This article is sponsored by Medrina. In this interview, Skilled Nursing News sits down with Dr. Azlan Tariq, Chief Clinical Innovation Officer, Medrina, to talk about redefining the value of physician partners in the current SNF landscape. He discusses the key challenges physicians encounter when working in the post-acute setting, and how Medrina is addressing these challenges. He also shares an outlook on the future role of physician partnerships in skilled nursing facilities.
Skilled Nursing News: How has the perception of physician involvement in post-acute care evolved in recent years, and what factors do you think have contributed to this shift?
Dr. Azlan Tariq: I’ve observed a significant shift in the profile of doctors working in this environment, particularly in their frequency and manner of patient interaction—a direct consequence of the transition to value-based care. Traditionally, the medical director would receive a notification on the 29th day regarding a patient requiring attention the next day due to the 30-day limit.
In the past, it was rare to find a medical director present at the facility. However, there’s now a noticeable trend where the acuity of patients is increasing. Under value-based care, providers are no longer able to simply meet with patients once a month. There has been a marked decrease in length of stay, with robust metrics indicating that earlier patient intervention leads to improved outcomes. This approach not only reduces length of stay but also minimizes rehospitalizations concurrently.
Furthermore, there is a greater integration of Electronic Health Record (EHR) systems. In my facilities, we used to exclusively rely on paper charts, thereby adding to the documentation workload. Doctors are grappling to keep pace, resulting in the fragmentation of medical practice. Effective communication among hospices, Skilled Nursing Facilities (SNFs), and outpatient facilities is lacking, leading to oversight. Errors in these contexts are exceedingly costly, as they yield unfavorable outcomes and care.
What are some examples of successful collaborations between physicians and skilled nursing facilities?
Medrina firmly advocates for a physician partnership model. Traditionally Nurse Practitioners go through approximately 1,600 hours of patient care training. To put this into perspective, I personally received around 16,000 hours of training, highlighting the significance of having a board-certified physician on-site.
The crux of the issue leading to some physicians not thriving in the Skilled nursing environment lies in the lack of understanding of how to navigate in this space. Often, they fail to grasp the importance of Interdisciplinary Team (IDT) or multidisciplinary meetings. At Medrina, we mandate physician attendance at these gatherings, as they serve as pivotal hubs for collaboration. While, like any other profession, there exist varying skill levels among physicians, our focus remains on training and familiarizing them with Electronic Medical Records (EMR). Transitioning from the residency model to this distinct setting requires adaptation; it’s not merely a matter of ordering tests or treatments at will. Resources are limited, including the knowledge base of nurses and the scope of therapy services.
Providers must adeptly maneuver within these constraints to optimize efficiency and efficacy. Technology plays a significant role in our operations, and we are fortunate to possess ample resources in this regard. We leverage Artificial Intelligence (AI) extensively for patient and Prospective Payment System (PDPM) analysis. Our software streamlines the review process, reducing the time required for Minimum Data Set (MDS) evaluation from an hour to a mere two minutes by scanning PDFs rapidly. While technology undoubtedly aids in our endeavors, its impact is maximized through collaboration.
What challenges do physicians encounter when working in the post-acute setting, and how is Medrina addressing these challenges?
One of my enduring objectives is to alleviate burnout among physicians. Recent data, released just last week, indicates that 90% of physicians experience burnout, with approximately 60% expressing a desire to leave the medical profession altogether. Our physicians are extending their work hours and dedicating substantial time to documentation tasks. On average, a physician devotes around 60 hours per week to patient care and an additional 15 hours to administrative duties.
Our primary focus lies in equipping physicians with the necessary resources to thrive. We aim to streamline their workflow, allowing them to concentrate on clinical care while we handle backend operations. Integration of our Electronic Medical Record (EMR) system with platforms like PCC and Matrix facilitates seamless note-taking, enabling doctors to allocate more time to their passion for patient care.
Furthermore, we provide positive reinforcement and constructive feedback to our physicians. While our efforts do contribute to tangible improvements such as reduced falls, pain management, and enhanced functionality, we also ensure that physicians understand the impact they are making. In all our partnerships, we emphasize the importance of disseminating relevant research and information to empower physicians to excel in their roles.
How does Medrina leverage data and technology to support physician-led initiatives?
One advantage of EMRs is their ability to generate vast amounts of data. However, a significant challenge arises from the lack of integration among many of these systems. To address this obstacle, we’ve developed remarkable software that seamlessly plugs into EMRs across the continuum of care, assisting providers in overcoming this hurdle.
When confronted with an abundance of data, we specialize in distilling it into actionable insights. Through the utilization of analytics and Artificial Intelligence (AI), we aid providers in predicting potential risks such as readmission. It’s crucial to recognize that raw data, on its own, lacks utility. Managing this influx of data poses a frequent challenge for facilities, which is precisely where our solution comes into play.
With the increasing emphasis on value-based care and patient-centered models, how do you ensure alignment between clinical objectives and business priorities?
Value-based care represents the future of health care, yet it’s already in motion. This transition poses a significant challenge for most practices accustomed to the traditional fee-for-service model. Shifting the focus from quantity to quality of care necessitates robust data support, a component often lacking in prior methodologies.
Despite experimenting with various programs, protocols, and educational initiatives, we’ve come to realize that the most impactful strategy lies in care coordination. The crux of many issues lies in the realm of care transitions—ensuring smooth transitions between care settings is paramount.
Effective care transitions require collaborative efforts, particularly in partnership with Skilled Nursing Facilities (SNFs). By educating SNF staff on the program’s intricacies and the underlying data, they become empowered to demonstrate their contribution to the value-based organization’s objectives.
At its core, value-based care seeks to deliver optimal patient care while minimizing costs and resource utilization. Achieving this balance demands a concerted effort in care coordination and leveraging data effectively.
Looking ahead, what do you envision as the future role of physician partners in skilled nursing facilities?
Presently, there’s a noticeable shift in both the frequency of patient visits and the nature of care provided, yet the patient population remains equally medically complex. In this evolving landscape, the role of physicians will become increasingly pivotal.
Skilled Nursing Facilities (SNFs) are now managing patients with more complex conditions, including in-house dialysis and intricate pulmonary cases. However, sustaining quality care for such patients necessitates collaborative partnerships. Our model addresses this challenge by fostering collaboration, with approximately three physicians supporting each nurse practitioner.
A key aspect of our strategy involves establishing a command center capable of facilitating over three million patient encounters annually. This centralized approach streamlines care delivery and enhances coordination among health care professionals.
Transitional care emerges as another critical area of focus. Collaboration is often hindered by fragmented care settings, highlighting the necessity for a unified approach. While many hospitals recognize this need, effective transitional care requires the oversight of a nurse leader who can oversee patient care across the entire continuum. This comprehensive approach is essential for driving substantial improvements in patient outcomes.
Editor’s Note: This interview has been edited for length and clarity.
Medrina is the nation’s largest physiatry group. We are a doctor-owned and operated organization committed to improving patient outcomes by adding significant rehabilitative knowledge and value to skilled nursing facilities, rehab hospitals, and unified physiatry and clinician teams. To learn more, visit https://medrina.com/.
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