Cooperating for better care.

Robert Whitcomb

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Measuring the benefits of physician coaching

An article in NEJM Catalyst reports:

“Effective clinician-patient communication is essential for high-quality care and is linked to better patient adherence and greater satisfaction for both patients and clinicians. Direct one-on-one coaching has the potential to improve clinician-patient communication as well as clinician and patient satisfaction compared with other techniques commonly used. We tested its effectiveness in a randomized controlled trial of 62 clinicians at Duke University School of Medicine.

“High-quality care depends on effective communication between clinicians and patients. Effective communication comprises several components of patient-centered communication, including exchanging information, enabling patient self-management, and managing emotions.

“Robust evidence links effective communication to important patient outcomes, such as better adherence to instructions, greater satisfaction, and fewer malpractice suits.

“Further, evidence shows links between communication and clinician satisfaction. Satisfied clinicians are less likely to depart from an already understaffed workforce and make fewer medical errors….

“We found that the coaching improved patient satisfaction ratings and clinician communication skills. Coaching represents a method of teaching that requires little clinician time and seems to have a positive impact. This is consistent with a recently published study that showed that four coaching sessions had a greater impact on oncologist communication than just one.”

To read the article, please hit this link.

Rembrandt’s “The Anatomy Lecture of Dr. Nicolaes Tulp.”

How to avoid making physicians obsolete

Milton Packer asks in a Med Page Today piece if biomarkers will eventually replace physicians. He concludes:

“{I}F you are a non-procedural physician — someone who is paid to interact with patients, make a diagnosis, order tests, and prescribe non-procedural treatments — your days may be numbered. Artificial intelligence can easily do all of these things, with no need for an expensive intermediary.

“Artificial intelligence can even be programmed to say hello, ask about symptoms, and provide comforting words. The computer would be very thorough and can be programmed to be very empathetic. Arguably, some patients might not even notice the absence of a human presence, or miss it.

“Fortunately, that day has not yet arrived.

“However, if you are a physician who robotically moves through their daily routine with minimal patient interaction and with a heavy reliance on ordering and treating biomarkers, you are only one step away from making yourself obsolete. In ten years from now, who will need you?

“So here is my advice to all healthcare providers: The mission of delivering healthcare is being a healer — a uniquely human experience. If you do not want to be replaced by a computer, then you should stop acting as if you are following a programmed algorithm.

“Think about that the next time you order your next routine biomarker.”

To read his whole piece, please hit this link.

After a heart attack some cardiac biomarkers can be measured to determine exactly when an attack occurred and its severity.

How to nurture a hospital

Madeline Bell, the CEO of Children’s Hospital of Philadelphia, discusses how to cultivate a better culture in hospitals. Among the observations of the former nurse in Becker’s Hospital Review:

The infrastructure has to be in place so you have collaborative space with ways to mine new ideas, cultivate them and take them to the next level. On the people side, it’s about hiring people with new ideas from outside of your organization and, at the same time, promoting the right people from within. Half my team is promoted from within and half come from the outside, so there are new ideas and ways of looking at things. The cultural piece is always a journey. Hospitals used to be relentlessly standardized and deliver things the same way, because you want to be highly reliable and not harm patients. That’s really important, but it has to coexist with the spirit of innovation and entrepreneurship. Hospital leaders and staff have to coexist with the idea that they can make mistakes and learn from them to think about new ways of solving problems.”

To read the whole article, please hit this link.

Orszag touts healthcare vertical integration, experimention

Peter Orszag, vice chairman and global co-head of healthcare at Lazard, discusses the need for vertical integration and experimentation in a piece in NEJM Catalyst, which summarizes four of his points thus:

  1. “There is significant opportunity to improve value in health care; recent research indicates both the availability of that value improvement and where it may reside.
  2. “To create and capture that improved value, it’s important to influence what doctors recommend.
  3. “To influence doctors’ recommendations, change the financial incentives and information that providers face. The best approach to doing that is vertical integration.
  4. “It is a mistake to elevate the status quo in asking whether the alternative is better than today. Instead, ask, “Is the alternative statistically worse than today?” If it’s a draw, try something else — experiment aggressively.’’

To read and hear his remarks, please hit this link.

5 steps to transform U.S. healthcare into a true ‘system


In a MedPage Today piece, Stephen Parodi, M.D.,  chairman of the Council of Accountable Physician Practices (CAPP), a coalition of multi-specialty medical groups and health systems,  presents five things needed to improve America’s mediocre medical-delivery world.

He notes that ”to improve the healthcare industry’s quality and costs, we need a true ‘system,’ with coordinated care delivered by teams linked by technology that closes the gaps in our current fragmented structure. ”

His five steps are, in an edited version:

More Value-Based Care

“First, we must continue the march toward value-based care and away from fee-for-service payments. Payment by service discourages the cooperation and collaboration each and every patient deserves. Fee-for-service payment increases the likelihood of poor communication. In contrast, when healthcare providers are paid based on their ability to improve the patient’s condition, the care team and the patient can come together to achieve common goals. Consequently, outcomes are better, and resources are used wisely.”


“Second, we need to accelerate the journey toward interoperability. Everyone on the care team needs the latest information on the patient’s condition, at their fingertips at all times. When everyone is connected to the medical record, the best, most timely decisions are made and errors avoided.”

Balance Digital and In-Person Care

“Third, we must rapidly move forward to leverage digital communication in patient care and in physician-to-physician consults.”

Address Drug Prices

“Fourth, high drug prices must be addressed and remedied. When patients can’t afford their medications, they can’t get the treatment needed. … Fortunately, there may be bipartisan support for solving this problem. We need better, independent data to assess new therapies so we truly understand which patients need a particular treatment. We need to subject high drug prices to public scrutiny and oversight and give Medicare, purchasers, and patients more tools to rein in escalating drug prices.”

Let’s Set Standards

“Finally, we must establish common consensus standards to measure quality care. Patients, health plans, providers, government entities – everyone needs clarity on the high-impact, minimum set of quality measures that capture outcomes and patient experience. We must leverage the electronic medical record to lower the administrative burden of collecting measures.”

To read his whole article, please hit this link.


Benefits of patient safety organization alignment


An article in Medical Economics discusses how providers can benefit from patient safety organization (PSO) alignment.

The article concludes:

“By aligning with a PSO, a provider’s internal deliberations and analysis conducted within its own patient safety evaluation system are also privileged and confidential PSWP (patient safety work products).  As a result, a provider can evaluate its own data before sending it to a PSO, and can also consider a PSO’s recommendations in a completely privileged and confidential setting that avoids the scrutiny of regulators and potential litigants.

“The other major benefit of alignment with a PSO for providers involves improvement of patient safety and clinical outcomes. By contracting with a PSO, providers gain immediate access to evidence-based recommendations on quality issues confronting their peers, as well as empirically-based recommendations on how their practices might be improved and made more efficient. ”

To read the article, please hit this link.


Opioid crisis helps energize leaderships and create partnerships


Three physician leaders in Michigan agree that it takes a health crisis, such as opioid-addiction disaster, for partnerships to form to try to adequately address the issue.

One of the three, John Ayanian, M.D., said, in an NEJM Catalyst conversation: “A crisis can often unmask deep, underlying disparities and disadvantage in the communities we serve.” Dr. Ayanian is the inaugural director of the Institute for Healthcare Policy and Innovation, which includes over 500 faculty members from 14 schools and colleges at the University of Michigan.

To read and hear the conversation, please hit this link.





2019 outlook for not-for-profit hospitals not that grim


The financial outlook for not-for-profit hospitals has sounded  dismal for the past several years. As FierceHealthcare reports:

“They face ongoing pressures of soft revenue growth, weak inpatient volumes and single-digit reimbursement increases, pushing margins down as expenses outstrip revenue—a trend that Moody’s called an ‘unsustainable path,’ earlier this year.

New reports from the two top rating agencies—Moody’s Investors Services and Fitch Ratings—offer, for yet another year for not-for profit hospitals, a gloomy outlook for 2019. But, Fierce reports:

“[W]hile these hospitals face a tough road ahead, the news is not as bad as it might seem, said Kevin Holloran, senior director at Fitch who just gave the sector a ‘negative’ outlook.

“‘We’re putting warning flags up, but no ones calling for disaster,’ Holloran said. ”

”He acknowledged operating margins have been on the decline while hospitals deal with nontraditional competition, new technology changing the way medicine is practiced and the continued shift from inpatient to outpatient care. ‘But pretty much, however, you want to measure it, balance sheet strength is pretty much at an all-time high.”’

“He pointed specifically to hospitals’ days’ worth of cash on hand, as well as their cash-to-debt and debt-to-capitalization ratios as measures in particular that had been improving over time, leading to stable ratings for the sector.

“That’s because when times were good and the markets were rebounding several years ago, hospitals were building up their reserves and shrinking their capital expenditures.

“‘Until a significant market dislocation, we expect those balance sheets to remain kind of robust which is going to balance out the negatives from operations.”’

To read the whole article, please hit this link.

Relying on ’15-minute huddles’

Marc Harrison, M.D.,  CEO of  Salt Lake City-based Intermountain Healthcare, based in Salt Lake City,  writes in the Harvard Business Review about his system’s intense use of “15-minute huddles” to maximize care and efficiency.

“At Intermountain, the 15-minute huddle is the key. It enables knowledge from activities throughout the organization in the previous 24 hours to escalate up to executive leadership — Tier VI in our model — and be addressed.

“Using that 15 minutes effectively requires structure: Each huddle has a leader; the participants are designated, as is the recorder of the data; the huddle is scheduled; and the categories of reported information are captured on a prepared chart. We have four fundamentals of extraordinary care that are covered in our daily huddles: safety, quality, access, and stewardship of resources so they are used to provide the best possible care. Across those fundamentals, eight key topics are reported every day. They include potential serious safety events that could have harmed a patient, caregiver injuries, and reported downtimes (of equipment, elevators, systems or processes, for example).”

To read the article, please hit this link.

The transformation of Ohio’s healthcare


Governing Magazine looks at how a small state office in Ohio has transformed healthcare in that state. The article concludes:

“When he ran for president in 2016,  {Ohio Gov. John} Kasich took heat from his Republican primary opponents for his health-care decisions. He was assailed for expanding Medicaid, which many Republicans see as an unsustainable financial proposition that merely increases the size of government. These days, Kasich says he’s not interested in pleading his case to other Republicans about why he believes expanding and transforming health care works. He says he’s convinced history will show he made the right decision. ‘Tell me how [else] you’re going to go about meeting the needs of people. Tell me what you’re going to do to help the drug addicted and mentally ill. I haven’t heard of a better solution,’ he says. Everything else ‘is all smoke and mirrors.”’

To read the article, please hit this link.


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