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More and more hospital mobility

A new  Zebra Technologies study predicts that 97 percent of bedside nurses and 98 percent of physicians will use mobile devices in hospitals by 2022.

The Zebra researchers last year connected with 1,500 nursing managers, IT decision makers and recently hospitalized patients in the United States, Brazil, China, Kuwait, Saudi Arabia, United Arab Emirates, Qatar and United Kingdom.

Respondents predict that mobile devices  will become much more integrated into the healthcare experience, with, for example, 92 percent of surveyed nurses anticipating being able to access medical and drug databases using mobile devices by 2022.

“[T]here is a higher demand for services and support that are not sustainable with existing resources and methods,” the study notes. “Hospitals are increasingly turning to technology and automation to reduce the strain on an already fragile system.”

To read more, please hit this link.


Hospitalizations in the current flu epidemic

The New York Times looks at  the extent and geography of hospitalizations in the  current  national flu epidemic and what’s making it so bad this year.

To read the article, please hit this link.


Experts look at Amazon-Berkshire-JPMorgan health project

From Kaiser Health News

 

An announcement Tuesday by three of the nation’s corporate titans — Amazon, Berkshire Hathaway and JPMorgan Chase & Co. — that they are joining forces to address the high costs of employee healthcare has stirred the health policy pot. It immediately sent shock waves through the health sector of the stock market and reinvigorated talk about healthcare technology, value and quality.

Though details regarding the undertaking are thin, the companies said in a release that their partnership’s intent is to improve employee satisfaction and hold down costs by bringing “their scale and complementary expertise to this long-term effort.”

They plan to create an independent company, “free from profit-making incentives and constraints,” to focus on “technology solutions.”

Berkshire Hathaway CEO Warren Buffett described healthcare costs as “a hungry tapeworm on the American economy,” and Amazon founder and CEO Jeff Bezos said the partnership was “open-eyed about the degree of difficulty” ahead. Jamie Dimon, chairman and CEO of JPMorgan, said the results could benefit the employees of these companies and possibly all Americans.

But what does all of this mean and how can it be successful when so many other initiatives have fallen short? KHN asked a variety of health policy experts their thoughts on this venture, and what advice they would offer these CEOs as they go forward. Some of the advice has been edited for clarity and length.


Tom Miller, resident fellow, American Enterprise Institute (Courtesy of Tom Miller)

Tom Miller, resident fellow, American Enterprise Institute:

“It’s great that someone theoretically with resources would try to build a better mousetrap. But it’s been difficult to do, and part of it is regulatory and competitive barriers are well-constructed in the health care sphere, which tend to make it less receptive or subject to competitive pressures.

“I welcome any new capital trying to disrupt healthcare. … The incumbents are comfortable and could use disruption. If Amazon has an idea, and is willing to put some money behind it, that’s wonderful. What they are willing to do other than fly low-cost providers for home visits in drones — I don’t know. They’d probably have to miniaturize them, wouldn’t they?”


Stan Dorn, senior fellow, Families USA (Courtesy of Stan Dorn)

Stan Dorn, senior fellow, Families USA:

“Number one, look at prices. America doesn’t use more healthcare than European countries, but we pay a lot more and that’s because of prices more than anything else. Look at hospital prices and prescription drug prices. I would also say, look to eliminate middlemen operating in darkness. I’m thinking in particular of pharmacy benefit managers. Often, the supply chain is hidden and complex, and every step along the way the middlemen are taking their share, and it winds up costing a huge amount of money.”


Bob Kocher, partner, Venrock (Courtesy of Bob Kocher)

Bob Kocher, partner, Venrock:

“It has been said that healthcare is complicated. One thing that is not complicated is that the way to save money is to focus on the sickest patients. And that’s the only thing that has proven to work in great primary care. I hope Amazon realizes this early and does not think that [its smart digital assistant] Alexa and apps are going to make us healthier and save any money.

“It would sure be nice if they invest in a ‘post-CPT-ICD-10-and-many-bills-per-visit’ world where we know prices, can easily know what is known about quality and experience, and have same-day service.”


Tracy Watts, senior partner, Mercer (Courtesy of Tracy Watts)

Tracy Watts, senior partner, Mercer:

“Everyone thinks millennials want to do everything on their phones. But that’s not necessarily the case.

“[There was a recent] survey about this — specifically, millennials are the most interested in new healthcare offerings, but it wasn’t as much high-tech as it is convenience they are interested in — same-day appointments with a family doctor, guaranteed appointments with specialists, home visits, a wider array of services available at retail clinics. That was kind of an ‘aha’ — this kind of convenience and high-touch experience is what they’re looking for. And when you think of ‘health care of the future,’ that’s not what comes to mind.”


John Rother, president and CEO, National Coalition on Health Care (Courtesy of John Rother)

John Rother, president and CEO, National Coalition on Health Care:

“Health care is complex and expensive, so the aim should always be simplicity and affordability. Three keys to success: manage chronic conditions recognizing the life context of the patient, emphasize primary care-based medical homes and aggressively negotiate prescription drug costs.”


Suzanne Delbanco, executive director, Catalyst for Payment Reform (Courtesy of Suzanne Delbanco)

Suzanne Delbanco, executive director, Catalyst for Payment Reform:

“The biggest driver of health care costs is prices. Those are being driven up by health care providers who have consolidated and will continue to consolidate and amass more market power.

“It sounds like they [the companies] are limiting the use of health plans, but if they’re going to get into that business, they’re going to come up with the same challenges health plans face. What would be really innovative would be to build some provider systems from the ground up where they can truly get a handle on the actual costs and eliminate the market power that drives the prices up, and they can have control over their prices.”


Brian Marcotte, president and CEO, National Business Group on Health (Courtesy of Brian Marcotte)

Brian Marcotte, president and CEO, National Business Group on Health:

“They recognize this is [a] long-term play to get involved in this. I’d have to say, this industry is ripe for disruption.

“I think we know technology will continue to play an increasing role in how consumers access and receive healthcare. We’ve also learned most consumers do not touch the health care delivery system with enough frequency to ever be a sophisticated consumer. What’s intriguing about this partnership is Amazon for many consumers has become part of their day-to-day world, part of their routine. It’s intriguing to consider the possibilities of integrating health care into consumer routine.

“And I think that therein lies the opportunity. Employers offer a lot of resources to their employees to help them maximize their experience, and their No. 1 challenge is engagement.”


Joseph Antos, health economist, American Enterprise Institute (Courtesy of Joseph Antos)

Joseph Antos, health economist, American Enterprise Institute:

“My first suggestion is to look at what other employers have done (some unsuccessfully) and consider how to adapt those ideas for the three companies and more broadly. Change incentives for providers. Change incentives for consumers. Work on ways to reduce the effects of market consolidation. The bottom line: Don’t keep doing what we are doing now. I don’t see that these three companies have enough presence in health markets to pull this off anytime soon, but perhaps this should be viewed as the private-sector version of the Affordable Care Act’s Innovation Center — except, this time, there may be some new ideas to test.”


Ceci Connolly, president and CEO, Alliance of Community Health Plans (Courtesy of Ceci Connolly)

Ceci Connolly, president and CEO, Alliance of Community Health Plans:

“We know that 5 percent of any population consumes 50 percent of the health care dollar. I would encourage this group to focus on how to better serve those individuals who need help managing multiple chronic conditions.”


David Lansky, CEO, Pacific Business Group on Health (Courtesy of David Lansky)

David Lansky, CEO, Pacific Business Group on Health:

“The incumbent providers of services to our members are not doing as much as we need done for affordability and quality. So, we are pleased to see them go down this path. We don’t know what piece of the puzzle they will tackle.

“We know well-intended efforts over the years haven’t added up to material impact on cost and quality. I would suspect they are looking at doing something broader, more disruptive than initiatives we have tried before.

“I think across the board they have the opportunity to set high standards for the health system in whatever platform they use. These companies have a history of raising the bar. Potentially, it could be a help to all of us.”

Staff writers Julie Appleby, Rachel Bluth, Jenny Gold, Jay Hancock, Shefali Luthra, Jordan Rau, Julie Rovner and Chad Terhune contributed to this report.


Taking on the ‘tapeworm’: 3 huge firms forming healthcare company to lower costs and improve care

News that Amazon, Berkshire Hathaway and JPMorgan Chase are forming an independent healthcare company to serve their  U.S. employees is probably very good news for those seeking cheaper and better healthcare in what is now among the Developed World’s worst healthcare systems, albeit very profitable for many physicians, hospital executives and insurers. The three companies are so big and powerful that many institutions will feel compelled to follow their lead.

The new enterprise would initially focus on technology to develop simplified, high-quality  care for their employees and their families at a reasonable cost.  The American healthcare system is by far the world’s most expensive on a per-capita basis as well as its most complicated, confused and inefficient.  And medical outcomes are worse than in most of the Developed World.

The companies said the initiative would be a long-term effort “free from profit-making incentives and constraints.” That’s bad news for our currently heavily profit-driven system of providers and insurers.

As The New York Times noted, the announcement “illustrates the rapid changes affecting the healthcare industry in the United States, where lines that have separated traditionally distinct sectors, like care provision and insurance, are increasingly blurred. CVS Health’s deal last month to buy the health insurer Aetna for about $69 billion is just one example of the shifts underway.” The project by the three huge companies could be very bad competitive  news for the likes of CVS.

It could also be very bad news for some providers now making big profits.

“The ballooning costs of health care act as a hungry tapeworm on the American economy. Our group does not come to this problem with answers. But we also do not accept it as inevitable. Rather, we share the belief that putting our collective resources behind the country’s best talent can, in time, check the rise in health costs while concurrently enhancing patient satisfaction and outcomes.”

To read the article, please hit this link.


Many Boomers want to leave their providers

 

Many Baby Boomers are surprisingly willing to leave their providers.

As an article in Medical Economics notes ” {P}roviders have thought that patients generally left a practice only for a couple of reasons: changes in insurance or a personal move to a new location. Times have changed, and the Patient Provider Relationship Study recently revealed that this just isn’t the case anymore.”

“When patients were asked if they were considering leaving their provider in the next two years, about one in three said they were. When broken out by generation, Millennials were the most likely to be thinking about switching, but even Boomers were at risk. Twenty percent of Baby Boomers said they were at least considering switching primary care providers. They cited such  issues as dissatisfaction with the office staff, poor communication, feeling more like a number than a person, and difficulty with scheduling.”

To read the study, please hit this link.

To the Medical Economics article, which gives guidance on how providers can retain patients, please hit this link.


Hospitals not using drug-discount-program savings to improve care for the underserved

A new study says that hospitals that have been saving money through 340B program discounts have generally not been been using  those savings to improve care for low-income and  other underserved patients, although that’s been one of the program’s missions.

Researchers at Harvard Medical School and the New York University School of Medicine studied data on Medicare beneficiaries from hospitals with 50 or more beds that were just above or below the 340B program’s 11.75 percent disproportionate share hospital threshold.

According to FierceHealthcare, “They found that hospitals eligible for 340B discounts administered more drugs, and also increased their ability to administer more drugs by absorbing physician practices, particularly in oncology. The study, which was published in the New England Journal of Medicine, found that 340B participation was linked to an increased number of hematologist–oncologists, ophthalmologists or rheumatologists working in the hospital.

“The study also analyzed the impact of the program on quality improvements and mortality rates for low-income patients and found little evidence that hospitals were investing the 340B savings in these areas. ”

“We found evidence of hospitals behaving in ways that would generate profits, by building their outpatient capacity to administer drugs,” Sunita Desai, Ph.D., an assistant professor in the Department of Public Health at NYU School of Medicine and the study’s senior author, said in a public announcement.  “But we did not see any evidence that hospitals are investing those profits in safety-net clinics, expanding access to care for low-income Medicare patients or improving mortality in their local communities as the program intends.”

To read the New England Journal of Medicine article on the study, please hit this link.

To read the Fierce report, please hit this link.

 


New, unified health system planned for Brooklyn

Kingsbrook Jewish Medical Center, a partner hospital in the new “One Brooklyn Health”.  It looks remarkably bucolic for a institution in Brooklyn.

New York Gov. Andrew Cuomo has announced that the state is setting  aside $664 million to create a new, unified health system in Brooklyn.  $70 million of that will be reserved for a new technology platform.

Through a partnership with three existing providers—Brookdale University Hospital Medical Center, Interfaith Medical Center and Kingsbrook Jewish Medical Center—the state will build a 32-site ambulatory-care network in one of the most vulnerable (in terms of poverty) areas in the state.

The state estimates that the new network,  “One Brooklyn Health,” will add up to 500,000 new ambulatory visits each year.

The aforementioned $70 million will be used to build an “enterprise-wide health information technology platform”  for a single medical-records system across the three partnering hospitals and the rest of the provider care network. This, it is hoped, will permit uniform measurement of medical and social determinants of health.

To read more, please hit this link.

 


The great potential of improving nonvisit care

They write in NEJM Catalyst that “Face-to-face interactions will certainly always have a central role in healthcare, and many patients prefer to see their physician in person. But a system focused on high-quality nonvisit care would work better for many others — and quite possibly for physicians as well. Virtually all physicians already use nonvisit interactions to some extent, but their improvised approaches could be vastly improved if health systems were designed with such care as the explicit goal.”

To read their essay, please hit this link.

 

 


How some hospitals responded to unexpected disasters

By ANA B. IBARRA

For Kaiser Health News

It was 3:35 a.m. and flames from a massive Northern California wildfire licked at the back of a Santa Rosa hospital.

Within three hours, staffers evacuated 122 patients to other facilities — something they’d never come close to doing before. Ambulances sped off with some of the sickest patients; city buses picked up many of the rest.

With phone lines charred and communication restricted, doctors and nurses struggled to figure out who was sent where — forced to keep their wits even as some of their own homes burned and their families fled.

This was not exactly covered in their meticulously executed drills and disaster-preparedness videos.

“You never know how you’ll react until it comes your way … until fate taps you on the shoulder,” said Dr. Josh Weil, an emergency medicine physician at Kaiser Permanente in Santa Rosa who led the hospital evacuation operation on Oct. 9.

America’s hospitals were beset by an unusual number of calamities in 2017: The fires that raged in Northern and Southern California; hurricanes that displaced thousands in Houston, Florida and Puerto Rico; the deadliest mass shooting in modern history that killed 58 people and wounded more than 500 others in Las Vegas; and the attack at a Bronx hospital in which a doctor turned a gun on his former colleagues, killing one and injuring six.

Across the country, natural disasters have become more frequent and more deadly; the carnage from mass shootings resembles that on a battlefield. In some cases, these crises are more severe and elaborate than most hospitals — particularly smaller ones — are prepared for, and experts say it is time to bring facilities up to speed.

“The probability that any individual hospital will be involved in an unusual event is increasing,” said Dr. Carl Schultz, professor emeritus of emergency medicine and public health at the University of California-Irvine. “All hospitals are potentially vulnerable,” he said, and “there is more pressure for hospitals to be prepared.”

That’s the case, he added, even though hospitals often lack the resources and funding to upgrade their disaster plans.

In the new year, hospitals that responded to outsized tragedies in 2017 are reassessing their plans in light of their painful experiences. Below are some instructive examples:

Keeping Track Of Patients

In Northern California, staffers from the Kaiser hospital in Santa Rosa rushed to clear out their wards as the ferocious Tubbs Fire approached. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

The original plan was to jot down details from each displaced patient’s identification bracelet so that the hospital could later confirm that patients arrived at other hospitals safely. But with the fire coming fast upon them, it became clear this would take too long, Weil said.

On the fly, one staffer suggested taking photos of patient wristbands with smartphones, he said.

“That was a brilliant idea that really saved us,” Weil said.

The hospital is now considering whether smartphones might be of greater use in future emergencies, or if there’s a more efficient way to track patients who must be rapidly whisked away.

Eight days earlier, another tracking issue surfaced at Sunrise Hospital & Medical Center, in Las Vegas — this one concerning incoming patients. The facility was suddenly inundated by people shot or otherwise injured during the tragedy at the outdoor country music festival; 212 patients were admitted in a two-hour window, 124 of them with gunshot wounds.

Of those, 92 had no official photo identification on them.

Families dashed desperately from one hospital to another searching for their loved ones, said Alan Keesee, the hospital’s chief operations officer. Without IDs for patients, it was a challenge to confirm whether they were at the hospital, let alone whether they would be OK.

Enterprising staffers listed their unidentified patients’ physical traits and unique features, such as tattoos, to help match people with the descriptions family members provided. In turn, many relatives pulled up social media profile photos of their loved ones to give the hospital something to go by.

The chaotic process of patient identification exposed a desperate need for a centralized data hub where descriptions of unidentified patients in a massive emergency could be uploaded and accessed by all area hospitals, Keesee said.

And indeed, he said, his hospital is working with the Nevada Hospital Association and other local health agencies to determine whether the hub can be created.

Communication And Coordination

Last June, a former doctor stormed Bronx-Lebanon Hospital armed with a semiautomatic rifle.

Staff members had trained for just this kind of incident. But they had not anticipated how restricted their movements would be once police took over, said Dr. Sridhar Chilimuri, the physician-in-chief that day.

“Shooting victims need blood transfusions, so you need to get from the blood bank to the operating rooms quickly,” Chilimuri said.

But the hospital lockdown blocked access to elevators. Doctors and nurses also had to fetch surgical instruments and move patients, he added, but they couldn’t do so without approval from police.

Because it was an internal shooting, police had to clear staffers of suspicion before they could return to work — even the doctors needed for lifesaving operations.

The hospital has since updated its drills to include an accelerated process of police screening — targeting the medical staff most urgently needed — and its training videos now show an attacker armed with an assault weapon rather than a small handgun.

“Hopefully that will help us cut down on the time we are crippled,” Chilimuri said.

Running Low On Supplies

When Hurricane Irma barreled into South Florida in September, the 10 Tenet Health hospitals in the region felt ready.

They had beefed up their disaster plans after Hurricane Matthew landed a year earlier, said Cathy Philpott, a director of nursing practice and clinical operation for the hospital system. They also brought in staff from other states and rolled in backup generators, she said.

Even so, they faced an unexpected challenge: a shortage of platelets, cells that help the body form clots to stop bleeding.

Until sister hospitals in Boston could airlift platelets in, the hospitals had to work with local blood banks to conserve the supply and prioritize their use for trauma patients. When hurricanes are forecast in the future, the hospitals will reach out to local blood banks and host platelet drives as the storms approach, Philpott said.

“That’s the lesson learned,” she said.


Time to move faster to health-system decentralization

 

Kent Bottles, M.D.,  writes in an essay in FierceHealthcare that now is the time for hospitals to move to much more decentralized healthcare-delivery system. Among his remarks:

“Seven years ago, I anticipated this developmen {the need for decentralization}  and proposed that hospitals must totally rethink their mission and strategy by becoming Community Hubs of Wellness and Health. The traditional clinical delivery system model—organized around a centralized hospital that provides diagnosis, treatment and disease management—simply no longer makes sense.

“Community Hubs of Wellness and Health would:

  • “Support a community’s embrace of the Healthy People 2020 program goals, which provide science-based 10-year national objectives for improving the health of Americans
  • “Create links between hospitals and other community groups
  • “Become a meeting place that is seamlessly integrated into the community
  • “House a trusted repository for advice on how to use new technologies—such as digital devices, AI virtual reality—to attain wellness
  • “Connect with diverse communities as the demographics of a community changes.”

To read his essay, please hit this link.


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