Cooperating for better care.

Robert Whitcomb

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Aledade might offer a route out of U.S. healthcare swamp

The New York Times reports that a medical technology startup called Aledade might be demonstrating a  route or routes out of America’s healthcare swamp.

The Times reports: “The company’s software addresses {the fragmentation of American healthcare} by collecting patient data from a variety of sources, creating a helicopter view. Doctors can see which specialists a patient has visited, which tests have been ordered, and, crucially, how much the overall care might be costing the healthcare system.”

“More important, the software uses the data to assemble a battery of daily checklists for physicians’ practices. These are a set of easy steps for the practice to take — call this patient, order this vaccine — to keep on top of patients’ care, and, in time, to reduce its cost.”

“Thanks to Aledade, practices’ finances had improved and their patients were healthier. On every significant measure of healthcare costs, the Aledade method appeared to have reduced wasteful spending.”

To read the article, please hit this link.


Study: Surprise! ‘E-visits’ led to more office visits and fewer new patients

FierceHealthcare reports:

“Researchers at the University of Wisconsin and the University of Pennsylvania reviewed 5 years of healthcare encounters at a larger primary care practice, including ‘e-visits,’ phone consultations and in-office visits, and discovered that providers that accepted e-visits actually saw a 6% increase in office visits. As a result, physicians spent more time each month seeing patients in person, which led to a 15% decline in new patients, according to the study, which will be published in Management Science.

”For the purposes of the study, e-visits were broadly defined to include patient portals, electronic communication and telemedicine. But researchers say the study unearths a new layer of unintended consequences associated with technology that may not be as beneficial as some have anticipated.”

To read the FierceHealthcare summary story on the study, please hit this link.

To read the study, please hit this link.

 


CMS to reduce audit burden on physicians

 

In what might be seen as further evidence that Health & Human Services Secretary Tom Price, M.D., is taking a much more pro-physician  stance toward physicians paid by Medicare than his predecessors, the Centers for Medicare & Medicaid Services (CMS) is, in the words of Medscape “lightening the audit burden on physicians by rolling out a new approach to claims review that targets fewer providers and requires the review of fewer claims than the current approach does. This new policy reduces the likelihood that physicians who follow sound billing practices will be audited.”

“CMS explained that it was revising its medical review process to target only specific providers or suppliers who have billed Medicare for particular services, rather than all of them. Referring to the two-step process of identifying providers who have made billing errors and then educating them, the agency calls this new approach Targeted Probe and Educate (TPE). It replaces the current Probe and Educate program, which began in 2014 and targets all providers who bill for particular services or items.”

To read more, please hit this link.

 


Looking at Medicare’s ‘skeletal’ site for hospice comparison shopping

By MELISSA BAILEY

For Kaiser Health News 

Medicare has launched a web site aimed at helping families choose a hospice — but experts say it doesn’t help very much.

The Centers for Medicare & Medicaid Services this week released Hospice Compare, a consumer-focused site that lets families compare up to three hospice agencies at a time, among 3,876 nationwide. Following similar Web sites for hospitals and nursing homes, the site aims to improve transparency and empower families to “take ownership of their health,” according to a press release.

Through the website, families can see how hospices performed in seven categories, including how many patients were screened for pain and breathing difficulties, and how many patients on opioids were offered treatment for constipation.

But the measurements of quality, which are self-reported by hospices, have limited utility, some experts say. Over three-quarters of hospices scored at least 91 percent out of 100 on six of the seven categories, a recent paper in Health Affairs found. Because so many hospices reported high marks, there is “little room” for using these metrics to measure hospice quality, argued the authors, led by Dr. Joan Teno at the University of Washington.

The Hospice Compare grades are based on hospices reporting whether they followed a specific process, such as screening for pain when the patient arrives. This type of metric may lead staff to just check a box to indicate they completed the desired process, resulting in high grades for everyone, which is not helpful for consumers or for quality improvement, the authors wrote.

Meanwhile, Teno’s other research has found troubling variation in hospice quality, measured by how often hospice staff visit a patient when death is imminent.

“It’s nice that they’re at least beginning to be concerned about hospice quality,” said Dr. Joanne Lynn of the Altarum Institute, a longtime hospice physician  and researcher, of CMS’s new Web site. But “at the present time, it’s of pretty limited value.”

Lynn said people trying to choose a hospice would be better helped by other kinds of information, such as the average caseload for hospice staff; what percentage of patients are discharged alive; and whether the hospice predominantly serves nursing home patients or devotes significant resources to at-home care.

The Hospice Compare site also doesn’t say how often hospices run awry of federal regulations: Inspection reports, which contain verified consumer complaints as well as problems uncovered during routine inspections, are not part of the website, as they are for nursing homes.

Recent hospice inspection reports may be hard to find. Until a recent federal rule change, hospices could go as long as six years without being inspected. By 2018, CMS requires states to increase the frequency to once every three years.

Common quality measures for hospitals and nursing homes, such as mortality rates, don’t translate well to the hospice setting, where people are expected to die, Lynn noted.

Although Hospice Compare is “skeletal” at the moment, Lynn said, it does enable families to search which hospices are near them, and find the hospice’s phone number to start asking questions.

“I’m hoping that it continues to improve over time,” as CMS’s other consumer-focused sites have, she said.

Next year, CMS plans to add family ratings of hospices, including how timely hospice staff were when a patient needed help. CMS is also collecting data on the number of staff visits a patient received in the final week before death. That information should be made public in late 2018, a CMS spokesman said.


Video: Addressing rural staffing shortages

Video: Benjamin Chaska, M.D., chief medical officer of Catholic Health Initiatives’s North Dakota/Minnesota Division, discusses CHI’s team-based strategy to deal with rural staffing shortages. He advises thinking long term.

To watch the video, please hit this link.

 


The challenge of leadership in complex care

 

In a NEJM Catalyst piece, three physicians discuss “Leadership for Complex Care: The Ship’s Ballast in Troubled Waters.” Among their observations:

“As clinical leaders who have developed teams in different organizations to navigate complex care environments, we have long maintained that the traditional focus on who captains the ship is misguided. In many complex clinical scenarios, there is often no single right way to do things. Having many different physicians bring their attention to a difficult problem can minimize the chance that something will be missed. Specialists tend to see care from their particular perspectives and, in the absence of collaboration, may not fully appreciate the effects of a therapeutic intervention in areas where they do not usually focus.”

And:

“Novice clinicians sometimes look at the need to communicate intensively as a rite of passage — something that must be done until their colleagues gain confidence in their abilities. This thinking is misguided. The issue, again, is not that one is communicating because of a concern about competence, but because counterparts are equally invested in care. Indeed, the most experienced and skilled physicians often communicate about seemingly minor issues more frequently and adeptly than their more junior colleagues. Sharing small nuances and occurrences empowers all physicians to speak knowledgeably and consistently when they interact with families and referring doctors.”

To read the whole article, please hit this link.

 

 


Physicians warming to a single-payer system

 

By RACHEL BLUTH

For Kaiser Health News

Single-payer healthcare is still a controversial idea in the U.S., but a majority of physicians are moving to support it, a new survey finds.

Fifty-six percent of doctors registered either strong support or were somewhat supportive of a single-payer health system, according to the survey by Merritt Hawkins, a physician-recruitment firm. In its 2008 survey, opinions ran the opposite way — 58 percent opposed single-payer. What’s changed?

Red tape, doctors tell Merritt Hawkins. Phillip Miller, the firm’s vice president for communications, said that in the thousands of conversations its employees have with doctors each year, physicians often say they are tired of dealing with billing and paperwork, which takes time away from patients.

“Physicians long for the relative clarity and simplicity of single-payer. In their minds, it would create less distractions, taking care of patients — not reimbursement,” Miller said.

In a single-payer system, a public entity, such as the government, would pay all the medical bills for a certain population, rather than insurance companies doing that work.

A long-term trend away from physicians owning their practices may be another reason that single-payer is winning some over. Last year was the first in which fewer than half of practicing physicians owned their practice — 47.1 percent — according to the American Medical Association’s surveys in 2012, 2014 and 2016. Many doctors are today employed by hospitals or healthcare institutions, rather than working for themselves in traditional solo or small-group private practices. Those doctors might be less invested in who pays the invoices, Miller said.

There’s also a growing sense of inevitability, Miller said, as more doctors assume that single-payer is on the horizon.

“I would say there is a sense of frustration, a sense of maybe resignation that we’re moving in that direction, let’s go there and get it over with,” he said.

Merritt Hawkins emailed its survey Aug. 3 and received responses from 1,003 doctors. The margin of sampling error is plus or minus 3.1 percentage points.

The Affordable Care Act established the principle that everyone deserves health coverage, said Shawn Martin, senior vice president for advocacy at the American Academy of Family Physicians. Inside the medical profession, the conversation has changed to how best to provide universal coverage, he said.

“That’s the debate we’re moving into, that’s why you’re seeing a renewed interest in single-payer,” Martin said.

Dr. Steven Schroeder, who chaired a national commission in 2013 that studied how physicians are paid, said the attitude of medical students is also shifting.

Schroeder has taught medicine at the University of California-San Francisco Medical Center since 1971 and has noticed students’ increasing support for a single-payer system, an attitude they likely carry into their professional careers.

“Most of the medical students here don’t understand why the rest of the country doesn’t support it,” said Schroeder.

The Merritt Hawkins’ s findings follow two similar surveys this year.

In February, a LinkedIn survey of 500 doctors found that 48 percent supported a “Medicare for all” type of system, and 32 percent opposed the idea.

The second, released by the Chicago Medical Society in June, reported that 56 percent of doctors in that area picked single-payer as the “best care to the greatest number of people.” More than 1,000 doctors were surveyed.

Since June 2016, more than 2,500 doctors have endorsed a proposal published in the American Journal of Public Health calling for a single-payer to replace the Affordable Care Act. The plan was drafted by the Physicians for a National Health Program (PNHP), which says it represents 21,600 doctors, medical students and health professionals who support single-payer.

Clare Fauke, a communications specialist for the organization, said the group added 1,065 members in the past year and membership is now the highest since PNHP began in 1987.


Joint Commission officers criticize federal outcomes-measures system

 

A study in the Annals of Internal Medicine says that few medical-outcome measures being used or considered for federal accountability programs are adequate. Of 10 measures analyzed using four key criteria, only three fulfilled all criteria, and half of the measures met   one or no criteria.

David W, Baker, M.D., the Joint Commission’s executive vice president, and Mark R. Chassin, M.D., president and CEO of the Joint Commssion, wrote: “During the past few years, federal public reporting and payment programs have focused less on measuring processes and more on measuring outcomes, such as readmission, health care-associated infections, and mortality. [O]utcome measures must be chosen carefully to ensure that the outcomes can be influenced by providers and that differences in outcomes are attributable to disparities in the care provided rather than the result of variations in the populations of patients seen.”

As part of their conclusion, they write:

“The [National Quality Forum’s] seminal work in this area is driving the field forward to a better understanding of how best to structure patient-reported outcome measures, capture meaningful information for patients as well as providers, and lay a solid foundation for the use of these measures for accountability. Given the critical importance of these measures, we need to rapidly explore and adapt to novel methods to capture the patient voice, including the use of computer-adapted technology.”

And:

“We believe that the gold standard for assessing a risk-adjustment methodology is to compare the risk factors in the model with the true prognostic factors for the outcome that have been identified in detailed clinical epidemiology studies.”

To read the Annals piece, please hit this link.

 


Video: Taking a medical home to next level

 

Stephen Mundy, president and CEO of CVPH Medical Center, in Plattsburgh, N.Y., discusses its efforts to improve its medical-home program. To see the video,  please hit this link.


UMD Medical Center to put inpatient floors atop an outpatient facility

 

 

In an unusual arrangement, the University of Maryland Medical Center, in Baltimore plans to add three inpatient floors atop a planned 10-story outpatient center at its Midtown campus.

Karen Lancaster, a spokeswoman for the facility, told The Baltimore Sun that the hospital is, in The Sun’s words, “adding the floors in anticipation of future patient care needs and an expected expansion of services offered at the Midtown campus.”

The Sun reported: “The $100 million outpatient center at the Midtown campus, formerly known as Maryland General Hospital, won regulatory approval in March and is slated to focus on chronic disease management and community health. Construction is slated to begin soon and the building is expected to open in 2019. It will take the place of an administrative building.”

To read more, please hit this link.

 


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