Læger er nu enige – fedme er en sygdom

Et ord kan have en stor indvirkning på den måde, lægerne behandler fedme i USA.

American Medical Association har vedtaget en ny politik, der officielt etiketter fedme som en sygdom “, der kræver en række lægelige indgreb for at fremme fedme behandling og forebyggelse,” ifølge en AMA erklæring.

Lægernes gruppe stemte for at godkende fedme politik bl.a. tirsdag under sit årlige møde i Chicago.

Den amerikanske fedme steg næsten 50% mellem 1997 og 2012, ifølge Centers for Disease Control og Forebyggelse. I dag er næsten 30% af amerikanske voksne anses fede, og problemet er næsten lige så udbredt i børn. Fedme blandt børn er mere end fordoblet i de sidste 30 år, siger CDC.

Fedme for voksne er defineret som at have et body mass index, eller BMI, på 30 eller højere. BMI er en måde at måle kropsfedt baseret på din vægt og højde. (Beregn dit BMI her)

Nations fedme krise

At være overvægtige stiger din risiko faktor for at udvikle mange alvorlige lidelser, herunder hjertesygdomme, type 2-diabetes, forhøjet blodtryk, slagtilfælde, leversygdom, søvnapnø og slidgigt. Faktisk har fedme blevet forbundet med næsten alle kronisk sygdom på en eller anden måde.

“Erkender fedme som en sygdom, vil bidrage til at ændre den måde, det medicinske samfund tackler dette komplekse problem,” medlem AMA board Dr. Patrice Harris sagde i en erklæring.

Fedme har længe været anerkendt som en sygdom af andre grupper, men dette spil fra AMA sender et stærkt signal til det medicinske samfund, siger CNN Chief Medical korrespondent Dr. Sanjay Gupta.

Nogle eksperter bekymre pludselig erklære en tredjedel af amerikanerne “syg” eller “syge” vil øge ønsket om hurtig indgriben eller medicin og afskrække folk fra at foretage de livsstilsændringer kendt for at bekæmpe fedme.

På den anden side kunne AMA erklæring bidrage til at øge midlerne til fremtidig fedme forskning. Det kunne også føre til betaling for læger, der ønsker at blot tale med patienterne om ernæring eller motion – tid, der er i øjeblikket ikke refunderet af forsikring planer.

Identifikation fedme som en sygdom kan også hjælpe med at reducere den stigmatisering ofte er forbundet med at være overvægtig, siger Joe Nadglowski, president og CEO for fedme Action Coalition.

“Fedme er blevet overvejet i lang tid at være en fiasko af personligt ansvar – et simpelt problem med at spise for meget og udøver for lidt,” sagde han. “Men det er en kompleks sygdom … vi håber holdninger vil ændre sig.”

Nadglowski mener AMA støtte er også et vigtigt skridt i at hjælpe mennesker få adgang til fedme behandling. De fleste former for forsikring dækker ikke fedme alene. For eksempel kan en overvægtig patient ikke ansætte en ernæringsekspert eller en træner og få det dækket af hans eller hendes plan blot at tabe sig.

“Vi dækker behandling forbundet med en co-morbiditet,” siger Don McLeod, en talsmand for Centers for Medicare & Medicaid Services. “For eksempel, hvis du har diabetes og fedme er forværrer diabetes, vi kan dække fedme behandling som en måde at behandle diabetes.”

Fedmerelaterede sundhedsudgifter koster amerikanere mellem 147 milliarder dollars til 210 milliarder dollars om året. Forebyggelse og behandling af fedme, før det fører til mere alvorlige sygdomme kan hjælpe med at bekæmpe disse omkostninger, siger Nadglowski.

AMA beslutning kommer på et interessant tidspunkt. Den fedme Action Coalition har arbejdet på at indføre Treat og Reducer Fedme Act i Kongressen.

Lovforslaget blev genindført i Parlamentet på onsdag og vil blive genindsat i Senatet onsdag eftermiddag, i henhold til kontor senator Tom Carper, D-Delaware, en af ​​foranstaltningens sponsorer. En lignende lovforslag sidste år gik i stå i udvalget.

Lovforslaget vil øge fedme behandlingsmuligheder for Medicare patienter, udvide de typer af udbydere, der kan tilbyde fedme rådgivning og tage væk nogle fedme medicin grænser.

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The Commonwealth Fund Gets It Wrong

flying cadeuciiA new report from the usually sensible Commonwealth Fund got lots of media attention this past week. The report –“Competition Among Medicare’s Private Health Plans: Does It Really Exist?” –quickly led to headlines like “Is private-sector Medicare becoming a monopoly? [PBS]” and “Robust Medicare Advantage competition almost non-existent [Modern Healthcare],” and “Health insurance is staggeringly uncompetitive in America, and is poised to get even worse for everybody [Quartz].”

It sounds like Medicare Advantage is headed for disaster, but is this really the case?

The Commonwealth report’s major findings are summarized in one sentence, likely the one that grabbed media attention: “Using a standard measure of market competition, our analysis finds that 97 percent of markets in U.S. counties are highly concentrated and therefore lacking in significant [Medicare Advantage] plan competition.”

The “standard measure” used by the Commonwealth authors is the so-called Herfindahl-Hirschman Index. This grandiosely-named tool takes the squares of the percentages of each competitor’s share of a market and totals them to arrive at a numerical score. The Commonwealth report provides two examples of interpretation of the HHI score:

“Region A has five firms, with market shares of 40 percent, 30 percent, 20 percent, 5 percent, and 5 percent. The HHI would therefore be: 1,600 + 900 + 400 + 25 + 25 = 2,950. Market A would be described as highly concentrated, or less competitive.

“Region B has 10 firms, each with equal market shares of 10 percent. The HHI would be: 10 × 100 = 1,000. Market B would be described as non-concentrated, or more competitive.”

The fallacy of this approach becomes obvious if we consider an extreme example in which a region has one hundred health plans with a one percent market shareeach. The Commonwealth logic would indicate this to be a very highly competitive market.  The reality, however, is that every plan would be at its providers’ mercy and unable to cover its fixed costs with affordable products.

As the extreme example shows, having more competitors does not necessarily result in more effective competition in the sense that consumers get a more affordable or better quality product. Equally, having fewer competitors – short of a monopoly – doesn’t necessarily lead to less competitive products. (Just ask Boeing or Airbus if there’s inadequate competition in their two-manufacturer market!)

The Commonwealth authors counted the number of MA health plans and their respective market shares in each region, and then computed the respective HHI scores to reach the findings quoted above. The first part of the findings – that almost all markets have relatively few health insurers — is unarguable, although whether it is appropriate to characterize them as “highly concentrated” (a term attached to HHI scores) is more questionable. What is even more questionable is the implication that consumers are suffering as a result. The Commonwealth report tries to justify this by saying “Generally, greater competition [i.e. more competitors] is seen as beneficial to consumers and purchasers, in terms of controlling costs and promoting quality. This has been found to be true in health care markets as well….”

Well, not exactly. The few studies of health insurance markets cited in the Commonwealth report are much more ambivalent. The most extensive regression analysis study (of a segment of the large group market), published by the National Bureau of Economic Research in 2009, found no overall correlation between market concentration and premium growth.Theresearch did produce two other (somewhat contradictory) conclusions. The first was that insurer market concentration resulted in lower physician earnings (as expected when purchasers have more power). The second, obviously relevant to current merger proposals, focused on Aetna’s acquisition of Prudential’s healthcare business in 1998 and concluded that in this case the increase in market concentration resulted in a significant increase in annual premiums, of up to seven percent. However, two caveats must be made: The impact on Aetna of the Prudential acquisition on top of a still-in-process takeover of New York Life’s healthcare business was near-disastrous, and it is at least possible that the apparent high increase in premiums may have been due to Aetna’s troubles at the beginning of the study period. It is also possible that the seven percent number is overstated; for the mostly self-funded groups in the study, this would amount to a fifty percent increase in fees (assuming claims costs were unaffected), an unreasonable bone for any company benefit manager to swallow.

None of this uncertainty stopped the Commonwealth authors from making another leap of logic. Having bemoaned the level of MA competition, they then decided that increasing competition in the broader Medicare program through, say, a premium support approach, may not be desirable and conclude (roll of drums): “The benefits of competition can be relied on only in markets where the elements of competition exist. It is not clear that merely expanding the role of private plans would improve Medicare’s ability to serve its beneficiaries, either in terms of the quality or cost of care.”

The reader may well be bewildered. If more competition in MA is good, why is this not also true for Medicare as a whole? The Campaign for a Rational Healthcare System estimates (based on studies by the Congressional Budget Office and by the Kaiser Family Foundation) that a premium support model for Medicare could save up to $30 billion a year and provide enhanced basic benefits. Maybe the Commonwealth Fund should get over their infatuation with the HHI index and focus on ways to cut Medicare costs.

Roger Collier was formerly CEO of a national health care consulting firm. His experience includes the design and implementation of innovative health care programs for HMOs, health insurers, and state and federal agencies.  He is the founder of The Campaign for a Rational Healthcare System.

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The Human Side of Corporate Medicine

Screen Shot 2015-08-29 at 12.49.35 PM“I want to explore employment opportunities with you.”

He is looking at me. Trying his hardest. Passion, yet anger, in his eyes.

Everything I know about him and his tenure in the community helps me understand how difficult this conversation is. Everything I see in his eyes helps me understand how painful this is.

Private practice is dying…on the vine…in America.

The practices fold or reach a critical point and they come running to Big Med to fix all the problems.

Absorb. Acquire. Integrate. Consolidate.

Every week I get a call.

“Will you buy my charts? Why not? I have been a longstanding provider in this community?

“Will you buy my practice? Why not? I have been loyal to the system?”

Fact is. We are all struggling to stay afloat. I live in the guts of Big Med and let me tell you…we are doing the best we can to survive. We are trudging the influx of government regulation, population health contracts, outcomes data, patient experience pressures, reimbursement changes, meaningful use, union negotiations, massive expansion of Medicaid and quality control.

Physicians write about “raging against the machine” or finding the “Katniss” of healthcare

But the reality is that we cannot all go out and be independent. That may work for some primary care innovation, but how does it work for subspecialty care in which providers are dependent upon a large referral network or a large amount of hospital inpatient care? How does that work for bundled payments and government payers? How does that work for the millennial physician workforce that is FLOCKING to employment?

In some ways, they just got us by the balls.

So, I take a different approach. Rather than fight the machine, I dive deep inside the confines and internal mechanics. I place my stamp of influence in the core function of the beast. If physicians are unhappy about the way our Big Med Corp is run, they should get involved and be part of the solution. Take a seat at the table. Get involved. Otherwise, stop complaining about what Big Med is “doing” to you.

While I know we were trained to be clinicians and care providers, the rapidly changing and evolving healthcare environment requires more of us. The train has left the station. More and more physicians are enrolling in leadership programs and earning advanced degrees in business administration and medical management. The age-old days of a token MD in the C-suite are a thing of the past. Physicians are also taking a seat at the helm of Big Med.

“Being employed is different from an independent model. While there are some benefits, the loss of autonomy can be a challenging and difficult adjustment…”

I spell it out to him. No sugar coating. No false promises. No unrealistic expectations.

He loves his patients. He loves his community. This is his life. He is willing to try and make it work. I’m nervous of his ability to adjust, but value his commitment to his patients and community. We agree to give it a try.

I make no excuses about the experience of being an employed physician or provider. It is very different from private practice. It’s not for everyone. But, as a leader in Big Med with a large constituency of providers in my department, I do value their employed experience. I want them to be happy. I want to set realistic expectations of what we can and cannot do. I want to be fair. I want them to have work-life balance. I want them to be paid fairly. I want to listen. I want them to want to take good care of our patients.

But, I recognize that we will continue to make difficult decisions as time goes on. Decisions that will affect some people negatively. Decisions that will push providers to change behaviors. We will no longer be able to build a care program around providers, rather we will need to build care programs around our patients and our systems. Physicians should not only have a voice in this process of change, but they should be intricately involved in creating the solutions.

Disclaimer: All medical leadership stories are fictionalized.

Eve Shvidler, MD is a physician and the author of “Burning the Short White Coat: A Story of Becoming a Woman Doctor.”

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Hypnobirthing and Yoga for a Natural Pregnancy Plus a Giveaway!

You may already know this but even before I became pregnant I was a huge fan of yoga for many reasons. It helps me relax, it reduces inflammation, helps me connect with my body and disconnect from distraction. It also had a profound effect on my acceptance of my body when I first began practicing in my early 20′s. joyous bump Once I became pregnant, I had to take a break from my favourite and more vigorous forms of fitness such as running and barre because my body just didn’t feel good doing them. That’s not to say that these forms of exercise aren’t good if you’re pregnant. I know many women who continue with their same exercise regime, I just personally had to scale back and listen to my body.

When I hired my doula from Toronto Yoga Mamas (who has been amazing by the way) I noticed they had a package with unlimited yoga so this was the option I choose and I’m so glad I did! I’ve been doing prenatal yoga four times per week. I absolutely love it. It’s my next favourite thing to do other than hanging with Walker and cooking! I’ve made it a priority and put it in my calendar every single week.

Hypnobirthing

Along with my regular yoga practice, Walker and I started taking a 5-week hypnobirthing course at Toronto Yoga Mamas. When I tell people about it they often think it must be some sort of weird hypnosis where Walker swings a pendulum in front of me to hypnotize me chanting some odd mantra, HA! While I wouldn’t be against this, it is not what hypnobirthing is about.

What it IS about … Hypnobirthing is about learning to breathe, positive visualization and meditation techniques. I’m not finished the class yet, but so far I’m learning so much and absolutely love it. Last week we talked about positive affirmations. This is something I have always been a fan of but I didn’t really think about it for my labour.

During my first trimester I had these power cards that I kept in my pocket all the time that reminded me to “trust my body” and know that “my sweet bean is growing so perfectly and joyously”. Hypnobrithing Affirmations-1 I will definitely be creating some positive and powerful affirmations for the labour and birth of our baby girl to help bring me to a positive space and help me connect with my body. I feel as though Western society creates so much fear and negativity around labour and birth, like it’s an illness that must be treated and medicated. This just doesn’t jive with me. So I’ve decided to look at it with a more optimistic perspective and follow the direction of my yoga goddesses, doula and hypnobirthing teacher. I’m under no illusions that labour will be a walk in the park but I’m quite certain that if I wasn’t taking steps to prepare my mind, body and spirit I’d be having a much different experience filled with anxiety and fear.

Now apparently we will be discussing massage techniques in an upcoming class and I’m certainly looking forward to Walker practicing on me!

For the duration of my pregnancy I’ve done things as naturally and drug-free as possible so I hope the same for my birthing journey of this sweet bambina. However, I am going into it with any open mind and I have no expectations. This is uncharted territory for me that I welcome with joyous open arms. I do feel more confident and prepared with a doula, midwife, weekly yoga and my hypnobirthing class.

Lastly, I’ve got some great news!!! I spoke with the lovely owner of Toronto Yoga Mamas and she wanted to do a giveaway on Joyous Health!! So here’s a chance for you to win a $100 gift certificate to use on whatever your heart desires at Toronto Yoga Mamas — hypnobirthing class, yoga … whatever you like :)

Two ways to enter! Enter below, or comment and share what is your favourite mama-memory? It could be about being a mom, your mama, becoming a mom etc. I can’t wait to hear what you have to say!

Toronto Yoga Mamas
http://ift.tt/1mFzCXA

Have a joyous day, Joy

Ps. As you may have noticed I’m reading the book in the photo above which I do recommend even if you don’t live in Toronto and can’t take the class. There are so many great tips and techniques in the book. However, I do strongly recommend you ignore the nutrition tips listed in this book as ice cream and frozen yogurt are NOT good sources of protein! haha!

Joy McCarthy

Joy McCarthy is the vibrant Holistic Nutritionist behind Joyous Health. Author of JOYOUS HEALTH: Eat & Live Well without Dieting, professional speaker, nutrition expert on Global’s Morning Show, Faculty Member at Institute of Holistic Nutrition and co-creator of Eat Well Feel Well. Read more…

The post Hypnobirthing and Yoga for a Natural Pregnancy Plus a Giveaway! appeared first on Joyous Health.

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The Tower of Babel and the Sea of Consumer Confusion

Joseph KvedarEarlier this summer, I was fortunate to be invited to speak at the recent AHIP (America’s Health Insurance Plans) conference in Nashville. This is an annual gathering of health insurers and it was my first time attending. My experience there, and a few recent news items, got me thinking about about how health care is evolving and whether we once again will ignore Santayana’s admonition, “Those who cannot learn from the past are doomed to repeat it.”

As we continue our journey to change provider reimbursement to a “Pay for Value” system, the lines between health insurers and health care providers are blurring. Physician/hospital systems, like Partners HealthCare, where I work, are taking on risk for populations of patients through contracts with the Federal government and local payers. According to Secretary of Health & Human Services, Sylvia Burwell, this trend is going to continue. She stated recently that HHS set a goal of tying 85% of all traditional Medicare payments to quality or value by 2016 and 90% by 2018. Since the whole insurance industry is based on risk, we inevitably have to start thinking more like insurers if we’re going to be taking on risk.

So I cleared my calendar and attended as many content sessions as I could at the AHIP conference, in hopes that I’d soak up knowledge on how these companies approach their craft.

Sadly, I didn’t learn much. Not because I didn’t listen and not because the speakers were less than talented. I walked away feeling like I hadn’t learned anything because I felt I had gone to a foreign land and was listening to talks in a foreign tongue. I simply couldn’t decipher the health plan lingo.

This worries me because it’s time for these two sectors of the industry to collaborate more. If we can’t understand one another though, it will indeed feel like the Tower of Babel.

At the highest level, it seems like we should be natural collaborators, as we bring very complimentary skills to the shared goal of building a health care system. As providers, we excel at understanding physiology, pathophysiology diagnosis and therapy. In most cases, we have strong relationships with the end users of the services offered, our patients, which often includes a high degree of trust. When someone’s doctor recommends a course of action, most people at least take it seriously and many often follow that path.

Payers, on the other hand, have always been challenged connecting with their members (you see, we are all a member, a consumer and a patient – all in different contexts – an example of the babbling). Payers excel at understanding risk and setting premium costs, something we as providers have no feel for. But if we’re going to take on risk, we’ll have to learn. Can these former negotiating foes come together to help improve your health? The current landscape does not lead to enthusiasm.

I’ll use some telehealth implementations as examples. Several national payers are adopting virtual visits as a tool for their members. For me, this is a dream come true! BUT, most payers are doing so in collaboration with one of the major vendors in the space and creating shadow physician networks to offer the service to their MEMBERS. When that member’s primary care doctor eventually sees them in the office, she will be puzzled that her PATIENT had an encounter via their health plan that she did not know about.

Walgreens just rolled out a virtual visit program as well. This could create even more confusion, as it brings in a new entrant — the pharmacy — into the battleground for that relationship. Will EMR interoperability solve this confusion? It certainly helps, but I’m also concerned about mixed messaging to the consumer/patient/member. It seems like we’re all fighting for your attention, which may lead to conflicting messages.

This reminds me of a time, about 25 years ago, when this new thing called disease management sprung up. Payers were frustrated by the cost of managing patients (members) with chronic illness. They got no help from providers, so they took matters into their own hands, hiring call centers staffed with nurses to contact patients/members with tips on how to manage their illness, and often sent generic brochures about high blood pressure and other conditions. Payers may have influenced the care of some patients/members, but no one was ever able to prove that this was an effective strategy.

There were numerous stories about patients receiving conflicting advice from these ‘disease managers’ compared to their own doctor’s advice, leaving patients confused. Doctors would get faxes from these same disease management companies and (perhaps arrogantly) throw them in the waste basket without reading them. As a result, the disease management industry collapsed in the middle to latter half of the last decade.

In the meantime, we now have workplace wellness programs, virtual visits offered by your health plan, retail clinics, virtual visits offered by pharmacies and — dare we forget — advice your doctor gives you, which should be more in tune with prevention now that providers are taking on risk.

See what I mean by a Tower of Babel? How do we fix it?

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Can We Tame The Wild West of Health Care Pricing?

Improving our system starts with driving payers and consumers to high value providers. But first, we must know who is charging what. Price transparency tools offer that important information, enabling people to actually comparison shop for their health care services.

In early July, CMS released a proposed rule aiming to address price variation by starting with joint replacements. According to CMS, there were more than 400,000 Medicare inpatient joint procedures, resulting in more than $7 billion in hospitalization costs in 2013. The average Medicare expenditure for surgery, hospitalization and recovery ranged from $16,500-$33,000 depending on geography, with widely varying rates of infection and implant failure post-surgery.

To address this variation, CMS outlined a new payment model that would make some hospitals accountable for the costs and quality of care from the time of surgery through 90 days after. Based on their performance on cost and quality metrics, participating hospitals would either earn a reward or be required to repay some of the Medicare costs.

This is a step in the right direction, but policies that target only one program, like Medicare, ignore trouble spots in other areas, including the employer and commercial markets.

CMS’ proposed rule on joint replacements, for example, does not address broader issues with price variation that impact our system as a whole. As indicated below in Figure 1, HealthSparq’s data shows that hip replacements are more costly in the commercial market than in Medicare, with costs ranging from $26,000 – $49,000 in 2013. California, Texas and parts of the Northeast are at the upper end of the cost spectrum, while parts of the Midwest and Mountain region are at the lower end.

Figure 1. Cost Variation for Hip Replacements in Commercial Market

USAmap

In addition to higher overall costs in the commercial market, data shows that hip and knee replacements are increasing exponentially among patients 45 to 64 years old, many of whom receive health insurance coverage from their employer or a commercial plan. When combined with higher costs, the increased service volume among this population suggests that the total costs associated with joint replacements in the commercial market may exceed costs in the Medicare market.

Given the challenges we’ve discussed, consumers are using price transparency data in the commercial market to fend for themselves. Working with over 70 health plans and reaching a total of 72 million beneficiaries, HealthSparq has unique insight into consumer shopping behaviors and the types of information consumers are using for health care decision-making.

Our data on joint replacements shows:

  • Consumers want to know how much their joint replacements will cost. Viewing of cost estimates related to hip/knee replacements are in the top five of more than a thousand different searches viewed by consumers on our cost estimator over the last year.
  • Consumers know that prices may vary across facilities. Approximately 54 percent of the hip/knee replacement cost estimates requested by consumers also included a request for facility-specific information.
  • Consumers are using price data to compare prices at different facilities. Approximately 38 percent of patients requesting a facility-specific estimate did so for more than one facility. This is evidence of shopping behavior.

To tame the Wild West and improve the health care system, payers and consumers must use all of the tools at their disposal, including health care shopping tools. Transparency helps consumers better navigate health care, while allowing plans, providers, and employers to identify and steer patients toward opportunities for savings when medically appropriate. It also helps consumers understand quality, timeline and more.

Let’s use health care shopping tools to put the days of pricing duels and shootouts behind us. Consumers deserve a better health care system.

Torben Nielsen is SVP of Product and Strategy, HealthSparq

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Are Physicians Really Dissatisfied With EHRs? Should We Be Concerned?

Microsoft Office was first introduced by Bill Gates at COMDEX, Las Vegas, in August, 1988.

Here we are almost exactly 27 years later, and if you plug the words ‘hate,’ ‘Microsoft’ and ‘Office’ into Google, you’ll get more than 4 million results. Remove ‘Office’ and Google returns more than 33 million results.

Clearly, some people don’t feel like Microsoft has perfected products to their satisfaction.

The perpetual unhappiness with a monolith like Office comes to mind as I read reports on the most recent surveys of physician satisfaction with electronic health records (EHRs). Let’s sum up, for those unfamiliar with the reports

First, reporting on survey data from last year, the American Medical Association (AMA) and American EHR, a division of the American College of Physicians (ACP), recently published “Physician Use of EHR Systems 2014.” Among other findings, the reports includes these nuggets:

  • 42 percent thought their EHR’s ability to improve efficiency was difficult or very difficult.
  • 72 percent thought their EHR’s ability to decrease workload was difficult or very difficult.
  • 54 percent found their EHR increased their total operating costs.
  • 43 percent said they had yet to overcome the productivity challenges related to their EHR.

Contrast those figures and levels of satisfaction with a survey of large physician practices released last week by market research firm Black Book that shows significant increases in physician EHR satisfaction. In particular, physician experience satisfaction has risen from 8 percent to 67 percent in the last three years. Physician documentation satisfaction went from 10 percent to 63 percent over the same time period, while practice productivity enhancement satisfaction has gone from 7 percent to 68 percent.

Worth nothing is that, with the AMA/ACP surveys, “Each society was allowed to select the population of their members to receive the survey. Information about EHR use by individual society members was not available. Therefore, the survey went to both users and non-users of EHRs.”

Also important: A similar ACP survey from five years ago showed significantly higher levels of satisfaction among the physicians surveyed.

The cognitive dissonance over EHRs continues, giving rise to theories on the Interwebs about the actual source of this disconnect.

At Healthcare IT News, contributing writer Jack McCarthy wonders if the constraints of Meaningful Use are antagonizing doctors, or if increased expectations and more sophisticated technology that fails to improve the daily challenge of patient care (in effect, a mashup of the two ideas) is creating dissatisfaction.

“Now, however, we have a lot more users who were forced to adopt EHRs meaning their tolerance for poor performance or usability will be lower,” notes health IT expert Shahid Shah in the article’s very interesting comments section. “I think it’s pretty easy to see why clinicians are less satisfied — if it was their choice they would be more tolerant. Since it’s not their choice in many cases, they’re less tolerant.”

Adds O’Reilly Media editor Andy Oram: “They [doctors] could be more familiar with the advantages computers offer in other areas of life … In short, having seen what a good interface can do, doctors become more demanding of the sub-par interfaces on EHRs.”

Expanding on the ‘why’ question, Michelle Ronan Noteboom (formerly ‘Inga’ of HIStalk fame) offers similar theories—MU forces doctors to use EHRs a certain way, compared to Facebook and Amazon most EHRs are clunkers, EHRs don’t deliver the ROI they promised—for the ACP survey results and asks if we should care whether or not physicians are happy.

“I’m of the opinion that physician satisfaction matters, but not nearly as much as improving the quality of patient care,” she writes at Healthcare IT News. “Patient care will be enhanced when all providers have access to thorough and accurate documentation. Ideally the patient records from one provider will integrate with records from other providers to create a single longitudinal record that is easy to decipher and provides a full picture of the patient’s health history.”

That sounds like a worthwhile goal. And Noteboom also has an explanation for the ACP survey results, pointing out “a direct correlation between physician satisfaction and the number of years a physician used his/her EHR. For example, among physicians on their system for three years or less, only 25 percent reported any level of satisfaction; satisfaction jumped to 50 percent among physicians that had used their EHR for five or more years.”

Sure, the differences between the two cited surveys could be attributed to methodology. But we know too much about how EHRs are influencing clinical culture to leave it at that. Physicians are human and subject to the same impulses—resentment when forced to do something; envy and confusion when seeing technology function well in other contexts; fear and consternation when learning something new—we probably faced when Microsoft started to become a rather sizeable part of our lives.

And, let’s recall, we’re really not that far into the ongoing transformation of American health care. Only now are we on the leading edge of value-based care as a replacement for fee for service. As EHRs evolve to improve quality, increase revenue, ensure patient safety, etc., instead of just meeting the contrived requirements of Meaningful Use, they will become the essential tools we envisioned at the beginning of this long and complex dance.

So it’s encouraging when both surveys show that physicians who’ve had their system for a while are happier with it. Indeed, while we continue to ask the specific question, “Are you happy with your EHR?”, maybe we don’t consider often enough the general frustration of digitizing processes that were once manual.

Also, it appears that plenty of hospital and health system administrators didn’t get the memo about creating buy-in before selecting and implementing an EHR. As David Whiles, former CIO at Midland Memorial Hospital said of their EHR journey, “Implementing an EHR is definitely an organizational project, not an IT project.”

And even though we are dealing with computers, this isn’t a binary choice of EHRs OR physician satisfaction. No one thinks computers are going anywhere, even if the Meaningful Use program ends. And physician satisfaction, to a reasonable extent, must be a high-level consideration for all clinical organizations. Over time, EHRs will improve and doctors will become more satisfied with them, perhaps will even depend on them, as essential clinical tools.

In the meantime, plug ‘hate’ and ‘EHRs’ into Google from time to time and see what you get. When we get over 30 million results, we’ll know we finally achieved Microsoft-ian levels of influence.

Irv Lichtenwald is president and CEO of Medsphere Systems Corporation, the solution provider for the OpenVista electronic health record.

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