Guest blog post taken from content presented by Dr. Scot Morris, OD, FAAO Eye Consultants of Colorado, from the Eyemaginations Premium Webinar Series
Why Is Change Important?
Often, we don’t want to look into technology that we feel will not benefit or aid us in some way—but that thought process is a dangerous one. It’s dangerous because if we think about the technologies from fifty years ago, we realize that many of them are now obsolete.
And many of the technologies that we will talk about here, maybe even the ones that you’re looking at right now, will also become obsolete in the next few decades.
Our world—the world of optometry and ophthalmology, what we practice and how we practice—is all about to change. Our professions are definitely challenged right now with the latest health care reforms, and our survival is going to depend greatly upon our ability to adapt, adjust, and survive.
As I often like to say, “facts don’t cease to exist just because they’re ignored.”
So let’s talk about the paradigm shift in the history of optometry, a profession that has seen many changes over the years. We started out as a primarily refractive society, but then transitioned into one that diagnoses and treats numerous eye diseases. In some instances, optometrists are even doing surgery now.
Where once we used to dilate every patient, we now focus on imaging and even have non-mydriatic imaging. We’ve switched to using IOP, Visual Fields, and RNFL scan compared to 15 years ago when it was just the sphygmomanometer and tangent screen. Not that those technologies didn’t work, but we have so much more data at our disposal now.
We can look at EHR much in the same way. Those of us who are in a paper-based practice are wondering “how can we move to EHR” while those of us who have EHR are thinking “how could we ever go back to paper.”
My intention and hope is that I leave you asking “how can we only be on EHR” because the world is moving towards storing data in the cloud and not on hard-drives in your office. Soon, all your data will soon be accessed through a website.
Here are few thoughts to consider:
1. Increasing Costs of the Current Medical Paradigm
The reality is that our system isn’t working, and it’s only getting worse. While costs are increasing, the efficiency of our delivery systems is decreasing, and in the United States, we are definitely behind the rest of the worldworst health care systems. It is an inarguable fact we have one of the in the civilized world.
In 2008, we were spending an average of $7,439 per person on health care and by 2006, our total spending had surpassed two trillion dollars. This meant that 19 cents out of every dollar spent by the government was for health care! Currently, health care expenditures are growing at a rate of 6.7 percent – well in excess of inflation. Obviously, this has to change.
The U.S. spends the most on health care than any other industrialized nation, even though nearly 46 million people are uninsured. Individuals without insurance still get care, but they end up using the most costly settings for care, such as hospital emergency rooms. Consequently, these costs are passed on to other payers, driving up health care premiums. Since 1999, employment based health insurance premiums have increased 120 percent, compared to cumulative inflation of 44 percent and cumulative wage growth of 29 percent.
2. Our Health Is Declining
Here are some staggering statistics; the U.S. is ranked 37th in the world in terms of healthcare performance and 24th in life expectancy, yet we’re ranked first in per capita expense. We have the highest rate of obesity of any similarly developed nation, the highest adult mortality rate for white males between the ages of 20 and 55, AND the highest infant mortality rate of any developed nation. Yet we spend more than everybody else—most of which is out of pocket.
3. The Path to Evidence-Based Medicine
In the 80’s, medical experts began to develop a strategy for implementing evidence-based medicine versus the fee-for-service payment system that existed at the time. And since evidence-based medicine could not exist without a way to report on it, technology became an integral part of the process.
HIPAA was the first step towards EBM, in which protocols were established to protect the privacy of patients and standardize electronic data exchange. Once privacy controls were in place, the government could move towards experimenting with incentives for a small sample. This was known as the Physician Quality and Reporting Incentives program or PQRI for short. Health quality reporting was only possible due to the utilizations of EHR systems, which allowed for the government to experiment with outcome based incentives.
The next step toward EBM was to unify our vocabulary, or implement ICD-10. With ICD-10, the amount of codes available increases drastically, further pushing the need for EHR. While the U.S. is currently the only developed nation that has yet to implement ICD-10, we are set to switch over on October 1, 2013. Once this happens, we will have our standardized and unified vocabulary with the rest of the world.
The U.S. government is also in the process of completing the EHR mandate. This mandate will provide a future national database portal that will funnel information from various parties. The last step is the expansion of this database into a global portal in which health care could be monitored and followed by the entire world.
4. The Role of EHR in EBM
Clinical Decision Support
One way that EHR will help in clinical decision support is through e-prescribing. Most of you probably already e-prescribe, and if you’re like me, you can’t imagine practicing without it these days. In the future, we’ll also have the capability to track and analyze outcomes. This means that we will all be judged, based on certain diagnostic codes, on our ability to successfully treat the average patient that comes in the door.
We still have a long way to go in terms of integrating both clinical decision support and the standard for current best practices. And as we’ll find out, EHR and EBM may actually change what those best practices are. In fact, clinical decision support functionality is a necessary addition to EHR systems and crucial for meaningful use.
Another role EHR will play is as facilitator of patient information transfers among medical agencies, government agencies, and public health agencies. Under HIPAA guidelines, we will be able to connect all areas of health care therefore allowing a physician to review medical data from across the world.
EHR is going to affect not only clinical knowledge, but also business knowledge. This new influx of information will allow you to manage your business better, slicing through the data to see what works and what doesn’t. You might find that certain tests and procedures prove to be more effective than others.
There are some business intelligence systems on the market right now that allow you to actually track business operations on a daily basis. My personal favorite is the The Edge. This software downloads information every night at midnight from your EHR system and runs analysis reports. It can also provide data such as average revenue per frame sale, profit made by one optician versus another, number of prescriptions being written by one doctor versus another and how many of those are being filled, or even the percentage of consumers electing anti-glare coating.
5. The Impact of EBM on Medicine
There will be some paradigm shifts in eye care as well as in the rest of the health care industry. This future trend will include an evidence-based rating system. Today, you can already research how you rank on various websites subjectively by both your peers and by consumers, but this new system will be on a much larger scale, which will definitely drive consumer choices in the future.
Consider this scenario: a patient will be able to choose between Doctor X, who has a $20 copay and a high rating at treating corneal ulcers, or Doctor Z, who has a lower rating and requires a $40 copay. Who do you think the patient will choose?
So, how will that patient decision-making process impact us as providers? A lot will depend on which side of that pendulum you’re on. And if you’re not so good at treating cornea conditions but yet you see a lot of cornea patients, your reimbursements will go down.
Standard of Care Revisions
Ultimately, the goal of utilizing EHR for EBM is to save lives. We’re going to see the standard of care improve as we follow the outcomes and usage of different medications and treatments through the use of EHR. I think that all of us in practice today know many therapies out there that claim to be the best, but yet don’t really work. Likewise, there are also many medicines out there that aren’t approved, but work great for other conditions. Now all of a sudden, you can start slicing and dicing information in many different ways to find out which drugs and treatments are most effective.
What’s the best way to treat a person who is diabetic and has a history of macular degeneration? Would certain types of omega-3 work better than in others? This is the type of information that, right now, we’re completely dependent upon pharmaceutical companies or device companies to provide us with. After this national health database has been developed, this information will become publicly available, therefore providing information on the most effective medicines and treatments from practices around the country.
Teaching Future Doctors
Future doctors will definitely experience changes in both how they learn and what they learn. With EBM in place, they will have to learn evidence-based care and ultimately consumer choice, because that is how their success will be measured in the future.
We are already starting to see changes in learning style. When I travel to universities to speak, most of the students are using laptops or iPads. They are learning in a whole different way and in a much more interactive way than we ever did.
6. The Impact of Technology
Pharmaceutical companies are going to change the way they spend their resources when we implement best practices from the information provided by EHR systems. These companies may not be able to recoup their costs for R&D if it is shown that their new drugs are no better than the old. And consequently, we may see exorbitantly high costs for certain drugs as a result.
We may also see fewer marketing dollars available to sponsor industry events such as continuing education meetings and medical societies. When we consider the amount of support we get from these companies, the effects of spending changes could be quite significant.
For example, take a look at the estimated cost per hour for continuing education credit in the optometric world. Right now, it’s about $300 per credit hour. This includes time away from the office, travel expenses, and the actual cost of the CE. The industry supports about 62% of this number now. If the industry contribution was to be reduced by half, and they reduced support to about a third of the cost of CE, then that estimate per hour of CE will grow to about $600 per credit hour. So if you need 20 hours of credits every year, then that’s about twenty times six hundred. Continuing education could get a lot more expensive.
There’s also going to be a huge impact on marketing. With this reform, patient health information and demographics will reside in a centralized national database where it can be shared very quickly between people and companies. Presently, we don’t know who will control access to this information or what they’ll be able to do with it—but all that information will prove to be invaluable for marketing purposes.
A growing trend within pharmaceutical companies over the last few years has been direct-to-consumer marketing. In this type of marketing approach, they’re passing by the providers and asking the patients to bring treatments up directly with the providers instead of relying on the providers. This DTC approach may continue to spread into other emerging media channels, such as social media and search engine marketing.
In Your Practice
Technology is going to change the way you market to your consumers, making you more efficient and requiring less money. For example, instead of advertising on the local TV station, you might send an email to all of your patients instead. Not only is this direct marketing approach more cost effective, but you’re likely to see better results.
Here is a good example from our practice. We often do trunk shows that can sometimes generate between $25,000 and $30,000 in a day. To promote this trunk show sale, I can target my email to all patients between the ages of 25 and 55 with one child, living in one of three selected ZIP codes, and has spent more than $500 in our optical over the last three years.
So why target that specific group? Well, because we know that those people are the most likely to attend and therefore spend money. Our patient contact management system allows us to segment our audience and send a targeted email to those who we feel will take action first, all in about 8 seconds!
The reality is that technology is going to affect everything in health care. What choice will you make when it comes to embracing it? What will you do to protect your practice, your business, and your profession as we look forward and move into the future?
An important rule of thumb to remember is that it’s never too late to start. Wrap your arms around the fact that your paradigm is going to change and that all of us have a choice—we can either accept it or get run over by it. And as I’ve said before, the world’s moving so fast these days, the man who says it can’t be done is generally run over by someone doing it.