There are many contributing factors to the burnout that is affecting healthcare professionals and the job they are trying to do. Many organizations are bringing in technology to help ease the burdens on physicians, but some of that technology may be creating more work, rather than helping lessen the load.
Here are a couple of contributing factors to the issues in the healthcare system in Massachusetts, how technology is meant to be helping the cause, and what analytics can actually do to improve the circumstances of everyone involved.
Technology vs. technology
The Boston Globe reported on a new program Blue Cross Blue Shield of Massachusetts is rolling out in early November. The insurer, citing what it says are the fastest rate of increasing health care costs in more than 20 years, says it has a duty to help control costs for its 3 million members. In order to do that, Blue Cross is reviewing claims from providers who routinely bill medical cases at ‘moderate’ and ‘high’ complexity and risk of complications, which Blue Cross says has surged since 2021. The insurance company is using an algorithm to analyze claims, compare the claims to those of peer doctors, and if they identify physicians who overcharged, editing claims to pay a level lower than originally billed.
Doctors argue that some patients need more care and time. If a doctor sees more patients who are older and more medically complicated, they are more likely to have higher-level insurance claims. “When primary care is thriving, we keep people out of the emergency department and prevent unnecessary hospitalizations,” Dr. Wayne Altman, chair of family medicine at Tufts University School of Medicine, told the Globe. “Those are huge-ticket items. If they’re trying to control costs, they’ve come to the wrong place.”
Part of the problem Blue Cross is uncovering might have been caused in the first place by the fact that some physicians use AI to transcribe conversations with patients which then automatically generates clinical notes. Blue Cross says these tools can categorize appointments as more complex in claims than they actually were.
What are pharmacy deserts?
The issue is complicated by new research from the Massachusetts Health Policy Commission which identified communities without convenient access to a pharmacy and the medication and services they provide – otherwise known as a pharmacy desert. Since 2019 the number of pharmacies in Massachusetts has decreased 17%, resulting in about 580,000 people in Massachusetts currently living in a pharmacy desert. Another 525,000 live in an area that would be a desert if the one pharmacy in the area closed.
Pharmacy closures result in higher spending, as patients are more likely to use hospital and emergency department services. It also strains even further a healthcare system that is having trouble meeting patient needs. If doctors are unavailable, pharmacists can often step in to answer some patient questions, or administer vaccines.
How can analytics help out?
One of the frustrations physicians have with the actions being taken by Blue Cross is the fact that, even though they have the opportunity to appeal decisions, the time they could spend making their case is time they could be spending helping patients rather than settling claims. The AI the doctors use is meant to save them time. In reality, though, it could be costing them time.
This is an example of how technology can backfire. Instead of saving everyone time, it is causing reviews that end up setting everyone back and forcing them to start a process over that should have been completed. Doctors are now being forced to double-check the work of an algorithm that is possibly double-checking the work done by AI which was originally meant to save doctors time so they could focus more on patient care.
It’s hardly any wonder that when it comes time to make a technological transformation in a hospital system, many of the stakeholders are skeptical about the difference it can make. With the right analytics solution, though, and the right approach to implementing it, healthcare professionals can see results. An organization should be very specific about the goals the technology is trying to help the organization accomplish. By including everyone impacted by those goals in the process, everyone plays a role in making sure the correct data is being accessed and used in the best way to find efficiencies in processes and in making decisions that can have positive impacts down the line.
Technology in healthcare should be helping to improve patient care, not standing in the way of those trying to provide it. The right analytics solution can provide results that can help healthcare professionals see where improvements can be made in operations that can have a direct impact on the treatment of patients. In any other industry, the misuse of technology simply reflects a bad investment. In healthcare, it can be a matter of life and death.
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