Specialist Survey Results

Specialist Survey Results

We greatly appreciate all of the ideas communicated in the physician surveys! You can view the results below. The specific areas that had the highest level of responses and SIP’s actions follow:

Quality: We need to have new ways of identifying what our patients need and ways to capture the data. SIP is developing a schedule based tool to make this happen.
Patient satisfaction: The old surveys were too few and too late to give a good look at our practices. SIP has contracted with a new survey vendor (NRC) that will allow us to use email as well as snail mail, and we are developing a schedule based tool to get the surveys to patients soon after their visit.
Chronic conditions coding and associated increased revenue: Physicians need to be able to tell which diagnoses should be refreshed at each visit, and how to easily do this. SIP is developing a schedule based tool to identify diagnoses, and education around how to easily do this.
EMR: Physicians not using an EMR are concerned about a loss of efficiency with EMR’s, but the responses from those using EMR’s indicate they are more efficient than before (56-65%) or about the same (20-24%), so 76-89% are the same or better than before they began using an EMR. Sutter and SIP continue to support Sutter Community Connect with greatly subsidized costs.
Practice support: Many physicians expressed interest in a variety of areas of support, from practice counseling to buying office supplies to billing and coding. SIP is working to put together a panel of resources to help those who are interested.
A vision for the future of SIP: Most physicians felt priorities for SIP included helping independent practices compete with big groups in quality, service, and cost plus advocating for independent practices to continue to be a significant part of Sutter by participating in all (or most) Sutter contracts. This remains a core value for SIP administration.

Thanks to all who participated!

Dave

SIP lags behind others within Sutter in measures of quality, such as documenting vaccinations and aspirin use. Why do you think this is the case?
Answer Options / Response Percent / Response Count
Some practices are too busy to pay attention to all of the details. / 27.9% / 29
The metrics aren’t appropriate measures of good care and so they are ignored. / 19.2% / 20
It is too difficult to figure out all of the things needed at every visit. / 24.0% / 25
We are doing all of the appropriate interventions but the data is not being captured. / 55.8% / 58
Other (please specify) / 35
answered question / 104
skipped question / 20

Comments

Flu Vaccine; PNA Vaccine
I do not know I am an orthopedic surgeon
#1-espec. documentation for the sake of documentation. #2-At least, that's how they're perceived...
Reimbursements for OB as specialists does not/may not reimburse for vaccinations that are indicated OB – TDAP
having more integrated EHR makes it easier to measure such metrics
Lack/difficulty of communication among office especially among offices with different EMRs
N/A for Podiatry
Doesn't apply to Pediatric subspecialist
Subspecialist practice
We are dermatologist -we don't document vaccinations. We do document aspirin - anticoagulants.
as a specialty, don't routinely assess
help educate on best practices and who is being measured
other agencies have "hard stops" for addressing such topics as part of a visit through EMR
Specialty practices feel that this should be monitored by PCP's
What is important vs. what is not
suspect a issue with EHR utilization
suggest in-office patient surveys - better participation, better outcomes for all of us
rendering great but docs aren't documenting adequately
Sutter interface is very hard to use. Example when Sutter took over RAS - images are hard to get.
should be provided with forms from Sutter to capture patient visit
lack attention to details
a list of missing variables that is needed is identified in EPIC would be helpful
problem focused exam by specialists
Lack of financial support from Sutter Health to provide medical assistance and other support staff to enter information necessary
Have never talked with PCP providers as to why?
not in my specialty
Need to ensure clinician UTD on guidelines and accurately recording date of administration. Some given in hospital (i.e. flu shot, pneumovax) not always communicated.
Unrelated to specialty measures
Need good EHR to help with this. Ours makes it easy (EMA)
As specialist unaware it was needed.
Not sure how to document correctly is EMR
no idea
How is workflow supported by Sutter to or within SIP? This seems like a workflow issue?
this may be inappropriate to the medical issue
For specialists, this info is not always available. Some practices are not on EPIC, so it is difficult to assess.

Question 3

Purchasers of health care are demanding documentation of good quality. How can SIP improve?
Answer Options / Response Percent / Response Count
Make it easier to see what others have already done for the patient. / 31.4% / 37
Make it easy to see what needs to be done for every patient at every visit. / 39.8% / 47
Increase the incentive payment for completing quality interventions. / 33.9% / 40
Provide more education about what quality issues are being looked at by insurers and patients. / 60.2% / 71
Other (please specify) / 16
answered question / 118
skipped question / 6

Comments

So many diagnoses accumulate & aren't removed, so tendency is to not consider them accurate.
Good quality/good case
(Employers?) I don't think this is true! Most employers (who are the "purchaser") are way more interested in cost than anything else! They also simply want their employees to be "happy". And employees care about access, local presence & cost. Sorry, but patients don't care that a "group" has good documentation of quality!
Again, barrier is communication among offices especially with different EMRs
Solicit input from specialist to gather metrics that are appropriate and relevant to that practice
Make all EHRS communicate with each other
Need to come up with own measures of quality
I build EHR plot forms
so many things SIP can do! Patients want to know that their various providers talk to one another!
Pick a few things for specialists to target & COACH. & SIP staff support
come up with questionnaires that are more positive outcome biased
how do you quantify quality while accounting for variability in diagnoses/co-morbidities?
Interpret quality data appropriately
good HER
and how to influence patients opinions positively
Work flow. Documenting measures would seem to play a large note. Once you have the data, it will speak for itself.

Question 4

SIP lags behind others within Sutter in measures of patient satisfaction. Why do you think this is the case?
Answer Options / Response Percent / Response Count
The surveys are sent out so long after the appointment that only relatively unhappy patients bother to complete them. / 34.6% / 36
The number of patients surveyed may be adequate to look at all of SIP, but it is too small to distinguish one practice from another and to help us improve. / 51.0% / 53
Many practices are so busy that personal attention suffers. / 18.3% / 19
Physicians are not necessarily skilled trainers/managers, and so their office staff do nothave the skills to insure great care every time. / 22.1% / 23
Other (please specify) / 28
answered question / 104
skipped question / 20

Comments

I don't know
test results calls (press re: email communication. post surg. calls social media educating pt re: should be satisfied with outcome info "positive positioning" SIP to Pt. reduce wait times
Difficult for small practices to have consistent processes
Need better communication about test results
Doctors do not call patients w/ test results . Tell patient at check in that SIP is a great group
Don't know
Some measures are based on time
Patients to busy to complete survey
I have no idea
3-4 pts on IPAD survey at time end of visit
Asks wrong questions - How about "can you see after care"
Also, the questionnaire/survey needs to change
make sure survey asks good questions
organization is poor
Survey sample is small
We may be surveying the wrong patients
measure problematic Access - Referral - Wait times > problem for busy practices
physician need to talk to patients about surveys
no standard for "visit" patient unsure about what to expect
both are valid
SMG has staff to do just this, the rest of us don't/can't
paying for survey data is a pricey overhead, what is measured may not be appropriate to visit. visit may be with people of limited English or limited education and they influence the capacity of patient to response.
Patient satisfaction often focuses on factors other than quality of care - such as the physician beauty of office, communication, etc all of which are enhanced by Sutter Health financial support of practice overload.
Staff training in patient satisfaction issues - very important
Surveys have no evidence base
Not sure. My patients are happy.
Difficult to know what patient will be surveyed so that they can be targeted and encouraged to return response
How is data conveyed? All above could be true is EPIC the answer?

Question 5

Independent practices should excel at patient satisfaction. How can SIP get there?
Answer Options / Response Percent / Response Count
Improve the survey tool: higher volumes, sent out sooner. / 50.5% / 56
Provide more training to SIP physicians and their staff. / 55.0% / 61
Increase the incentive payment for patient satisfaction. / 33.3% / 37
Other (please specify) / 23
answered question / 111
skipped question / 13

Comments

I don't know
Roll out lean transformation to private practices
Improve communications with patients
Call patient with test results. Tell patients at check in that SIP is a great group
Give doctors more time with patients.
Improve EMR functionality appearances
EMR facilitated surveys/engaging patients to sign on to MyHealthonline etc
Sooner rarely means better in surgical practices
see above
Change the metric for measuring satisfaction
All
Encourage communication between SIP providers for shared pts
remind patients of their outstanding care and have them pro-actively complete PS surveys
in office forms
announce high performing practices at meetings
see above
identify bad practices - fix them
contemplate that all our patients not SIP patients and when we take all comers in order. patients on Medical may proceed patient time of a SIP patients and these private pay patients may feel slighted when all patients are treated as equals.
Get more overhead support from Mother Sutter!
Learn from auto dealerships to beat the current system of evaluation
Find out what patients expect, than educate ourselves and our patients.
Use a different tool that is more intimate(sp?) with the patient and the physician
Identify MD's @ such issues

Question 6

Finance: Many SIP practices do not receive revenue to which they are entitled for Medicare patients because chronic diagnoses are not all refreshed every year. This applies to specialists as well as primary care. Why do you think this is the case?
Answer Options / Response Percent / Response Count
It is hard to determine which diagnoses need to be refreshed. / 74.5% / 70
My coder does not bill for chronic illnesses if I note them in the chart but make no change in management. / 39.4% / 37
Other (please specify) / 36
answered question / 94
skipped question / 30

Comments

I was not aware of this, likely many others feel similarly
education of our staff....we'll do it now!
What does it mean to refresh
I did not know this was necessary, so how I can do it
Better clarity guidance, tracking
lack of knowledge about these revenue streams
lack of attention/documentation of chronic illnesses
What does refresh mean
Guidance needed/instructions
Hard for specialists to review no time
This is very difficult for specialists to do. We already are limited in what we can do
Specialist....
Didn't know that it mattered for reimbursement
This is captured with our Athena Health EMR.
Concern about consequences of refreshing diagnoses unrelated to practice.
We do not see Medicare pts in our practice
unsure of need to refresh and how to do it
4 diagnoses rule
lack of physician education regarding the financial impact of NOT doing this
I was not aware of this opportunity
Specialists not really doing
unaware of the importance of this
I didn't even know about this.
It is not worth the effort to get paid a little bit more.
elevate billers
extra work for all of us if no reimbursement
need to identify which factors include patients, which diagnosis. need training
we do not see Medicare patients
I don't even what is meant by "refreshed". I mark the problem list "reviewed", don't know if that is the same.
we MDs can code for many diagnoses. we just don't know the value of adding all these diagnoses. most patients have multiple diagnoses, we figure this out when recording drug history.
these just not considered important topic. Is it fraudulent to enter all chronic diagnoses in "visit diagnosis" even if these were not the diagnosis for visit?
Need more training how to do it
Did not know it was needed.
Workflow and education, ease of communication
"A" coder
It is unclear if "refreshing" makes it to the billing and coding list.

Question 7

Finance: SIP practices could greatly increase their revenue by refreshing chronic illness diagnoses every year. How can SIP help to accomplish this?
Answer Options / Response Percent / Response Count
Make it obvious at every visit which diagnoses need to be refreshed. / 55.9% / 66
Provide more education about refreshing chronic diagnoses by specialists. / 50.8% / 60
Enlist specialists in the effort to capture and refresh these diagnoses / 30.5% / 36
Provide a financial incentive directly linked to refreshing chronic diagnoses. / 41.5% / 49
Other (please specify) / 11
answered question / 118
skipped question / 6

Comments

Highlight flashing indicators
Even better, solicit CMS to just drop it from specialists. That's a PCP or even physician extender/Care liaison role.
Specific to our EMR
PCP to refresh more often
do not know
color - code it in the chronic dx list of the patient
Providing snapshots or other tools
we can help but focused, but focused list staff (SIP) assistance incentive
give or deduct a point to specialist - they are the legs!
we aren't on EMR but can add to our list when billing the other diagnoses, we don't know the value.
Specialists are not sure that listing chronic diagnoses makes a difference in reimbursement,

Question 8

EMR: Electronic medical records are becoming essential to comply with requirements from Medicare and an increasing number of commercial payers, and efforts to accomplish clinical integration are greatly facilitated by a common EMR. Yet there are many issues with EMRs. Your thoughts, please.What system do you currently use at your practice?
Answer Options / Response Percent / Response Count
System: / 100.0% / 111
How long? (years) / 95.5% / 106
answered question / 111
skipped question / 13

Comments

Answers ranged in time from less than a year to up to 23 years. Average seemed to be around 3 years.

Question 9

Is your EMR meaningful use (MU) certified?
Answer Options / Response Percent / Response Count
Yes / 88.5% / 92
No / 5.8% / 6
I don't know / 5.8% / 6
answered question / 104
skipped question / 20

Question 10

My EMR lets me readily access the care others are providing to my patients.
Answer Options / Response Percent / Response Count
Yes / 45.6% / 47
No / 50.5% / 52
I don't know / 3.9% / 4
answered question / 103
skipped question / 21

Question 11

My EMR readily identifies care needs (such as those used for quality metrics) and chronic diagnoses that need to be refreshed.
Answer Options / Response Percent / Response Count
Yes / 25.7% / 26
No / 35.6% / 36
I don't know / 38.6% / 39
answered question / 101
skipped question / 23

Question 12

After the initial learning curve:
Answer Options / Response Percent / Response Count
I am more efficient than before / 55.9% / 57
About the same / 19.6% / 20
Less efficient / 24.5% / 25
answered question / 102
skipped question / 22

Question 13

My practice management system (scheduling, billing) meets my needs:
Answer Options / Response Percent / Response Count
Strongly Agree / 28.7% / 31
Agree / 44.4% / 48
Neutral / 23.1% / 25
Disagree / 1.9% / 2
Strongly Disagree / 1.9% / 2
answered question / 108
skipped question / 16

Question 14

What is your overall satisfaction with your EMR?
Answer Options / Response Percent / Response Count
Great!! / 20.4% / 21
I like it / 28.2% / 29
It's OK / 43.7% / 45
I don't like it / 5.8% / 6
Terrible!! / 1.9% / 2
answered question / 103
skipped question / 21

Question 15

I don't use an EMR and don't plan to because:
Answer Options / Response Count
22
answered question / 22
skipped question / 102

Question 16

I don’t use an EMR, but will purchase one in:
Answer Options / Response Percent / Response Count
0-3 months / 0.0% / 0
3-6 months / 33.3% / 2
6-9 months / 16.7% / 1
9 months or more / 50.0% / 3
answered question / 6
skipped question / 118

Comments

I have heard from other Eye MSs that it will be slower forever. I don't have EMR. Will purchase this year only because you are forcing me to.
The most difficult part of EMR is COST! especially for small group practices.
Very time consuming
not ready to switch to EMR
will look at changing to econnect for patient communication
Practice Mgnt Only Will go live in February
I am potentially too close to retirement & can't amortize the cost/Inefficiencies of data entry in time left. Want to focus on face-to-face with pt & not data collection.
EMR is a disaster. It slows the delivery of patient care to a crawl.
no EMR yet- Considering. Waiting to see what community does Sutter EPIC- Hills now prob EPIC or is there an HIE friendlier than EPIC choice ( other EMR's that can Integrate) don't like EPIC.
will adopt, waiting for consolidation of systems
don't want to make investment until i am certain our practice will benefit
we are electronic for tasking, management, patient communication (relay health) scheduling, we will go back on EMR this year
I am too old and too close to retirement
paper records go back over 35 years and are easy to read and no redundancies.
EMRs reduce productivity and interfere with patient care. not cost effective for my practice
It is a template which encourages pre-verification. Visit consists of 6 pages but 4 lines are relevant. there are diagnoses but no assessment.
I like the efficiency of paper charts.

Question 17