3 strategies for building physician professionalism

Medicine is a profession, not a trade. It is based on a covenant of trust between physicians and the patients they serve.

In an era of transformation in healthcare, physician professionalism demands that practices and medical groups develop a framework that ensures physicians’ commitment to patients’ welfare and community health is at the center of every decision, action, and investment.

In the landmark book Measuring Medical Professionalism, editor David Thomas Stern defined the core qualities of medical professionalism as:

• Excellence, or a dedication to high-quality care and continual improvement.

• Humanism, or a devotion to human welfare.

• Accountability, or the responsibility of physicians to hold themselves to high standards of care and to put patients first in all they do.

• Altruism, or unselfish devotion to the welfare of others.

However, digital innovation and a demand for 24/7 access to data are blurring the lines between where and how physicians provide care. Practices and medical groups, therefore, need more than these four values to guide their work. They require a model for governance and operations that enables physicians to respond quickly to changes in the market, test new ideas, and apply innovations more broadly to meet patients’ needs.

With the right infrastructure, physicians can draw from the core principles of physician professionalism to offer personalized, responsive care. Here are three strategies physician practices can incorporate to build a framework for physician professionalism that drives greater value for both providers and patients.

Invest in real-time data sharing capabilities with providers.

Accessing data from multiple providers at the point of care through a community health information exchange (HIE) provides a critical line of sight into patients’ care needs and concerns. When an electronic health record (EHR) is combined with a rich community HIE, physicians can more easily identify patients who are at high risk of developing chronic conditions or who show signs of complex health issues that are not being properly managed. They are also better positioned to support continuity of care, reduce redundant workflows, and ensure appropriate allocation of resources when they gain access to a complete narrative of patients’ health history.

In addition, support of a community HIE reflects the four core values of excellence (supporting high-quality care), humanism and altruism (sharing data with competitors for the good of the patient), and accountability (putting the patient first in every aspect).

Holston Medical Group (HMG), a regional medical group serving northeast Tennessee and southwest Virginia, began participating in the area’s only fully functioning, bidirectional, common medical record system in 2012. The group cares for 200,000 patients, many of whom are economically disadvantaged and have substantial healthcare issues.

For HMG, access to the community HIE provides a more comprehensive picture of each patient’s health history and challenges at the point of care, thereby strengthening performance under value-based contracts. Since joining the community HIE, HMG:

• Increased pay-for-value payments by 44 percent, with more than $13 million in value-based revenue annually.

• Increased fee-for-service payments by 7 percent.

• Significantly reduced readmissions, down nearly 7.5 percent through participation in an accountable care organization (ACO) and decreases between 6.8 and 12.3 percent under contracts with payers.

• Reduced the employee-to-provider ratio by 0.7 full-time employees.

• Reduced emergency department (ED) visits, with an ED utilization rate that is 25 percent better than other providers in the market.

Build automatic alerts into the EHR to improve one-on-one patient interactions.

This is an important step toward fulfilling the core value of excellence. Building automatic prompts can alert front-desk staff to patients who are covered by value contracts. With this information at hand, front-desk staff can better ensure these patients are seen right away when they call for assistance and limit the number of patients who seek care in the ED.

Meanwhile, instant decision support for physicians and nurses provides frontline access to information that could be important to determining next steps in care. With automatic alerts, data from a patient’s recent trip to the ED is available in just a few clicks-even when the patient forgets to share that such a visit took place. The clinical data received and the one-on-one conversations that occur afterward may lead to adjustments in the patient’s chronic care plan.

Provide room for frontline innovation. Providing opportunities for physicians to share and act upon the creative ideas without worry of approval reflects the core values of humanism, excellence, and accountability. Typically, this approach is easier to implement in a physician-owned practice; however, collaboration among practice leaders and a hospital or health system’s performance excellence committee could also support development of the appropriate innovation structure for your practice.

Something to consider is the establishment of an innovation committee that meets monthly to present ideas that challenge legacy approaches to care, such as:

• Nontraditional partnerships that position providers to test the application of precision medicine in clinical settings.

• Care delivery innovations that help patients with complex care needs avoid a trip to the ED, such as after-hours care for patients with specific conditions.

• The use of nurse-facing technologies to continually monitor vital healthcare data from patients with complex needs.

When physicians have the freedome to innovate, they can thrive as they build upon their passion for medicine and display high levels of professionalism while elevating patient care.

A core model for value

The decisions physicians make have important implications for downstream medical care, such as through specialty referrals, imaging and laboratory testing sites, urgent care facilities, and end-of-life support. Developing a framework for physician professionalism that is supported by access to comprehensive data-including data that stem from physician-led innovation-ensures the core values of professionalism are reflected in every decision made at the point of care and beyond.

It’s an approach that strengthens the value of care while supporting the long-term sustainability of vital health resources for the communities served.

Scott Fowler, MD, FACOG, is president and CEO of Holston Medical Group.