**I = Interviewer
**R = Robert Hickey
Welcome to the D&Y Innovators exchange. A podcast series focusing on medical staff development leaders whose dedication, work ethic, and unique industry approaches have enhanced and inspired their medical staffs to provide the highest levels of clinical service and quality patient outcomes to the communities they serve
With us today is Robert Hickey, a tenured position recruitment leader with a Kaiser Permanente Mid-Atlantic division to discuss cost reduction and containment.
I: Every health system is still tasked with cost reduction, and cost containment at least. We’re all being tasked and asked to do more with less. Are there, Bob, any trends you’re seeing within your organization again, from the standpoint of cost containment and reduction measures impacting your ability to go to market and successfully recruit the providers your patients need?
R: Actually the way we’re set up saves a ton of money and it makes a lot of sense. Because like a said without the duplication of tests, cause everyone is on EMR – we order about half the number of MRCT’s that the fee for service world does
I: You’re kidding…
R: No. and the reason being is that once it’s done it doesn’t have to be redone
R: So they go to the PCP and get their cat scan – they send it to the orthopedist, and he already has the information, they don’t have to redo it
If that is not the right physician to go to, he refers him to someone else. That carries along cause it’s all tied into that system, the bloodwork, all that done one time. So it’s non-invasive but it makes a big difference
The other thing, too, we are a captive audience where our members pay a certain amount of money for the best possible healthcare they can get. In the fee-for-service world, the sicker you are the more money you make.
So, the goals of the fee for service aren’t aligned with our members. Our goals are aligned with our members. We’re big on preventative care. We’re #1 in the nation for screening mamo.
I don’t know where else you can get this. If you get screening mammo done in the morning, they find a problem, they can do a biopsy that afternoon. Two days later, they can tell you what it is.
Why can we do that?
Because our radiologist got with our pathologist group and says this is an initiative we’d like to do, and they said let’s make it happen.
Again, a very cooperative relationship. The other thing is, all of our physicians because it’s not RVU driven – are financially incentivized to teach people what they know. And the reason being our cardiologist makes the same salary whether they get the phone call or don’t.
They don’t have to do a full-blown consultation. They can do a chart review which can be done same day. So, your Primary Care Physician takes good notes, they have the EKG and all that, they have the cardiologist take a look at it, and determine if you’re on the right path or something needs modified.
Think of how much better that is for the member because a lot of people as they get older have mobility issues and have transportation issues and things like that.
I: So then that access becomes an issue.
R: Exactly. So it’s cheaper, more efficient, and more time-sensitive. So it works out.
With Dermatology we can snap off a picture and send it to a Dermatologist, and within 15 mins they can tell you what the rash is and what prescription to get
R: So the number of people that actually have to go to the dermatologist is way down. Those that need to be seen due to a history of melanoma or whatever the case may be, access is there because we’re not tying up the dermatologist.
The other thing is we don’t do bogus visits. If you have strep throat and it’s bacterial – if I prescribe an antibiotic I almost guarantee you’re gonna clear up in 5 days. In the fee-for-service world, they have you come back.
I: Oh, of course!
R: Why? Because it’s a moneymaker.
I: It’s business
R: They can’t bill you if they don’t.
Med reconciliations – why can’t that be done by email? You can email your doctor, you can skype with your doctor here, so it’s much more efficient for the patient, more timely. With the skyping, we’ve found that manipulation of your arm and things like that – does the doctor really have to use a stethoscope on you?
R: So our physicians get to know their patients significantly better. They are capped as far as the panel of patients they get to see. They get to know their patients much better. And we Metrix everything, so we know very well where they are.
Our specialists are incentivized to teach our Primary Care and HBM physicians everything they know. So it sounds like a marketing thing and it’s really not. If somebody comes to work for us for 5 years as a HBM or PCP I will put them up against anyone in the community and they will smoke them.
The reason being is their medical knowledge skyrockets after they get here.
I: Yeah. Bob, this question is a little bit off-topic, but i think that our conversation is just so interesting. So, with the direct contact that the patient can have of their own volition, whether it’s skype, email, etc… there would have to be certain firewalls and protections in place from a HIPPA standpoint, PHI information standpoint, how would those issues be addressed?
R: All of our emails are secure email, and it’s sent in EMR – the telephone calls are initiated by our members, so they can call in and ask questions as far as that.
I: So essentially that consent is the individual proactively reaching out?
R: Yes. And then we have a call center, so they can call the call center, and based on certain protocols they can direct them to be scheduled with PCP or this is an urgent matter do you need to go to urgent care? Or is this serious enough you have to go to the ER?
So the triaging is very good. That is available 24 hours a day, through our call center.
We have what we call clinical decision units. They are free-standing and look like an ER and act like an ER – staffed with a Family Medicine physician that does urgent care, an emergency medicine physician and a hospitalist that works as an observationalist.
So if a person goes in with chest pain, they roll out an MI they can keep him for 23 hours and 59 minutes. It’s cleaner, safer, and nicer than a hospital. It doesn’t bog down our hospitalist, with seeing a patient for 24 hours when basically they’re all being managed in that clinical decision unit. It really works out to be super-efficient.
And it’s a huge cost saver.
I: Oh yeah that’s incredible.
R: Well the other thing too is that elderly people freak out when they go to the hospital. They are afraid they’re going to die. It’s cleaner, safer, nicer than an ER. So, there are all Kaiser members there.
This has saved us a ton of money, been a huge member satisfier. And the fact that they can get in there very quickly, it’s not a long wait like a lot of ER’s.
I: How many of those free-standing facilities do you guys have?
R: We currently have 5, we’re going to be adding 2 more as far as for the clinical decision units, as far as for urgent care – roughly 12, but that number is expanding too.
A lot of that is after hours care from 5 – 1 AM – and there again if you need to have a plain film, if you need lab work, things like that that can be done at those centers. We’re trying to bring it closer to our patients.
I: It all goes back to access then?
R: Yes, and which is really interesting is when the affiliation took place with Northern CA, this is what we’re going to do this year, next year, and after. And he said, “do you have any questions?” I raised my hand and said, “what are we gonna do the year after that?”
Dr. Pearl said I don’t know. And I kind of looked at him dumbfounded and he said it depends on where our members take us and where our needs are.
And we’re constantly assessing where our members are taking us and where our needs are.
Fredericksburg for example is one of our smallest centers, also one of our fastest-growing centers – we saw the need that this is where our members are coming from – let’s build a center there.
I: Yeah, pull that area in, right?
R: Yes. And Woodbridge VA and now up in the toust area we’re gonna move into Timonium – we’re gonna build other clinical decisions units. Which are huge hubs. We call them a hub that have a clinical decision unit and many specialists there. So, again it’s access. The ability to get to the physician.
Many of our patients, if they don’t work, they don’t get paid. They have to take time off with no pain. How cool is it when you can email your doctor or call your doctor or skype your doctor literally from your office or your home so you don’t have to go in?
I: Yeah. Are you guys, and again we’re sort of, getting a little off topic but I just find it fascinating, are you guys into the realm of having an app where your patients can go in and essentially book an appointment, change the time of appointment, cancel an appointment if need be.
R: We already have it.
The other thing too is the lab results. You can get that through a secure email where you can see your lab results. It’s very exciting how when you take a look at the dynamics in medicine are changing and a lot of our physicians were getting a ton of emails.
They don’t really need to get an email “I want to change my appointment from today to tomorrow…”
Those are getting picked off by the nurses and now…
I: Right – it’s not really clinical, more a logistics request
R: Right – how late is the lab open? Things like that.
So they’re able to do that. But again, this is able to cut down on the number of visits and things like that, which are very big for patients.
You’ve been listening to the D&Y innovators exchange featuring physician recruitment leader Robert Hickey with the Kaiser Permanente Mid-Atlantic division
Join us next time when we discuss the anticipated physician shortage with Mr. Hickey.