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Population health: Partner with Uber?

uber

Uber driver on his way to customer.

Nick van Terheyden, M.D.,  chief medical officer of Dell Healthcare Services, writes in Becker’s Hospital Review that population health must, of course, focus on primary care. But his specific suggestions include:

On data analysis, he cites:

“A western Massachusetts integrated health system includes in their risk algorithms factors such as distance from a patient’s home to a primary-care provider and availability of transportation and family support. Their thinking is that if you live too far from a clinic or don’t have transportation or family support, you are less likely to get regular care.”

“This is just one example of the kind of challenges we face in population health. It’s going to be as much about social support as it is about medical intervention. Income, location, health literacy, family support and a dozen other factors will have far more power over outcomes than anything that happens in the exam room.”


“….I wrote about high-value primary-care providers, those who got stellar outcomes with only about half the per-capita healthcare expense as other practices. These primary-care teams (and they are teams, not just physicians) exhibit significant cultural differences from other practices, starting with a laser-like focus on patient needs that go beyond diagnoses and medications. When they invest in technology, they choose carefully….”

“Notably, all of these practices make sure their physicians have mobile access to the electronic health records of their patients. That means a physician on call will have all the information needed to help a patient and to make good care decisions. ”

“Physicians  {should} take their own after-hours calls most of the time, making use of mobile access to the EHR to ensure all knowledge of each patient’s condition is available for decision-making.”

“Transportation is also a barrier for many patients, and some healthcare systems are partnering with Uber to get patients to checkups. While the cost may not always be covered I’m willing to bet the data will quickly show the payoff from this will justify the expense of providing the transportation.”

“But telehealth, remote monitoring and even free rides with Uber won’t make a lasting difference unless they are part of a culture that cares more about patient convenience than provider convenience.”

To read Dr. van Terheyden’s entire essay, please hit this link

 


Medicare annual wellness visit very underused

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Researchers report that  the Medicare annual wellness visit,  mandated under the Affordable Care Act and including an assessment of mental impairment, is underused.
MedCity News reported that  an analysis of electronic health records (EHR) from Allina Health System, based in Minneapolis, found that only about 30 percent of its eligible Medicare population had an annual wellness visit in 2015.

And, not surprisingly, the researchers determined that the patient groups who would benefit most from cognitive screening were less likely than other elderly people to go for an annual check-up.

Sounds as if a lot more public-information outreach is  needed.

To read the article on this, please hit this link.


CMO touts systems offering insurance

 

Nick van Terheyden, M.D., chief medical officer of Dell Healthcare Services, has some interesting observations in a piece headlined “Is healthcare transformation the ‘age of wisdom’ or the ‘winter of despair’ for hospitals?”

He writes: “Hospitals that are part of an integrated health system, rather than standalone facilities, will fare better under the new system because they will automatically be part of a team effort. The incentives for integrated health systems are clear: They sell insurance, and the healthier their members, the lower their costs will be. That clarity of incentives will help integrated systems move swiftly toward value-based care, and having all members of the care team under one umbrella will help ensure better coordination of care and less duplication and waste. We’ve seen this trend growing over the past few years, with health systems buying hospitals and physician practices.”

He also noted:

“One of the biggest challenges hospitals will face in the next couple of years will be data integration. All those mergers and acquisitions in healthcare have turned many organizations into the Tower of Babel, where so many data languages are in use that care coordination becomes a nightmare. To standardize and integrate data, some systems have taken the route of converting all of their facilities to one EHR, but that is enormously expensive and very disruptive, and it ultimately doesn’t solve the bigger issue. The EHR is only one source of clinical data, and as analytics are increasingly important, healthcare organizations will need to integrate data from a wide variety of sources beyond the EHR.”

To read his essay, please hit this link.


Electronics and physician burnout

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The editors of Physicians Practice write:

“The idea that physicians are burned out isn’t news, it’s an accepted fact. What’s happening now is researchers and other industry observers are trying to figure out why they’re burned out.”

“…. In conjunction with the AMA, the Mayo Clinic researchers surveyed more than 6,500 physicians to evaluate the various reasons for physician burnout, as well as the effects of digitizing medical practice. Needless to say, researchers found a direct link between burnout and usage of the EHR and computerized physician order entry (CPOE) systems.

“Electronic health records hold great promise for enhancing coordination of care and improving quality of care. In their current form and implementation, however, they have had a number of unintended negative consequences including reducing efficiency, increasing clerical burden, and increasing the risk of burnout for physicians,” Tait Shanafelt, M.D., Mayo Clinic physician and lead author of the study, said.”

”The results varied by specialty, with family medicine physicians, urologists, otolaryngologists and neurologists being affected the most. Yet, it’s clear from reading about the study that most physicians are feeling the crush of clerical burden related to EHR and CPOE systems.”

To read the whole article, please hit this link.


Deconstructing Medicare quality programs

 

alphabet

Have some alphabet soup.

This analysis breaks down the MACRA proposed rule. MACRA stands for this mouthful: the Medicare Access and CHIP Reauthorization Act. MIPS (below) stands for the Merit Based Incentive Payment System. Government programs, dating back to the New Deal, in the ’30s,  are rife with abbreviations.

As this piece in HealthAffairs reports:

“As outlined in MACRA, the proposal would consolidate three currently disparate Medicare quality programs into MIPS:  (1) the Physician Quality Reporting System; (2) the Value-Based Modifier Program; and, (3) the ‘Meaningful Use’ of electronic health records. CMS proposes that eligible clinicians receive a composite score relative to their performance in each of four categories. Quality measures for these core domains will be selected annually, with the data regarding clinician performance on the measures made available via the Physician Compare Web site.

“The four performance categories are:

  1. “Quality: 50 percent of total score in year 1;
  2. “Advancing Care Information: 25 percent of total score in year 1, formerly EHR Meaningful Use;
  3. “Clinical Practice Improvement Activities: 15 percent of total score in year 1, this is essentially the ‘new’ domain added to the previously existing other three.
  4. “Cost or Resource Use: 10 percent of total score in year 1, based on Medicare claims data — no reporting necessary.”

7 things to know about CMS’s new primary-care initiative

 

Here are seven things to know from Becker’s Hospital Review about CMS’s  new primary-care initiative that seeks to help practices transition to  value-based primary care.  It’s called the  Comprehensive Primary Care Plus model (CPC+). “Participating practices will be in one of two tracks. In both tracks, practices receive upfront incentive payments that they will either keep or repay based on performance and quality metrics,” Becker’s says.

2. “Practices in both tracks are required to use certified health IT to allow remote access to the EHR, allow 24/7 access to the EHR for the care team members with real-time access, report on electronic clinical quality measures and generate quality reports.

3. “However, there is a heavier emphasis in Track 2 on leveraging health IT to achieve healthcare delivery changes. ‘The care delivery CMS expects in Track 2 is reliant upon the use of advanced health IT capabilities that practices will need to attain through EHR enhancements or by adding or securing additional health IT services/tools,’ according to CMS. ‘Thus practices will engage their vendors to support the attainment and optimization of health IT to meet the goals and objectives of practice transformation.’

4. “‘The IT requirements pertaining specifically to Track 2 include adopting IT certified to ‘Care Plan’ and ‘Social, Behavioral and Psychological Data’ criteria as identified in the certified EHR technology definitions in the Medicare EHR Incentive program.

5. “Track 2 participants will be expected to leverage health IT capabilities that are not always available in current platforms or are not required for ONC certification. Some of these capabilities include risk-stratifying patient populations and identifying patients with complex needs; producing and displaying eCQM results at the practice level; assessing patient’s psychosocial needs; establishing a patient-focused care plan to guide care management; and documenting and tracking patient-reported outcomes.

“As such, practices in this track will work with vendors to develop and optimize functions to support clinical objectives. ‘CMS will not prescribe how the health IT enhancement is accomplished, rather only that the health IT solution meets the CPC objective for use of the health IT by the CPC practice site team,’ according to CMS.

6. “Furthermore, vendors of Track 2 participants will provide a ‘Letter of Support’ to the CPC+ practice indicating they are willing to support the practice in the initiative if the practice is selected for participation. If the practice is selected for participation, the vendor will enter a memorandum of understanding with CMS outlining their commitment to support the practices in reaching the goals of the initiative. CMS will not pay vendors for their involvement in CPC+.

7. “All health IT enhancements are expected to be completed within 24 months of the January 2017 program launch.”


The EHR holdouts

This piece in Governing.com  discusses why some physicians don’t use electronic health records. One example is Michael Ciampi, M.D., a family practitioner in Portland, Maine, who says he doesn’t have anything against technology but says that  when he tried EHRs several years ago:

“{W}e found was a system that just wasn’t patient-centered.The primary function was to enhance billing, not to build a physician-patient relationship. Our productivity went down 25 percent.”

So he went back to paper, joining the  fifth of doctors don’t have an electronic health record system, commonly called an EHR, in their offices. But then,  only 34 percent of doctors surveyed by the American Medical Association said  that they liked their electronic systems.

A new challenge is that the federal financial incentive program to encourage clinicians to adopt EHRs will be phased out by the end of  this year.

And, as the Governing piece notes, “For a five-physician clinic, the initial cost to implement an EHR is around $162,000. Additional maintenance expenses in the first year can be around $85,000.”

Further, “rural physicians often have trouble getting IT support and access to high-speed broadband, which is necessary to run an EHR properly.”

Readers might enjoy the Rube Goldberg movie short Something for Nothing about the ambiguous charms of technology. Sometimes it’s technology for the sake of technology.

 


Don’t skimp on RCM systems

 

Even financially struggling hospitals need to update their revenue-cycle-management systems in order to work with multi-provider bundles, shared savings or other complex payment models.

Jay Sultan, principal strategy adviser at Edifecs, a health IT company, told Becker’s Hospital Review that using  antiquated RCM systems to add the new data sources and analytics needed to validate inbound revenue is like “trying to deliver the functionality of a modern EHR using a typewriter.”

“Payment reform is driving CMS, Medicaid and commercial payers to alter the revenue cycle, with a larger portion of provider revenue driven by performance elements outside of a traditional RCM system’s capability,” he added.

He told the news service that hospitals should prioritize technology investments based on bottom-line projections. In some hospitals,  he said, “current RCM technology and the processes that it drives are so antiquated that maintaining the system costs more than the revenue assurance/enhancement it delivers.”

 

 


Do medical scribes slow EHR improvement?

scribe

Some physicians at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS) expressed concerns about the growing use of medical scribes  to make entries into electronic health record systems.

George Gellert, M.D., of the CHRISTUS  Health hospital system in Texas, said:

“The use of scribes is undermining the usual market forces that would drive the advancement of EHRs,” arguing that physicians may be “satisfied with a suboptimal product because ‘my scribes deal with it,'” thus slowing improvement of EHRs, which still leave much to be desired. Other physicians at the meeting discussed the danger of “mission creep,”  in which over-busy physicians would let scribes, who are not clinicians, make EHR entries that should only be made by physicians.

 


Time to push the ‘Quadruple Aim’

 

This column by Yul Ejnes, M.D., an internist and a past chairman of the board of regents of the American College of Physicians, says medicine needs a “Quadruple Aim” instead of the “Triple Aim”.

The “Triple Aim” is a concept developed in 2007 by Donald Berwick, M.D., and the Institute for Healthcare Improvement (IHI). Its three dimensions are “Improving the patient experience of care (including quality and satisfaction); improving the health of populations; and reducing the per capita cost of health care.”

Then in 2014, to Doctors and Christine Sinsky published a paper in the Annals of Family Medicine titled “From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider.”

Dr. Ejnes notes that “{T}hey very effectively made the case that our ability to achieve the triple aim is jeopardized by the burnout of physicians and other healthcare providers. They proposed adding a fourth dimension to the three in the triple aim: ‘the goal of improving the work life of healthcare providers, including clinicians and staff.”‘
“{E}fforts to achieve the triple aim have in many cases made things worse for providers. The added workload related to performance measurement, EHR use, greater documentation requirements, and increased access (expanded hours, e-mail, etc.) have had detrimental effects on the satisfaction and morale of members of the healthcare team.”

“It’s not about just physicians, either. All members of the healthcare team are at risk. The ‘Quadruple Aim’ bolsters the well-being of nurses, medical assistants, receptionists, and anyone else involved in providing care to patients.”

So here is Dr. Ejnes’s campaign platform:
“Healthcare leaders should discuss the quadruple aim when they would normally mention the triple aim, and explain to their audiences why that change is so important. (Also, when you hear a speaker refer to the triple aim, ask him/her about the quadruple aim in the Q&A.)
Changes designed to improve how we deliver care should also improve the work life of healthcare providers (and certainly not worsen it).”

 

 


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