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Can/should bedside manner be measured and reported?

bedside

In a NEJM Catalyst piece, Paul Rosen, M.D., looks at attempts to measure  and report physicians’ bedside manner. Among his remarks:

“Is there common ground between patient and physician perspectives? When approaching an encounter with a patient, the physician goal typically is to make the correct diagnosis and provide an evidence-based, efficacious treatment plan.”

“Consumer surveys show that patients value the correct diagnosis, a proper treatment plan, and the doctor’s medical knowledge. However, patients also value whether the doctor treats them with respect and dignity, listens and cares, takes time, and takes them seriously. The ideal patient experience merges excellent medical care, high-quality outcomes, compassion, and empathy that address the emotional needs of patients. Can physicians deliver all these things given the other constraints of practicing modern-day medicine?”

“Research demonstrating the correlation between service and quality is mixed. Some studies find a correlation between service and medical outcomes, yet other reports show no linkage between patient experience and outcomes, and some show a negative correlation. Study in this area, and the controversy, is ongoing.”

“The more cynical among physicians feel that the patient experience movement is just another cottage industry within medicine that enables consulting companies to thrive, while detracting from the real practice of medicine. It has become another charged administrative issue and another bully club for administrators to use against their doctors. The fact that many physician bonuses depend on the results of these survey scores drives further embitterment.”

Still, “many industries improve their performance when their data are shared transparently. Health systems, too, that are posting their patient satisfaction data on the Internet are seeing improvement in their scores and comments.”

To read  more, please hit this link.

 


Trump’s CMS pushes back against bundled payments

knee

The CMS has delayed the expansion of a major bundled- payment pilot, Comprehensive Care for Joint Replacement, and implementation of its bundled-payment initiatives for cardiac care to Oct. 1, 2017, from July 1, according to an interim final rule posted to the Federal Register. It also again delayed the effective date of a final rule detailing the  implementation process  for CJR and other bundled-payment programs, to May 20, 2017 from March 21.

The agency is considering delaying  implementation of all bundled-payment initiatives even further, until 2018.

Modern Healthcare speculated that the Trump administration’s “move to delay these initiatives raises questions about the future of government initiatives to usher healthcare out of fee-for-service operations and into a new age of value-based payment.”

The new secretary of health and human services is Tom Price, M.D., who had a very lucrative career as an orthopedic surgeon and has been a major investor in some medical companies. CMS ultimately reports to him and President Trump.

To read more, please hit this link.


Four tips for clinical documentation improvement

Jonathan Elion, M.D., a cardiologist and associate professor of medicine at Brown University, has four tips for clinical documentation improvement in ambulatory settings.

They are:

  • “Define the exact patient and visit categories that you think merit inclusion in a CDI workflow.
  • “Determine how these patients can be identified by information in the HIS {hospital information system} and its associated electronic messages.
  • “Make sure that you can define your facility’s use of account numbers in open or recurring visits.
  • “Be specific about what you want to accomplish and how you will measure your progress.”

To read more, please hit this link.



Providers complain about lack of guidance on ‘observation’ status

 

Modern Healthcare reports that  providers say that the lack of guidance from CMS about a new rule mandating that hospitals notify Medicare patients why they are receiving “observation” care could cause hospitals to lose billing privileges and patients.
Beneficiaries must spend three consecutive nights as admitted patients in a hospital  for Medicare to cover subsequent skilled-nursing facility costs; observation days don’t count.

The publication reported that  as of March 8 hospitals had to begin “giving out the notices, which alert patients that they received observation care rather than being admitted as an inpatient. CMS estimates as many as 1.4 million beneficiaries will receive the notices every year, and they are meant to cut down on the surprise bills observation patients tend to receive.”

“The CMS requires hospitals to give patients a reason for their observation status, but the CMS has declined repeated requests from hospitals to suggest language that providers should use. Providers are concerned that the vague instructions put them at risk of auditor citations.”

“The stakes are huge in that without guidance from CMS, each auditing organization is left only with their personal interpretation if a hospital is in compliance or not,” Ronald Hirsch, M.D., a vice president at R1 Physician Advisory Services, a consulting firm on billing matters for providers, told Modern Healthcare.

The publication added that a CMS spokesman declined to comment on the issue, but pointed to an FAQ document on the agency’s Web site “that encourages providers to use their clinical judgment when writing the notices and make them ‘reasonably understandable’ to the beneficiary.”

To read more, please hit this link.

 

 


Should standards be lowered for safety-net hospitals?

 

The federal government sometimes withholds money from safety-net hospitals because they fail to meet certain standards.

A piece in governing.com asks whether those standards should, at least in some cases, be lowered.

Penalties “handed down by CMS are part of the Affordable Care Act {and} are meant to motivate hospitals to correct procedures so as to avoid patient safety violations. But the problem with these penalties, some health policy experts say, is that they don’t take into account the particular challenges that individual hospitals face.”

“Most of the penalized hospitals take care of the poorest and sickest,” Ashish Jha,  M.D., a  Harvard professor who focuses on patient safety, told the news service.

“Jha and others argue that CMS should add a risk adjustment factor. Until then, safety-net and academic-centered hospitals {with the most challenging patients} will continue to get slapped with the most penalties.”

“Adding to the hospitals’ exasperation is the fact that there is little information about whether the penalties have actually improved health outcomes.”

To read the piece, please hit this link.

 


How MACRA will fail

napolean

Napoleon’s Retreat From Moscow.

David L. Keller, M.D., a California internist, writes that the Medicare Access and CHIP Reauthorization Act (MACRA) will fail. In a piece in Medical Economics he writes:

“The last thing doctors need is another set of distracting bureaucratic measures to be satisfied before we can attend directly to the patient’s needs. CMS is rushing to implement MACRA, despite the heavy burden this will place on physicians and their patients. MACRA will supposedly improve the quality of medical care while decreasing its cost and increasing the amount of information that doctors collect from their patients and report to CMS. 

“MACRA will, inevitably, fail on all counts: It will increase the cost of medical care, degrade the quality of care and it will clog patient charts with even more of the useless and distracting ‘junk’ information that already litters patient charts and records, due to prior mandates by CMS. 

“CMS can save American physicians (and their patients) a great deal of stress and expense by postponing the implementation of MACRA and reopening the question of whether it is needed at all. ”

To read his article, please hit this link.


Psychological safety and physician teams

Jessica Wisdom, Ph.D., and Henry Wei, M.D.,   writing about a project they did at  Google, discuss the importance of psychological safety in physician teams.

They note at the start that “Physicians may enter training drawn to the autonomy of medicine, but effective health care delivery — particularly in the era of Accountable Care Organizations and patient-centered medical homes — will likely be driven by effective teams, not individuals working solo.”

“But what is the secret to creating an effective team? Over two years, Google conducted 200+ interviews and a series of analyses of over 250 attributes to understand what drives team performance. What emerges is not the who, but the how: the attributes of the team members matter less than how the members interact, structure their work, and view their contributions.”

“For healthcare, this may mean that individual clinicians’ technical excellence is necessary, but insufficient to improve team-driven patient outcomes.”

“We’ve learned that there are five key dynamics that set successful teams apart from other teams at Google:

  1. Psychological safety: Can team members take risks by sharing ideas and suggestions without feeling insecure or embarrassed? Do team members feel supported, or do they feel as if other team members try to undermine them deliberately?
  2. “Dependability: Can each team member count on the others to perform their job tasks effectively? When team members ask one another for something to be done, will it be? Can they depend on fellow teammates when they need help?
  3. “Structure & clarity: Are roles, responsibilities, and individual accountability on the team clear?
  4. “Meaning of work: Is the team working toward a goal that is personally important for each member? Does work give team members a sense of personal and professional fulfillment?
  5. “Impact of work: Does the team fundamentally believe that the work they’re doing matters? Do they feel their work matters for a higher-order goal?”

“It may surprise people to learn that psychological safety is the most important of these five dynamics by far. In fact, it’s the underpinning of the other four.”

In their piece, they outline six steps to improve team performance and psychological safety

To read their piece, please hit this link.

 


MDLive: We have virtual mental-health services in all states

Freud's_couch,_London,_2004_(2)

Photo by Robert Huffstutter

Couch now in London on which reclined Sigmund Freud’s patients as they were psycho-analyzed.

Telehealth provider MDLive says that it’s   the first company to offer telepsychiatry and other virtual mental-health services in all 50 states. The Sunrise, Fla.-based company recently added practitioners in Mississippi and Vermont to fill out the map, Med City News reported.

“It’s national now,”  MDLive Chief Behavioral Health Officer John Sharp, M.D., told the news service. “In a way, it’s not earth-shaking because we’re all going to everywhere soon.”

“I think it’s going to be one of the new norms. You can’t imagine banking without ATMs or online services anymore.”

MDLive, founded in 2009, says it now has more than 1,300 behavioral-health practitioners in its network of online healthcare professionals. “We had to go scouting around,” Dr. Sharp said. “We had to get board-certified, licensed doctors” in every state.

Med City noted: “Indeed, with the exception of physicians employed by the federal government, state licensure has long remained a hurdle to wider deployment of telehealth and telemedicine. A physician providing remote medical services generally must be licensed in the state where the patient is located, though the situation has improved somewhat in recent years.”

To read the full piece, please hit this link.


CMS nominee wants to overhaul Medicaid

 

Seema Verma, nominated by President Trump to lead the Centers for Medicare & Medicaid Services, told her confirmation hearing at the Senate Finance Committee that she’d consider clawing back parts of a rule set during the Obama administration that overhauled Medicaid managed-care programs.
She also  said he doesn’t want to turn Medicare into a voucher program, an idea backed by Health and Human Services Secretary Tom Price, M.D., and thinks  that rural healthcare providers shouldn’t face risk in alternative-payment models.

Ms. Verma said  that one of her priorities would be re-assessing a rule issued under the Obama administration that ordered states to more vigorously oversee the adequacy of Medicaid plans’ provider networks and encouraged states to establish quality rating systems for health plans. She raised the question of whether these mandates have  overly burdened the states financially.

On Medicaid,  she said that  “the status quo is not acceptable.”

“I’m endorsing the Medicaid system being changed to make it better for the people relying on it … and whether that’s a block grant or per capita cap, there are many ways we can get there.”

On Medicare, Modern Healthcare reported that Sen. Ron Wyden (D.-Ore.), the ranking Democrat on the Finance Committee, “said that she sounded like she wanted to keep Medicare a fee-for-service system.” The CMS under the Obama administration set goals to move Medicare away from fee-for-service, which was viewed as prone to abuse and fraud even as it has been very lucrative for physicians and hospitals and encourages much medically unneeded ordering of tests and procedures to maximize providers’ income.

But Ms. Verma denied Senator Wyden’s assertion and said that she supports Medicare focusing more on quality of care instead of volume.

To read more, please hit this link.

 

 

 


The ‘GOP Doctors Caucus’

By PHIL GALEWITZ

For Kaiser Health News

The confirmation of Tom Price,  M.D., the orthopedic surgeon-turned-Georgia congressman, as secretary of Health and Human Services represents the latest victory in the ascendancy of a little-known but powerful group of conservative physicians in Congress he belongs to — the GOP Doctors Caucus.

During the Obama administration, the caucus regularly sought to overturn the Affordable Care Act, and it’s now expected to play a major role determining the Trump administration’s plans for replacement.

Robert Doherty, a lobbyist for the American College of Physicians, said the GOP Doctors Caucus has gained importance with Republicans’ rise to power. “As political circumstances have changed, they have grown more essential,” he said.

“They will have considerable influence over the considerable discussion on repeal and replace legislation,” Doherty said.

Price’s supporters have touted his medical degree as an important credential for his new position, but Price and the caucus members are hardly representative of America’s physicians in 2017. The “trust us, we’re doctors” refrain of the caucus obscures its heavily conservative agenda, critics say.

“Their views are driven more by political affiliation,” said Mona Mangat, M.D., an allergist-immunologist and chairwoman of Doctors for America, a 16,000-member organization that favors the current health law. “It doesn’t make me feel great. Doctors outside of Congress do not support their views.”

For example, while the American College of Obstetrics and Gynecology has worked to increase access to abortion, the three obstetrician-gynecologists in the 16-member House caucus are anti-abortion and oppose the ACA provision that provides free prescription contraception.

While a third of the U.S. medical profession is now female, 15 of the 16 members of the GOP caucus are male, and only eight of them are physicians. The other eight members are from other health professions, including a registered nurse, a pharmacist and a dentist. The nurse, Diane Black of Tennessee, is the only woman.

On the Senate side, there are three physicians, all of them Republican.

While 52 percent of American physicians today identify as Democrats, just two out of the 14 doctors in Congress are Democrats.

About 55 percent of physicians say they voted for Hillary Clinton and only 26 percent voted for Donald Trump, according to a survey by Medscape in December.

Meanwhile, national surveys show doctors are almost evenly split on support for the health law, mirroring the general public. And a survey published in the New England Journal of Medicine in January found almost half of primary care doctors liked the law, while only 15 percent wanted it repealed.

Rep. Michael Burgess, R-Texas, a caucus member first elected in 2002, is one of the longest serving doctors in Congress. He said the anti-Obamacare Republican physicians do represent the views of the profession.

“Doctors tend to be fairly conservative and are fairly tight with their dollars, and that the vast proportion of doctors in Congress [are] Republican is not an accident,” Burgess said.

Price’s ascendancy is in some ways also a triumph for the American Medical Association, which has long sought to beef up its influence over national health policy. Less than 25 percent of AMA members are practicing physicians, down from 75 percent in the 1950s.

Price is an alumnus of a boot camp the AMA runs in Washington each winter for physicians contemplating a run for office. Price is one of four members of the caucus who went through the candidate school. In December, the AMA immediately endorsed the Price nomination, a move that led thousands of doctors who feared Price would overturn the health law to sign protest petitions.

Even without Price, Congress will have several GOP physicians in leadership spots in both the House and Senate.


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