Managing the physician relationship in senior communities
Here is my question: Do your house physicians manage you or you them?
Recently, McKnight's Long-Term Care News published an article on the use of antipsychotics in nursing homes. The essence of the article is that CMS partnered with the American Health Care Associations Quality Initiative (AHCAQI) in an effort to effect a 15% reduction in antipsychotic drug use in nursing homes by the end of the 2012. The data demonstrates they did not come close to meeting that goal. It appears the principal reason for this failure is because physicians continue to prescribe them. AHCAQI is now calling for CMS to put more pressure on physicians to reduce antipsychotics.
While the McKnight's article specifically addresses physician issues relative to skilled nursing, the more fundamental question is really who or perhaps how senior communities manage their physician relations.
This issue is particularly important in at least two areas:
1. Solving the Readmission Problem — It is baffling to me that, whenever I see discussions about reducing hospital readmissions, there is much talk about things nursing homes and assisted living communities can to do or should do to help hospitals avoid readmissions, but essentially no discussion about the role physicians play in the process even though they are the ones who make both discharge and admission decisions. How they manage the process of discharging patients to a senior community and how they make readmission decisions about residents in skilled and assisted living buildings can make or break those senior communities and the affiliated hospitals.
2. Keeping your community full - Unless your senior community is full - and full of the right kinds payer mixes — your physician should be a partner in making referrals to your community.
Managing Your Physicians
1. It needs to be a partnership — If you have physicians coming to your senior community, it may be somewhat of an inconvenience for them but it also represents a captive group of patients. That means a captive easy revenue source. While meeting the needs and wishes of residents must always come first, there can be multiple ways to accomplish this goal and you need to be able to have open dialog about the needs of your community. If you can't, you should fire that physician and get someone you can work with.
2. You need to create a great physician experience — I don't know for sure, but I suspect that, sometimes, bad physician relations are the result of not creating a great physician experience. This does not mean a “suck-up” relationship, but it does mean getting to know your physician well enough to understand how he/she likes to work. You should find out what annoys him/her and what delights them. They will appreciate being asked.
The goal should be to create such a great experience that physicians see their visits to your community as the highlight of their week or their day.
3. Patient flow needs to be a two way street — I am astonished at how often when I talk with senior community leaders about their physician relationships, to discover their physicians never or almost never refer patients to their community. This can be true even those that are receiving extra compensation for being a house physician!
If your physician is not helping keep you bed full, you should fire him or her. But there's a big caveat:
If you are not doing a great job of serving your residents (and I am sure this does not apply to my readers) you don't have the right to demand a give-and-take relationship or insist on resident referrals. Good physicians can't ethically recommend a place that isn't providing reasonable care.
I know there are some physicians who have geriatric practices that read this blog. Ihope they will chime in, even if it is to tell me I have it all wrong. To start, how are your physician relationships?
What are you doing to have great physician relationships?
Steve Moran is a blogger for Senior Housing Forum.