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Getting Medicaid repeaters out of the E.R.

 

The New York Times reports on experiments across America meant to better manage the impoverished, mentally ill and/or addicted people who drive up Medicaid and other public-health costs by frequenting hospital emergency rooms when they could be better and (often) more economically be treated elsewhere. Cambridge Management Group has been intensely working in this area of community health.

The Times reports that the Center for Healthcare Strategies  has documented such efforts in 26 states. “Some are run by private insurers and healthcare providers, while others are part of broader state overhaul efforts. The federal government is supporting some, too, through its $10 billion Innovation Center….”

“They raise a new question for the healthcare system: What is its role in tackling problems of poverty? And will addressing those problems save money?”

“We had this forehead-smacking realization that poverty has all of these expensive consequences in healthcare,” Ross Owen, a Hennepin County, Minn., health official, told The Times. “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.”

”Now health systems around the nation are trying to buy the boots, metaphorically speaking. In Portland, Ore., health outreach workers help patients get driver’s licenses and give them essentials, such as bus tickets, blankets, calendars and adult diapers. In New York, medical teams are trained to handle eviction notices like medical emergencies. In Philadelphia, community health workers shop for groceries with diabetic patients.”

“The idea — to eliminate avoidable hospital use — went against years of economic habit. Hospitals make money by charging per visit and procedure, and fewer of both would dent revenues.”

So some jurisdictions, encouraged by Affordable Care Act incentives, have offered carrots.  Consider  Hennepin County {Minn.} Medical Center, which is paid a fixed amount per patient and gets  to keep the money even if patients  don’t show up, or use less medical care than was paid for.” Such pilot programs seek to care  for patients in places cheaper than hospitals — which is most places.


Happy news from new Hopkins workflow system

FierceHealthcare reports that a “new workflow optimization system piloted at Johns Hopkins Kimmel Cancer Center clinic could significantly benefit both doctors and patients, according to a study published in the Physician Leadership Journal.”

“Under the system, the clinic’s daily patient volume is up 31.4 percent, and for the first seven months of the year, when the clinic is typically busiest, doctors were able to see 10 patients a day, double their existing average, according to the study.

”Meanwhile, patients who made follow-up calls to the clinic about unresolved problems within 30 days of their visits fell from 34 to 22 percent, while patients who required emergency care after their visit fell from 9.9 percent to 7.9 percent.”

 


New alert system for medication adherence

 

As pressures rise on healthcare organizations to reduce hospital readmissions and other costly adventures, MedCity News reports that Cincinnati-based Medacheck  has developed an alert system for seniors and others requiring medication adherence,.

Led by chief executive officer and founder Jeffrey Shepard and founded in 2012, Medacheck is partnering with ”hospitals, long-term care facilities, physician practices and going direct to consumers and caregivers to assist with medication adherence, an issue that costs the {U.S.} healthcare system up to $300 billion” a year.


Privacy fears vs. need for national patient ID’s

 

Nati0nal patient ID’s are essential f0r healthcare technology’s long-term success but endless hacking floods many with doubts that privacy can be protected.

 


‘Reimagine our work in a digital environment’

 

Robert M. Wachter, M.D., in “Why Healthcare Tech Is Still So Bad,” writes:

”This means training students and physicians to focus on the patient despite the demands of the computers. It means creating new ways to build teamwork once doctors and nurses are no longer yoked to the nurse’s station by a single paper record. It means federal policies that promote the seamless sharing of data between different systems in different settings.

”We also need far better collaboration between academic researchers and software developers to weed out bugs and reimagine how our work can be accomplished in a digital environment.”


Do solons unfairly harass health agencies?

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Do federal legislators engage in too much heckling and other harassment of hard-working healthcare agencies?


Technological ‘exuberance’s’ threat to healthcare

 

They write:

“{A} very serious and insidious deficit also plagues our optimistic, ‘benefit-oriented’ outlook on innovation and progress in corporate medicine. We do not always place sufficient emphasis on the concept of ‘harm’. That is, in our quest to save lives and innovate, the cost to those who do not benefit is often disregarded or minimized.”

”We do not focus enough on whether the harm brought about by our ‘beneficial advances’ could have been avoided – nor do we evaluate the tangible and intangible costs of advancement when we construct our new standards of care.”

“{W}e may be on an ‘irrationally exuberant‘ path to financial and spiritual ruin in medicine, despite our best intentions. Our financial markets have demonstrated this phenomenon repeatedly over the past three decades in America.”

“Of course, this irrational exuberance in American medicine stands to be dramatically worsened by medicine’s corporate nature today.”

 

 


Population health in Medicaid delivery systems

 

A Milbank Memorial Fund report’s  writers conclude that ”Medicaid ACOs have the potential not only to align payment and care delivery incentives to promote high-quality, well-coordinated care, but also to improve population health within their enrolled population and beyond. States, in conjunction with county governments and commercial payers, can help ensure that Medicaid ACOs play an important role in improving health outcomes across the life course by (1) requiring ACOs to incorporate population health–focused design and governance structures, patient services, metrics, and information-sharing systems; and (2) focusing on building strategic partnerships between ACOs and other population health–oriented entities. States that incorporate population health components in Medicaid delivery system reforms will experience health improvements and cost reductions—but these improvements will only reach the height of their potential if states coordinate these initiatives with other agencies, insurers, and providers.”


Physicians’ bias and black lives

 

In  an essay in The New England Journal of Medicine, David A. Ansell, M.D., and Edwin K. McDonald, M.D., discuss “Bias, Black Lives, and Academic Medicine.’

Among their conclusions:

“First, there is evidence that doctors hold stereotypes based on patients’ race that can influence their clinical decisions. Implicit bias refers to unconscious racial stereotypes that grow from our personal and cultural experiences….Although explicit race bias is rare among physicians, an unconscious preference for whites as compared with blacks is commonly revealed on tests of implicit bias.

“Second, despite physicians’ and medical centers’ best intentions of being equitable, black–white disparities persist in patient outcomes, medical education, and faculty recruitment. In the 2002 report Unequal Treatment, the Institute of Medicine (IOM) reviewed hundreds of studies of age, sex, and racial differences in medical diagnoses, treatments, and healthcare outcomes.The IOM’s conclusion was that for almost every disease studied, black Americans received less effective care than white Americans. ”

 


The physician-patient surveillance society

 

This JAMA article says physicians must get used to the idea that patients may be recording each encounter.

Sounds scary, but the authors close their essay with:

”Unless federal or state laws change, physicians should be aware of the possibility that their conversations with patients may be recorded. If physicians embrace this possibility, establish good relationships with their patients, provide compassionate and competent care, and communicate effectively and professionally, the motives of patients and families in recording visits will be irrelevant.”


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