This article appears in the December 2011 issue of HealthLeaders magazine.
Until recently, Don Chomsky, MD, cardiologist, spent a lot of valuable work time on the road. In addition to his regular work at Saint Thomas Heart in Nashville, he covers appointments for patients at two outreach clinics in rural Tennessee, which takes up about six days—more than a quarter—of his work month. Both are about an hour and a half drive one-way from Nashville, and that’s when traffic is good.
“I drove out here last Friday, and my hour-and-a-half drive was four hours because of a wreck on the highway,” he says, speaking of his once weekly trip to Winchester, TN. “For us there’s a lot of dead time with these commutes where we could be doing something much more useful than sitting in a car.”
Indeed. Multiply Chomsky’s “windshield time” by dozens more physicians at Saint Thomas or by several hundred at Ascension Health, of which Saint Thomas is a part, and we’re talking about real money and real waste. That’s why hospitals and health systems are getting increasingly sophisticated about ways to reduce waste and improve profitability while at the same time preserving what patients like about their healthcare. If it sounds experimental, that’s because some of this work is, indeed, new.
Some of it simply involves measuring and evaluating. But what’s indisputable is that innovative techniques for finding efficiencies in the work schedules of the most highly compensated workers—physicians—are long overdue. With more and more physicians working directly for the hospital or health system (as does Chomsky), incentives for cutting costs are starting to line up, and physician productivity has never been more critical.
Wasted time no more
Physician productivity concerns were one of the most compelling reasons for Saint Thomas Health’s parent organization, Ascension Health, to start to work seriously on finding ways to replace time-consuming in-person visits to remote areas by physicians.
They chose Saint Thomas to pioneer the program as part of a broader initiative, MissionPoint Health Partners, a group of business relationships envisioned as Saint Thomas’ accountable care organization. Saint Thomas, Cisco Systems, Crimson Services, the YMCA of Middle Tennessee, and Applied Health Analytics are partners in the project, which is headed by MissionPoint Health Partners CEO Jason Dinger. The partnership that’s most important to Chomsky is the one with Cisco and AHA, which allows physicians to do a real-time patient visit remotely.
“There’s a cost and value opportunity here,” Dinger says of the partnership. “It’s also a way to work more strategically with further-away markets.”
Hospitals and other health providers have been experimenting for years with telemedicine as a substitute for office-based visits. But it’s not progressed much past the experimental stage until recently. Its use has always been beset by problems, which include whether health plans would reimburse for them and whether patients would resist them. Dinger thinks those problems have been solved with the introduction of a new system that incorporates not only high-definition television and voice technology, but also the ability to use sophisticated instruments remotely with the assistance of an on-site nurse or other midlevel practitioner.