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Hospitals trying to flag high medication costs

 

Hospitals around America are looking for new and creative ways to control spiraling drug costs.

For instance, as this Washington Post story reports:

“Doctors at the University Hospitals of Cleveland see an immediately recognizable symbol pop up alongside certain drugs when they sign in online these days to prescribe medications for patients: $$$$$.

“The dollar signs, affixed by hospital administrators, carry a not-so-subtle message: Think twice before using this drug. Pick an alternative if possible.”

“Here’s the thing that makes it more challenging: The patient doesn’t initially see the price increase,”  Scott Knoer, chief pharmacy officer at the Cleveland Clinic, which has built an algorithm to monitor drug prices, told The Post. “But it raises the cost for the hospital. Eventually, it catches up and it raises the cost for insurance companies, which is passed on to employers, employees and taxpayers through higher premiums and co-pays.”

The paper said that “Last year’s headline-grabbing spikes appear to have waned in recent months, perhaps because the issue has come under such an intense public spotlight.”

“I don’t think you’re going to see these 300, 400, 500 percent increases, at least for a while,” Mr. Knoer said, “even as he noted one 120 percent hike flagged by the hospital’s new algorithm.”

“We’ll still see significant increases, but it won’t be so obvious. Prices are not going down,” he said.


Mo. hospital links with Cleveland Clinic

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In another example of marketing-obsessed healthcare facilities around America linking up with the most famous institutions, St. Luke’s Hospital in Chesterfield, Mo., has  set up an exclusive affiliation with the Cleveland Clinic Heart and Vascular Institute. Chesterfield is an affluent suburb of St. Louis.  Quite rationally,  such prestigious institutions as the Cleveland Clinic, the Mayo Clinic, Johns Hopkins and the Harvard-affiliated Partners HealthCare seek out connections with affluent places where patients have generous private insurance plans.

Becker’s Hospital Review reports that under the five-year deal, Cleveland Clinic will contract directly with payers and employers to create incentives for employees to seek cardiac care from St. Luke’s.

The affiliation will  give St. Luke’s access to Cleveland Clinic clinical trials, new technology, reviews of complex cases and continuing medical education, St. Luke’s hospital officials said. St. Luke’s specialists will be able to consult with Cleveland Clinic physicians to obtain a second opinion.

Cleveland Clinic will be a consultant for the 493-bed hospital, and St. Luke’s will pay the world-famous institution for its “expertise and guidance,” said St. Luke’s CEO Christine M. Candio. Operating as a group purchasing organization, Cleveland Clinic will also help St. Luke’s buy the latest technology at a lower cost.

 


Cleveland Clinic clinicians to shadow patients

 

 

Cleveland Clinic’s executive chief nursing officer, K. Kelly Hancock, R.N., discusses in MedPage Today a new program this year at the Cleveland Clinic in which providers, such as nurses and physicians,  shadow patients during their inpatient stay or outpatient visit to better understand, she says, “what their experience is through their lens…. {It’s} important enough that it’s clearly worth the investment to take those caregivers offline.”
“….We know the best feedback is from the patient. We think it really will lend itself to some great feedback to develop stronger interventions.”


Love on hospital walls

 

In a New York Times posting, Mikkael A. Sekeres, M.D., writes about the love  that he sees in the pictures that patients and their families put on many hospital-room walls at the Cleveland Clinic, where he heads the leukemia program.

“I admire the creativity, the support, the love that I see on the walls of these rooms. I get to appreciate my patients from the time before they were sick and I can also see what they are trying to return to. I also breathe a sigh of relief that, when these patients are discharged from the hospital, they will be cared for.

“The displays increase manifold with approaching holidays, as families experience the loss of their loved one’s presence so much more acutely, and home invades the hospital, trying to bring them back.”

But:

“I worry about the patients whose walls are bare, though. These are the people who may not have a ride to the outpatient appointments and treatments that are so necessary for their survival, and who won’t have a partner at home who can call the ambulance when they spike a fever. We spend extra time with them on discharge planning, involving our social work team, to help ensure they are as safe as possible when they leave.”


Cleveland Clinic’s CIO on leadership requirements

 

In this interview, C. Martin Harris, M.D., chief information officer of the Cleveland Clinic and a practicing internist, shares his thoughts on  health-system decision making and leadership. Among his remarks:

In 2016 and beyond, CIOs should be thinking about bringing new skill sets into their organizations. To me, those skills sets would include business analyst capabilities and enterprise-wide systems design. And by that, I do not mean just information system design. In the 21st century, we must reimagine a healthcare system that will be built upon capabilities and connections that simply did not exist just a few years ago. To envision a new kind of HIT-enabled system of care, we will need people who see the role of technology in a more integrated way.”

 

 


Turning good physicians into strong leaders

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Julius Caesar.

This Medical Economics piece notes that among all the groups in healthcare, physicians are “the most likely candidates to be agents of change” in these transformative times.

So it has convened this round-table discussion of three experts to discuss how good physicians can be turned into strong leaders. The panelists are:

  • Peter B. Angood, M.D., chief executive officer and president of the American Association for Physician Leadership;
  • Maria Chandler, M.D., MBA, founder of the Association of MD-MBA Programs and the University of California, Irvine MD-MBA Program, a practicing pediatrician, and a member of the Medical Economics Editorial Advisory Board; and
  • Robert Juhasz, D.O., immediate past president of the American Osteopathic Association, a board-certified internist affiliated with the Cleveland Clinic, and an associate dean at Ohio University Heritage College of Osteopathic Medicine.

Comparing Mayo Clinic and Cleveland Clinic

 

Herewith  five key comparisons between the iconic Cleveland Clinic and May Clinic.


Curadux CEO looks at overtreatment and undertreatment

We were pleased to read this essay in Modern Healthcare by David L. Brown, M.D., chief executive and co-founder of Curadux, a healthcare decision-support firm that’s partnering with Cambridge Management Group in some projects.

Americans dealing with advanced illness are at risk of overtreatment and undertreatment of their conditions because powerful and silent incentives are often driving their healthcare, rather than their own unique values and goals. After 38 years of practicing medicine inside the world’s elite healthcare institutions, and as a survivor of my own advanced illness, this is my foremost concern for current and future generations of patients and their families.

For those serving inside modern medical institutions, these risks are well known. As one caregiver recently told the Institute of Medicine, “When you take the time to find out what’s most important to patients and families, they make very reasonable choices. The challenge is that our healthcare system does not encourage these conversations, our professional providers frequently do not have the time or training, and treatment measures default to those that are health system centered.”

Healthcare is not always patient-centered because our third-party payer system disrupts the normal buyer-seller relationship we often take for granted. In healthcare, for reasons of public policy, the consumer isn’t always the paying customer for the services they consume, which distorts incentive structures throughout healthcare (and not always for the patient’s benefit).

Overtreatment — treatment that is unnecessary or futile for improving a person’s quality of life—is the dominant problem today. It may cause unwanted, invasive and expensive care, as well as unnecessarily prolonged and painful deaths. Health systems are subtly incentivized to overtreat patients because they generate more revenue based on the volume of services provided. Physicians are incentivized to recommend more services because they want to minimize perceived risks to patients and their own legal liability. Without clear guidance to the contrary, physicians default to treating a condition, often no matter how futile or painful for the patient.

Undertreatment — the lack of necessary treatment for improving a person’s quality of life — is the emerging problem. Policymakers are seeking ways to control healthcare costs as governments bear more financial responsibility for healthcare due to an aging population, the expansion of government programs, and increased consumption of healthcare by individuals. Since policymakers can’t change demographics and since a policy decision has been made to expand programs and subsidies, the primary option left for policymakers is to limit consumption of services.

Like most service industries, healthcare providers have traditionally been paid fees for the services they provide. Healthcare is unique, however, because the third-party payer system eliminates the natural market mechanism for limiting consumer demand and optimizing the quality and quantity of services around the perceived value to the consumer. At present, without a meaningful limit on consumer demand, providers act in their self-interest and deliver higher volume of services, which generates more revenue and increases costs.

To control costs, whether wise or unwise, policymakers opted against moving toward a market-based model whereby consumers assume more responsibility for healthcare and, instead, expanded the current system. They are now testing an artificial mechanism for controlling demand by simply capping payments to providers through population-health concepts. While this may reduce costs, it creates the risk that providers may discourage healthcare services for people who may legitimately benefit from them.

To permanently realign healthcare incentives around the individual would require overhauling the entire system so market forces could naturally optimize consumption. This is unlikely because of legitimate public policy issues and the practical difficulty of overhauling established commercial, financial, and regulatory frameworks in a polarized political environment.

Today, patients must educate themselves and stay actively involved in aligning their values and goals with their healthcare decisions. Primary-care physicians traditionally led this process through end-of-life conversations, but as clinical production pressures and demands have increased, physicians have less time to thoroughly discuss and analyze each patient’s unique values and goals. Instead, physicians now often rely more on other staff to perform this function. While these staff can be useful, the rich expertise provided by experienced physicians is often lost. True patient-centered care for patients and families facing an advanced illness is clearly ready for further innovation.

Dr. David L. Brown has practiced medicine for 38 years. He recently retired as chairman of the Anesthesiology Institute at the Cleveland Clinic. He has also led the anesthesiology departments at the University of Texas M.D. Anderson Cancer Center, University of Iowa Hospital and Clinics, and Virginia Mason Medical Center, as well as serving as professor of anesthesiology at the Mayo Clinic. 

 


Hospitals working on bedside manner

 

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By SHEFALI LUTHRA for Kaiser Health News

 

A doctor’s training hasn’t historically focused on sensitivity. And too often while juggling heavy workloads and high stress, they can be viewed as brusque, condescending or inconsiderate.

A 2011 study, for instance, found barely more than half of recently hospitalized patients said they experienced compassion when getting health care, despite widespread agreement among doctors and patients that kindness is valuable and important.

But payment initiatives and increasing patient expectations are slowly forcing changes, encouraging doctors to be better listeners and more sensitive to patients’ needs.

“We train people to ask the question, ‘What’s the matter?’ We train toward diagnosis,” said Martha Hayward, who leads public and patient engagement efforts at the Institute for Healthcare Improvement, a Massachusetts-based nonprofit. “We don’t train toward lifestyle understanding.”

Many medical centers across the country are striving to improve doctors’ bedside manner. Even some physicians in private practice are working to improve.

Much of the motivation is financial. Under the 2010 health law, Medicare payments to hospitals can be affected by patient satisfaction surveys.

The trend is also fueled by consumer demand. As patients pick up an increasing share of the cost of care, they’re becoming more particular about quality and experience and choosing doctors accordingly.

The University of Michigan, the Cleveland Clinic and some Catholic health systems are among medical systems experimenting with techniques to encourage physicians to be more responsive, said Tim Vogus, an associate professor of management at Vanderbilt University who has researched the relationship between compassion initiatives and patient satisfaction scores.

His research found that hospitals that promote compassion – especially with rewards — are more likely to have higher patient satisfaction scores.

Partners HealthCare in Massachusetts and medical schools such as Duke are requiring some residents to take courses to help them be empathetic and offering training to practicing physicians. Other medical organizations encourage physicians to put personal details about patients in their medical charts so they can bond over topics like hobbies or sports teams. Some urge doctors to send handwritten follow-up notes to patients and their families, according to a survey of 35 health systems published this March by the Schwartz Center, a Massachusetts nonprofit that promotes compassion in health care.

Small gestures, like a follow-up phone call from a doctor, go a long way, said Matthew Taylor, 57. After his daughter was prescribed new medication for her anxiety and depression, the doctor called to check up on her.

“That [the doctor’s office] considered it important — even if it’s only taking 30 seconds or a minute of time to say, ‘Are things going well? Is there anything we need to be concerned about?’ — shows that they’re paying attention to things they need to be doing,” said Taylor, who lives in Mount Airy, Md. “It’s not out of sight, out of mind.”

Such small behavioral modifications aren’t “a panacea,” the Schwartz Center researchers noted in their paper. But they can improve patient experience.

Recognizing Doctors’ Efforts

Doctors working in hospitals are at the forefront of the efforts, often because of the patient surveys’ effects on Medicare payments. But health staffers also need to know how patients view them, so they can figure out what actually works, experts said. At the Cleveland Clinic, employees get a quarterly report that includes feedback from patients’ reviews, said Adrienne Boissy, chief experience officer. If they do things patients dislike, they’ll find out and can adjust.

“If you really don’t get any feedback on your ability to communicate or be empathic,” she said, “you won’t think you have a problem.”

At the University of Rochester Medical Center in upstate New York, doctors who demonstrate compassion are recognized in monthly notes the department head sends out to the hospital’s faculty. Those notes are often based on patient evaluations, which mention, for instance, listening well, spending extra time at a bedside and answering questions in ways the patient can understand.

“These practices are pretty simple things – recognizing people publicly for giving especially compassionate care,” Vogus said. And they can pay off in higher patient satisfaction.

At Rochester, physicians can get coaching. Other doctors watch them practice and work one-on-one with them to help them talk to patients. After shadowing, the coach might talk the doctor through interactions that could have been more thoughtful; then, depending on the critique, they might role-play scenarios based on that conversation.

Coaching changes doctors’ behavior, said Susan McDaniel, a psychologist who directs Rochester’s coaching program. “They’re exhibiting skills that they weren’t exhibiting before.”

It’s hard to say whether factors like age make a difference, she said. Some older doctors are less enthusiastic about changing their ways, but often, they “know better how important good communication is, because of their years of experience,” McDaniel said. Younger doctors are likelier to have had some kind of communication training in medical school, but that doesn’t necessarily mean they’re always better at talking to patients.

“I don’t think I’ve ever in my medical career – this included medical school – had somebody observe me to this degree,” said Jonathan Friedberg, Rochester’s chief of hematology and oncology, who participated in the program. He has since noticed small changes, he said, in how he interacts with patients. The exchanges have become less rote and routine, and more of a conversation.

Improving Health

If patients feel their doctors genuinely care, experts said, they’re more likely to take medications and comply with recommendations.

“Empathic care is a real intervention that has impact on patients’ adherence, whether they’ll come back to see the doctor or just skip town and go untreated,” said Stephen Post, who directs the Center for Medical Humanities, Compassionate Care and Bioethics at Stony Brook University in New York. And listening more carefully could lead physicians to pick up cues and details they might otherwise miss, and consequently prescribe better treatments.

When that thoughtfulness is absent, patients can be turned off. Harvest Moon, 42, who lives Grand Prairie, Texas, found a new doctor condescending and dismissive during a visit in August. She was so upset she forgot to ask about the problem that brought her in and left reluctant to get follow-up care.

“I was feeling obstinate,” she said. “It was almost a way to get back at him.”

When talking with a patient, doctors need to do more than just run through a list of questions. “It’s important to train physicians not to just ask about a patient’s medical history and medications but to make a meaningful inquiry,” Post said.

Doctors can easily forget to listen, Boissy said. Even in her own experience, she’s seen doctors who don’t introduce themselves when they walk into the exam room – a small gesture, but one that helps establish trust and gets patients to open up.

“It’s not that they don’t care. There’s a depth of caring,” she said. “But they forget.”


Cleveland Clinic plans to take over Akron General Health System

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The Cleveland Clinic.

After a year as a minority investor, Cleveland Clinic is exercising an option to take on full ownership of Akron General Health System.

If cuts are made, the Clinic tends to encourage those individuals to apply for others jobs throughout its system. At present, the Clinic has roughly 1,700 job openings.

Toby Cosgrove, M.D., chief executive of Cleveland Clinic, says the internationally famed system does not  currently have plans for layoffs at Akron General.

“What we are looking at is a gradual integration of the two organizations that will benefit both of them,” he told Crain’s Cleveland Business, which also noted that “Officials stress the plan is to expand — not gut — services at Akron General.”


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