Every health care organization faces crises at one time or another, but the ones who weather them best have a clear sense of mission, a strong leadership team in place, and communicate regularly with staff, patients, and the community throughout the crisis.

That was the message from Aimee Greeter, senior vice president at the health care consulting firm The Coker Group, and Alan Vierling, MSN, president of Sparrow Hospital in Lansing, Mich., during a virtual session on effective leadership during a crisis. The session took place on the first day of the Medical Group Management Association’s 2020 medical practice excellence conference.

Greeter stressed the need for preparation, even though leaders may not know what sort of crisis they will face. But having a strong team, appropriate protocols and templated communications always in place are keys to being ready for any situation that may occur. “I would say that while leadership in a crisis is important, equally if not more important is being a leader in those preparatory actions,” she said. 

 “Having experienced crises of almost every nature during my 40 years in this business, I can tell you that the same standards apply almost all the time,” Vierling added. “And handling a crisis is not that difficult as long as you are intentional and pragmatic in your planning.”

Greeter and Vierling outlined the following techniques for effective leadership during a crisis:

 It’s important to establish an organizational goal at the start of the crisis, one that’s consistent with the organization’s larger mission. When the COVID-19 pandemic arrived, Vierling said, Sparrow decided its goal was to ensure that none of its caregivers died. “That’s been our guiding motivation throughout COVID-19,” he said, with the result that only .4% of its employees have been impacted by the disease.

 In the midst of a crisis, Vierling said, leaders generally have to act quickly, and often with little information to go on. Still, “what you don’t want to do in a crisis is waver. Once you’ve made a decision, stick with it and follow it through. Give your staff the opportunity to make decisions, then trust them to do the right thing and get out of their way.

Vierling cited the example of Sparrow’s response to the start of the COVID pandemic, when the hospital issued daily memos to staff, and supplemented it with seven-day-a week “COVID calls” for several months. “That communication. “That daily communication is essential and provides a sense of being connected,” he said, adding that it also contributed to a greater degree of employee engagement that has remained.

“Sometime in a crisis the first thing you feel like doing is going into your office and plan, but that’s not what you need to be doing,” Vierling said. Instead, leaders need to publicly explain the nature of the problem or crisis, what’s known about it and how the organization plans to address it.

Equally important he said, is developing strong relationships with the people in your organization. “You need to know your staff, your providers, your contacts at the hospital system, so in a crisis you can be that voice of authenticity as you deliver your message. But you can’t do that from your office.” 

Stay tuned to Medical Economics for more coverage of MGMA 2020.

Articles

MGMA

Two experts outlined the following techniques for effective leadership during a crisis.

MGMA 2020: Four keys to effective leadership in a crisis 

While traversing the pitfalls of transitioning from clinician to physician-leader, a common stumbling block can be creating a strategic plan, according to a talk given by Steve Quach, MD, CEO of CarePoint Health in Denver, Colorado, at the 2019 MGMA Annual Conference.

Building off his previous remarks about the importance of 

, Quach says one of the best skills a physician leader can possess is being able to create a strategic plan-and effectively implement it.

“The job of a leader is to take a number of unrelated initiatives and vectors of different employees going in different directions and use that process to align them toward a common vision,” he says.

Quach compared and contrasted practices that physician leaders should and should not do while creating a strategic plan. These include:

Committing the time and resources required and not succumbing to the pressures of other competing priorities

Employing a structured process and not trying to reinvent the wheel or do it all yourself

Involving the appropriate leaders and stakeholder and not involving too many or two few people in the strategic planning process

Using the strategic plan to define goals and guide decisions rather than wasting your time and effort creating a paperweight

Updating the plan regularly instead of falling victim to the pace of change

The last point is important, according to Quach, because as time passes and situations change the strategic plan can become less effective.

But even with these tips, Quach says there are still specific challenges for new physician-leaders who are building a strategic plan which include:

A lack of experience with strategic planning

Authoritative leadership styles may inhibit the sharing of ideas

Clinical thought processes promote risk aversion which stifles change

Differences between clinical and administrative prioritization

Managing extroversion and agreeableness in the strategic planning process

Another challenge Quach identified is that new physician-leaders is the “obvious” trap of mission and vision healthcare.

“In many organizations that I have been in, the typical person thinks that we know our mission and vision is we’re here to deliver excellent care to patients,” he says. “Often the reality is, a really good mission and vision is not all about reiterating what we all do as healthcare providers.”

He says a good strategic plan is more about what kind of excellent care the organization sees itself providing to patients.

A physician CEO gives advice on strategic planning for new physician-leaders

MGMA 2019: A physician-leader’s guide to strategic planning

Samantha Beatty, director of operations at Women’s Healthcare Associates LLC, and Linda J. Carpenter, CEO of Carpenter Smith Consulting, paired up at MGMA 2019 in New Orleans to give a lecture about tips women to find leadership success.

In the professional world, women have not always had the same leadership opportunities as men. Recent data shows that even though 52.9 percent of the college educated workforce is female, only 26.5 percent of executive and senior level positions are held by women, Carpenter said.

“It has historically been difficult for women to be in leadership roles,” Carpenter said. “As a result, it was more challenging to want to support other potential new female leaders because you were seen as having to drive for yourself first, in order to maintain the same sort of floor as your male counterparts.”

This leads to what has led to a phenomenon known as “queen bee syndrome”.

“Oftentimes women drive for themselves first and not always support one another,” Carpenter said. “Women would get into these leadership roles, and they wouldn't support other women, because they would feel so threatened.”

As the number of women in the workforce continues to grow, there has been an increased need for effective leadership skills to help combat “queen bee syndrome”.

Carpenter and Beatty talked about their three-step system that they believe will help women in leadership roles everywhere, specifically when faced with a difficult situation. 

“The pause is a very active process in which you ask yourself, ‘is what I’m about to do or say in alignment with my goals?’” Carpenter said. “Leaders need to stop being reactive and they need to be able to be responsive.”

One of the most useful ways to approach conflict is by understanding what motivates you and the other person. Usually, fear is a motiving factor in these situations.

“This is where you pay close attention to the circumstances,” Carpenter said. “Nobody who’s confident and strong acts like a jerk, right? So, how do you increase their sense of safety?”

“There’s always obstacles and challenges and there’s of people who get stopped by those,” Carpenter said. “But the really inspiring leaders, they will start to think, ‘well, gosh, there's this really cool obstacle.’”

Beatty shared an example where she used the three steps to make the best of a challenging situation.

Her story focused on a new position where she was suddenly in charge of a large group of people. During a meeting, one of these employees said Beatty didn’t care about them, and Beatty had to pause, reflect, and act.

“I stood there and I kind of grabbed my hands, which I do when I'm trying to ground myself. I said, ‘Wow, thank you, that took a ton of courage,’” Beatty said. “I said, ‘I bet
	that if you were thinking that, that there are a bunch of other people in this room that are thinking about that, too, so let's talk about it.’”

Beatty said she shifted that meeting’s agenda to have a discussion about the concerns that employee brought up.

“I needed to hear from them,” she said. “I needed to make it safe.”

Carpenter ended the session with a call to action.

“Given what you’ve heard here, what will you do in the next week to more fully step into the leader in you? Name it and put a stake in the ground.”

As opportunities increase in healthcare, how can women prepare to take on leadership roles?

MGMA 2019: Three tips for women leaders

Making the leap from a physician to a physician-leader can be a struggle, says Steve Quach, MD, CEO of CarePoint Health in Denver, in an October 15 session at MGMA 2019 in New Orleans.

Quach says that many physicians received little to no leadership training. Because of this, part of the complication in transitioning from doctor to physician-leader lies in the difference in clinical thinking and leadership thinking.

a clinician acts as the subject matter expert while a leader is just a subject matter expert

clinicians are authoritative leaders while leaders are more collaborative

clinicians have a short term/tactical focus and leaders focus on more long term/strategic thinking

physicians have a checklist-type mentality while leaders need to prioritize

doctors use efficient, top down communication and leaders should have expanded communication with crucial conversations

physicians delegate tasks and physician-leaders delegate responsibility

In healthcare’s current state, Quanch says the reality is a mix between a “team sport” where everyone has a voice and a hierarchy where doctors give orders and everyone else executes.

“That’s the meaning of healthcare,” he said. “Nothing happens without the stroke of a physician’s pen, or now the stroke of a keyboard.”

The problem arises when physicians take that same mentality into leadership positions, Quanch says. But he doesn’t discount the importance of physician-leaders.

That’s because physician leaders have credibility with physicians and other clinicians, understand the subject matter and the realities of practicing medicine. Non-scientific evidence suggests hospitals run by physicians produce better quality scores, Quanch says.

So he advised new physician leaders to consider the difference between authority-which is defined and limited in scope-and influence-which is broad and versatile.

“I would postulate to you that influence is the most important thing for leadership,” he says.

In order to create influence, Quanch advises physicians to use the CARVE method, which stand for: courage, authenticity, rational appeal, values, and emotional quotient.

The mental or physical strength to face danger, fear, or pain allows a leader to embrace the uncomfortable tasks that they are called upon to perform, champion change or unpopular ideas, tolerate risks that are required for success, and recognize and accept one’s mistakes and failures.

This raises challenges with physicians in relation to their training to do no harm, which leads to risk aversion, and their tendency to be mediators rather than leaders among other physicians, Quanch says.

 Being genuine, real, legitimate, or true allows a leader to show behaviors which match with their expressed beliefs, demonstrate humility, and express an appropriate amount of vulnerability.

Quanch says he feels authenticity to be the most important facer in creating influence, but many physicians might have trouble with displaying vulnerability and relatability due to their experience as clinical leaders and subject matter experts.

The ability to leverage intellectual reason appealing to the reasonable side of others allows a leader to recognize the importance of rationality in healthcare while effectively wielding data and empiric evidence.

Physicians can have trouble with this due to evidence-based medicine only supports 20 percent of current clinical practices and doctors are challenged to integrate both clinical and non-clinical rationale, Quanch says.

 The principles and standards of behaviors, and judgment of what is important which when shared increases employee trust in their leader, increases employee engagement, engages employees more than compensation and benefits.

Quanch did not identify any physician-specific challenges when it comes to values.

The ability to understand and manage not only one’s own emotions but also those of others, along with values, can create an emotional appeal which can be more powerful than a rational appeal.

For physicians, this can raise the challenge of their training and experiences focusing all of their emotional intelligence purely into the context of the doctor-patient relationship, Quanch says.

A physician-CEO offers tips on how physicians can become organizational leaders

MGMA 2019: Making the jump from physician to physician-leader

Joseph DeVeau, MD, says he started feeling burnout after he was sued.

DeVeau, MD, a physician and virtual health medical director for Privia Health out of Fayetteville, Georgia, told his story during a presentation October 14 at the Medical Group Management Association (MGMA) 2019 General Conference in New Orleans.

“[A lawsuit is] devastating for us doctors in many, many ways and had me questioning whether I was a good doctor,” he says. “It really kind of started the decline for me in terms of burnout.”

As a busy family doctor who had 4,500 patients between himself and his nurse practitioner, DeVeau tried to just push through it and felt like he was running on a “hamster wheel.” He eventually felt that he was reaching a breaking point.

“I remember I was sitting on my back-porch one February just saying, ‘I don’t want to do this anymore. I’m a good doctor, I just don’t want to do this anymore,’” he says.

That’s when he read the JAMA article title “Addressing Physician Burnout, The Way Forward”, by Tait Shanafelt, MD, the so-called godfather of physician burnout, which gave him a name to attach his feelings to, and outlined a way out.

What DeVeau couldn’t understand, though, is why his peers weren’t talking about the issue. So, he left clinical practice and entered the Brown University Master of Healthcare Leadership Program to create a conversation around burnout.

Through the program, he was tasked with identifying a problem in medicine and identifying solutions for it. He focused on the burnout he was feeling in his practice.

“Through that program, I really, kind of, healed myself and really love doing what I do again,” he says.

During the session, he helped the attendees identify what physician burnout looks like and what sort of actions can be taken to address the issue.

DeVeau says 44 percent of American physicians are exhibiting at least one symptom of burnout, including 54 percent of family doctors like himself. Symptoms include emotional fatigue, cynicism, depersonalization, and a loss of meaning in the work.

Without any intervention, patients will not be able to receive the care that they need either due to a decrease in quality or a decrease in access. It can also increase healthcare costs, he says.

There has been a decrease in burnout rates since 2014, according to DeVeau, but the top three specialties that can be affected are emergency medicine, OBGYN, and family doctors.

Throughout the session, DeVeau presented a wealth of suggestions for how to prevent and combat physician burnout. Some of these include:

Lose the mentality that a physician should do it all, or the “lone-ranger mentality”

Do “doctor-work” only, and leave administrative and bureaucratic duties to others

Use patient efficiency cards which asks them to list a few things they would like to discuss during appointments rather than allowing them to barrage you with issues

Optimize schedules so doctors can focus on patient care

Encourage doctors to be kind to themselves and keep themselves healthy

Joseph DeVeau, MD, found himself burned out due to overwork and shared tips on how to avoid the condition

MGMA 2019: One doctor's tips to reduce physician burnout

The Medical Group Management Association (MGMA) kicked off their annual conference October 13 in New Orleans with a bit of local flavor as U.S. Sen. Bill Cassidy, MD, spoke during the conference’s kickoff.

Cassidy began his speech after MGMA Board Chair Todd D. Grages, MSBA, ACMPE, and CEO Halee Fischer-Wright, MD, greeted the crowd and spoke about the conference’s goal to “ignite excellence.”

The senator, a Republican and gastroenterologist, started his remarks by urging physicians and others in the healthcare industry to bring their expertise into the political realm.

“My premise is that, unless we in healthcare, physicians and those who are so familiar with healthcare systems such as you, bring our expertise to the public policy debate, we’re going to end up with public policy that does not work,” he says. “But if we do, we end up serving our patients and our profession in a different way, but in an incredibly powerful way.”

He said that the issues of high cost of healthcare stretches across both sides of the current extreme political divide, saying that both President Donald J. Trump and Democratic presidential candidate Bernie Sanders are both trying to attack the problem of providing quality, affordable, sustainable healthcare from different angles.

Cassidy said that he believes Medicare will go bankrupt in eight years.

“Clearly Medicare gives access to quality affordable healthcare, but if you go bankrupt it is ultimately not affordable,” he says.

Cassidy expressed his distaste for the Democrats’ calls for Medicare for All and pushed for market-based solutions, decrying the “silo-ization” of care.

He spent a majority of his presentation speaking about surprise medical bills and told an anecdote about how he was preparing to get a colonoscopy when he was presented with a document to sign saying he would be liable for any costs not covered by his insurance.

“What a time to ask me, right?” he says. “I’d taken the prep, my wife had left to get a cup of coffee. I could have walked home, she had my clothes. There goes my re-election, so of course I signed it.”

Cassidy says this highlighted how even “sophisticated” people can be surprised by these issues. He also compared and contrasted the Democratic bill in House of Representative seeking to end surprise healthcare bills with the proposal he supports.

The bill Cassidy signed onto is based on the New York law governing out of network billing. If the physician or hospital is paid by the insurer less than they think is fair the two parties negotiate and if the negotiations break down the claim then goes to arbitration with the loser paying the arbitration costs.

The House’s bill is based on California’s law, which Cassidy says gives the insurance company more power than the physician group in a similar situation by forcing the hospital or physician group to just accept the insurance company’s rate.

Cassidy says he believes the issue of surprise billing will be worked out by the end of the year.

Other topics Cassidy touched on in his remarks included:

Cassidy claimed that in conversations with Federal Reserve Chairman Jerome Powell about the national deficit, which has reportedly surpassed $1 trillion this year, the chairman put the blame at the feet of healthcare and said that if something is done about those costs the deficit “goes away. Everything else is easy.”

He says Trump is making a push to bring more transparency to healthcare prices saying, “The administration has proposed that hospitals and insurers publish their negotiated rates for things which they’ve commonly before.”

Trump is also looking at Medicare Advantage as a model for where the program should go saying that premiums have decreased 34 percent over the years because of the shift to Medicare Advantage over Fee for Service.

The annual conference of the Medical Group Management Association kicked off October 13 with a presentation by Louisiana Sen. Bill Cassidy

MGMA 2019: Sen. Bill Cassidy says doctors must help fix healthcare

Â End-of-life (EOL) discussions with patients are never easy, but they can be especially difficult when the patient is of a different race and/or ethnicity than the doctor. It can lead to assumptions about the patient’s EOL care that are based on the patient’s background, or the doctor’s own implicit biases, rather than the patient’s actual preferences. To avoid this, doctors need to practice “cultural humility” and spend time getting to know patients individually before engaging in EOL discussions.Â 

Slideshows

This slideshow will guide physicians towards effective end-of-life care discussions with all patients.

ACP 2019: Overcoming racial and ethnic barriers to end-of-life care discussions

A new position paper by the American College of Physicians says Congress must strengthen the Affordable Care Act (ACA) by creating a public insurance option and expanding Medicaid coverage in all 50 states.

In addition, the ACP’s leaders said last week they plan to embark on a wide-ranging project to recommend a way forward on healthcare in the United States. They will include a viability study on Medicare for All, which has gained popularity among voters and Democratic presidential candidates as the ACA continues to face political and legal challenges nine years after it became law.

“The ACP is committed to universal coverage,” said Bob Dougherty, the ACP’s senior vice president of governmental affairs and public policy. “For too long, we feel we have been playing defense and reacting. We decided it’s time to look at if we could reinvent the healthcare system, what would it look like?”

Dougherty said the project would take an evidence-based analysis of what’s working well in healthcare and what’s not, and would take the same tact when exploring insurance options for the future, which would range from single payer to ACA public options to coverage protections building on the existing healthcare system.  The college will have more details on the project later this year.

In the shorter term, Dougherty and ACP leaders are concerned about a legal challenge to the ACA in Texas. In that case, the U.S. Department of Justice is seeking to challenge the legitimacy of the entire law. 

Dougherty said the ACP believes the Trump administration is using a “dubious legal argument” and if the case ends in the White House’s favor, it will eliminate protections for pre-existing conditions, wipe out the Medicaid expansion, and shut down the Center for Medicare & Medicaid Innovation, which develops practice and payment models to help physicians and healthcare organizations transition to value-based care.

“There would be no replacement plan,” Dougherty said. “It would create absolute chaos. We are really worried and concerned about what would happen.”

And so the position paper, which will be published tomorrow in the 

, makes a case of bulwarking the ACA. The paper, authored by Sue S. Bornstein, MD, and Ryan A. Crowley, calls to:

Create a public insurance option to “ensure enrollees have access to a variety of coverage options in their area.”

Have federal or state government ensure all patients are enrolled in coverage, either by creating an auto-enrollment program, instituting a penalty for failing to enroll and/or some form of individual mandate.

Increase tax credits to help patients better afford ACA marketplace coverage.

Limit the sale of individual market plans that do not comply with ACA regulations.

Increase and provide sustained funding for marketing, outreach, and patient enrollment assistance.

“The ACA has made health insurance accessible and affordable for millions of Americans, but many remain uninsured or burdened with unaffordable coverage,” the authors write in the paper. “Adopting these policies will be a step toward realizing what has been an unachievable goal: affordable, comprehensive insurance for all.”

A new ACP position paper says Congress must strengthen the Affordable Care Act by creating a public insurance option and expanding Medicaid coverage in all 50 states.

ACP calls for public insurance option; will research viability of Medicare for All

Patients with chronic conditions such as diabetes, COPD, and congestive heart failure are some of the most challenging for physicians to treat. 

The good news is that there are proven strategies for physicians to help patients improve their management of these difficult conditions, said Edward Wagner, MD, MPH, an internist and director emeritus for MacColl Center for Healthcare Innovation, Kaiser Permanente Washington Health Research Institute, Seattle, Wash.

Practices that have succeeded in improving the care of patients with chronic conditions have done it by transforming their workflows and enlisting the entire staff into the care team. This ensures that each staff member to work “at the top of their license,” Wagner said. 

This team-centered approach has care benefits for patients, but it is often uncomfortable for physicians who are used to being in charge and responsible for all aspects of patient care.

“They use the practice team in ways I suspect that many of us would be uncomfortable with,” Wagner said.

“Making these changes actually reduced their burnout, not increased their burnout, because they were able to reduce their responsibility and share responsibilities with their teams,” said Wagner, who presented a lecture on managing chronic conditions at the American College of Physicians conference in Philadelphia.

“This is now the responsibility of staff, not just physicians,” Wagner added.

Wagner said patients with chronic conditions share these common needs:

Effective support so that they can competently manage their illness. 

Preventive interventions from physicians and clinicians when appropriate.

Evidenceâbased monitoring and selfâmonitoring to detect exacerbations and complications early.

Followâup tailored to severity, and more intensive management for those at high risk.

Timely, wellâcoordinated services from medical specialists and other community resources.

In the 1990s, Wagner said, chronic conditions were not particularly well managed, as quality metrics went largely unmeasured and a large percentage of physicians did not have their conditions under control.  Furthermore, office staff was barely involved, and treatment standards were not standardized. That changed with more research and emphasis on new models such as the patient-centered medical home.

Wagner said that there are key functions that practices must provide to patients to better manage chronic conditions. These include:

Population management: Staff uses data to identify and close care gaps by reaching out to patients with conditions judged by performance metrics.

Planned care: A planned visit is an encounter that uses patient data, team and practice organization, and decision support to ensure that patients receive the care they need.

Self-management support: Since managing chronic conditions often requires patients to change daily habits, practices must work with patients to create plans and help link them to services such as health coaches, nutritionists and more. Setting goals and documenting progress is key, Wagner said.

Medication management: the goal of this function is to treat to target using protocolâbased prescribing and monitoring of adherence and outcomes. Medication reconciliation is viewed as a critical intervention, Wagner said, and the process begins with a medical assistant reviewing meds before every visit. Pharmacists also have a role to play, Wagner said.

Referral management: Staff provides assistance and support to link patients to the specialists and community services they need to adhere to their treatment plans.

Care management and follow-ups: Staff stays in regular contact with patients between visits in order to address their concerns and questions. Patients with greater care needs may require more intensive monitoring.

Behavioral management: Primary care and a behavioral health team must form an “integrated care team” and share accountability for the whole health of patients with behavioral health issues such as chronic depression, addiction and other conditions.

Wagner said that this model is proven to improve patient health and boost quality metric performance. The next step, Wagner said, is for specialty clinics to work on transforming their models to make them more compatible with their primary care brethren.

Key functions that practices must provide to patients in order to better manage chronic conditions

ACP 2019: Chronic care patients improve through teamwork

Doctors know that growing numbers of their patients are having difficulty paying for their healthcare. Even so, many doctors are reluctant to bring up the question of care costs, due in part to concerns that they won’t have any solutions for patients who can’t afford the care they need. 

Helping doctors become more comfortable holding cost-of-care discussions was the goal of the session, “How to Talk to Your Patients about the Cost of Their Care” at the 2019 ACP Internal Medicine Meeting, held last week in Philadelphia. And it’s increasingly important that they raise the subject with patients, says C. Jessica Dine, MD, FACP, associate professor of medicine in the division of pulmonary and critical care at the University of Pennsylvania’s Perelman School of Medicine and one of the session’s speakers.

“Out-of-pocket costs are increasing to the point where it’s affecting patient care, which means it has a direct impact on outcomes,” Dine told 

prior to the start of the meeting. For example, some of her pulmonology patients use their inhalers less often than prescribed so as to make the medication last longer, with adverse long-term health consequences. 

In addition, she notes, cost considerations need to include indirect expenses associated with receiving care, such as taking transportation to the physician’s office and taking time off from work. For example, her patients often require chest imaging or other tests before seeing her, so they have to miss two work days if those can’t be scheduled on the same day as their appointment with her. 

Many practices have someone other than the doctor screen patients for cost concerns, but Dine prefers to do so herself. “Most of my patients are actually relieved when I bring it up,” she says. 

The good news is that doctors don’t have to have all the solutions for their patients’ cost concerns. But it is important to know that cost could be a problem, so the physician and patient together can figure out alternatives. One possibility is to develop a care plan that, while perhaps not optimal from a medical perspective, is one the patient can afford. “Coming up with a less expensive plan “B” is better than doing nothing,” Dine says.

Dine adds that doctors need to be aware of their own biases when approaching cost-of-care discussions, since it’s not always apparent for which patients costs are an issue. “I would caution health professionals to screen everybody so as to remove any implicit bias as to who might be struggling,” she says.

Dine notes that the ACP offers a variety of resources on its website to help doctors, such as suggestions for ways to raise and discuss care costs with patients, as well as tools for estimating costs when developing treatment plans. 

While some physicians fear that cost discussions will reduce the time they have to address patients’ medical issues, Dine says most studies show that most such discussions average only one to three minutes. “We’re not talking about a lot of time, and these conversations have such a huge potential impact on patient outcomes that we have to do it,” she says. “The healthcare costs patients have to shoulder nowadays is just too big for us as physicians to ignore.”  

ACP session focuses on overcoming fear of cost-of-care discussions.

Latest Conference Articles