Taking a Stand Against Clinician Burnout

Envision Healthcare, March 14, 2023

Clinician burnout isn’t a novel issue. However, it is one that recent events, including the nation’s COVID response, have thrust into the spotlight.

Last year, the federal government passed the Dr. Lorna Breen Health Care Provider Protection Act, which establishes grants to hospitals and other healthcare entities for programs to improve mental and behavioral health among healthcare providers. That legislation was passed thanks in large part to the work of the Foundation that also bears the late Dr. Lorna Breen’s name.

Envision Healthcare and the Dr. Lorna Breen Heroes’ Foundation have partnered to continue and expand upon that work. HealthLeaders sat down with Stefanie Simmons. MD, FACEP, who serves as Vice President of Patient and Clinician Engagement for Envision Healthcare and as Chief Medical Officer for the Dr. Lorna Breen Heroes’ Foundation, to discuss the state of the national burnout crisis and the benefits of the partnership between Envision and the Foundation.

What makes Envision a good partner for the Foundation?

The Foundation’s mission is to reduce burnout of healthcare professionals and reduce clinician suicide. They also have a record of effecting real change. Envision is a national medical group composed of and led by clinicians, so it knows what’s at stake when it comes to burnout, and it has the resources to effect change on a national scale. Those resources and a willingness to leverage them make Envision an excellent partner.

From Envision’s perspective, partnering with the Foundation is a natural step in fulfilling the group’s commitment to ensuring clinicians have every resource and opportunity to thrive.

What is the goal of this partnership between Envision and the Foundation?

We’re partnering to save clinician and patient lives, to put it plainly. This is the second year during which Envision is offering financial support to the Foundation via the Envision Charitable Fund, and this new partnership is an evolution of that support. The partnership itself is unique among non-profits and national medical groups, and we expect that our combined resources and expertise will help to better effect change.

It’s a great opportunity for both organizations to make a larger impact via the Foundation’s advocacy to improve working conditions locally and to increase our support for clinician well-being at the state and national levels.

Why is burnout so prevalent among clinicians, and what makes it such a serious issue?

Just a few weeks ago, Medscape published their 2023 Physician Burnout & Depression Report, in which 53 percent of the physicians surveyed indicated they are burned out and 23 percent indicated that they were depressed.

Healthcare workers experience burnout at higher rates than the general population. We’ve all experienced the self-propagating effects of the physician shortage, in that practitioners burn out because their hospital is understaffed, then they quit because they’re burned out and now the shortage is even worse. But the system doesn’t have to operate that way. That line of thinking is defeatist.

The National Academy of Medicine put out a consensus statement in 2019 labeling burnout a systems issue and outlining a systems approach to fixing it. Since then, the American Medical Association, the American Hospital Association, the Surgeon General and the Dr. Lorna Breen Heroes’ Foundation have put out plans to address the issue.

Clinicians across the United States work in environments that aren’t conducive to providing quality care. They’re spread too thin, working too quickly and working too many hours, and it’s creating suboptimal conditions for their well-being, as well as the health and safety of their patients.

We know what the solutions are, and we need to be good stewards of those solutions in order for them to take root and replace the older mindset of keeping one’s head down and getting the work done. The “on to the next patient” mindset isn’t good for anybody.

You mentioned that there is work to be done at the state and national levels. What type of work?

The Foundation has already seen great success influencing legislative action with the Lorna Breen Health Care Provider Protection Act, which has established grants to be awarded to hospitals, professional associations and other entities for programs that promote mental health and well-being among providers. We plan to continue being active in promoting impactful legislation in that same vein.

The licensing process is one place where changes can have a great impact.

Right now, the licensing process in most states includes having to answer questions about one’s mental health. The answers to these questions have absolutely no bearing on a provider’s fitness for practice, and the questions themselves have a massive cooling effect on practitioners’ seeking help for mental health issues. We want to refocus the questionnaires on areas that indicate fitness for practice.

 

Want to read the full article? Here’s a preview of what you’ll find:

  • Dr. Simmons’ outline for how individual medical groups, hospitals and health systems can improve their clinicians’ professional well-being;
  • And what Envision and the Dr. Lorna Breen Heroes’ Foundation are developing to help them do so.

 

Read the Full Q&A Article

 

Q&A: Exploring Healthcare Innovation with Rich Sanders

Envision Healthcare, December 12, 2022

As the healthcare sector continues to face headwinds impacting the cost of care, clinician burnout, patient experience and more, leaders are responding with innovative care models and technologies that have potential as scalable solutions. 

Leading national medical group Envision Healthcare is particularly focused on how innovation can empower its 25,000 clinicians’ efforts to deliver high-quality patient care alongside its hospital and outpatient partners. HealthLeaders sat down with Rich Sanders, vice president of innovation at Envision, to discuss COVID-19’s role in accelerating innovation in the healthcare sector, the way Envision is leveraging new technologies to deliver value-based care, and the most important measure to consider when determining the success of each implementation.

How would you define innovation in healthcare? What makes it so important to the future of care delivery?

Innovation in healthcare is really a focus on new care models that deliver clinical value and positive outcomes to patients. Exploring new technologies is certainly a part of that, but innovation in healthcare shouldn’t be driven solely by technology. Rather, the essence of innovation is whenever a clinician applies a technology to improve the delivery of safe, clinically-appropriate and compassionate patient care.

The COVID-19 pandemic accelerated the way we implement new methods to improve patients’ access to care. What did that timeframe look like for Envision, and were there any key learnings or takeaways?

Envision found itself, like many others, needing to adapt rapidly to an ever-evolving situation, both for care delivery and team member support. The pandemic impacted everyone, but geographic hotspots and emerging knowledge created an opportunity to evaluate how we viewed the care delivery paradigm and responded to unique needs in a highly variable situation.

The conditions demanded we look at data and processes differently. While this is a best practice for any organization to do on routine, the pandemic catalyzed that process. Oftentimes, answers were found by asking more questions and discovering how we could leverage clinical expertise across geographies, which led us to utilize technology as part of the solution. We took up the mantra of Right Care, Right Place, Right Time.

Thanks to that work, we are now better positioned to apply technology to care delivery. The success of that application as we move out of the pandemic toward a new future will always be measured by how we align with our clinicians and ensure that technological enablement matches their workflow. Innovative care methods should improve clinicians’ ability to deliver exceptional patient care, and it’s our responsibility to ensure that technology never impedes that function.

What kind of influence do you see value-based care having on emerging innovations? How do the two inform one another?

Applying new technologies, such as virtual health platforms and AI-enabled radiology, to our existing care models will certainly propel our efforts in value-based care. However, a value-based delivery system doesn’t have to mean that technology is necessarily at the point of care. More often, we need to apply our clinical knowledge, better understand our data on the back end and empower clinical decision making. These kinds of innovations are subtle—they may not be recognizable to the patient during a visit, but they will make a difference in outcomes.

The nature of innovation is to be curious and evolve. This matches up well with the pursuit of value-based care, which demands a level of curiosity, persistence and patience to move beyond the traditional fee-for-service model. Innovation in this space naturally leads us to questions that align with the Quadruple Aim of lowering cost, improving health outcomes and improving both patient and clinician experience. Innovations that don’t align with the tenets of the Quadruple Aim won’t succeed in scalability in the healthcare ecosystem and certainly wouldn’t be adopted by Envision.

As a leading national medical group, how else is Envision implementing tech or innovative care models to support clinicians’ delivery of high-quality care?

We are proud of the work we did during the pandemic to shift hundreds of thousands of visits to virtual health. While those numbers have reduced during the last year or so as we transition out of that period, virtual health has a definite home in our care delivery models as both a primary patient visit and an escalation pathway.

For example, one of the exciting services we have today is working directly with our partners in EMS to deliver a virtual health consult for low-acuity patients directly with one of our board-certified emergency physicians. This application has already helped thousands of patients receive more timely care in a more convenient setting, which is often their home. This improves patients’ access to care and their care experience while aligning with our goal of providing the right care, in the right place, at the right time.

We are also using advanced machine learning and artificial intelligence to help our radiologists prioritize cases and be alerted early to potentially high-risk findings. The application of these technologies has helped us manage workflows better and improve patient outcomes. It is also very satisfying to our clinicians to know that they have the latest tools to assist them in their clinical decision making and communication of critical results.

Why Value-based Care Is the Future of Medicine

Envision Healthcare, July 29, 2022

Value-based care is the growing alternative to healthcare’s traditional fee-for-service payment model as the industry seeks to evolve to a more effective healthcare delivery system. Instead of paying providers for the sheer quantity of healthcare services performed, value-based arrangements incentivize providers on the quality and/or effectiveness of that care.

Centers for Medicare & Medicaid Services’ (CMS) Innovation Center recently accelerated this transition by publishing a 10-year strategic roadmap that prioritizes value-based care.

“For healthcare leaders who are not yet there, now is the time to embrace the value-based journey and refocus efforts on putting the patient first,” says Chan Chuang, MD, Chief Medical Officer and Medical Group President at Envision Healthcare. Below, Dr. Chuang addresses key highlights in the landscape of value-based care, the critical role clinicians will play in bringing about that future, and the importance of innovative care models such as integrated care and the Emergency Triage, Treat, and Transport (ET3) model.

Q: When discussing healthcare’s future, value-based care always comes up. How do you describe value-based care, and what makes it so critical to the evolution of our healthcare system?

A: Given how our current healthcare system, care delivery and reimbursement model are structured, our country is faced with an unsustainable cost structure of increased healthcare spending coupled with relatively low health outcomes. The U.S. ranks close to last among developed countries in terms of health index and life expectancies. The pressure to shift to value-based care is not only about putting the patient-clinician relationship at the forefront but also about making care more accessible, affordable and sustainable while improving patient outcomes and the overall health of our communities.

One area in which we can see the value-based equation in action is the focus on appropriate sites of care. An example of this is the move of select elective surgical cases from higher-cost inpatient settings to ambulatory surgery centers (ASC). ASCs have demonstrated to be a more convenient setting for patients, a more efficient model for surgical cases and a lower cost of care environment, all while yielding the same or better clinical outcomes. COVID-19 has also shifted how patients and clinicians approach and embrace alternative care settings, such as virtual healthcare, urgent care clinics and in-home care. Aligned with the right incentives, these care models allow patients to receive the most appropriate care when and where they need it while achieving the Triple Aim: improved patient experience, improved population health and stewardship of our resources.

Q: What are the major advantages of value-based care as opposed to a fee-for-service model?

A: Value-based care enables us to pivot to a model that is more sustainable for patients and clinicians, one which is also grounded in scientifically proven data points that more care doesn’t equal better care.

From the clinicians’ perspective, our goal is to provide the best possible care to patients and make sure they are set up for success throughout their care journey. Value-based care aligns with that effort because it prioritizes reimbursement for positive clinical outcomes, allowing for investment into healthcare infrastructure that focuses on the health of the population. More importantly, it encourages every stakeholder in the healthcare system to be more intentional about how they support clinicians in the delivery of patient care.

Healthcare systems and providers who participate in an alternative value-based payment model differentiate themselves and put themselves in a stronger business and financial position to lead the healthcare industry, especially in the current environment where we are faced with significant clinician and nursing labor shortages, increased patient volume lability and uncertainty, and declining fee-for-service reimbursement.

From the consumers’ vantage point, in the ideal value-based world, patients will be able to spend more time with their physician and/or care team, be motivated to improve their health outcomes with lower cost-sharing responsibilities and have better experiences without being rushed through the healthcare delivery system.

Want to read the full article? Here’s a preview of what you’ll find:

  • How Envision is incorporating value-based care into their services
  • Dr. Chuang’s advice for hospital leaders who are either still on the fence about transitioning to value-based care or ready to get started but unsure exactly where to begin.
  • Read the Full Q&A Article

Chan Chuang, MD, FCCP, FACP is the Chief Medical Officer and Medical Group President at Envision Healthcare

Two Key Solutions to Building a High-Value Radiology Program

Envision Healthcare, May 5, 2021

In radiology, flexibility drives efficiency, and efficiency drives the overall value of care.

Without flexibility, facilities large and small can encounter hurdles to delivering high-quality care and reducing healthcare costs.

Radiology teams at smaller healthcare facilities can often lack the support of a full suite of subspecialized radiologists. It isn’t uncommon for such a facility or system to have multiple contracts for radiology-related services, causing a rigid, imbalanced workflow. These contracts may include radiology groups, “nighthawk” services to cover the times at which the radiology group is unavailable, and transcription services, just to name a few.

On the other hand, a larger facility with a full suite of subspecialists may experience lulls in demand for subspecialized reads. This leaves the subspecialists tasked with generalized work that doesn’t require their expertise, which can contribute to burnout. In addition, hospital-based operational concerns can limit the effectiveness of on-site radiologists, causing excessive study repeat rates, poor throughput and unhappy patients.

To consistently provide high-value radiology services, facilities of all sizes must be nimble enough to meet imaging demands without sacrificing quality. The solutions: an optimized radiology team and refined case routing.

See how an evolved radiology model can be the solution—regardless of facility size.

Optimizing your radiology team means striking a coverage balance by pairing an on-site team with teleradiology support, but that balance also requires a refined protocol for case routing to ensure that individual reads are performed by the most qualified specialists. Together, these solutions make reads timelier and more accurate, improving overall quality and patient experience—two key drivers of care value.

Envision Physician Services’ distributed radiology model provides both of these solutions. With a team of more than 1,250 radiologists, our distributed model pairs on-site radiologists and a dedicated medical director with a comprehensive network of off-site subspecialists. In addition, we refine case routing using our proprietary software, coupled with an innovative artificial-intelligence-driven workflow and critical real-time support through a dedicated Care Management Center.

For one Envision partner facility, our radiology services improved performance across several metrics as the hospital improved its turnaround times (TAT) and reduced its radiology subsidy:

  • $600K reduction in radiology subsidies
  • 99 percent of critical findings communicated in less than 40 minutes
  • 17-minute average Stroke Alert TAT

To see how Envision’s radiology services helped a partner facility improve the overall quality of its care, visit.