside Consult” on the HISTalk blog.
We look forward into our crystal balls to tease out what might be on the horizon for healthcare with so many organizations and the world in general playing catch up from the wide ranging impacts of the pandemic perhaps offering some hope for everyone in the potential for shorter buying cycles in healthcare technology. And a look at the impact of the great resignation on healthcare that has seen droves of qualified staff leaving their jobs
We discuss what organizations can do to stem the tide – hint creating a positive and nurturing relationship is critical as is removing the busy work that fills many clinicians inboxes. As pointed out you may lose some short term business by limiting appointments but they come back, whereas burnt out staff do not
We talk about the recent CES show and the big focus on consumer engagement and the technology to support the medical home, remote patient monitoring and virtual primary care. As Jayne points out with the baby boomers there is a big wave of folks pushing for innovation and support that is more than clinical.
As Craig highlights in many cases the technology has existed for many years but the challenge has been the payment flow has failed to provide compensation or incentive for its use. Case in point the Telehealth capabilities have been around for a long time but insurance and reimbursement would not pay for activities that were not in person. That all changed with the pandemic and now the question is can we continue the great in roads made to innovation that supports better ways of working
You get what you measure and why customer satisfaction and drugs makes for poor bedfellows
Listen in to hear a different take on solving the high cost of drugs that starts with acknowledging a different approach and set of priorities especially when it comes to incentives and public health policy. And while happiness and customer satisfaction are good measures, if these are the integrated into the incentives they make for bad bed fellows. This is especially true in the United States which remains one of only 2 countries with Direct to Consumer drug advertising (DTC) doctors are often faced with patients who want what they have seen in adverts and any deviation from this results in poor rating of the doctor.
You get what you measure
You can read more about the series here and the concept of keeping up with innovating in healthcare. Please send me your suggestions on topics you’d like to see covered. You can reach out direct via the contact form on my website, send me a message on LinkedIn or on my Facebook page (DrNickvT), or on Twitter tagging me (@DrNic1) and #TheIncrementalist or you can click this link to generate a ready-made tweet to fill in:
Listen live at 4:00 AM, 12:00 Noon or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today as I am each month, I’m delighted to be joined by Dr. Craig Joseph. But this week we have a special guest joining us, Dr. Jain. She is the resident blogger at his talk. She’s also an urgent and emergency room care physician widely experienced among the medical informatics community. Thanks to both of you for joining me today.
Craig Joseph
Glad to be here. It’s a pleasure, Nick. And yeah, typically, it’s just you and me. And now we have I feel like we have royalty with us today. And so even though she doesn’t have an accent, Dr. Jane is royalty to me.
Nick van Terheyden
I can’t agree with you more. So let’s kick off. We’re at the beginning of the year. And I always think about what’s going to happen. I look back at the previous year, it’s sort of arbitrary, because it’s, you know, the calendar year. Tell us if you would, Dr. Jane, your thoughts for what’s going to happen in 2022? In the healthcare space?
DrJayneHisTalk
Yeah, so I think we’re going to continue to see a lot of organizations in transition, you know, certainly the pandemic shows no signs of being over. And I think at least in the US, a lot of us are still waiting to come down the backside of this horrific epidemiological roller coaster that we’ve been on for the last, you know, month and a half, two months. And I think organizations are going to spend any downtime they have trying to figure out how to recover from that. And also how to catch up on any other priorities from 2021 and 2020, that they didn’t get done, because they were busy dealing with COVID. So most of the organizations that I work with, they have a lot of things that they’d like to do as far as usability, and patient engagement, user satisfaction. But those efforts really have gotten derailed. During all of this. I think you’ve seen a lot of organizations that haven’t been willing to spend any money because they’ve been trained to deal with COVID. And hopefully, if we move into a more endemic split and endemic stage with a pandemic, we’ll see more organizations start to loosen those purse strings, and maybe make some of those technology investments. And they’ve been putting off for the last two years as well. So for those folks that are on the vendor side, I think that’s very exciting. They’ve certainly experienced these ridiculously long sales cycles over the last couple of years, because nobody wants to do anything, because we don’t know what’s going to happen tomorrow or next month or in six months. And I hope we see a lot of relaxation with that. That’s my optimistic prediction. You know, of course, I have some other predictions that, you know, I don’t want to be Debbie Downer today. So I’ll just leave it that with the optimism.
Nick van Terheyden
I got it. So what I heard was really short sales cycles in healthcare for the vendors.
DrJayneHisTalk
That may be overly optimistic.
Craig Joseph
Yeah, I heard everything is going to be great. Um, well, you know, I certainly agree with Dr. Jean about from an IT perspective, I think, you know, we’re going to continue to see at a more global scale, more mergers and acquisitions, right. So a lot of these hospitals, and clinics that have been kind of damaged by this fun pandemic that we are still going through, are ultimately going to come to the decision that they can’t do it alone anymore. And so we’re gonna see a lot more, or continue to see, I guess, mergers and acquisitions. The other thing I think we haven’t come to terms yet with in the United States, at least is, is the great resignation. And now it’s happening at a global level in the I think everywhere, actually. But certainly, it’s not just a healthcare thing. But doctors and nurses and technicians and pharmacists are at alarming numbers deciding that they are gone. And they are either retiring or looking for other things that they can do that are kind of adjacent to health care. And so that is that is a problem that’s not going away. You have hospitals today that are spending millions of dollars on traveling nurses, and oftentimes, those are nurses traveling from the suburbs. And so they’re not going across the country. They’re really nurses who were just working at that hospital right over there, and they quit and now for significantly more money that a little bit significantly more money. They’re called the traveler, and that is is not supportable long term. Some would argue, others would argue Yeah, you should have been paying them this month. So all along and they bring a lot of value. And and so I you know, I don’t know where it’s going. But I see that as a major tripping point, that we’ve got to figure out what you know, we’re what What’s gonna happen in terms of staffing our hospitals and clinics?
Nick van Terheyden
So it’s interesting, you talk about that, you know, the resignation, because that what that does is essentially loads more on the clinical staff. Because now you’re spreading across a lower number of resources. Yeah, you’ve got this sort of pull in, but there’s essentially this limited pool. And the other thing that we’ve seen very clearly, in my mind, is this massive increase, or maybe it’s just an exposure of this behavioral health. And it’s across whole chunks of society. I mean, we see it in the kids, we see it in society in general, but I guess very personally, certainly for me, and I would imagine for you both is amongst the clinical staff who have just been bearing this burden. And to me, it feels like this is it was the case before. Is there any hope on the horizon around that?
DrJayneHisTalk
So I’ll go ahead and jump in on that one, I think that there is hope for folks that are working for progressive organizations that see what the problem is, and are willing to make investments to address that. And, you know, it’s not just some of the things that we’ve seen over the last two years, you know, you can’t just throw a pizza lunch at it, or a challenge coin at it and hope for the best, you really have to look at what are the what are the organizational steps that you’re willing to take to make life better. So you know, don’t call the therapy dogs, you know, yeah, they’re fun, and they’re cute, and we all love them. But I think we need to see change. You know, along though the order of magnitude of truly controlling patient volumes. And actually one organization that I worked with very closely over the last year, that’s an urgent care, and they’ve just literally been getting clobbered throughout all of this, they finally had to come to a decision that they were just going to cap their volumes every single day. So they opened up in the morning, they take a certain number of patients onto the books, and when that number is met, and it’s usually met within 30 minutes of when the those schedules open, they’re done, they’re not going to continue to, you know, harass the staff into seeing just one more patient, just one more patients, because they know the staffs at the breaking point. And they’ve actually seen a dramatic change in their staff retention rates since they introduced those caps. And they realize that they’re losing patients to competitors, they realize that they’re losing potential revenue. But I think they learned from the experiences that they had early in the pandemic, that, you know, it doesn’t matter if you see one more patient, if you lose a season staffer, that’s a significantly harder thing to overcome those patient volumes will come back, the staff will not. And I look at my former colleagues. And you know, I was a little bit part of the great resignation. So I guess I’m part of the problem. So I should be part of the solution. I left my Urgent Care role earlier, in 2021. And part of it was it was just not sustainable. The the mental toll, the physical toll. And what was going on as our practice went through a private equity and private equity acquisition was just not something that I was willing to continue to do. And my peers, you know, almost exclusively went to environments that had better work life balance, whether it was, you know, an eight hour shift in a community, er versus a 12 hour shift at our place. We had three people go to a med spa. And I think that’s really telling when people would rather do something that, you know, they they don’t necessarily perceive as, as what they were trained for. I mean, that’s a far cry from emergency medicine. But now these three are running a med spa. So that’s just, you know, it’s very interesting.
Nick van Terheyden
I, and as you think about the work life balance, I mean, that pervades everywhere. I mean, if if I was to sort of tease out the one thing, if you were to try and solve it, it is the work life balance. One of the things that I’ve heard a number of times now is a move to a four day working week. And part of this feels immaterial in healthcare, because it’s a shift based, but is there some scope to maybe reduce hours overall, given that we’ve got a insufficient resources given the traveling nurses that you talked about? Craig?
Craig Joseph
Yeah, I would say I think it’s just my personal opinion, I think it’s more of a quality issue than a quantity issue. Right. And so if you you know, kind of everything that I say often comes fective team space care and everyone working here at the top of their, their license. I think physicians are going to be much happier doing jobs that they think bring value and that only they can do and so having physicians look through tons and tons of messages that many of which can be competently and actually sometimes often better handled by by others buy by nurses or medical assistants, and letting dogs do the things that only dogs can do and that dogs are really good at doing. I you know, I don’t think people mind working that eight hour shift or or even a 12 hour shift again, assuming that they’re being there, they think that they’re spending their time. Well, you know, and then, since we we like to bash electronic health records, and sometimes technology, I don’t personally but Nick, you do all the time, and it’s really inappropriate has to stop spending time in the electronic health world record, not, you know, clicking boxes that really don’t bring any value that you didn’t need to go to medical school and do a residency to do. That’s often what what gets people to go to the medical spots? And I completely understand it. Some of it is the technology’s fault. Absolutely. Some of its that the electronic health record, much of it in my, in my estimation, is the rules and regulations and legal environment that we find ourselves in the United States. So I think it’s a, you know, it’s a combination of other of all of these things, not just hours, but the quality of time and what people are, are doing in that time.
Nick van Terheyden
So, thinking about the technology, and you know, the three of us focused on innovation, you know, what can the technology bring? We just had the CES show, which had a whole digital health component, anything that stood out, you go, wow, that could really help solve or resolve some of those problems. I mean, I think specifically to your point, Craig, all of the what I call scut work, which we used to unload on the junior doctors, I think we still do they spend 70% of their time in the basement. To my understanding. We don’t seem any closer. That was the same before we were just doing it on paper. Now. We seem to be doing it more digitally.
DrJayneHisTalk
Yeah, well, I’ll jump in on CES, I have kind of a love hate relationship with CES this year. So despite being able to attend last year as a credential media person this year, they did not allow me to attend would not give me credentials. And it was funny, though, because they sent a survey asking me why I didn’t go. So I made sure that I responded, I didn’t go because you wouldn’t let me. So fortunately, I have a good network of folks that that fed me a lot of interesting things. And they know I was really interested in the consumer side last year. It’s funny, because it seems like there there was much more focus on interesting things for consumers things to make people’s lives easier at home, a lot of smart home technologies. And I think that’s interesting from the healthcare standpoint, because a lot of those things that we may not consider to be really a health investment, could be a health investment. So you know, the smart home devices, it’s not just about convenience, when you start to think about patients that are mobility impaired or have different needs as far as being able to control things in their home, you know, even when you think about like a voice controlled faucet, you know, that seems very Jetsons, it seems very, you know, very space age, and like, do we really need this, but if you’re someone who’s mobility impaired, or someone who has a sensory issue, and you can’t perceive temperature, and you need to be able to tell that faucet, you know, I want that water at 110 degrees, so that you have more freedom to stay at home and not rely on caregivers, I think we need to start looking at some of those unique consumer offerings and figure out how they can fit into the healthcare infrastructure, and make sure that we have the ability to make those products accessible to our patients. I think being able to keep people at home is really going to be a big thing, you know that this was not part of my predictions for 2022. But just looking long term, at the aging of the baby boomers in the US and looking at folks that want to stay happier and healthier at home. Certainly remote monitoring and virtual primary care. And all of those things that we’re already talking about make a big difference in that, but also enabling those people to be able to do what they need to do from a technology standpoint, you know, like a Walk In Bathtub. And you know that that seems like such an out there kind of thing. But when you really think about it, what a difference that could make to a patient and being the difference between care at home versus care in a facility. I think that stuff is really interesting. So I enjoyed watching the consumer side from CES a little better about the healthcare IT side. So I can’t say too much about that.
Nick van Terheyden
So for those of you just joining, I’m Dr. Nick the incrementalist today. I’m talking to Craig Joseph as I do each and every month. And this month, we’re joined by Dr. Jain. She is the resident blogger at historic and also an emergency room physician. We were just talking about the innovation and specifically speech and I you know, most folks will know that I’m a big passionate player in that space. I’ve you know, done a lot of things always seen the value. It was always the great leveler. And you know, subject to many jokes across, you know, years of time for its inability, but for me, it’s tipped over, in part because we’ve gotten better at the accuracy. And as you rightly point out, Jane, that those things seem like they’re, you know, that’s just icing on the cake, but it’s not. And I saw that with my mother when she couldn’t open the stupid bottle that was designed for child proofing. That was completely impossible for her. Now, you’re not going to solve that with voice. But we do have to think about access. Craig, you’ve looked at this, you know, throughout your career, are we seeing some innovation in that space that will really change the way that we deliver care and allow people to age in the home?
Craig Joseph
I think to some extent, it’s a technology thing. I you know, I feel like I’m a broken record, I’m very boring. To to a greater extent it’s payment, right? Boy, you couldn’t get paid as a physician to give advice over the phone or over the over the computer, you had to do it in person. Otherwise, it was it was free. And so we’ve had the technology for a lot of these, we’ve had the ability to create Walk In Bathtubs for a long time. It’s just that well, who’s going to pay for that? And the answer was no one, which is why it’s not going to happen society to benefit. I didn’t see the benefits of it. And I do think in hope that a lot of you know that this technology, which is maybe not been amazing, but has been acceptable, will now get looked at with a different light. And just like you said, you know, how much is it to prevent a hospitalization? And now it’s, we really have to think, at a high level, right? It’s really a national question, not a not an individual patient level. But yeah, I think it’s going to be we’ve talked on this on this part of this radio show, for a while now about the fear that some of the telehealth regulations that have been eased, that have been allowing us to, to do this for the last couple of years are going to be removed when the pandemic starts to, to, to improve. And as long as I feel like that, it’s a danger, but coming increasingly unlikely, because people are going to are going to reasonably say, Hey, why why do you want me to come to the office again, just so I can tell you the answers to the questions that you can tell me over the phone or over that over the over the computer? And so, yeah, I’m hopeful that they’re they’re certainly technologies improves that voice recognition is better, not so much in the being able to understand what I’m saying, but the words at least being able to understand kind of comprehension of what am I trying to get across and then being able to, to react to that? Clearly, that’s, that’s much better. So yeah, as long as we don’t shoot ourselves in the foot, Dr. Nick, I think we’re, I think we’re going in the right direction.
Nick van Terheyden
I’m just gonna say that the technology doesn’t understand you, because you have this funny accent. If you spoke the Queen’s English, that wouldn’t be this problem. I’m just saying, that’s been my experience.
Craig Joseph
I admit, I admit, I’m not gonna, I’m not gonna get in a fight with you about this.
Nick van Terheyden
So, um, let’s talk drugs. It’s this burgeoning problem that continues to eat into the limited pool of resources available. It went from somewhere the 5% of you know, total spend, it’s now easily at 20%. It’s increasing. We’ve seen recent entrants, I’ve got to call out Mark Cuban, he’s got this whole sort of concept to try and deliver generic drugs as a whole thing around generics as it is, is, is the some pathway that we can see for our patients. And is this even the right thing to be thinking about? Are we just using too much of these things? Where do we stand on treatments and affordable treatments?
DrJayneHisTalk
Yeah, I think this is really an interesting topic. And kind of going back to, to, you know, my primary care routes. You know, we have this whole culture in the United States about just wanting to throw medications at things, you know, doing the things to avoid medications are difficult, you know, getting out and walking every day getting out and exercising to maintain your weight or making good food choices, is difficult for a variety of reasons. You know, sometimes it’s it’s human nature and choice. Sometimes it’s related to the availability of grocery and other suppliers. You know, we have areas in our country that are food deserts, you know, where there’s not a place that people can go buy fresh vegetables that’s easy to get to. So I think we’ve got a human nature piece. We’ve got, you know, kind of a supply chain piece. But then we’ve got this relentless advertising and I am 100% against direct to consumer advertising. You know, it’s all over the internet, it’s all over television. And so often we can do what we need to do with generic medications. And I think patients don’t understand that sometimes, and to have that thoughtful conversation and explain to them what it means to be a generic Med, we don’t get paid for that, you know, we’re on this this throughput treadmill, trying to see all these patients. And that’s really an education piece. And that’s a public health piece. And we’ve seen how woefully we’ve underfunded public health, you know, around the world, and particularly in the US. And I think COVID is a prime example of this as well, you know, we look at, you know, what is the true cost of a vaccine, so, okay, if I have to get three vaccines, even if you figure $20, a vaccine for COVID, which is roughly the contracted price, even if they charge you, you know, another 2030 $40, for administration, you’re talking, you know, a grand total of a couple 100 bucks to to potentially prevent a hospitalization prevent a 15 to $20,000 hospitalization. And there’s a lot of people that honestly believe that, oh, well, I don’t need that vaccine, I’ll just get Regeneron. Or I’ll just get, you know, XYZ new pill that’s being approved from Pfizer or Merck. And those are so much more expensive, and they don’t fix the root cause. So the reality is prevention is not sexy, generic drugs are not sexy. And we need to figure out how to make them sexy, if we’re really going to turn the tide on this drug spending.
Nick van Terheyden
So I great point, I’m just going to correct you slightly and say, That’s not just an American problem, I can tell you with certainty that that was the case. And it’s partly because it was, I don’t want to say getting the patient out. But it was it was giving a resolution that was immediate. For an individual that was part of handing the script, it was part of my environment. We clearly see challenges with this. How do we fix this? How do we go about this and and turn the tide to allow for it? It feels like I’m going to ask you that, that question. And you’re going to come back and say the same thing again. Craig, it’s it’s all about follow the money.
Craig Joseph
Oh, you Yes. It’s all about follow the money. You know, one thing to think about? First of all, I think we can solve this problem by only allowing pediatrician. So just preventing all other doctors from seeing patients, only pediatricians because we don’t understand how this whole medication thing works. Because auto lock, as I used to tell the parents of my patients, little Johnny generally gets better despite anything I do for him. And that’s a that’s a, but it does, it does changes as we age, right, like, in for young kids. It was originally just to antibiotics for ear infections, right? And, and we hardly do, we do a lot less of that now than we did a couple of decades ago. So you know, here’s some of the problems again, and I, as you point out, I like to always highlight system problems. Physicians are now more than ever being evaluated based on how happy their patients are with them. And so if I if you walk into your PCP or your urgent care, doctor’s visit with the idea that because of direct to consumer advertising, you need x medication for your problem, and nothing else is going to solve it and you don’t God forbid, even get a medication or let alone you don’t get the medication that I wanted, when I walked in, I am going to give you a bad review. And and that has monetary implications ultimately or or our promotion issues for for them. And so you know, what we get what we what we measure, we get what we asked for. And in that case, we’re programming our physicians to give us these things that are I don’t think anyone’s out there saying, well, I’ll give you this medication, even though it’s going to hurt you. No, but I think what they’re saying is, hey, I’m going to give you this medication more easily than than I normally would have, and it may not help you. And what really is going to be helping us is exercising and eating well and doing those things. So yeah, there are system problems and and if we don’t at least talk about them, then we shouldn’t wonder why he’s, you know, mad that people are over prescribing with little context or little proof or causing such problems.
Nick van Terheyden
Yeah, great, great point. So let me close unfortunately, we’ve run out of time, but let me close as I do frequently by pointing out that one of two countries that has direct to consumer advertising the United States and New Zealand still blows my mind. I still can’t get my head around it. I can’t ever see it changing. It seems like the the push to keep that will continue but in the meantime, we have to enable or empower our clinicians to combat that. combat the information void that exists. We’ve run out of time. It’s been a true delight. Thank you for joining us, Jane and Craig as always, it’s been a great pleasure thanks to both of you.
DrJayneHisTalk
It’s really enjoyed being here.
Craig Joseph
I can’t I feel like I’m with royalty. So we should do this as frequently as possible.
