Where Physician Burnout and Value-Based Care Intersect
This series explores legal issues related to physician burnout and potential solutions, and here we explore the potential impact of value-based care (“VBC”). Our first post addressed how healthcare organizations can foster the psychological safety and emotional well-being of their physicians. Our second post discussed artificial intelligence solutions as a potential way to attract, support and retain overwhelmed clinicians. Here, we explore how VBC can promote physician satisfaction and physician wellness by:
- Streamlining clinical pathways to simplify physician decision-making,
- Improving chronic disease management programs by enhancing patient communications and employing non-physician providers to support proactive patient care strategies; and
- Transition appropriate clinical and care management responsibilities from physicians to other members of the healthcare team, such as clinical pharmacists and case managers.
Understanding Physician Burnout
Burnout is a long-term stress reaction characterized by emotional exhaustion, negative attitudes toward patients and staff (whether or not expressed by an individual to others), and a feeling of reduced efficacy at work. While clinician burnout manifests individually, much of the blame can be attributed to systemic working conditions.[1] Contributing factors include long hours, inordinate administrative burdens, and lack of support. The traditional fee-for-service (“FFS”) structure in healthcare incentivizes greater physician productivity that can exacerbate these factors. [2] In a study published in Mayo Clinic Proceedings, 63 percent of US physicians surveyed reported at least one symptom of burnout at the end of 2021 and the beginning of 2022. For 2023, 48.2% of physicians reported experiencing at least one symptom of burnout, down from 53% in 2022.[3] While the data includes signs that physician burnout has fallen since its peak in late 2021, the extent of the problem remains a startling reality that demands ongoing attention.[4] VBC offers potential solutions to physician burnout, which threatens physician retention, professional satisfaction, and the sustainability of our healthcare system.
Meaningful VBC Solutions to Burnout
In an effort to contain costs, particularly in federal healthcare programs like Medicare Advantage, the healthcare industry has been slowly transitioning toward VBC. Payors, health systems and providers are collaborating on VBC efforts, developing creative ways to shift risk from government and commercial payors to health systems and providers. VBC focuses on improving quality outcomes and enhancing patient experience through careful utilization management, chronic disease management programming, enhanced primary and specialty care interventions and expanded patient support services. VBC encourages personalized care and proactive interventions that can reduce unnecessary utilization, ultimately improving patient satisfaction and lowering healthcare costs. VBC programming efforts can alleviate physician burnout in the following ways:
1. Identifying Potential VBC Solutions
Leaders must strategically select their organization’s goals and corresponding VBC initiatives, and educate their providers and staff on how VBC will change workflow and processes. Pre-planning should also include appropriate staffing (i.e., coders, clinical pharmacists, case managers, nurses, care coordinators, etc.), team-based care workflows, supportive technology, staff education, and ongoing performance assessments relative to selected benchmarks and clinical practice areas. Organizations must also consider appropriate incentives (both economic and non-economic) for clinicians and staff to achieve the established goals. Selecting and implementing VBC programming based on available resources can be a complex task requiring input from across a given organization.
2. Streamlined Clinical Processes/Team-Based Care
The VBC model promotes streamlined care processes by incentivizing development of effective clinical care algorithms and standardized care pathways, particularly for high-cost, high-acuity patients and patients with chronic conditions. High priority VBC projects can include adopting electronic medical record features that support physician decision-making and documentation, such as suggested diagnoses or automated messaging.
Likewise, other important VBC solutions are those that enable redistribution of care responsibilities from physicians to other members of the healthcare team, such as clinical pharmacists, case managers, and nurse practitioners. This allows physicians to focus on complex tasks and patient care decisions while ensuring that other aspects of care are handled efficiently by professionals who are best equipped for those tasks. For example, medication reconciliation, data collection and analysis, tracking patient outcomes and ensuring compliance with VBC metrics can be delegated to non-clinical staff. Coordinators and health coaches can manage patient navigation, ensuring timely follow-ups and appointments. This streamlined workflow can reduce physicians' workloads and administrative work by transitioning routine charting to other providers, follow-up care and messaging to trained nurses and/or care coordinators, support for risk adjustment to trained coding staff, and support for risk stratification and achievement of required quality metrics to operations and financial staff.
In a VBC model, there is a strong emphasis on preventive care and proactive management of chronic conditions, such as diabetes, hypertension, and heart disease. VBC encourages preventive and proactive interventions to reduce the need for acute care interventions. Regular check-ins, remote monitoring, and patient education help identify issues early so chronic conditions can be managed more effectively, thereby reducing physician visits. VBC tailors care to the needs of individual patients, with a focus on their health goals and lifestyle. Reducing patient acuity and better managing chronic conditions allows physicians to manage patients’ care more effectively, reducing redundancies and acute issues that contribute to physician workload and burnout.
3. Enhanced Patient Relationships
VBC models prioritize patient outcomes and build relationships between physicians and other care team members . Stronger patient-physician relationships in a VBC model can lead to greater job satisfaction, as providers see the positive impact of their work on patients’ lives. By focusing on disease prevention and chronic disease management, physicians can help patients maintain better health, reduce inpatient and outpatient care needs, and this alignment in work efforts and outcomes can create a more collaborative, satisfying and motivating work environment.
Implementing a VBC Model
There is no “one size fits all” approach to success in VBC. As the healthcare industry continues to evolve, the need to address physician burnout becomes increasingly critical. VBC offers a promising pathway to not only enhance patient outcomes but also improve the work experience for healthcare providers. The Sheppard Mullin Healthcare team regularly assists clients in establishing and operating effective VBC models, including evaluating organizations’ readiness to transition to VBC (whether upside only or full-risk models), developing policies and procedures to ensure success, developing provider alignment strategies that support VBC goals, and providing guidance to ensure regulatory compliance of policies and incentive programs. For more information, please contact a member of the Sheppard Mullin Healthcare Team.
FOOTNOTES
[1] The American Medical Association, Christine Sinsky, MD, On What Physicians Need To Know About Burnout In 2022 (Jan 4, 2022).
[2] Medical Economics, Fighting Burnout Through Value-Based Care, Brian Steele, M.D.(December 12, 2022).
[3] Shanafelt TD, Hasan O, Dyrbye LN, et al. Changes in Burnout and Satisfaction with Work-Life Balance in Physicians During the First 2 Years of the COVID-19 Pandemic Mayo Clinic Proc. Volume 97, Issue 12, P2248-2258 (December 2022).
[4] The American Medical Association, Sara Berg, MS, Physician Burnout Rate Drops Below 50% For First Time In 4 Years (July 2, 2024).