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A new study found that cell-free DNA from routine prenatal testing can accurately identify preterm birth risk without added cost or procedures.

New blood test predicts preterm birth risk early in pregnancy

A new study links gestational diabetes and high blood pressure during pregnancy to higher long-term cardiovascular disease risk, especially among women with obesity.

Pregnancy complications may increase future heart disease risk

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

A novel oral antibiotic, gepotidacin (Blujepa; GSK), has demonstrated its effectiveness in treating uncomplicated urogenital gonorrhea, according to the results of a recent phase 3 clinical trial.

Gepotidacin demonstrates efficacy, safety as treatment for gonorrhea 

A new study finds that digital behavior change programs do not significantly increase moderate to vigorous physical activity among women with a history of hypertensive pregnancy disorders.

App interventions not found to boost physical activity in HPD patients

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It's imperative to identify more HIV-infected women earlier in pregnancy through HIV testing and to reduce mother-to-child transmission of the virus that causes AIDS.

Update on managing HIV in pregnancy

Those of us in management have come to recognize meetings as an inevitable part of our workday. The greater your administrative to clinical time, the greater the amount of time you will spend in meetings both as a meeting participant and as a leader. the increased number of remote meetings has had a negative impact as the threshold for creating a meeting decreased and the ease of inviting participants to meetings increased. The cost of meetings is rarely considered, but the next time you are at meeting, think about this: It is not unreasonable to estimate that an hourlong meeting of clinicians may cost close to $1000 in missed clinical revenue. It is imperative that meetings are managed as effectively as any common clinical scenario.

Whillans et al describe 6 pitfalls that lead to excessive meetings

1. Meeting FOMO (fear of missing out): What will our colleagues, or worse, our bosses think of us declining an invitation for a meeting of marginal necessity? this is rooted in the belief that just being present is being productive.

2. Selfish urgency: As leaders, not everything that we think is important justifies disrupting others’ days or adding an extra hour to the workday.

3. Meeting as a commitment device: using a meeting solely to establish a deadline is not a great use of time.

4. The mere urgency effect: This is where we feel better for completing a task, no matter what the value is. An example is low-value regular meetings. If we complete a series of meetings, we feel we have accomplished something, even if we have not.

5. Meeting amnesia: this is the meeting to review what was accomplished (or not) at the previous meeting. A much better tactic would be real-time debriefs or distribution of meeting summaries.

6. Pluralistic ignorance: Chances are we are not the only one who recognizes that a standing meeting is a waste of time. Open dialogue can remove a standing meeting from our calendars. Action plans and end goals are neededthere is a lot of science around effective meetings. 

A review of 100 articles on the subject came up with some tips

: Do you really need a meeting? Can a quick call or email suffice? Invite the smallest number of people required. This not only makes the meeting easier to manage and more effective but will greatly facilitate its scheduling in a timely manner. Build an agenda and stick to it. This seems so simple yet is probably the most common reason a meeting succeeds or fails. Everyone should know the end goal of the meeting. An agenda describes the process, but an end point will drive efficiency. It is a great tool for refocusing those who may be derailing the meeting. End with an action plan and a follow-up deadline for items on the agenda. this will effectively reduce the frequency of a second, less valuable meeting. Allow participants to leave a meeting if they feel that they are not contributing or that the meeting is not of value. After evaluating whether a meeting is necessary, deciding who needs to attend, and establishing an agenda and goals, the next decision point is the duration of the meeting. Meeting content seems to follow the laws of natural gas: It will expand to fill the available allotted time. scheduling your meetings for shorter periods of time will force discipline around roles and agendas and will free your teams up to be more productive in other spaces. 

Lucy Handley takes the 30-minute meeting 1 step further and promotes a 15-minute meeting.

 The purpose of the 15-minute meeting is 2-fold. The 15-minute meeting is not just about going more quickly. It is about prework. The foundation of this prework is asynchronous communication. A shorter meeting requires individuals to read materials sent prior to the meeting so they need not be reviewed. 

One highly creative approach is a brief video sent premeeting by the organizer. this shows that the organizer values the participants’ time and will lead to greater focus. Although the 15-minute meeting is not for every subject, it can be a great strategic tool. Make the most of online meetingsAlthough the foundation of meetings remained unchanged when they moved online via Zoom, Microsoft teams, etc, there still are special considerations. 

 discussed the potential for remote meetings to be draining rather than energizing to those working remotely, along with reasons and tactics for mitigating the risk of disengagement. Although the discomfort of constantly being on display and having to look at a screen of others throughout a meeting is something we can get used to, other issues such as multitasking during meetings will always hinder the productivity of a session. Although some have advocated mandatory “cameras on,” constantly being present on screen can increase the fatigue of a remote workday.

 Suggestions for improving appearance on remote video calls include both technical and physical strategies. Computers’ imbedded microphones and cameras rarely compare in quality to many inexpensive combined apparatuses, which are easy to install. Individuals should be aware of posture and facial expressions, watch out for lighting mishaps, and make sure they are well lit from the front. Unlike an add-on camera/microphone, which is essential, professional lighting is not something everyone needs. But it is important to ensure there is not an intense light source behind you, which can cause you to appear as a silhouette.

In a recent Harvard Business Reviewarticle,

 Rae Ringel wrote that “I’m going to give you 10 minutes of your life back” is a phrase to stop using. Ringel points out that if a meeting is run properly, one might be able to say, “Because everyone was so productive, we’re done 10 minutes early. Thank you so much for your presence and participation.” That’s the kind of meeting you should be aiming for.  

1. Whillans A, Feldman D, Wisniewski D. The psychology behind meeting overload. Harvard Business Review. November 12, 2021. Accessed June 29, 2022. https://hbr.org/2021/11/the-psychology-behind-meeting-overload

2. LePage E. Tips for effective meetings we learned from reading 100 articles. Unito. January 13, 2020. Accessed June 29, 2022. https://unito.io/blog/running-effective-meetings-tips/

3.Handley L. The rise of the 15-minute meeting —and how to run one. CNBC. January 25, 2022. Accessed June 29, 2022. https://www.cnbc.com/2022/01/25/the-rise-of-the-15-minute-meeting-and-how-to-run-one.html 

4.Discovery RSM. How to have effective zoom meetings—and make them less boring. Forbes. March 4, 2021. Accessed June 29, 2022. https://www.forbes.com/sites/rsmdiscovery/2021/03/04/how-to-have-effective-zoom-meetings-and-make-them-less-boring/

5.Gabriel AS, Robertson D, Shockley K. Research: cameras on or off? Harvard Business Review. October 26, 2021. Accessed June 29, 2022. https://hbr.org/2021/10/research-cameras-on-or-off

6.Ringel R. Please stop using these phrases in meetings. Harvard Business Review. January 11, 2022. Accessed June 29, 2022. https://hbr.org/2022/01/please-stop-using-these-phrases-in-meetings4 / 466%

Tips to avoid wasting time and optimize meetings you do need.


Clinical

How much money are you losing in unnecessary meetings?

Many practices struggle day to day to get by and survive. Truly superior practices prepare for the future to ensure the best opportunities to survive and thrive. How do you prepare? What is the next big thing in medicine? What if you predict wrong and make a mistake? One of the worst mistakes is to stay static. Trust the trends you can see and make investments in your practice to move forward.


Adopting and implementing new technology can help practices, streamline processes, improve efficiency, and reduce costs. A clear technological process that is moving forward now is telemedicine platforms. These help improve care by increasing the provision of care where providers are limited. However, telemedicine can also be performed in a multioffice practice to allow employees to be in multiple sites. The use of telemedicine in this manner may improve scheduling, increase efficiency, and reduce scheduling conflicts when various types of providers work within a practice.

Consider purchases of other technology when they improve practice potential and efficiency. Ultrasound machines are expensive, but if they allow you to keep your practice at the forefront of diagnostic capability, what does that mean to your patient outcome, satisfaction, and referrals? Do new machine capabilities decrease scanning time and improve efficiency as well?

Forming alliances and partnerships with other practices, hospitals, or organizations can help practices attain economies of scale. Smaller practices may get assistance from joining a group purchasing organization (GPO). The most obvious benefit of joining a GPO is improved purchasing power. Vendors provide discounts to larger groups of physicians rather than to individual offices. Hence, GPOs may leverage negotiations to improve pricing or upgrade supplies that are usually unavailable to smaller practices. Also, in this time of shrinking supplies, a GPO has more extensive scale and may assist with procuring supplies, allowing a steadier inventory while reducing cost.

Joining a larger practice or alliance of practices can also assist with contract negotiations with payers. It is no secret that larger practices have more negotiating leverage with players during contracting. However, a larger group also can pool physician time in negotiation or share assets to hire an organization to assist in the process.

Foster a culture of continuous improvement

Practices should encourage providers and staff to identify inefficiencies and bottlenecks within a practice. Thereafter, a practice should implement continuous improvement processes to ensure that a practice works at peak efficiency. Providers should meet with staff regularly to listen to concerns and develop plans among staff to enhance implementation. Provider-led initiatives without other frontline staff input can be perceived as tone-deaf or forced and reduce the chance of implementation and change.

Physicians also should constantly work to improve. Providers should work to attain continuing medical education credits and attend in-person courses that enrich knowledge or skills in a specific key area of interest.

Organizations are moving away from traditional fee-for-service–based models towards value-based care. The standard definition of value care is outcomes divided by cost. Payers and governmental entities believe that providers should be incentivized on the quality of care they provide and the cost of how they provide this care.

1. Structural measures refer to
the characteristics of the care provider or the place where the care is given. An example is ultrasound accreditation.

2. Process measures focus on the series of events that take place during an episode of care, the appropriateness of care, timeliness of service, and providers’ proficiency. An example would be using a low-dose aspirin checklist in pregnancy to enhance the possibility of following the US Preventive Services Task Force guidelines for pregnancy.

3. Outcome measures evaluate whether the health care goals were realized. Mainly these focus on the patient’s health status but can also include health care costs or patient satisfaction. One example is cesarean delivery rates. This specific example has some controversy and requires risk adjustment but may be best followed via nulliparous, term, singleton, vertex rates or Society for Maternal-Fetal Medicine cesarean delivery rates, which make some mild or moderate risk adjustments, respectively. Almost all outcome measures may be affected by patient risk factors or medical conditions. Alternative measures for gynecologic procedures are postoperative surgical bed days and readmissions. The measurement of neonatal intensive care unit days for deliveries has a large effect on payer bottom line.

Practices should strive for improved quality of care as a sign of providing value. Specific quality initiatives should be highlighted by practices as a constant effort to improve and be shared
with payers.

Practices that build strong relationships with patients can foster trust and improve patient engagement. These factors may lead to increased adherence, better outcomes, and lower cost. Practices should keep patients informed about their health and treatment plans and encourage them to ask questions and express concerns. Listening to patients’ concerns and ensuring understanding demonstrates your concern for their well-being. Providers should involve patients in their care to enhance the probability of improving outcomes. Patients should be invited to assist in their care and treatment plans and involve them in goals and self-management strategies so they would be more likely to attain adherence.

Practices should make substantial use of patient portals, which allow patients to access their medical records, communicate with their health care providers, and schedule appointments in some circumstances. Utilizing patient portals, practices make it easier for patients to stay connected and engaged in their care.

You can’t teach nice. One of the most essential characteristics of a good physician or employee is a pleasant personality. People often can learn information, but changing character and teaching qualities of respect, friendliness, and work ethic is challenging.

For providers, time is often your most valuable commodity. Providers should have durable workplace relationships with their partners, demonstrating a devotion of time and thought to one another. Would you want to join a practice where people do not enjoy working and spending time during work with each other? In the book 

, Peter Thiele presents the converse: Why would you hire somebody who would not be excited about spending time with others in your business?1 When someone joins you for the culture of your practice, you are not fighting the war of perks and salary. The provider who joins your practice should want to do irreplaceable work in a unique specialty with great people.

Providers should stay involved in their professional organizations, which offer resources and educational events to keep up to date with industry trends. Physicians should also attend conferences and educational events that can provide a wealth of information about new technology and changes. Organizations also have online communities and discussion groups, which can provide information on industry trends and changes.

An alternative means of staying informed is to follow thought leaders and experts on social media. Many leaders and experts share their insights and perspectives on social media, which can be a helpful way for physicians to stay informed about upcoming industry trends. Platforms like LinkedIn allow networking with colleagues, which can be a valuable way for physicians to stay informed and share ideas and
best practices.

Trust the trends you can see and make investments in your practice to move forward.

How to future-proof your practice

I once was dealing with the purchase of equipment from an ultrasound vendor. We had worked with our current vendor for over a decade and had purchased over $2 million worth of equipment. Their machines were tremendous and provided excellent images for our patients in our maternal-fetal medicine practice. However, for a fair number of devices, their salespeople offered us no significant pricing breaks. We had little communication on our imaging experience, sonographer education, and lack of shared goals. We felt our practice was not being valued.

We opened the bidding to 2 separate companies. This took precious time to participate in machine demonstrations and learn about this new and different equipment. However, as our practice was large, these 2 companies gave incredibly competitive pricing to open the door to our practice and build a relationship. We purchased equipment from both vendors and ended our long-standing relationship with our first and only ultrasound vendor.

We wanted to be treated like the customer they wanted, not the customer they had.

In many circumstances, this is 1 of the critical issues in losing a provider. We will wine and dine someone to come into our city and let them get to know other providers and staff. However, we will not take the provider and spouse out annually to show them an appreciation for their work, listen to concerns, address issues leading to burnout, and ask them about future goals to hope they stay. Unfortunately, this lack of strategic involvement is unwise. The cost of turnover is staggering, with the average cost ranging from $500,000 to $1 million per physician.

Engagement of the person is the key to retention. Systems hire recruiters, but why not professional staff engagement officers? Smaller practices should have owners take a chief role in engagement. For provider engagement, a plan is needed and should be documented and followed. (See sidebar).

Coker’s tool for measuring physician engagement is a quantitative measurement of a qualitative experience and hence is limited in its application. Nonetheless, it is easy to garner feedback and upfront responses when administered, especially in an anonymous fashion.

Retention is important but recognizing burnout as a more insidious hazard in the workplace is critical. Professionally, burnout leads to decreased quality of care, increased medical errors, decreased productivity, and provider turnover.

Organizations should promote system-level solutions for retention and well-being. Mayo Clinic has announced

 organizational strategies for physician well-being.

Staff appreciate dialogue with their leadership, and it is critical that discussions are candid and heard. After that, routine measurement of physician well-being is essential to assess and act upon deficiencies.

Behaviors of leaders are critical to the well-being of the positions they lead. Leadership selection is crucial. Leaders must then be developed, prepared, and equipped for their roles. The effective leader recognizes the unique talents of the physician team. Evidence suggests that professionals working at least 20% of their time within their fields of strengths are at much lower risk for burnout.

Develop and implement targeted interventions.

Spreading these concepts out to your entire clinical team is important. Assemble a team for action and invite insight from physicians/providers. Form focus groups and have leaders steer facility change based upon the gathered information.

Peer support has always been critical in assisting physicians in navigating professional challenges. The support can come from various activities such as celebrating achievements or supporting each other through challenging experiences.

Pay based mainly or solely upon production may be unwisely guided. This eat-what-you-kill practice environment may shorten the time spent with patients, result in ordering more tests or procedures, or promote working longer hours. Instead, rewards such as work flexibility or protected time to pursue meaningful work may allow productive physicians other means to create professional fulfillment.

An organizational mission and vision must be kept at the forefront of interactions. Acting upon these values is critical to the organization to furnish provider guidance and later provider self-appraisal of living out the organizational values and hopefully
shared commitment.

Promote flexibility and work/life integration.

Physicians are almost twice as likely to be dissatisfied with work/life integration compared with workers in other fields in the United States. Providing physicians with options to reconstruct their work effort and tailor hours to meet personal and professional obligations may reduce and assist physicians in recovering from burnout.

Provide resources to promote resilience and self-care.

Providers should be given tools to encourage self-care, training, and skills that facilitate resilience. Resources should be customized to address personal well-being and work/life integration, financial health, and personal preventive health.

Facilitate and fund organizational science.

Larger institutions are responsible for funding research to develop metrics, establish benchmarks, and conduct trials and interventions leading to publications on physician retention and burnout. These efforts are critical to the viability of our nation’s health care system.

Regarding the new ultrasound systems, we ordered from the other 2 vendors. One company did not follow up on its system upgrade promises. The other vendor’s system had image issues resulting in diagnostic errors and our relegating the machine to be the ultrasound of last resort. After our recruitment, they quickly lost trust in communication, lacked accountability, and did not resolve conflicts—they had won our business, but it was clear we were 2 separate teams. Our original vendor came back with an unbelievable deal to upgrade all the equipment at an extensive discount. Everyone ended up losing, at least in some aspect. It would have been easier for all parties with a focused retention strategy. 

Greeter A, Harrison T. Physician engagement: a crucial component of a healthy organization. Coker Group. June 2018. Accessed August 10, 2022.

https://cokergroup.com/wp-content/uploads/2019/02/Physician_Engagement_-_A_Crucial_Component_of_a_Healthy_Organization_June_2018.pdf

Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. 

. 2017;92(1):129-146. doi:10.1016/j.mayocp.2016.10.004

Shanafelt TD, West CP, Sloan JA, et al. Career fit and burnout among academic faculty. 

. 2009;169(10):990-995. doi:10.1001/archinternmed.2009.70

Retention beats recruitment

Consumerism in health care is best defined as individuals proactively using trustworthy, relevant information and appropriate technology to make better-informed decisions about their health care options in the broadest sense, both within and outside the clinical setting.

Health care consumerism recognizes the importance of a patient or a family member in the continuum of the health care journey. As what becomes important to the patient becomes more evident, the concept continues to evolve.

The origins of consumerism can be tied to the push for health care insurance in the 1930s, with the patient having input into how their care would be paid for. The protest over provision of care for those with HIV/AIDS in the 1980s showed that patients, not government or payers, should drive how health care is provided to a population.

This article examines what is driving the current consumerism movement and explores evolution in the provision of health care and the health care system as a platform for how a practice can thrive. No discussion of health care consumerism would be complete without addressing legitimate concerns over the use of the term, both in possibly marginalizing the concept of the 

 as well as placing the burden of the health system’s shortfalls on the patient rather than the system.

What drives health care consumerism today?

A consumer-focused system needs to address cost and experience.

 When systems, practices, or individual providers try to address what is important for the patient or consumer, the foundational assumption—even if flawed—is that the quality of care will not differ among providers and that, with quality being a fixed variable, value is mostly cost dependent. 

Markets and consumers have always been focused on the cost of goods and services in places such as grocery stores and restaurants because the responsibility for payment rested solely on the consumer. 

For years, health care consumers have had little or no responsibility for payment as generous employer- or government-supplied insurance products covered most of the cost of care.

As the cost of these insurance programs became unsustainable, cost of care shifted toward the patient. When patients became sensitive to cost, they predictably became consumers in the traditional sense. 

Some consumers choose high-deductible health plans where lower premiums are balanced by higher co-pays or deductibles. These plans drive consumerism in 2 ways. Ostensibly they can promote personal responsibility for care. 

Making better lifestyle decisions and using preventive care would hopefully decrease not only overall health care spending but also out-of-pocket costs. Unfortunately, it often means that the overall health care spending is unchanged, but the consumer pays more of the health care costs. 

Data from 2018 showed that patient financial responsibility increased 11% in 2017. The impact of this increased spending has led to more than 10% of patients struggling with this financial responsibility.

Value-based care, the essence of consumerism, is more than just cost control. Although traditionally value has been related to only 2 variables—quality and cost—the definition of value is now in line with the Institute for 

Healthcare Improvement’s Triple Aim. This improves health while lowering per capita cost and also places value on the patient experience.

 The Washington Health Alliance defines the element of patient experience at each step of the health care journey from insurance product enrollment to before, during, and after each visit.5 Value, the cornerstone of consumerism, has a different formula.

Practitioners would be well served to understand the dynamic environment of consumerism and health care at this time, as well as anticipated changes, and how they will share responsibility and also benefit from the changes.

Although today’s health care system is characterized as a high-cost system with quality and safety performance less than what would be expected at the price, it has identified and is acting on several opportunities both at the payer and provider level.

Responsibility for cost should shift back to the health care system and by proxy to the provider. Despite introductions in payment reform, much of the nation’s health care dollar is still spent on volume as opposed to value. An acceleration to value-based programs that pay at either an episode (bundle) or population (accountable care organization) is inevitable. 

Physicians will need to learn that these modern systems thrive not when an individual tries to manage the complexity of care, but when well-crafted teams design programs that promote healing (surgery) as well as prevention and wellness. 

For physicians to succeed in this paradigm, they need to be prepared to lead teams and share the financial risks and gains that would occur with well-coordinated care.

Providers must rapidly embrace
evidence-based care and discontinue reliance on unproven expensive technology. In addition to financially incentivizing evidence-based care, incentives for low-value, volume-based care must be removed.

It is no longer enough to worry about the other health care systems or practices in your market. The most formidable competition will come from those who have already succeeded in a consumer-based world, such as companies that have proved facile in technology-driven service and artificial intelligence to guide effective marketing and targeting. 

These strategies are not only an opportunity for revenue generation but also a key part of disease prevention and management, especially of costly chronic conditions, pushing these entities toward success in a risk-based environment. 

For example, Best Buy, known for being more resilient than most retail electronic giants, is active in patient monitoring, a key component of the hospital-at-home movement that is a favorable space with respect to cost
and engagement.

Patients’ ability to choose can affect your practice.

Mary J. O'Sullivan, MD.

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