Welcome to the third and final installment of our series addressing the divide between providers and administrators. This chasm in both principles and practice has created an inability to work effectively together, which has established a modus operandi within the healthcare system not unlike the dysfunction we see in Congress. And there’s been very little compromise or real effort to build bridges in order to facilitate progress.
In part one of the series, we looked at the origins of the chasm between providers and administrators and the effort our industry needs to move forward in the new environment of the ACA. In part two, we examined how providers can help bridge the divide by becoming more aware of the impact their poor business habits have on patient access.
Today we’re focusing on the needs of administrators and how they can better partner with providers for the end goal of improving patient access and health. And perhaps the first step toward progress is the realization that providers and administrators share the same goal: good patient care.
As we discussed earlier, the blank check payment system made it possible to ignore the disconnect between administrators and providers. This payment structure allowed systems to benefit from hospitalizations resulting from a lack of good primary care. There was enough money in the system to pay providers—even if they weren’t running a successful practice with sufficient access. And due to the lack of access, patients would go to the ER or urgent care center instead of seeing a primary care provider—a scenario which often benefited the hospital system.
This created a significant problem in particular for patients whose chronic diseases went untreated and unmanaged until the costs were significantly greater. It actually incentivized many systems to not fix primary care because the significant cost of in-patient services could become a financial asset to the system. All that has changed now.
Playing on the same team
What it seems many of us—on both the administrative and clinical sides—have lost sight of is that administrators and providers ultimately want the same thing for their patient populations. Under the ACO structure, patients, in a sense, “belong” to administrators and providers, and both parties are responsible for patient outcomes.
Administrators are in a delicate position, addressing the challenges of patient satisfaction and poor outcomes while also bearing the financial responsibility for malpractice suits. If a provider can’t provide timely access and a patient experiences a worsening condition (or in a worst case scenario, dies from a lack of appropriate care), the system becomes responsible.
We all have a stake in our patients’ health now, whether we’re in the exam room or not. In order to meet the needs of their populations, administrators require competent care, convenient access and patient satisfaction. And the best starting point for administrators to accomplish those objectives is by helping their providers.
Expectations vs. reality
Administrators must realize most primary care offices are too understaffed and the clinical staff is too undertrained to deliver the appropriate level of care. Because primary care providers function as comprehensivists who manage all aspects of patient health, including both acute and chronic problems, there’s an enormous burden on both the provider and his or her staff to offer the same-day, competent care patients need.
The answer isn’t necessarily to hire more RNs, but to ensure providers are freed up from non-physician work by clinical team members with specialized skills for the exam room. Without addressing the primary care office’s challenges, administrators can’t expect more from their already over-burdened providers.
Just as providers have a responsibility to administrators to offer competent, self-sustaining practice with appropriate access, administrators owe providers the appropriate level of staff with the specific training needed for primary care. Overworked, burned-out providers can’t deliver consistent, high-quality care. The smartest thing administrators can do for the success of their systems is equip primary care providers with enough staff and the right skills to enable them to deliver excellent care.
Bridge over troubled water
As we’ve looked at the needs and responsibilities of providers and administrators, I hope you’ve recognized the effort to establish common ground and collaboration, rather than competition. It requires some give and take on both sides of the equation, but it’s worth the endeavor.
The changes needed to bring down costs and make primary care more accessible and affordable have come slowly (and more are still on the way), but I’m hopeful for what lies ahead. Moving the relationship between administrators and providers toward a stronger partnership will create a more effective system that better serves healthcare consumers.