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Conn. Children’s Medical Center focuses on analytics to make improvements

Hospitals & Health Networks reports that “analytics are the heart of data-driven continuous improvement and performance excellence initiatives at Connecticut Children’s Medical Center in Hartford.”  To read H&HN’s whole report, please hit this link.

Richelle deMayo, M.D., the hospital’s chief medical information officer, said: “Reporting, dashboards and registries permit us to examine relationships between process and outcome. We can also identify and address opportunities to achieve operational efficiency. Patient throughput, readmissions, timely discharge, clinical documentation improvement and charge capture have all benefited from our ability to benchmark and track key performance indicators.”

Hospitals & Health Networks reports that  the hospital focuses on:

  • “Developing reporting tools and dashboards for performance improvement.
  • “Using clinical and business intelligence tools to track patient and provider-level metrics and outcomes.
  • “Reviewing scorecards regularly by all clinical managers, directors and vice presidents.
  • “Using scorecards for early detection of potential problems and care redesign.
  • “Redesigning EHRs to remove features with questionable value that distract and detract from clinician-patient interaction.”






The foggy future of ACA implementation

Ken Bottles, M.D., a lecturer at the Thomas Jefferson University School of Population Health, in Philadelphia,  and chief medical officer of PYA Analytics, made these predictions to FierceHealthcare:

  • “Congress will not revisit the repeal and replacement of the Affordable Care Act before the end of the year. It is simply dealing with far too many other issues—passing a budget, raising the debt ceiling, approving disaster aid for Harvey and Irma, not to mention its desire for tax reform—that lawmakers must address.
  • “While the Senate HELP committee is attempting a bipartisan effort to shore up the ACA, the issues listed above will make it almost impossible for such a law to be passed during this session.
  • “The leadership of the Department of Health and Human Services ideologically opposes the very concept of the ACA and is also responsible for implementing the law. The tension between those two facts will lead to confusion and uncertainty for those of us in healthcare.
  • “The passage of the ACA changed the terms of debate around healthcare reform. Granting health insurance to more than 20 million Americans has now shifted public opinion so that a solid majority believes the federal government should ensure that its citizens have insurance.
  • “The ACA is not failing, but going forward it can be undermined without congressional action.”

To read more,  please hit this link.


Probe suggests Joint Commission accreditation a joke

The Joint Commission, the accrediting organization for about 80 percent of U.S. hospitals,  rarely revokes its approval of facilities out of compliance with Medicare rules, reports The Wall Street Journal.

The WSJ, after digging into  Joint Commission inspection reports from 2014 through 2016, found that in 2014, about 350 hospitals with Joint Commission accreditation had violated Medicare requirements that year, and about a third had additional violations in 2014, 2015 and 2016.

The paper reported that the commission  revoked accreditation for just 1 percent of hospitals out of compliance with Medicare. More than 30 hospitals retained their accreditations even though the Centers for Medicare & Medicaid Services found their violations important enough to cause, or likely cause, serious patient injury or death.

“It’s clearly a failed system and time for a change,” said Ashish Jha, M.D., a health policy researcher at Harvard’s T.H. Chan School of Public Health and a practicing internist, told the paper.  The probe “shows accreditation is basically meaningless—it doesn’t mean a hospital is safe.”

To read more, please hit this link.

Parlor games to strengthen clinical teams

— Photo by Jennifer Belaco

Fred Pelzman, M.D., a New York primary-care physician, writes about how to make a better clinical team with higher morale, “at the cost of a truth and a lie” at some nice parties.

He writes:

“Lately, I’ve felt sort of giddy, as our team may have discovered the secret sauce, the magic that might make us work better together.

“Believe it or not, we call these Color Group Socials.

“Our practice is divided into the Red, Green, Blue, Purple, and Yellow teams, and each area has a practice leader.

“On our administrative morning, when the practice is closed, we divide up into our separate areas and everyone gathers in the waiting areas where patients usually sit, and we play parlor games.

“It has been remarkable to watch how much fun everybody has, how relaxed everyone is, and how the barriers between us all fall away, as we play something as simple as A Truth and A Lie.

“Everyone writes down on a slip of paper something true about themselves, and something false. Then everybody has to try to guess who wrote which, and which is the truth and which is the falsehood.

“Everyone ends up laughing and having a great time, and we’ve learned that people have amazing lives beyond the walls of the office, beyond the roles we fill when we come to work.”

To read his essay, please hit this link. 

Physicians’ attitudes on over-treatment


A survey published in PLOS ONE gives  physicians’ perspective on over-treatment.  Of the  2,327 respondents, nearly 85 percent cited fear of malpractice suits as a major cause of unnecessary care. They  cited  pressure from patients  59 percent of the time, and around 38 percent referenced issues regarding access to medical records.

Daniel Brotman, M.D., professor of medicine at Johns Hopkins University School of Medicine, and one of the report’s authors, wrote: “Interestingly, but not surprisingly, physicians implicated their colleagues (more so than themselves) in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level.”

In the course of the survey, researchers also solicited potential solutions to the problem from physicians. The top three responses, as summarized by FierceHealthcare:

  • “Improve training for medical residents so that they monitor specific criteria related to the appropriateness of a given procedure, test or prescription.
  • “Continue to work to improve access to health records so that physicians have the information they need to make fully informed decisions about necessary tests and treatment.
  • “Improve guidelines for evidence-based care practices, so that doctors and patients can refer to a scientific basis for the best avenue of treatment for a given diagnosis.”

To read the survey article, please hit this link. To read the FierceHealthcare commentary on it, please hit this link.



How insurers ‘set up patients to fail’


David Russo, M.D., an Oregon psychiatrist, writes about how insurers set up patients to fail.

He writes in the (Portland Oregonian):

“Here’s how it works: First, a doctor comprehensively evaluates and diagnoses a patient’s health condition and counsels them about the benefits and trade-offs of various treatments. Then, the doctor prescribes a therapy best suited to the patient’s condition. But, more often these days, patients are stymied by the insurance company’s denial of the physician’s plan. Making matters worse, insurers will only approve the physician’s plan after the patient proves that they ‘failed first’ on the insurance company’s preferred alternative.”

“Patients shouldn’t suffer at the hands of insurance providers’ cost-cutting measures. It wasn’t Edison’s failure to first improve the candle that led to his breakthrough invention of the light bulb. When my patients fall victim to the arduous step therapy system, I join forces with them to battle the approval processes until they receive coverage for the right treatment plan — without substitutions.”

To read more, please hit this link.


Sutter shifting 10,000 Medi-Cal patients to FQHCs


The Sacramento Bee reports  that  Sutter Medical Group is shifting about 10,000 adult Medi-Cal {the state Medicaid program} enrollees with Anthem Blue Cross  to primary-care physicians at Federally Qualified Health Centers.

Ken Ashley, M.D., the medical director for primary care at Sutter Medical Group, asserts that  the change in providers will give the patients  access to more services.

“Some of the things that the (community health centers) can provide with the funding that they are receiving are things that sometimes we struggle to find for our Medi-Cal patients, things like optometry and dental, behavioral medicine,” Dr. Ashley told The Bee. “I feel like these patients are finally going to receive things I could not provide as their primary-care doctor. I’m OK with our partners helping to take care of these patients.”

He noted that the huge increase in the number of new patients as a result of the Affordable Care Act   has put great pressure on many providers as they seek to make appointments available. Meanwhile, the ACA has made more resources available to FQHCs.

Sutter, Dignity Health, the University of California at Davis and other providers have  contributed funding and expertise to expand the network of the FQHCs, the newspaper reported.

To read more, please hit this link.



Video: Addressing rural staffing shortages

Video: Benjamin Chaska, M.D., chief medical officer of Catholic Health Initiatives’s North Dakota/Minnesota Division, discusses CHI’s team-based strategy to deal with rural staffing shortages. He advises thinking long term.

To watch the video, please hit this link.


How to ensure Medicaid patients have enough access to specialists?


Michael H.  Katz, M.D.,   writes in JAMA:

“Timely access to specialists has been a longstanding concern for patients with Medicaid compared with patients who have private insurance. Thus, instituting requirements that Medicaid managed care plans adhere to timeliness and proximity standards seems like an excellent solution to a longstanding problem. However, as with so many things in health care, the issue is more complicated.”

To read his essay, please hit this link.


The powerful benefits of clinical ‘design thinking’

Amitha Kalaichandran, M.D., a hospital resident physician and journalist based in Toronto, writes in The New York Times about the growing attraction of “design thinking” by clinical teams. (Cambridge Management Group has done a lot of work in such design thinking.)

Dr. Kalaichandran  writes: “In recent years, a growing number of healthcare workers have been stepping up to create innovations by applying ‘design thinking’ – a human-centered approach to innovation that was originally developed in the business world to create new products. Traditionally, hospitals were designed with input from administrators. With design thinking, the innovations come from those who actually work there, providing feedback to designers to improve the final product.

“A 2016 report that looked at ways in which a health system can implement design thinking identified three principles behind the approach: empathy for the user, in this case a patient, doctor or other health care provider; the involvement of an interdisciplinary team; and rapid prototyping of the idea. To develop a truly useful product, a comprehensive understanding of the problem the innovation aims to solve is paramount.”

As an example of what can come out of design thinking by clinical teams, Dr. Kalaichandran writes that:

“The leader of our trauma team  now wears an orange vest.

“The easy-to-spot garment, called the trauma team leader identification vest, clearly identifies who’s in charge. It’s a simple yet effective innovation created by a nurse after a hectic gunshot trauma simulation, in which a huddle of highly stressed emergency room staff members spoke over one another and there were no clear roles. In particular, no one knew who was leading the trauma code. The orange vest became routine part of emergency care at our hospital earlier this year, and the trauma team reports it has helped clarify who’s in charge and strengthened communication among members.”

To read more, please hit this link.

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