Liability: “What if a patient’s data shows signs of an ailment, but no one notices?”
Reliability: ”Devices such as fitness trackers aren’t regulated by the Food and Drug Administration, so how much should doctors rely on them?”
Privacy and security: “Health privacy laws don’t extend to technology companies that make trackers and apps.”
How to get paid for the time reviewing the data from these devices?
“It is slowly changing…but it’s still challenging to get paid for analysis and for email and phone call time,” John Schumann, M.D., a Tulsa internist who blogs on health issues at GlassHospital, told the AP.
Other problems:
The AP also noted: ”These devices and apps do little to ensure that patients take the medicines they’re supposed to. There are companies developing sensors to record when you pick up a bottle, but for now, doctors have to trust their patients.”
And “What we need is data for older people, and they are not doing that {using the apps and devices} right now, with rare, rare exceptions,” said David J. Cook, M.D., who is leading research at the Mayo Clinic into how trackers and apps can improve care.
The Pennsylvania Healthcare Cost Containment Council reports that 3 percent of patients hospitalized in Pennsylvania in fiscal 2014 were “super-utilizers” — admitted five or more times in a year. Those 21,308 patients accounted for 11 percent of total admissions and 14 percent of hospital days. Those 21,308 patients accounted for 11 percent of total admissions and 14 percent of hospital days.
Michael Consuelos, senior vice president of clinical integration for the Hospital and Healthsystem Association of Pennsylvania, told The Philadelphia Inquirer that the report was “no surprise for us folks who work in the quality improvement arena.”
The paper said: ”He said super-utilizers were often people with complex needs and limited access to primary and specialty care. The degree to which behavioral health was a factor was one of the more striking aspects of the report, he said. That illustrated the need to address the social determinants of health …{such as} poverty – and better coordination of mental and physical care.”
”Consuelos said some health systems were experimenting with putting mental-health and medical providers in the same office.”
“We all know, whether we’re talking about a renovation or working under a new ED director, that change is not painless. But, pain has its benefits, too. Being part of a team focused first on serving those who have served {in the military} and then on being agents of change is rewarding. Plus the simple fact is that although change is slow within this system, it is likely to be lasting … because, well, change is slow.”
Illinois Hospital Association President and CEO Maryjane A. Wurth told Becker’s Hospital Review that the proposed cut, as well as the governor’s policy changes, “would .. undo the substantial, groundbreaking progress being made to transform the Medicaid program and the state’s healthcare delivery system” and hurt the economy. She asserted that a 10 percent spending cut to hospitals alone would kill more than 8,200 jobs and $1.1 billion in economic activity.
She also cited various evidence that the state Medicaid program has been ”cost-effective, … such as Illinois being ranked as 49thin the nation in Medicaid spending per enrollee…{and} that state taxpayer costs per Medicaid beneficiary have dropped an average of 1.2 percent per year over the past 10 years….
“To the extent that the State does not adequately fund Medicaid, these unfunded costs are shifted to middle class families through higher insurance premiums, co-payments and deductibles.”
Of course a reduction in Medicaid money could also mean a reduction in hospital executive salaries, though nothing to compare with cuts in Medicare.
The new center already includes an urgent-care center, cardiac and primary-care service; a wound-care center and cardiology testing facility will open in the Stratford building soon. But what particularly intrigued us at Cambridge Management Group was that space was set aside on the second floor for community groups to meet. CMG has been working, particularly in Oregon, on such community-health projects.
Hospitals are re-inventing themselves as the definition of health moves well beyond just medical care to encompass a wide range of services to serve the welfare of entire geographic regions.
“We’re bringing St. Vincent’s out into the community rather than making people come to us,” Dianne Auger, senior vice president at St. Vincent’s Health Services, told The Stamford Advocate.
Perhaps the creation of such centers will, in a modest way, re-energize Americans’ sense of civic-mindedness that has declined so much in recent years with the self-absorption encouraged by social media and the decline of close family ties.
“That’s prompting a sea change in attitudes among mental-health advocates, who are starting to look at solutions that are broader than just training more psychiatrists.”
Among the strategies:
“{W}orking more closely with nurse practitioners and physician assistants, after a long history of protectiveness over its members’ powers. ”
And:
”California health centers are also gaining acclaim for their efforts to merge primary-care and behavioral-health services under one roof, which often ensures that many aspects of mental health can be addressed by providers other than psychiatrists.”
And help from techn0logy, such as:
”Robert Bosch Healthcare Systems Inc. says it has developed a device that providers can use to monitor patients with bipolar disorder and major depression, to make sure they are managing their illness through medication and behavioral therapy.”
This story is part of a reporting partnership between NPR, WFAE and Kaiser Health News.
In Medical Park hospital in Winston-Salem, N.C., Angela Koons is still a little loopy and uncomfortable after wrist surgery. Nurse Suzanne Cammer jokes around with her. When Koons says she’s itchy under her cast, Cammer laughs and says, “Do not stick anything down there to scratch it!” Koons smiles and says, “I know.”
Cammer is wearing charm-bracelets and jangly earrings, so she literally jingles as she works around Koons. Her enthusiasm for her job puts Koons at ease and is making her hospital stay more comfortable.
“They’ve been really nice, very efficient. Gave me plenty of blankets because it’s really cold in this place,” she says.
A reporter takes a quick informal poll, asking Koons and her stepfather, Raymond Zwack, to rate their satisfaction with the hospital on a 10-point scale. They both give Medical Park the same rating: a perfect 10.
Other patients — Karen Siburt, George Stilphen and Emily Willard — all agreed. They would rate the hospital a 9 or a 10.
Hospitals take more formal surveys from Medicare very seriously because the Affordable Care Act ties some hospital payments each year to how patients rate the facilities. Medical Park received a $22,000 bonus from Medicare in part because of sterling patient satisfaction surveys.
Novant Health is Medical Park’s parent company, and none of their dozen or so other hospitals even come close to rating that high on patient satisfaction. Figuring out why Medical Park did so well is complicated.
First, says staff surgeon Scott Berger, M.D., this isn’t your typical hospital.
“It kind of feels, almost like a mom-and-pop shop,” he says.
Medical Park is really small, only two floors. Doctors just do surgeries, like fixing shoulders and removing prostates, and mostly for people with insurance.
Another key is that no one at Medical Park was rushed to the hospital in an ambulance or waited a long time in the emergency room; in fact, the hospital doesn’t even have an emergency room. The vast majority of the surgeries done at Medical Park are elective.
“They’re choosing to come here,’’ says Chief Operating Officer Chad Setliff. “They’re choosing their physician.”
These are the built-in advantages small, specialty hospitals have on patient satisfaction, says Chas Roades, a consultant with The Advisory Board Company.
“A lot of these metrics that the hospitals are measured on, the game is sort of rigged against [large hospitals] in a sense just because of the kind of facility they are,” he says.
This is the third year hospitals can get bonuses or pay cuts from Medicare in part because of those scores. They can add up to hundreds of thousands of dollars.
Hospitals that handle many more patients – often massive, noisy and hectic places – are more likely to get penalized, says Roades.
“In particular, the big teaching hospitals, urban trauma centers, those kind of facilities don’t tend to do as well in patient satisfaction because they’re just busy, crowded, [and] there’s a lot of different caregivers that interact with the patients,” he says.
Roades says the patient surveys aren’t perfect, but they are fair: “In any other part of the economy, if you and I were getting bad service somewhere – if we weren’t happy with our auto mechanic or we weren’t happy with where we went to get our haircut – we’d go somewhere else.”.
In healthcare, patients rarely have that choice. So Roades says hospitals should be assessed in part by patients.
And Medical Park executives say there are ways big hospitals can seem smaller – and raise their scores.
Nurse Gennie Tedder is walking patient Jeremy Silkstone through a pre-surgical visit. It’s a chance a week or two before surgery to connect with patients and prepare them for what can be a painful process.
“It’s very important that you have realistic expectations about pain after surgery. It’s realistic to expect some versus none,” she explains to Silkstone.
Medical Park now handles this part of surgery prep for some of its parent company’s other, bigger hospitals. Silkstone, for example, will have surgery at the huge hospital right across the street, Forsyth Medical Center.
Medical Park Nursing Director Carol Smith says when her staff took over pre-surgical, “Forsyth’s outpatient surgical scores increased by 10 percent.”
But some doctors and patients who’ve been to both hospitals agree that the smaller one is sure to have higher scores. It’s just warmer and fuzzier, one patient says.
