Carilion doctors explore the business side of medicine
The Hispanic OB clinic is an example of how Carilion is bringing physicians into business decisions to improve care and the system's financial bottom line.
By Sarah Bruyn Jones | The Roanoke Times
With the help of interpreter Lucia Driscoll (right), Murchison talks to Idalia Reyna-Reyna about Reyna-Reyna's pregnancy.
As Idalia Reyna-Reyna sat on the exam table, Dr. Amanda Murchison drew a picture of a womb to help describe what the ultrasound had shown.
At 19 weeks pregnant with her second child, Reyna-Reyna watched, glancing away from the doctor every few seconds to listen to Lucia Driscoll interpret Murchison's words.
While Murchison can say a few common phrases in Spanish, Driscoll is on hand to make sure the Spanish-speaking patients at Carilion Clinic's obstetric clinic really understand.
For Reyna-Reyna, 26, this meant understanding that the placenta was lying low in her uterus.
"It's OK right now, but later, if this is covering the cervix, the baby can't come out through the vagina," Murchison said in English, pausing for Driscoll to interpret.
"Most of the time as the uterus grows, the placenta will move up," Murchison continued. "We'll repeat an ultrasound in maybe five weeks and hopefully the placenta will be fine. If not, we'll talk about what we need to do down the road."
The rest of the exam went smoothly, and when Murchison asked if Reyna-Reyna had any other questions, the answer was no.
While having an interpreter available to help communicate with Spanish-speaking patients has been a practice for a while, Murchison recently took the lead in implementing some changes to improve the service.
About two months ago, her efforts paid off, when the first Tuesday morning Hispanic OB clinic kicked off.
Previously Spanish-speaking patients came to the clinic throughout the week -- and they are still welcome to come anytime -- and any interpretation was done over the phone. But by setting aside a morning to serve the Spanish-speaking population, Murchison was able to get three interpreters assigned to help meet the needs of every patient.
The story of the Hispanic OB clinic is just one of the changes that Carilion management says it's embracing as it seeks to bring physicians into business decisions. By turning to practicing physicians such as Murchison, Carilion officials said they believe they can improve care and improve the system's financial bottom line.
Murchison's idea for reshaping the clinic to better communicate with Spanish speakers came about as part of an internal 12-week development course to teach physicians business leadership. In all, 22 physicians participated in the course, each developing a project to restructure some aspect of their departments. Some of the projects, like Murchison's, focused on business plans for changing patient care, while others focused on ways to save money by cutting wasteful spending that may not be directly associated with patient care.
With management often describing the transformation of Carilion from a traditional hospital system to a "physician-led" clinic, the course was the first step in creating those physician leaders, said Dr. Mark Greenawald, who is the medical director in Carilion's office of professional development.
"We can't say magically that we are physician-led and all of a sudden doctors are leading," Greenawald said. "We have to give them the tools to lead and teach them the necessary skills in a deliberate way."
Greenawald was one of two people to develop and lead the course. The other was Mary Elizabeth Vogel, who was killed in an apparent murder-suicide in January.
Besides forming business plans to improve operations at Carilion, the group was also asked to help facilitate conversations with other physicians during the transition to the clinic. During the final class, Dr. Mark Werner, Carilion's chief medical officer, talked openly with the group about the tensions and concerns surrounding the transition.
"We have an incredible challenge," he said.
Teaching physicians leadership skills is a key component to the transition, Werner said, not only in fiscal management, but also in communicating the Carilion vision to other staff.
For Murchison the course forced her to step out of her comfort zone focused on treating patients and put together a business plan. She equated the course to a mini-MBA program.
"The slippery slope of that is we're trained to be health care providers, and not necessarily trained to be business people," she said.
Instead of simply proving that her Hispanic OB clinic idea was the right thing for patients, Murchison had to develop the business plan to support the concept. And once she started looking at the costs, she quickly realized that her dream of having six certified medical interpreters wasn't going to pass the financial viability test. She settled for three interpreters.
Dr. Tony Stavola, who was also a course participant, said it is imperative that physicians learn not only to make decisions based on what is in best interest of patients but also be aware of the financial consequences of those decisions.
"The most expensive item in medicine is the doctor's pen," Stavola said. "We [physicians] have to understand the health care system is not meeting the needs of the patients, it is not providing adequate chronic disease management. We have an obligation to get out in front of this discussion and try and take a lead in it, because otherwise we will be in the position of answering to someone else's lead."
That's a point that Greenawald emphasized during the class.
"When physicians realize there is financial accountability and there is an economic consequence and that patient quality of care still matters, then they start to understand what the numbers mean," Greenawald said.
Like Murchison, Stavola also developed a plan to address a patient care issue.
A physician in the Carilion Medical Group primary care division, Stavola wanted to make sure asthma patients were getting proper follow-up and preventative care. He teamed up with another Carilion Clinic Family Medicine physician, Dr. Michael Jeremiah, to tackle the issue.
Using Carilion's new electronic medical record system, Stavola and Jeremiah set out to develop a disease registry for asthma patients.
Using the electronic medical record, Stavola said he can give patients more educational material during the visit by simply hitting print. Additionally, Stavola said the registry will help monitor other things such as medication compliance, emergency room visits and whether the patient got a flu shot.
Stavola projects the registry will reduce costs by 10 percent. He's only tracking Carilion employees because he was able to make an arrangement with the insurance provider to access the necessary information.
"If we can reduce costs by 10 percent, then conservatively we would probably generate $100,000 in savings," he said. "Even in a fairly small group of patients, I'm talking about 800 to 1,000 patients, that's significant."
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