Preparing the Front Line of Medicine to Prevent Needless Work Disability: Private & Public Sector Initiatives Panelists: Dr. Edward Alvino, Dr. Jennifer

Preparingthe Front Line of Medicine to

Prevent Needless Work Disability: Private & Public Sector Initiatives

Panelists: Dr. Edward Alvino, Dr. Jennifer Christian, Dr. Marianne Cloeren, Dr. John

Dreyzehner, Dr. Ray Garman, Dara Johnson

Christian-Letz IFDM 2010-07-21 2

How Many Need Training?

• Approximately 1,000,000 physicians in US• >800,000 now in active clinical practice

(maybe 600,000 non-federal) • >80,000 in training now (med school &

residency)


2005 EstimatesSpecialty MDs DOs Total Primary Care 271,400 34,700 306,100

Non-Primary Care 491,800 19,600 511,400

Total 763,200 54,300 817,500

2007 Count155, 729 office-based, nonfederal family physicians and general internists in the AMA Masterfile.

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Practical Issues• Who (exactly) needs this training and why?• Shall we offer training or get them trained? • What training method will we employ?• What will make them take the training? • When do we want them to do it?• What do we really want them to do differently? • What subject matter must the training cover?• Will they actually take it? • Will the training have an impact?• And what will we do when a doc is STILL weak?

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Precedent Situations

• Domestic Violence• Chronic Pain• End of Life Care• Opioid Prescription

Short Stories: Webility’s Participation in

Physician Training Initiatives

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6 Approaches 1. Sessions at existing medical education events2. Offer of on-line CME training4. Free on-line CME; “Medical Rounds” in a talk

show format5. Free live CME sessions marketed to &

brought to providers’ facility

5. Request by large payer perceived as mandate; on-line training as a option.

6. Employee training : optional vs required ©Copyright Webility Corporation – all rights reserved

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6 Approaches / Many Sessions1. Sessions at existing medical education events– Lectures, grand rounds, student/resident

teaching, sessions professional conferences, day-long course.

– 2,000+ attendees cumulatively (not all in USA)

2. Offer of on-line CME training w/ trivial reward– FL, CA & Nationwide Physician Networks– Hundreds offered training; Less than 2%

participated

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6 Approaches / Many Sessions3. Free on-line CME = “Medical Rounds” talk show – Series of 10 webinars over 10 months on “hot topics”

requested by target audience– Funded by AZ Medicaid agency (MIG grant)– Marketed via email to 900 clinicians (500 in AZ)– Average attendance <20.

4. Arizona & Kansas Free CME Sessions On Site – Offer free live training by local faculty with free CME

at their convenience at their facility with free food. – Funded by AZ & KS Medicaid agencies (MIG grant)– Conducted 50 (AZ) / 20 (KS) CME sessions – Trained 500 clinicians in AZ; 200 in KS. ©Copyright Webility Corporation – all rights reserved

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6 Approaches / Many Sessions5. California Training at the request of big payer– Goal: Train all clinicians in a contracted network– “Pseudo-mandate” by dominant wc insurer in state– 90 day period to complete training; 3 reminders– Option of on-line CME course; $49.50 tuition– 100% chose on-line course.– Participation rate was 50%. 812 clinicians trained.

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California Results: Compliance• Project cost +/- $30,000 paid by doctors;

$3,000 in sponsor staff time. • Approximately 50% participation rate• Example as of July 2010

AREA LETTERS All areas 880 458 52% 427 49%San Diego 124 85 69% 80 65%Stockton 175 86 49% 79 45%Oxnard 210 118 56% 110 52%Sacramento 242 126 52% 118 49%Redding 129 43 33% 40 31%

REGiSTER COMPLETE

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California Results: Participation

As of Sept 2010

650Started

CME course%

615 Completed

course%

261Took

survey%

MD/DO 58 57 53

DC 34 35 37

Psych 3 3 5

Mid-level 1 1 1

DPM 2 2 3

Unclear 1 1 2

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California Results: Course Evals

• 46% liked the CME course• 58% see their role in a new way; almost all the

others already thought that way. • 80% feel more prepared to manage non-

medical issues• 74% would recommend course to a colleague• Good change in pre-post confidence scores

©Copyright Webility Corporation – all rights reserved Christian-Letz IFDM 2010-09-19

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California Results:Opinion Survey >> 20 Days Later

• 88% of clinicians personally read SCIF letter• Impact on their view of SCIF– 40% more positive; 50% no change; 6% negative

• Reaction to general idea of requests for CME from employers/payers– 65 % positive / agreeable; 14 % negative


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California Results:Post-Course Survey

• Sent to all who had completed course >20 days earlier (up to 12 months earlier!)

• Initial email request plus 2 reminders. • 9 questions, 7 of them multiple choice• 2-3 minute completion time• Many free text comment boxes • 261 / 600 eligible = 43% response rate


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California Results:Impact of the Course

• 96 % remember taking the CME course• 69% report the course had at least 1 impact• >50% feel more confident with SAW/RTW and

have used ideas, concepts, tools from course • 38% pointed to 5 or more impacts• AND 44% report little or no impact because

they are already doing what the course advocates


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Bigger Impact Among the “Naive”STATEMENT All

Old Hands

New Ideas

I / my practice places a higher priority than before on preventing needless work disability 48% 27% 65%

I am now less likely to simply put people out of work on RTW forms. Instead I spend the time to write about current ability to work, restrictions & limitations

47 30 61

We made some changes in our office procedures 21 11 30I have changed how I talk to patients about SAW/RTW 35 17 50We changed how we communicate with ERs/ payers 27 15 37I am more comfortable working with State Fund 42 27 53


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6 Approaches / Many Sessions6. Texas, California & Multi-state - Employer-

driven training (healthcare delivery orgs) – 2 programs were mandatory; 1 was “offered”– Participation rate was >95% for mandatory.

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Strategies That Increased Participation

• Kansas & Arizona– Very active, very persistent marketing effort– Session conducted at physician’s own facility– Easy fit with facility’s usual schedule

• California– Request perceived as mandatory– Request came from a major source of referrals– Deadline for completion; multiple communications – Obvious tracking of compliance by requestor– 24/7 availability of course


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Conclusions • Training physicians/clinicians takes substantial

commitment and $$, but IS feasible. • The work disability prevention message is new to

MORE THAN HALF of them.• Training has a substantial impact on practices. • Once aware, physicians are more open to

collaboration. • Physicians are much more likely to take this training

if told to do so by those who pay them. • On-line training enables broader reach, is logistically

much simpler, costs less, and has good clinician acceptance.

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Thank You!

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Preparing the Front Line of Medicine to Prevent Needless Work Disability: Private & Public Sector Initiatives Panelists: Dr. Edward Alvino, Dr. Jennifer