I am not a physician and realize this raises another set of questions, but is it possible to differentiate the types of on-call services? I see the above comment about trauma system versus other types of call as one possibility, but I am anecdotally aware of “on call” not always meaning that a physician has to come in or otherwise engage (conversely, members of non-clinical service lines often take weekend “call” questions about operational and patient experience issues, but suggesting that they be paid any type of “call” premium or overtime would be a crazy concept).
The on-call payment model does not seem sustainable long-term, so perhaps there is an opportunity to experiment with other types of incentive-based compensation that reflects the time and effort commitments of the various providers? Good luck!
Fascinating data ownership and data governance questions in play here. CMS has been announcing (with latest pronouncements on interoperability, data “blocking” restrictions, etc.) a likely push for patient ownership of health records in the foreseeable future, which probably gives a degree of first-mover advantage to players like Cerner, Epic, Apple, Optum, but the role for health systems and other research institutions will need to be defined. I am intrigued by the various “data trust” models that have rolled out in a few U.S. and international jurisdictions, but those models require a degree of governmental ownership and regulation that may not be feasible in this instance.
If you figure it out, please let the rest of us know!
What in particular are you finding challenging about culture change for digital transformation? Is this referring to electronic health records or finding ways to adopt consumer-facing technology? Who are the holdouts, and why are they resisting if this change is inevitable?
Interesting questions. While I am not familiar with the various system cultural factors or overall structure, I took note of your comment about the hospital leadership being advised to add the academic/teaching services to build the “stable and regular supply of resident doctors” and ultimately lower costs. If those are the driving factors, it sounds like the need to expand beyond the wealthy client base to a broader spectrum of the population may be inevitable anyway? Are there structural mechanisms to have some type of VIP/concierge floor and limit the teaching hours for patients who may not be willing to choose those services?
It sounds like either way, leadership may need some consulting assistance on branding and strategic communications, in addition to whatever financial advice your team is receiving. It may be that the wealthy patients are more receptive to allowing (highly supervised) residents and trainees to participate in their care if they hear the big picture message upfront (“we are a teaching hospital so we make sure we have doctors when our kids and grandkids grow up”–or whatever is culturally and contextually appropriate in the situation).
Is there a generational shift possibility in the future as well–are younger “wealthy elite” patients perhaps more willing to allow for residents and others? I realize there are a host of regulatory, legal and business planning barriers that would have to be overcome in any of the design elements, but maybe something to keep in mind as you proceed. Good luck!
The volume measured on a per-hospital basis seems like a crazy system, and certainly a challenge for you and your colleagues in Maryland. Does CMS have to approve any major changes to the HSCRC readjustment mechanisms under the State’s current agreement? I am not familiar with the logistics of the Maryland system, but based on a quick read of the “final term sheet” of the current model on the HSCRC website (link below-but again I’m not sure how applicable this is to these facts), there appears to be at least some (admittedly arbitrary) criteria for going back to the State and CMS about changes in circumstances. The below language in particular is interesting, as it is very broad but also seems to be anticipating some fairly concrete contingent future events (e.g. new hospital construction–assume one in particular is in the pipeline)? Are there opportunities for regular education/outreach/dialogue with health system leaders/State HSCRC officials and CMS?
Sorry that’s not more helpful, but good luck! Very interesting issues.
From the “final terms” document p. 17: https://hscrc.maryland.gov/Documents/Modernization/7-30-18%20Announced%20Terms_FINAL.pdf
Exogenous Factors, Prince George’s County, ACA impact
Maryland and CMS recognize the potential for exogenous factors to affect cost growth and other
performance metrics, both for the all-payer and Medicare trends, in unpredictable ways. For example,
Maryland could experience a localized disease outbreak that does not occur in other parts of the nation.
Additionally, the Agreement will specifically identify four future events that could impact the projected
(1) Changes in health insurance coverage and funding, which are currently available
under the Affordable Care Act,
(2) Construction of a new hospital facility in Prince George’s County,
(3) Rapid adoption speed of a new technology, and
(4) Investments in care redesign at an accelerated pace.