EP323: A Short Take on Digital Tools Purporting to Maximize Throughput, With Arshad Rahim, MD, MBA, FACP, of Mount Sinai Health System

One way to spot a flash point is to notice when people are using different words to describe the same concept. Throughput is one example of this.

On one side of the table, you have those who grasp that if a provider organization is concerned about patient outcomes, with few exceptions, building relationships with said patients is essential. It’s not entirely clear to anyone anywhere how you manage to build relationships and trust without spending a certain amount of time with patients. These “we need time with patients” people will bring up the Quadruple Aim issues that arise from rigid 7-minute appointments or even 50-minute appointments really.

On the other side of the table, you have those who have built practice fiscal models on the backbone of however-many-minute appointments. They use different terminology for this whole concept, however. They call it throughput. How many patients can a physician manage to squeeze into a day? Some of these folks will tell you that throughput success is “more is more.” In other words, throughput is one of those things that you can never have too much of.

Let me back up for a sec and mention the mission of this show. It is to connect health care leaders together by helping everyone understand each other well enough to communicate effectively, which is rate critical numero uno for any collaboration. You can’t collaborate if parties don’t really grasp what anyone else is actually saying when they communicate their WIIFMs (their “what’s in it for me?”) or their organizational imperatives.

If we consider that the health care industry can only transform when multiple stakeholders collaborate, these little “language discrepancies” actually can have macro implications. In this respect, this throughput example—not in all cases but at a minimum—it’s an exemplar illustration and certainly something to contemplate. Consider people arguing against 7-minute appointments without mentioning the word throughput. They’re probably not going to even reach the headspace of those who just spent the past two decades in meetings to increase throughput. It’s like two ships passing in the night.

You could be sitting there right now pooh-poohing what I’m saying, but I’ve sat in enough meetings where people talk around each other using different terminology, think they’ve agreed on some collaboration or compromise or solution, except nothing happens because everyone got to walk out without addressing the elephant in the room. It sounds something like this:

DOCTOR OR NURSE: We need you to enable patients to have quality time with their doctors and the rest of the care team.

SOMEBODY ELSE: We need to get rid of inefficiencies, which means driving maximum throughput.

ANOTHER PERSON: OK, let’s compromise. Doctors should have quality time while maximizing throughput.

Don’t laugh. I’ve heard “action items” like this often enough, and so have you if you think about it. That’s why I originally started this podcast—because I can also guarantee you if this is the action item, no action will actually take place. The only way this conversation is going to net any change is if people around that table head-on confront that quality time with patients means less throughput. And how much less are we going to agree on and/or how are we going to creatively change the practice model so throughput is an archaic term (ie, asynchronous stuff, etc)?

I say all this to say that this throughput business also leaks into the technology space in ways that we should probably think about. Increasing throughput, after all, is one of the key ways to increase FFS (fee-for-service) revenue. FFS is all about the need for speed. The faster you can smack a billing code on a patient visit, the more patient visits you can pack into a day, the more billing revenue you can rack up. To some extent, throughput is code word for an addiction to FFS. You can always tell a