Rob Melendez, MD, MBA

What is wrong with Volume to Value based care? Focus on Hypervalue

What is wrong with Volume to Value based care? Focus on Hypervalue

Rob Melendez, MD, MBA  @DrRobMelendez

The phrase “volume to value” is a misnomer. It implies that we are not currently providing any value to our patients and that we are providers who are simply focused on RVUs and FFS. I am appalled by such a phrase. Our focus should be on the term that I will use “hypervalue.” Hypervalue is a term that raises the bar for patients at all levels of patient contact using lean management principles. We need to improve the healthcare system for one reason: to improve the health of our patients. As we have seen over the last 5 years, clicking on boxes to simply satisfy a payment requirement hasn’t increased value for the patient. These programs drive some people to play this game to simply get paid. Our standards should be so high for our patients that when the government mandates that we provide better value it will pale in comparison to what the increased value or hypervalue that we are providing for our patients. For starters, Let me review two hypervalue concepts for our patients.  1) Improving communication with the providers as well as with patients. 2) Using technology to reduce waste and to analyze how we are caring for our patients.

  1. Communication: We need electronic health records (EHR) that communicate with other providers and healthcare systems to streamline healthcare. Often times, duplicative testing is being performed and we are not aware of it. We also need to continue to improve communication with our patients. The Mayo Clinic has an excellent app for their patients to access their exam notes, labs, appointments etc. This app is an example of hypervalue for our patients. I personally have seen this app in action. Our practice currently uses a patient portal system to communicate with patients which brings value to the patient. We chose to implement EHR in 2005 before we had to because it provided a mechanism to access medical records across our 15 clinics around the state of New Mexico as well as the ability to analyze where we can improve processes and patient care points. Sadly, the cost is enormous for EHR. The costs of EHR can range from the cost of computer equipment, training, IT support and maintenance and beyond. The benefits are truly present today, but when were first started, the costs outweighed the benefits. The benefits today are nearly reaching the costs and will soon improve even more. For example, the IRIS® Registry created by the American Academy of Ophthalmology is a prime example of the huge advantage of EHR. This will increase value to patients or hypervalue. Just think, you now have the ability to easily determine how many of your glaucoma patients had a visual field in the last year and how many of your patients with Diabetes had macular edema to cite 2 examples.
  1. Technology: Can you imagine a time where patients can input their medical histories online before seeing the doctor via home computer, tablet, or phone with an app? It’s available now, but cost prohibitive in some cases. We trialed a kiosk in the waiting room with little success. It required extra people to teach the patients how to use it. I believe this will come back with time. Think how you first felt when you had to use the kiosk at airports to check yourself in, it was frustrating at first and still is at times. I remember a time in high school when I was a clerk in a grocery store and personally unloaded the customer’s shopping cart and checked them out myself. Now a days, businesses are trying to use technology to improve efficiencies and convenience for certain type of customers with fewer items. Hypervalue would be providing the technology option plus a person to educate the user one to several times until they learned how to use it. The benefit of updating your information before the visit would be to decrease wait times in the clinic. What if there was a faster way to verify insurances before the visit? Perhaps there is, so please share any insights. As we move from so-called volume to value, let us remember that the patient is always first and trying to improve their experience while improving their health is paramount — Focus on hypervalue.

RVUs = Relative value units

FFS = Fee for Service

EHR = Electronic Health Records

#hypervalue

The Art of Delegation

 

The Art of Delegation
Rob Melendez, MD, MBA
As you move along in
your leadership position as chief resident, stop and reflect on ways to involve
others more in your goals. As a leader, one of your jobs is to promote others. Seek to
include others in as many projects as possible. For example, as you begin
planning your goals for this year from creating a wet lab for your program to cre
ating a mock session for oral boards, invite others to chair one of those committees. If you do not have committees created, then take this time to create them. You will always have the title of chief resident and reap benefits from it, but think of others too who need help building their own leadership skills and portfolio.
Take assessment of your residency program to determine the weaknesses and create committees to create solutions for those deficiencies. By involving others, you are also practicing the art of delegation. This requires you to be willing to do any job yourself that you ask others to do. Delegation is not simply pawning a job off to someone that you would not do. Show extreme enthusiasm for any project to motivate the other residents. Remind them that you want them to take the lead on a specific project to help the program. If they are not motivated enough by improving your program, remind them that it will help them when they are applying to fellowship and for their first job. Obtaining planning and organizational skills during residency is great practice and will serve them well in future leadership positions. When we join a practice, we will be asked to oversee a project to improve the practice or department. Every resident should be given the opportunity to lead in a project to improve your program. I suggest creating a list of projects and solicit the residents’ ideas too and ask which one they want to implement. Can you imagine if every resident had one mini project to improve in their program? Our goal is to help every program improve and as a result will improve ophthalmology at large. Involve others.

What is groupthink?

Groupthink

Rob Melendez, MD, MBA

 

This term was coined by a social psychologist Irving Janis (1972). Groupthink occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgement.” Consider avoiding groupthink in your practice and while serving on committees.

 

When a practice experiences groupthink they can become too optimistic to the point that they take extreme risks. Individuals can also discount warnings and do not reconsider their assumptions.

 

Symptoms of Groupthink

  1. Having an illusion of invulnerability
  1. Rationalizing poor decisions
  1. Believing in the group’s morality
  1. Sharing stereotypes which guide the decision
  1. Exercising direct pressure on others
  1. Not expressing your true feelings
  1. Maintaining an illusion of unanimity
  1. Using mindguards to protect the group from negative information

 

Recommendations to avoid Groupthink:

 

  1. Use a policy-forming group which reports to the larger group
  1. Having leader remain impartial
  1. Using different policy group for different tasks
  1. Dividing into groups and then discuss differences
  1. Discussing within sub-groups and then report back
  1. Using outside experts
  1. Using a Devil’s advocate to question all the group’s ideas
  1. Holding a s “second-chance meeting” to offer one last opportunity to choose another course of action.

 

Irving, Janis. (1972). Victims of groupthink. Boston: Houghton Mifflin; Irving, Janis. (1982). Groupthink: Psychological studies of policy decisions and fiascos. 2nd ed. Boston: Houghton Mifflin.

 

 

Cataract Surgery Pearls: CW Technique for 4+ NS Cataract

Watch the video here:

Surgeon: Dr. Rob Melendez  @DrRobMelendez

Illustrator: Sam Hobbs, MSIV @SamHobbsMD

Ophthalmology Buzzwords®

800 Questions and Answers Audiobook

https://www.facebook.com/OphthalmologyBuzzwords/

 

Purchase the audiobook on the EyeHandbook App

http://www.eyehandbook.com

Cataract Surgery Pearls

Videos will be submitted highlighting the following steps:

Wound Creation

Sculpting

Chopping

IOL Selection

Cataract Surgery: Clockwise (CW) Technique for 4+ NS

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