Marisa Torrieri

7 reasons to be happy you’re in primary care

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Looking for the positive in the pandemic. 

 7 reasons to be happy you’re in primary care

Here are some of the most outrageous things physicians, administrators, and staff members say they have heard from patients and their family members. Click here to view the slides in PDF format.

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Here are some of the most outrageous things physicians, administrators, and staff members say they have heard from patients and their family members.

Nine Outrageous Things Patients Say

On the fence about participating in your medical board's Maintenance of Certification (MOC) program?

Family medicine physician Russell Thomas isn't.

Russell, who practices in a three-physician medical group in rural Eagle Lake, Texas, is a huge fan of his specialty board's MOC program, the ongoing re-certification program offered by the American Board of Medical Specialties (ABMS) and its 24 member boards. The programs require physicians to participate in activities specific to their specialties, including ongoing knowledge-improvement projects, in addition to taking an exam at least once every 10 years, to demonstrate they are staying up to date in their fields.

But while Thomas says it takes upwards of 50 hours a year to focus on MOC-related activities, he believes it makes an enormous difference in his day-to-day practice.

"I see it as an absolute necessity." says Thomas. "I think all of us think we know a whole lot more than we do."

Endocrinologist and internal medicine physician Arvind Cavale, it seems, couldn't disagree more.

While the Feasterville, Pa.-based physician admits he enjoys the thrill of taking tests and took his first, post-board-certification MOC exam in 2005, he has no plans to continue the MOC program - it just takes too much time, for very little return on investment.

"What does recertification mean? It's not a license to practice medicine," says Cavale. "What is relevant in day-to-day practice is to identify what your patient is asking you."

Physicians Thomas and Cavale represent two ends of the spectrum on a divisive issue: whether MOC is worth a doctor's time. In 2013, the debate over the program's merit reached its highest pitch when the Association of American Physicians and Surgeons (AAPS) filed an anti-trust suit in a federal court in New Jersey against ABMS. Among other things, the 20-page complaint claims the defendant's program "is designed primarily to enrich [the organization] and its own executives, rather than any genuine attempt to improve quality of care for patients."

For physicians still going back and forth on the voluntary program, this ongoing debate raises important questions: Is it worth the time and money involved? What are the benefits? What are the alternatives?

For starters, physicians are proving that they are up to date on the changes and professional developments in healthcare - and this matters to patients, says Lois Margaret Nora, ABMS president and CEO. Today, 800,000 physicians are ABMS board certified, and last year, about 450,000 to 460,000 of those physicians participated in MOC programs, she says, adding that number is increasing every year.

After obtaining ABMS board certification, a process that entails "an extended period of time of training and assessment of the knowledge, skills, judgment, and professionalism of their particular medical discipline or specialty," physicians are eligible for MOC, says Nora. And the program, which is intended to reflect that physicians have achieved the highest standards in their discipline, is pretty rigorous.

"At the beginning of the 2000s, it was recognized that medicine and science changes so regularly and so ongoing that ABMS board certification became more associated with a more comprehensive program of Maintenance of Certification," says Nora. "What Maintenance of Certification  is intended to do, and we believe it does do, is, first of all, signify to the public … that we deserve their trust because physicians are doing an ongoing program of assessment and learning in their discipline."

Russell says the program helps him improve his areas of weakness through study and by informing him of quality standards that he should adhere to, such as guidelines for hand hygiene and infection control.

"For me, it's a very important way for me to identify my weaknesses in various areas of care, and do an improvement process or course to provide better patient care in that area," says Russell.

But efforts to stay up to date aren't just potentially beneficial to patients. Some hospitals choose to use ABMS board certification as one of the criteria to determine whether to add a physician who applies to the hospital for medical staff privileges, and some insurance networks also use it as a criterion, according to an ABMS spokeswoman.

If MOC makes a difference to patients, in the nearly 10 years since he's been certified, Cavale hasn't seen evidence of it.

"In 17 years of practice, not once has a patient asked me if I am board certified or if I am involved with MOC," says Cavale, adding that being part of the program also hasn't made him more efficient or reduced his malpractice risks.

In addition to not making a difference to patients, the program costs too much in time and money, says Jane Orient, an internist and executive director of AAPS.

"If you have to spend every waking hour that you're not working cramming on material that is useless to you and you have to spend thousands of dollars buying the review materials, and thousands of dollars taking the exams … plus the expense of being away from your practice and traveling to remote locations, it amounts to many thousands of dollars and it means that you can't study the things that are most important to you, you can't spend extra time with your patients, your family life is devastated," says Orient. "It's really a huge burden with no purpose. Doctors are overworked as it is. Why do we want them to do busy work?"

Indeed, the time invested in preparing for his first MOC examination in 2005 has reaped very few benefits, say Cavale.

"In order to qualify for the board test you need to complete so many modules," he says. "And a course to complete one module could take four to six hours. These modules … have no meaning to actual patient care. With age you realize all this is bogus."

While each board exam is different - and ABMS says annual MOC participation fees cost, on average, $300 a year - ABMS confirms other expenses may include travel to test locations (and, therefore, hotel accommodations) and time spent away from patients (and the revenue generated from those patient visits). However, the board also notes that other professions like law and accounting have similar programs and associated costs.

Earlier this year, ABMS enacted new standards to encourage its member boards to continue to look for ways to reduce physicians’ cost, time, and administrative burden associated with participating in MOC as well.

Trying to decide whether MOC is worth your time and money? In addition to the more publicized pros and cons, physicians should also consider the following:

 "First and foremost, they should look at, 'Does this process contribute to the ability for me to provide the best care I can for my patients?'" says Thomas. "Things change very rapidly in our business. At the end of the day, it's a minimum thing that physicians should do to ensure they're providing the best care for patients. If you're not trying to learn something all the time, you're going to get woefully behind very quickly. Maintenance of Certification is the best option we have currently." But not all physicians agree. If you believe your time is better spent focusing on your patients and learning from them, as Cavale does, then MOC might not be right for you.

 While some of you are motivated to keep up with your profession by studying and passing exams, others may prefer self study: reading journals, talking with partners, going to society meetings, and the like. "There are many assessment programs and self-study programs put forth by our various medical societies," says endocrinologist Marc Frager, who practices in a six-physician group in Boca Raton, Fla., noting that these programs cost much less than MOC. "And there's no reason to believe that Maintenance of Certification is any better than the medical-society-sponsored programs."

 If hospital privileges are important, you might want to check into what your local hospital partners are requiring. "My partners are younger and some of them have to participate in Maintenance of Certification because board privileges are required for hospital privileges at my hospital," says Frager, who, because he was board certified before 1990, doesn't have to recertify to have hospital privileges. "So If I don't participate, I still have my board certification, but they lose theirs if they don't. They have time-limited certification, so after 10 years theirs expires."

A closer look at the pros and cons of the popular ABMS MOC program, and whether it's worth a doctor's time and money.

Debating Maintenance of Certification for Physicians

As CIO for Atrius Health, a Massachusetts-based alliance of physician groups, a home health agency, and a hospice, that includes more than 50 medical practices and 1.2 million patients, Daniel Moriarty manages a small army of about 200 IT workers. Yet while you'd think having so much technology talent on hand would be sufficient, Moriarty only sees his needs for more dedicated help growing in coming years.

"We're up about 35 people over five years ago," says Moriarty, adding that the growth has been due to a number of different factors. "We became one of the Pioneer ACO organizations. … That triggered a whole series of different IT requirements in terms of improved care coordination, additional investments, and population management to identify and manage our highest-risk patients … and we have had new practices join Atrius as well. More recently, it's ICD-10, meaningful use Stage 2, continuing the build out of the [health information exchange]. So frankly, we really see no end in sight in terms of the growing demands and new areas [of IT]."

While Moriarty manages a large IT staff for a huge network of practices, his growing need for IT staff is an issue that transcends practice size. Even small practices are in need of dedicated IT help. But determining what kind of help and how much you need is difficult. What's more, the market for qualified healthcare IT help is competitive, as demand is increasing far faster than the supply of talent.

Here's how to figure out what you need - and how to get it.

A late 2013 report by consulting firm Research and Markets reveals the North American healthcare information technology market is forecast to grow at a compound annual growth rate of 7.4 percent to reach $31.3 billion by 2017 from $21.9 billion in 2012. 

own 2013 Technology Survey, Sponsored by ZirMed, which received responses from more than 1,200 physicians, reveals practices are relying on a growing slew of software and services: More than three out of four respondents said their practice has a fully implemented EHR (or uses one from its hospital parent). A whopping 70 percent of practices use billing or coding software, and 44 percent have implemented a patient portal. More than one out of three physician practices say they're part of a health information exchange (HIE).

But managing all that technology themselves is too much for most practices to bear - unless physicians and/or administrative staff possess an IT background.

"You're going to have desktop support needs, network needs, hardware installation and maintenance, server infrastructure, applications development and support, management, reporting, upgrades … and then now we're getting more and more into mobility," says Dallas-based John Whitham, who leads consulting firm ECG's national healthcare IT practice. "For any organization, that's a really tall task. It's really hard to be able to scale those services without looking for some kind of external help."

IT talent runs the gamut of basic desktop support to highly skilled experts who are well-versed in everything from EHRs to HIPAA compliance. Just as the type of help varies, so do your practice's needs. But two things, primarily, should drive your hiring decisions.

The first is your actual, day-to-day, tech-support requirements.

"Practices need to look at the functions that they need, and a lot of it is going to depend on their specific situation," says Whitham. "What's their relationship with their hospital? Are they in an urban or rural setting? We need to look at what is the most effective way to get the most for the least amount."

A lot of times a practice will be able to save money if they share a full-time employee with a hospital, he adds.

"A lot of hospitals have affiliate programs, and are offering or sponsoring EHRs for independent physician practices," says Whitham, noting that hospitals sometimes offer IT support along with the technology. "Even if not, ask [your hospital partner] what they're doing or willing to do, because more often than not, there might be some scale in the community."

Second, your practice must consider its budget. A dedicated desktop-support staff member will run your practice about $40,000 to $50,000 per year plus benefits, notes Whitham.

But if you want someone to do more than desktop support - to actually run the technology systems that are becoming increasingly important to medical practices - you'll have to part with much more: upwards of $100,000 per year, says Beverley Caddigan, president of New York-based IT consulting firm Bevtek Solutions, which employs a national team of IT engineer contractors who can oversee everything from desktop support to EHR management and data-breach prevention efforts.

Many of the company's clients are small- to medium-size practices. That's because the pricing model for consulting is based on economies of scale, as one engineer can work with multiple practices, says Caddigan. For example, some smaller practices opt for a $500-a-month IT management-services package, which fulfills most of their IT needs. Even premium packages are far less expensive than a dedicated full- or part-time worker, she adds.

"There are number of advantages to hiring a consulting firm," says Caddigan. "IT firms are up to date with what is going on. Very often full-time or even part-time IT staff, they aren't as fully trained as you need them to be or want them to be because they're not getting the support they need to do their job."

Whether your practice is seeking a full-time IT staffer (or two), or wants to hire an IT consulting firm, your ideal IT help should possess certain skills. Three of the most important include:

 While larger operations like Moriarty's can get away with having IT staff members who lack specific healthcare experience, as there are enough with healthcare experience to balance things out, the smaller the practice the more important experience is. Knowing how to use and work with technology without violating HIPAA security rules is especially critical."The first question I'm going to ask is, 'Are you familiar with HIPAA compliance, and are you familiar with what I need to do with my networks to ensure I don't find myself in breach?'" says Caddigan.

 Someone with great analytic skills will be able to see a practice's long-term needs. For example, when it comes to implementing an EHR, an analytic person will have a clearer understanding of clinical work flow - and how an EHR should be set up to support that work flow, says Bruce Metz, the CIO and a senior vice president at Lahey Health, an integrated healthcare delivery network serving Northern Massachusetts.

"It really helps if people are just really motivated to make a difference," says Metz. "This is a unique opportunity in healthcare. We really are trying to elevate the quality of patient care and safety in dramatic ways. We found a lot of success with people who are highly motivated when they understand, not only do I get to be a member of a high-performing team, but I get to learn some new skills and broaden my horizons and make a difference."

For more on what to ask potential healthcare IT staff, as well as what qualities you should look for, visit 

If finding qualified IT help weren't hard enough, most practices are also dealing with the reality that there's more demand for qualified IT professionals than supply.

This means you have to focus on selling your practice to candidates.

During interviews with potential candidates, Moriarty strives to stress Atrius' "great culture where people are doing really cutting-edge things, and market-leading activities."

He also emphasizes the organization's mission "to make it easier for patients and communities to be healthy by developing innovative, high-quality, and efficient models for delivering care" across the range of healthcare settings.

"This inspires dedicated and passionate people who want to make impactful changes to improve the health of a large population to join our team and that is what we are looking for," says Moriarty. "A lot of people who come here versus, for instance, going into financial services, [do it] because they feel they are contributing to something that makes a difference. It does matter to them."

. She can be reached at marisa.torrieri@ubm.com.

This article originally appeared in the April 2014 issue of 

Finding the right kind of IT help to move your practice forward.

Author | Marisa Torrieri

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