Care management

Why are Physicians of the U.S. Struggling to Close Care Gaps?

Abhinav Shashank
Tue 31 July 2018

“The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen.” -Atul Gawande, renowned physician, writer, and public health researcher.

The cost? $40,000 per year- just to close the quality gaps.

That’s right. Provider organizations spend $40,000 per physician per year on reporting on quality measures, according to a report. Considering the number of physicians a little over 950,000, the total amount healthcare spends on reporting on quality measures alone is approximately $38 billion- and this is only going to rise with the increase in risk-based contracts.

But that’s not exactly the right area of focus. Reporting on quality measures is the second part. The providers are not well equipped to meet the primary driver of quality- closing the gaps in care.

The biggest challenge is that physicians are hardly aware of what they need to look into or have the right tools they need to address these gaps in care. This ultimately cost organizations millions of dollars every year- this is money they just leave on the table.

Shifting the focus to the ‘real’ challenge

The challenge isn’t that data is not available in real time to report on the measures. The challenge isn’t even the lack of visibility into the care gaps that impact the metrics. The challenge that we need to solve proactively is engaging physicians.

As a patient’s direct point of interaction with healthcare, it’s physicians who have to be empowered enough to drive the right cost- and quality-related decisions. While organizations spend the lion’s share of their budget on compiling and reporting accurate care pattern data, they often overlook the ones on the frontlines.

Why are physicians not engaged and active in closing care gaps?

The longer I have worked with provider organizations, the longer I have realized that the biggest disconnected doesn’t exist between the practices. The biggest disconnect exists between the network and the physician. Provider organizations are going leaps and bounds to integrate their clinical and claims data together, analyze their performance, and pick the right quality measures that best reflect their performance- which is a very significant first step.

It’s the physicians of the network who have limited visibility into what care gaps have to be closed, how far along are they in chasing the measures, and what does the network’s performance picture look like. Here are some stats that shed some light on physicians’ distress:

  1. Physicians and staff spend no less than 15 hours a week, closing care gaps and satisfying quality measures.
  2. 74% physicians at a survey reported that collecting and reporting the information for these quality measures is a tedious task.
  3. 83% of them felt that the measures don’t accurately capture the quality of care for their practice.

What challenges to physicians face?

Here are some challenges physicians usually face while looking to address care gaps:

  • Identifying the gaps specific to a patient: for every hour physicians spend with their patients, they spend two hours on their paperwork, looking deep into the clinical records and trying to find the gaps for the patients.
  • Learning about the patient’s clinical history: since patients receive care across multiple practices, physicians spend too much time extracting clinical information data sources that might reveal anything about the patient.
  • Lack of information at the point of care: Most of the information that providers need to find details about the patient are distributed across the network, and physicians are tasked with putting them together when the patient is sitting across from them.
  • Not being able to communicate with the patient: This is the biggest challenge of them all. Physicians are nose-deep into the amount of data available, and there’s hardly any time to interact with the patient and understand their needs. 
  • Relaying updated information back in time: The fragmented and siloed nature of healthcare makes it almost impossible to have an interoperable communication and exchange patient information and insights into gaps in real time. 

What healthcare organizations can do to empower physicians?

The best way to close care gaps is face-to-face interaction, outranking any app or portal or surveys. Having said that, healthcare organizations need to decrease the amount of time physicians spend on computers, delivering them useful, actionable information at their fingertips.

    • How many care gaps need to be addressed? Physicians should not be chasing charts or hopping from one platform to other to find what gaps in care for a patient are. The gaps should be clearly accessible to the physicians, right from the start of their day where they put together their upcoming appointments of the day. The number of care gaps for each patient should be made available to physicians as a list, so they can gear up beforehand.
    • What gaps need to be addressed? The gaps in patient care or the thresholds that would negatively impact the quality of care should also be accessible to the provider, without the need to delve deep into clinical records. The information about high risk or increasing blood sugar level- should be visible at the point of care.  
    • What screenings are due for the patient? Without having to extract clinical information and analyzing them for gaps that have to be addressed, physicians should be aware of due screenings for the patient. No later than a physician looks a patient up, they are aware of their entire clinical information- right on their EHR.
    • Could there be some codes that were dropped? Physicians should also be aware of the codes that were entered along with the diagnoses, and make sure that they reflect the diagnoses correctly. Coding gaps also impact the overall outcomes significantly, and the physician should be aware of them to address any issues.
    • Which providers are associated with the patient? Patients receive care across different settings, and their physicians should be able to access the details of the entire care team to make sure the next steps for the patient are planned and their care experience is seamless.
    • Is there any opportunity to educate the patient? Physicians should also be aware of every detail that impacts the patient- even their frequent visits to the ED or no-shows. Physicians could suggest additional screenings or measures to enhance patient care and encourage them for preventive screenings.
    • Workflows with minimal impact on physicians: This is extremely important. Physicians should be struggling less with technology- they should be able to mark the gaps ‘close’ right at the point of care and the network’s clinical information would be automatically updated.

    Finally, it’s crucial to give physicians an insight into their own performance. The physicians should be able to evaluate their performance, view the number of care gaps they had closed, the efficiency they delivered, and make progress based on those results.

    At the heart of healthcare improvement

    It’s not about crossing items off a list or checking boxes. Capturing and addressing care gaps is a lifelong, continuous improvement. And since physicians are at the heart of healthcare improvement, they have to be engaged. It’s hard to drive change in healthcare if physicians are not onboard. To close the care gaps of the network efficiently and drive transformation, organizations need to understand the physicians’ desire to do the best they can for their patients-  and give them the skills to accomplish that.


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