HCB News: You’ve recently written an article in Trustee Magazine about emergency departments being on the front lines of patient satisfaction. What are the key dynamics and drivers there?

Dr. Derik K. King: Because EDs are often the first, and sometimes only, place people interact with their community’s hospital, they have a huge impact on a hospital’s reputation. They also generate a large percentage of inpatient admissions, a major source of hospital revenue. When run well, with a stable group of providers who deliver high quality care and excellent customer service, an ED can make a hospital’s reputation and boost its revenue. But if an ED is inefficient, with poor customer service, patients will be dissatisfied—regardless of the quality of care they receive. Positive or negative, a patient’s experience in the ED triggers a ripple effect that can be felt hospital-wide.

HCB News: Let’s explore the role doctors who you identify as the lynchpin in getting patient satisfaction scores in the ED up. Is this well understood and what happens when it is not?

DK: I think everyone in healthcare agrees that physician performance drives the patient experience. But what I think many overlook is the support physicians require to perform well—efficiently, compassionately, and consistently. Education and incentives are a great start. But a high-functioning practice environment, which is to say, one where operations, finances, and the team are stable and not a source of stress, is vital. So too is work-life balance and outstanding clinical leadership. You can’t have happy patients if you have miserable doctors. And you won’t ever have happy doctors unless you create an environment where they feel valued, supported, and can thrive.

HCB News: The Affordable Care Act’s newly created pool of insured individuals is fueling the growth of urgent care centers. In these somewhat uncharted waters, what are some of the challenges they face operating efficiently and profitably?

DK: Because of the growth, one of the biggest challenges new and established urgent care centers face is the ever-increasing competition. A location near a hospital or in a commercial area with 25,000 cars passing by is ideal—but it’s likely a competitor will agree. Many assume increasing volume is the way to survive and thrive. But I’d argue that mastering economies of scale and implementing lean processes must be done first.

So, cross-train staff to step into each other’s jobs as needed to maintain flexibility and flow. Keep costs lower by staffing only one shift initially—ideally 9 a.m. to 9 p.m. Utilize advanced practice professionals and other support staff to ensure good customer service and flow without overwhelming your existing physician—or adding another. The goal is to maximize your capacity without compromising patient safety or satisfaction, then marketing to increase volume and adding resources when volume truly permits.

HCB News: Changes in the healthcare system seem to be driving more physicians to become hospitalists. Is this actually the case and if so to what extent and why is it trending this way?

DK: Absolutely true. Hospital medicine is one of the fastest growing specialties today, in large part because hospitalist programs are proving to be a must-have. Regardless of hospital size, well-run inpatient programs deliver an exceptional ROI because they impact care quality, flow from the ED, admissions and transfers, length of stay, resource utilization, and countless other factors that keep a hospital viable and able to fulfill its mission for its community.

At the same time, patient population is quickly outpacing the number of available physicians. For primary care or internal medicine physicians running their own practices, hospital rounds before and after packed office hours can be overwhelming. The typically fixed schedule of a hospitalist, the comfort of being an employee of a hospital system or a partner in a managed group—there’s a real lifestyle appeal that, coupled with being highly valued and in demand, makes hospitalist medicine understandably attractive to private practice doctors and residents alike.

HCB News: For PCPs or internal medicine physicians looking to make the leap to hospitalist, what are some of the steps physicians need to take to dissolve their practice?

DK: When a physician running his or her own practice is mired in patients and paperwork—incidentally, two great motivators to take that leap—dissolving a practice seems an insurmountable task. In reality, it requires a few steps over three to six months. The least complex are driven by logic and circumstance: fulfilling any lease obligations or negotiating an exit, transferring patients or selling a patient list to a trusted colleague, developing a plan to collect forthcoming and outstanding payments, and securing nose or tail coverage.

The toughest task, of course, is taking care of your staff. Are pension or profit-sharing plans possible? Can any staffers stay on to fulfill accounts receivable needs? Finding solutions to ease the transition can go a long way in making the closure less painful for all, physician included.

HCB News: What’s the “state of the state” of telemedicine today, and as demand grows for telemedicine physicians, what must the providers (tech/software platform companies) understand to win? (Why isn’t having a stable of docs enough?)

DK: With so many emerging platforms and potential applications for telemedicine, the race is on for telemedicine-savvy physicians. But companies eager to corner the market need to understand that nabbing a huge roster of doctors isn’t the endgame. Recruiting high quality physicians, then credentialing them, insuring them, training them to deliver exceptional virtual care, and managing them—that’s where you start. And starting small is essential.

Many companies are projecting population/user volumes on par with that of an urgent care and staffing up accordingly. But despite its ease, effectiveness, and lower cost, telemedicine is still unfamiliar territory for most consumers. Demand will grow as familiarity does, but until it does, you don’t want a giant roster of physicians taking just a few calls here and there. They’ll lose interest, and you’ll lose them. Quality telemedicine physicians, a recruiting and management process that supports their practice, and smart physician recruiting that scales with consumer demand—those factors will help companies win the race.

HCB News: How do you ensure quality control with physician providers who are off-site, independent contractors?

DK: With in-person encounters, 99.9 percent of all patient interactions are high-quality, high-touch interactions. Removing the power of touch from the interaction typically won’t compromise the quality of care delivered, but it can challenge the patient experience. That’s why it’s imperative that telemedicine providers ensure their physicians are not only adept at but also strongly supported in their efforts to deliver engaged, compassionate, patient-centered virtual care.

You do that through a variety of means: training, continual education, peer review, monitoring—from video and audio call review to key metrics like prescription rate, average encounter length, referrals to immediate care, etc. The goal is to give physicians the tools they need to deliver the best care possible in the virtual setting, and to identify and correct any issues with quality or patient experience well before they become a problem.