Interview: Disruptive Forces in Healthcare
Dr. Christopher Rumpf serves in a dual role as SE Healthcare’s Vice President and Senior Medical Director. During his extensive career in healthcare, Dr. Rumpf has held numerous leadership roles including Chief Medical Officer of a multi-hospital system responsible for safety and quality; as Chief Medical Officer for a Blues plan, responsible for provider contracting; and President of a large, multi-specialty physician group. In the following interview, Dr. Rumpf provides insightful feedback on the effects of disruptive forces in healthcare.
SE Healthcare: One of the most discussed disruptive forces in healthcare is the shift to value-based pay. This shift has challenged providers to find the balance between quality of care and cost, and facilitates patients to take a more active role in their health.
Rather than taking an active role in their health, noncompliant patients are not engaged and have difficulty following their care plan. How do noncompliant patients contribute to the challenges a physician faces in a value-based pay system?
Patient engagement and a patient’s involvement in their care are key to success in value-based arrangements
Dr. Christopher Rumpf: Patient engagement and a patient’s involvement in their care are key to success in value-based arrangements. Compliance with treatment plans is essential to meet the clinical quality metrics that are part of value-based contracts. Patient satisfaction is essential to value-based contracts and patient engagement is important to assure that patients experience a high level of satisfaction.
A component of patient engagement is how closely they follow their care plan, whether this means compliance with medication, diet, or monitoring their condition. Some requests are difficult for patients to follow. The requests may overcome their ability to comply, especially if the patient is elderly or has multiple conditions to monitor. Healthcare technology, like alarms for medications, should be designed to help patients be compliant with their care plan.
Even when patients are empowered to follow their care plan, someone has to deal with the results. For example, if a patient is diabetic and is monitoring their blood sugar, there still has to be someone monitoring the results to make adjustments in medication and diet. Physicians are spread thin in resources to handle these results and to educate patients to handle the results themselves. Value-based contracts can provide the resources to assist patients in managing their care.
SE Healthcare: Precision medicine is another disruptive force in healthcare. According to the Precision Medicine Initiative, precision medicine is defined as “an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles”.
Precision medicine is more personalized, but requires additional interactions with physicians and physician burnout rates are worsening. What impact will physician burnout have on the advancement of precision medicine?
Dr. Christopher Rumpf: Precision medicine requires providers to engage with patients based on the disease risks revealed in their genetic profile. This will require a legion of well-trained genetic counselors to interact with patients to explain their genetic profiles and apply lifestyle and treatment recommendations outlined by their care team, including their physicians. To date, physicians have not been engaged in this work, nor has this work been slotted into their workflows, which are mainly focused on face-to-face visit productivity and reward models.
Value-based care essentially means shifting the clinical and financial risk from insurance companies to providers. If addressing the results of precision medicine assessments is expected, then time will need to be provided in practitioner’s schedules and they will need to receive compensation.
SE Healthcare: In an age of technology, virtual healthcare is becoming more prominent. How will physicians utilize this technology with elderly patients or patients in rural areas who may have limited access to or knowledge of technology?
Dr. Christopher Rumpf: Virtual monitoring of patients with chronic conditions with resultant adjustments in treatment and care plans will be a valuable use of technology. It will prevent patient travel for physician office visits and increase patient satisfaction. Virtual technology integrated into cell phones at a low price point will allow rapid adoption since cell technology has been readily adopted by the general population including the elderly. If the reimbursement for virtual visits can be improved, physician’s participation may improve. Right now, physicians receive significantly lower reimbursements for virtual visits compared to office visits.
SE Healthcare: Can you please discuss how the accessibility of virtual healthcare compliments value-based pay and how this technology could contribute to increased reimbursements for physicians?
Dr. Christopher Rumpf: There is a lot of potential with remote patient monitoring. Remote patient monitoring gives patients a way to better manage their own health, is convenient, and gives a full overview of the patient’s health. This can lead to better compliance with care plans and better quality of care, which is important for value-based contracts. For example, patients who are diabetic could use RPM to monitor their sugar levels for necessary adjustment in their care plan.
Fee-for-service is more prevalent in healthcare than value-based contracts. Recently, there was a program called MACRA that was being pushed to drive more value-based pay, but it was too expensive and too much work for doctors. The push back from doctors lead to changes; many doctors no long are required to comply with MACRA.
SE Healthcare: Technology is extremely accessible is today’s world. Does healthcare technology help level the playing field between independent practices and health systems?
Dr. Christopher Rumpf: Technology, specifically Electronic Medical Records (EMR), have been a disaster for doctors. Electronic Medical Records weren’t designed, thought out, or implemented well. It was implemented because of government incentives.
EMRs are a huge contributor to physician burnout – about 50-60% of physicians are experiencing burnout. Electronic Medical Records add unnecessary work to a physician’s already full workload because they have to gather information that isn’t necessarily important to patient care.
Independent practices are facing even more of a burden because of EMRs. The financial burden of complying with requirements for EMR documents are forcing some independent physicians out of practice. Physicians who are employed deal with less of this burden because the organizations handle the financial burden.
SE Healthcare: Thank you for your time and insight into the disruptive forces in healthcare. Before we wrap up, are there any other thoughts that you would like to share on this subject?
Dr. Christopher Rumpf: The biggest issue is figuring out how technology fits into the current economic situation and the transition to future reimbursement models.