Ethical considerations for Physicians?

The desire and need to have a better healthcare delivery system has necessitated implementation of a number of regulatory mandates and adoption of healthcare IT. This requires physicians to make considerable amount of investment in their clinical setups to obtain the required level operational efficiency and subsequently to avoid the risk of punitive actions by the government in the event of failure in compliance. All this has resulted in making the existence of independent medical setups very tough. The jobs of physicians now go beyond just patient care and involve understanding the implications of regulatory norms and changing their working styles so as to abide by them. In order to avoid the pain of dealing with so many factors, which are generally looked upon as nothing by hindrance to their core work of providing care, and risk profitability, physicians are actively getting into agreements with larger provider setups and picking up a payment method with suits their deal. It helps them avoid to a large extent the headache of keeping their clinical setups updated with evolving regulatory norms and making sizable investment in healthcare IT. All this is automatically taken care of by the larger organization they enter into a contract with. Physicians thus have all their energies to focus on their primary area of work and draw financial benefits based on the agreement they hold. This is where there is a need for them to be proactive and take into account ethical concerns around those financials incentives, offered as a part of financial arrangements, which influence their clinical decision making.

Capitation is a popular payment arrangement model, comes in different variants and can potentially result in offering cost effective and efficient care. However, there is a lot of scope for conflict in such systems too. The onus lies on physicians to guard against those. It starts right from the time they are about to get into one such agreement. Two factors which they should never compromise on are the quality of care and the range of services they offer. While arriving at a rate-of-capitation the existing conditions of enrolled patients should also be taken into account. While evaluating plans, they should look at the size of the plan and the duration; both of which should be large to bring in more predictability. Physicians generally get concerned when treatment expenses go beyond predictable limits. It has a possibility of influencing their behavior since outcome generally results in a financial loss for them. Stop-loss provides a good option to handle such situations. Finally, the sanctity of a physician-patient relationship needs to be kept intact. Although it is an obligation on the part of the physicians to consider and meet the broader needs of a patient population, in order to achieve it, they have to focus their energies into every one-to-one relationship that they share with their patients. Any financial reimbursement system which acts as an impediment to this has to be avoided or worked around at any cost.

Health plans generally tend to set expectations for physicians which are not always easy to meet. For e.g. it could be in the form of a steep utilization rate which is difficult to achieve or making physician payment dependent on so many factors that it is next to impossible to get a good deal without affecting clinical behavior. All health plans have financial incentives. Physicians should keep a few things in mind before entering into a contract with any plan:

• large incentives generally make it difficult for physicians to turn down but more often than not require them to make commensurate compromises on clinical standards
• show more preference towards those types of incentives which are applied across broad physician groups
• advocate increase in the time-duration over which incentives get determined. It helps in negating the impact of fluctuations in utilization
• prefer those plans which have a large pool of patients
• avoid agreeing to a tiered system of incentive/penalty payout
• advocate for a stop-loss provision as a solution to handle outliers
• ensure that patients are informed about financial incentives which could affect the level-of-care that they receive.

Physicians should always urge for incentive programs which do not just primarily focus on utilization, efficiency and cost reduction. On the contrary, they should emphasize on those which lay importance to quality-of-care and patient satisfaction as well. Physicians ought to be given flexibility to accommodate the varying needs of patients. No incentive plans should tempt them towards selectively treating healthier people and avoiding the high-risk ones in order to improve their own and their groups’ chances of gaining financially. Creating custom solutions for your healthcare practice can help you immensely. Healthcare software development companies can assist you in this.

We provide healthcare software maintenance services for physicians and clinics. If you would like to hire healthcare software developers from us, we would be glad to assist you at Mindfire Solutions.

Will Computing take over the main tasks of Physicians?

Is it possible to automate a doctor-patient interaction with machines and algorithms handling 80% of the work? It might sound a bit outlandish but a reputed Silicon Valley investor feels it is quite a possibility. The person feels that general checkups can easily be handled by computer algorithms as well as an average physician. They may also have a lot of utility in recommending people for a physical visit to a doctor (when there is an actual need) after analyzing vital inputs shared by them and in the process save effort, time and money. Suggestions from these systems would also be based on history of illness, test results, symptoms etc. just like actual physicians would do.

Not many leaders from this field quite agree with this thought though. The argument broadly put across by them is in the lines of replacing human beings with robots. What a computer can replicate is the analytical and logical thinking which a physician would put in while treating a patient. However, it will fall short when qualities like creativity, experience and most importantly empathy comes into play. All these are adequately used by physicians when they arrive at conclusions related to a certain course of action for treatment. Also, another valid point to be taken into account is that each patient is different from the other; not necessarily reflected in terms of readings from tests, medical devices measuring vitals etc. This has led to the second school of thought by another bunch of healthcare leaders who take the middle path. According to them, the current state of affairs requires technology to permeate more into the healthcare domain but not so much so as to reduce the importance of physicians for making decisions. Ultimately physicians should have a role to play in validating technological inputs.

If the focus were to be shifted to the positives that technology has to offer, the list will be a long one. In fact, all the push from the Federal government for Health IT implementation under Obamacare is result of it. At an elementary level, technology in healthcare has led to marked improvement in provider adherence to clinical guidelines. At a more complex level, it has led to the process of “hot spotting”. This results in identifying problems in patients and making required interventions before a flare up happens; thereby saving high treatment cost and lives. Use of mobile devices like smartphones, tablets and other devices is also transforming the way healthcare delivery is taking place.

If we take a long-term perspective of the industry, within a few years from now there will be humungous amount of electronic healthcare related data created. Efforts are now being directed towards preventative care, population health, implementation of health insurance exchanges and a general shift from quantitative to qualitative healthcare. However, reaching a stage where disparate systems start talking to each other and are able exchange data will not be enough. There will be a need to have systems in place to mine the data available and come up with solutions to assist physicians in decision making – from suggesting the best treatment methods to other areas of decision making .These will become all the more relevant to the new healthcare delivery models e.g. ACOs which are emerging.

Thus, technology is proving to be very important in helping doctors to provide quality care. But expecting it to delivering the care outright would be a long shot. Also, the industry as a whole will improve only if the people at the core of the business i.e. the physicians are motivated to make a difference. Research done in this field has indicated that Physicians like to be given a certain level of autonomy in structuring their clinical activities and high control over the pace and content of patient care. The recent changes in terms of the compliance rules and regulations seems to be taking a toll on them as it indirectly reduces the time they get to spend with their patients . This problem is expected to be resolved over time as their familiarity with using new info systems and workflows gets better.

Leveraging newer technologies and building applications and systems which help make the tasks easier for physicians is the need of the hour and fortunately is on the rise as well. Healthcare software developers with solid domain expertise and strong technical know-how are making this a reality.

We provide medical software development services. That includes software development and independent software testing. So if you are looking at hiring certified software development experts for building healthcare applications, please feel free to speak to one of our developers or healthcare software testers at Mindfire Solutions and you will be glad you did.