Physicians: Open to ACOs
Physicians are enthusiastic about patient quality improvement initiatives while supporting frameworks for increased EHR adoption and accountable care organizations, according to the 2011 HealthLeaders Media Industry Survey.
But they are upset with the overall impact of healthcare reform, what they perceived as regulatory scrutiny and threats of malpractice litigation, the survey shows. Physicians also are concerned over reimbursement and continued shortages in primary care.
Despite a generally negative response toward healthcare reform, they foresee a positive impact with reform bringing 32 million more patients, now uninsured, into the system by 2014.
The survey reflects the physicians’ priorities over the next three years, which are: cost reduction; quality/patient safety; patient experience and patient satisfaction; reimbursement; developing an accountable care organization; and the need for technology systems.
Some 45% said they believe the healthcare industry is on the wrong track; 24% said it is on the right track, while 31% were undecided.
“As seen from the survey, most physicians understand that the current healthcare cost spiral is unsustainable, and are realizing they need to take a proactive rather than simply resistant approach to impacting it,” says Martin Hickey, MD, managing director of the healthcare practice for Navigant, a global consulting firm.
There were generally supportive comments about EHR adoption, with 28% strongly positive and 39% positive. About 13% were negative or strongly negative.
In discussing healthcare issues that would impact their organizations over the next three years, 37% of survey respondents said that ACOs would have a positive impact, while more than 12% were strongly positive. About 15% were negative or strongly negative; 35% were neutral.
“It’s invigorating to see the positivity and openness to quality assessment and new structures, particularly the small negative numbers about ACOs,” says Hickey. “This is critical to successful reform efforts, because without physicians who write the orders and generate the costs with their
pen, costs cannot be contained and quality improved.”
Physicians heralded the quality improvement initiatives, with more than 76% saying they believe such programs will benefit their organizations.
According to the survey, physicians consider the impact of patient experience and patient-centered care as extremely positive. The survey shows that 20% and 60%, respectively, believe such initiatives will have a positive or strongly positive impact on their organizations.
“The issue is how fast all of the changes noted in their priorities will be able to be executed appropriately as well as digested—by patients and themselves,” says Hickey.
Gregory Hudson, FACHE, vice president of strategic planning and marketing for SoutheastHEALTH, which runs the 266-staffed-bed Southeast Missouri Hospital in Cape Girardeau, MO, says the ACO “seems to be the right approach to take, as much as integrating physicians with hospitals. Pulling that all together is the way we should go as a nation,” he says, referring to cost reductions and increased quality.
Concerning increased regulatory scrutiny, some 45% of respondents said there would be a negative impact over the next three years, while 17% expect strongly negative. Only 8% said it will have a positive impact and just 4% said it will have a strongly positive impact.
“The fear of regulation is well founded given the past history of CMS,” says Hickey of the Centers for Medicare & Medicaid Services. But with the new reform legislation as well as Donald Berwick, MD,
head of CMS, “physicians have the opportunity to both impact and even lead much of the regulation.”
Nurses: Focus on Quality, Satisfaction
In a trying economic time, nurse executives are keeping their focus on ensuring their organizations provide safe, quality patient care, according to the results of the 2011 HealthLeaders Media Industry Survey. Top priorities are ensuring their organization’s patient satisfaction and quality/patient safety scores bring them their maximum allowable reimbursements.
In the survey, nurse leaders ranked their top three priorities as:
1. Patient experience/patient satisfaction
2. Quality/patient safety
3. Cost reduction
“These are the scores that the CEO will look at the nurse executive and say, ‘What are you doing about our quality? What are you doing about our patient satisfaction?’” says Eileen L. Dohmann, vice president of nursing at Mary Washington Hospital in Fredericksburg, VA. “Issues such as the drive for accountable care organizations are important issues, but the more burning issues are patient satisfaction and quality, because we know that that’s how we’re going to start getting paid next year.”
The study revealed nurse executives believe nurse-to-patient ratios are the most important factor for providing high-quality patient care. They aren’t worried about finding enough nurses to provide that care, with only 34% responding that they believe nurse supply will have a negative or strongly negative impact on their organization.
Nurse executives have not yet solved the impending issue of retiring baby boomer nurses, with 57% saying they are unprepared for the expected mass exodus of baby boomer nurses. However, in the short term, organized labor could be a more pressing concern as nursing unions have seen increased action in the last year. Forty-six percent of nurse leaders say organized labor will have a negative or strongly negative impact on their organization, which Dohmann reports is a sign of the times.