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Hospital patient advisory panels gaining clout

By SHEFALI LUTHRA, for Kaiser Health News

Jane Maier was one of a select group of patients invited in early 2012 to help Partners HealthCare, Massachusetts’ largest health system, pick its new electronic health record system – a critical investment of close to $700 million.

The system, which is now being phased in, will help coordinate services and reshape how patients and doctors find and read medical information. The fact that Partners sought the perspective of patients highlights how hospitals increasingly care about what their customers think.

“It’s such a great experience,” Maier said. “They treat us as a member – a partner – in their review process.”

Patient advisory councils, like the one Maier belongs to, often serve as sounding boards for hospital leaders – offering advice on a range of issues. Members are usually patients and relatives who had bad hospital experiences and want to change how things work, or who liked their stay and want to remain involved.

 

For Maier, it all started in 2009 when she had surgery at Brigham and Women’s Faulkner Hospital, a Partners facility. Her husband wrote to the hospital’s CEO, praising her experience. The couple was then invited to speak at a hospital leadership retreat, sharing with top executives both the good and the not-so-good, and Maier was recruited to serve on a new patient advisory panel.

This hunt for patient perspective, which is becoming more and more common, is fueled in part by the health law’s quality-improvement provisions and other federal financial incentives, such as the link between Medicare payments and patient satisfaction scores.

“It’s a change in culture,” said Jayne Hart Chambers, senior vice president for quality at the Federation of American Hospitals, which represents for-profit hospitals.

Data from 2013 suggested that 40 percent of hospitals had some kind of patient council, said Mary Minniti, a program and resource specialist at the Institute for Patient and Family Centered Care, a Maryland-based nonprofit organization. Though councils appear to have become more common in the past few years, experts say it’s too early to know whether they typically improve hospital practices.

“A lot of hospitals right now are very concerned because of the direction of [Medicare] payments,” said Carol Cronin, executive director of the nonprofit Informed Patient Institute, an advocacy group. “They’re very concerned about patient experience and patient satisfaction.”

But it’s not just federal incentives. Patients have greater expectations as they shoulder larger shares of healthcare costs, said Richard Evans, chief experience officer at Massachusetts General Hospital, another Partners facility. This, he added, leads hospitals to focus on customer service.

Cronin, who has had a relative stay for an extended time in the hospital, volunteers on the patient advisory council at Johns Hopkins Hospital, in Baltimore. She was struck, she said, by the “meaty” topics  that the group addresses. Hopkins’ medical researchers have even pitched their projects to the council to find out what patients and families think are worthy of scientific investigation.

To have an impact, though, these groups can’t operate in isolation.

Patient and family advisory councils are useful if they have the ear of hospital leaders, Minniti said. But the groups also have to be integrated into decision making.

Andy DeVries joined the first patient advisory council at Michigan’s Spectrum Health about 10 years ago, after he was hospitalized with life-threatening injuries from a motorcycle accident.

“Initially, nobody knew who we were and we had to sell ourselves,” said DeVries, who now serves on one of Spectrum Health’s 13 patient groups. Now, by contrast, his group offers input “any time there’s something new that involves patient or family care,” adding that the panel of patient advisers has tackled issues ranging from beefing up the facility’s security to how the hospital should give patients billing information. He’s even worked with the human resources department on what to look for when hiring doctors and nurses.

 

Such feedback led to marked increases in patient satisfaction scores, said Deborah Sprague, Spectrum Health’s program manager for patient and family services.

For instance, she said, a member of the orthopedics and neuroscience patient council noticed slow responses when he pushed the call button in his hospital room, a problem staff hadn’t noticed. The council worked with hospital employees to speed up response times. After the fix, positive patient assessments of the hospital jumped.

Maier, from the Faulkner council, recalled a time when hospital executives asked for help with patient complaints regarding nighttime noise levels. Late-night talking by staff was keeping patients awake.

The group discussed potential nighttime “quiet times” and other strategies to minimize noise without keeping doctors from doing their jobs. Once changes were made, patient satisfaction scores went up, Maier said — and a council member noticed a definite improvement the next time he was a patient.

Meanwhile, MedStar Health, which serves the District of Columbia and Maryland, has targeted advisory panels’ efforts to improve both the quality and safety of its care. The system has emerged as a model for finding ways to incorporate patients’ opinions, which was noted in a report from the American Hospital Association.

In one recent case, said David Mayer, MedStar’s vice president for quality and safety, patient advisers helped brainstorm ways to soothe the confusion and stress that often sets in when people have been in the ICU for more than a day. When implemented, the ideas led to reduced instances of patient confusion – known as delirium – which is linked to more destructive behavior, like patients trying to leave the room or bed before they should.

But even as the role of patient advisory committees grows, recruiting members continues to be a challenge. Finding people from diverse backgrounds with both the inclination and time to serve can be tricky, Cronin said. As a result, council members are often “middle-aged and older, white and English-speaking, and a lot of women,” said Deb Wachenheim, health quality manager at the Massachusetts-based advocacy group Healthcare For All.

For some hospitals and health systems, though, these panels are just the beginning. Massachusetts General puts patients on various policy setting committees, and Faulkner has a non-voting patient board member.

“As we continue to evolve,” Maier said, “the hospital looks to us more and more.”


Partners to face lower-priced rival

 

Tufts New England Medical Center and Boston Medical Center are pushing to complete a merger this year and set up the new entity as a lower-price competitor to Partners HealthCare.

Massachusetts regulators, long concerned about Partners’ pricing power,  presumably will help move along the merger.

 

 

 


Partners reassesses merger plan

 

Partners HealthCare, under pressure to stop its expansion drive, reassesses a  plan to absorb  another  suburban hospital system.

 

 

 


Mass. A.G. again pushes against Partners

 

Massachusetts Atty. Gen. Maura Healey is pushing back against Partners HealthCare’s plan to buy a 70-doctor physicians’ group — a move that would further strengthen its pricing power in Greater Boston. Partners has long charged the highest healthcare prices in the state. It has recently said it would reappraise expansion plans.

 

 

 


New Partners chief’s global market

earthy

 

The new head of Massachusetts behemoth Partners HealthCare, David F. Torchiana, M.D., a heart surgeon, will have his hands full as the system  continues to reappraise its controversial expansion plans after pushback from state regulators eager to limit its market power in the state, especially in Greater Boston.

Dr. Torchiana must deal with antagonism fueled by what some perceive as  the 10-hospital Partners’ arrogance and high prices.

Dr. Torchiana, seeming to refer to more restrained ideas about further Partners expansion in the Massachusetts, said future growth projects may be more  out of state and abroad.

Alan Sager, a professor at the Boston University School of Public Health,  told The Boston Globe that he’s not convinced that the new chief, who has been running Partners’ physicians network, will run things  much differently than the outgoing Gary Gottlieb, M.D

“I don’t know how much difference one individual can make. Partners has been saying for 20 years that its mergers would reduce costs and improve quality, and there’s no evidence they’ve done that. . . Now they want to expand to other states, other countries, other planets. That may or may not be good for Partners. But there’s no reason to suppose that would be good for the people who live and work in Massachusetts.”

With Massachusetts General Hospital and Brigham and Women’s Hospital and the affiliated Harvard Medical School, Partners certainly has the global  prestige to expand its marketing, albeit probably not to other planets for a few years.

Rich patients around the world like to tell their friends that they’ve been treated at MGH and or the Brigham, in the same way they brag about being treated at, say, the Cleveland Clinic, the Mayo Clinic, Johns Hopkins and M.D. Anderson. Even Boston’s snowstorms don’t scare them away.

 

 

 

 


New Partners chief takes a humble tone

 

The new head of Partners HealthCare implies that the powerful Massachusetts hospital system is reappraising its expansion plans and wants to address the impression that it’s arrogant. It would seem that its controversial plan to buy three suburban hospitals is off the table, at for now.

 

David Torchiana, M.D., a cardiothoracic surgeon, has run the 2,000-doctor physicians’ group for the past 12 years. That experience, presumably, will help better align the interests and missions of physicians and the system.

He told The Boston Globe. “We know we have to soften our external relations and get ourselves out of this place of being a miscreant in Massachusetts. It’s not a place we aspire to be.”

And, he said, Partners  will focus on controlling medical costs by higher efficiency, including better care coordination. That’s pretty much what all systems are promising to do.

Partners’  market power, high prices, but not always better patient outcomes, have been key to the intense opposition to its further expansion in metropolitan Boston, which  has involved two Hallmark Health hospitals north of the city and South Shore Hospital south of it.

Several years ago, The Globe ran a series detailing how much higher Partners’ charges were than its competitors’ for the same services, and its special deals with insurers.

 

 


Mass. judge rejects Partners’ expansion deal


Big payers, players join to push ‘Triple Aim’

“You can always rely on America to do the right thing, once it has exhausted the alternatives.”

— Winston Churchill

Some very big payers and providers have joined in the Healthcare Transformation Task Force formed to push  faster toward the “Triple Aim” of better patient care, better patient outcomes (which you’d think would follow from the better care) and reduced, or at least more controlled, costs. They include Partners HealthCareHeritage Provider Network, Dignity Health and Premier Inc.

 

Members seek to move three-quarters of their business into value-based models and away from the unsustainable fee-f0r-service model that threatens to  bankrupt America. The fee-for-service models reminds us of “cost-plus” Defense Department contracts.

HCTTF members include six of top  U.S. 15 health systems  and four of the top 25 payers.

 

 


New Mass. A.G. to try to thwart Partners’ expansionism

 

The Boston Globe’s Steven Syre is happy that the new Massachusetts attorney general wants to put the kibosh on Partners HealthCare’s buying three community hospitals in the Boston area. Mr. Syre thinks  that Partners would use the takeovers to  jack up prices even further in  that healthcare market, among the most expensive in America.

 



Jonathan Merril, M.D., joins Cambridge Management Group

Jonathan Merril, M.D., has joined Cambridge Management Group  (cmg625.com) as a senior adviser.

Dr. Merril has devoted his career to improving provider and patient education through technology. He is currently developing a “chronic care university’’ at Partners HealthCare. The new “university’’ is an online service for patients and primary-care providers meant to improve the lives of people with chronic conditions, with the first program to be focused on multiple sclerosis.

Cambridge Management Group (cmg625.com) has increasingly worked with providers to improve care and control costs associated with patients with chronic conditions as their numbers increase with the aging of the population. Dr. Merril and his colleagues at Cambridge Management Group recognize the growing need to manage chronic diseases with innovation in diagnostics and therapeutics.

He uses mobile and simulation technology and healthcare-education expertise to work with businesses, government and non-profit organizations to create novel opportunities to enhance care.

He is also the chief executive of Astute Technology, which streams large medical conferences, including those of the American Heart Association, the American Society for Clinical Oncology and many other organizations. Dr. Merril holds many patents in the digital capture of such gatherings.

Dr. Merril has used the Internet and App technology to build some of the most widely used online (including mobile) learning resources for physicians and patients. These systems power the Partners Healthcare Office of Continuing Professional Development and some key activities (including board reviews) of various other large non-profit healthcare organizations.

He is an expert in building and integrating platforms for continuing education, maintenance of licensure and promoting best practices for hospitals and professional societies.

Dr. Merril received his M.D. degree from The George Washington University School of Medicine and Health Sciences. He did his internship in internal medicine and then completed a fellowship in medical informatics in a joint program of George Washington and Massachusetts General Hospital. Jonathan Merril is married and has three children.


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