”In September, the insurer will debut three ‘integrated care’ facilities designed to cater to South and Central American populations by offering primary care, specialty services, labs and diagnostics under one roof — a model that is common in Latin America.
‘The move reflects a consumer-focused style of administering care that has grown in popularity since the implementation of the Affordable Care Act. Now, more consumers are insured than ever before — 1.6 million Floridians enrolled in the marketplace in 2015 alone — many also leaving their employer’s coverage to shop for individual plans on the exchange.”
”Consumers want more transparency and affordability, with the option to price compare and get speedy service.”
”At Virginia Hospital Center in Arlington, executives credit improvements in patient satisfaction to their psychological screening methods in hiring and rigorous job reviews. Potential nurses and other staff must first pass a behavioral screening test and then be interviewed and endorsed by some of the staffers with whom they would be working. In the third element of the program, every six months, managers rate employee performance as high, medium or low. Low performers are told to improve or find work elsewhere.”
But, ”Nudging up scores has been a frustrating endeavor elsewhere, like at Novant Health, a nonprofit hospital system that runs Rowan Medical Center and 13 other hospitals in North Carolina, South Carolina and Virginia. While some Novant hospitals have excellent patient reviews, Rowan’s scores have remained stubbornly low since Novant took over the hospital in 2008.”
Add to the other orthopedic (and some other) surgeries that tend to be very lucrative for physicians and hospitals, but may have mediocre or worse outcomesthe increasing trend for surgery for patients with displaced fractures of the proximal humerus.
The article in JAMA concluded: ”Among patients with displaced proximal humeral fractures involving the surgical neck, there was no significant difference between surgical treatment compared with nonsurgical treatment in patient-reported clinical outcomes over 2 years following fracture occurrence. These results do not support the trend of increased surgery for patients with displaced fractures of the proximal humerus.”
And ”Nonsurgical patients also had lower rates of shoulder complications compared with surgical patients (18% versus 24%).”
The Washington Post reports on “Oncotalk,” developed by medical faculty at Duke, the University of Pittsburgh and several other medical schools and part of a ”burgeoning effort to teach doctors an essential but often overlooked skill: clinical empathy….{C}linical empathy is the ability to stand in a patient’s shoes and to convey an understanding of the patient’s situation as well as the desire to help.”
{”A} spate of studies in the past decade has found that it is no mere frill. Increasingly, empathy is considered essential to establishing trust, the foundation of a good doctor-patient relationship.
”Studies have linked empathy to greater patient satisfaction, better outcomes, decreased physician burnout and a lower risk of malpractice suits and errors. Beginning this year, the Medical College Admission Test will contain questions involving human behavior and psychology, a recognition that being a good doctor ‘requires an understanding of people,’ not just science, according to the American Association of Medical Colleges.”
Further, “Patient satisfaction scores are now being used to calculate Medicare reimbursement under the Affordable Care Act. And more than 70 percent of hospitals and health networks are using patient satisfaction scores in physician compensation decisions.”
“Identify and quantify specific affiliation-related cost-saving opportunities within each department.
“Identify barriers to achieving the efficiencies.
“Identify the resource and time requirements necessary to implement the action plans.
“Lay out a game plan for aligning specialty programs throughout the system.
“Ensure accountability by specifying the individuals responsible for implementing the plan.”
They note that ”many partnering organizations craft a BPOE before any affiliation agreement is signed. This lets system leaders proactively identify savings opportunities after the transaction. A pre-transaction BPOE also might be required for regulatory approval by the state department of health, state attorney general, Federal Trade Commission or the Department of Justice.”
But “An inherent limitation of a pre-transaction BPOE is that the prospective partners are unable to share competitively sensitive information before closing. This limits the specificity and detail of cost-saving opportunities and action plans. But provisional BPOEs developed before the transaction are directionally accurate; they can also ensure that the prospective partners are strategically and culturally compatible.”
And they discuss the need for:
1. A clear leadership structure.
2. Clear ground-level integration plans.
3. Realistic and sustainable cost-saving targets.
4. A strong foundation for a system-oriented culture.
He says that hospitals should keep young workers in the know about leadership opportunities, and everyone aware of the need to seek out talents that the current administration, led by older people, may lack. And he discusses in a Q&A how to get along with a staff many of whose older members might be dismissive of a young leader.
He ranks among his biggest successes so far readmission rates that have dropped to 35 percent from as low as 12 percent and a 30 percent rise in outpatient surgery over the past few years driven by new service lines.
Tejeda told H&HN that youthful hospital execs should play into the stereotype that they’ll be energetic and enthusiastic.
“That’s one of the preconceptions that should be taken advantage of. Allow yourself to be dynamic. Allow yourself to have that energy and enthusiasm. People will feel it. They will want it. People who have been at the hospital for a long time have wonderful ideas that need to be implemented, but they haven’t had that spark. They haven’t had someone who is the impetus to get things done. If they see that you have that energy, they will latch on and together you can accomplish wonderful things.”
Prescription-drug spending rose rose 13 percent in 2014, compared with 5.6 percent growth of overall healthcare spending.
An article in Modern Healthcare says: “Critics say patient-assistance programs help manufacturers keep prices high and demand for their branded products strong, and discourage patients and doctors from switching to cheaper alternative medications. Even though some drugmakers have publicly disclosed their contributions to these programs—many of which purport to be independent charities—information about contributors remains incomplete. That makes it difficult to discern how much influence the donors have.”
“I believe the NNT really isn’t suitable for communicating with patients. And that’s not just because it takes data about patients, inverts it to a ‘treater’ perspective, and then requires them to go through cognitive gymnastics to get back to their point of view. That’s a big part — but not all — of the problem.
“…. There isn’t a powerful justification here for manipulating absolute risk data this way. And there should be no surprise, either, when a survey suggests less than half of clinicians consider themselves able to really understand and explain the NNT.”
”Statistics aren’t value-free, even though they are more objective than many other ways of distilling information. They’re difficult to translate for people who don’t already “get” them very well in their original form. You need lots of context and several statistics to get a handle on the results of most clinical studies anyway. I can understand the desire to invent, or grasp onto, something new. But innovation isn’t always progress, is it?”
Technology entrepreneur Jonathan Bush says he was recently watching a patient move from a hospital to a nursing home. The patient’s information was in an electronic medical record, or EMR. And getting that record from the hospital to the nursing home, Bush says, wasn’t exactly drag and drop.
“These two guys then type — I kid you not — the printout from the brand new EMR into their EMR, so that their fax server can fax it to the bloody nursing home,” Bush says.
In an era when most industries easily share big, complicated digital files, healthcare still leans hard on paper printouts and fax machines. The American taxpayer has funded the installation of electronic records systems in hospitals and doctors’ offices – to the tune of $30 billion since 2009. While those systems are supposed to make healthcare better and more efficient, most of them can’t talk to each other.
Bush lays a lot of blame for that at the feet of this federal financing.
Bush’s assessment is colored by the fact that the company he runs — Watertown, Mass.-based athenahealth — stresses easily sharing electronic health records using the cloud. It also got a lot of the federal cash.
Dr. Robert Wachter, a hospitalist at the University of California, San Francisco, says sure — in hindsight, the government could have mandated that stimulus money be spent only on software that made sharing information easy. But, he says, “I think the right call was to get the systems in. Then to toggle to, ‘OK, now you have a computer, now you’re using it, you’re working out some of the kinks. The next thing we need to do is to be sure all these systems talk to each other.’ ”
Right now, the ability of the systems to converse is at about a 2 or 3 on a scale of zero to 10, Wachter and Bush agree.
Wachter is about to publish The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, which assesses the value of information technology in healthcare. Up until now, he says, there has been a financial dis-incentive for doctors and hospitals to share information. For example, if a doctor doesn’t have a patient’s record immediately available, the doctor may order a test that has already been done – and can bill for that test. Keeping EMRs from talking to each other also makes it easier to keep patients from taking their medical records — and their business — to a competing doctor.
It’s time for that to change, says Dr. Karen DeSalvo, the federal government’s health IT coordinator. She is setting some standards for how to share digital information.
“The time of letting a thousand flowers bloom, and having a set of standards that are quite variable, should come to an end,” she says. “We should be working off the same set of standards.”
The billions of dollars a year the government pays out to doctors, hospitals and other institutions for patients enrolled in Medicare is a pretty good motivator. Already, Medicare is starting to increase pay to doctors and hospitals that work together to streamline care and avoid duplicative tests, and to penalize those that don’t. Winning the new payments and avoiding the penalties increasingly require proving that all of a patient’s doctors, no matter where they are, are working together. That means using electronic records that can seamlessly move from one system to the next.
Wachter says that consumers are now demanding better health information technology, too – “because we’re all used to our app stores and we know how magical it can be when core IT platforms invite in a number of apps.”
“So I think,” he says, “that even the vendors and healthcare delivery organizations that have been fighting interoperability recognize it’s the future.”
He says a lot of IT companies are now eager to come up with software that meets the demands of both the healthcare industry and consumers. About a dollar of every $6 in the U.S. economy is spent on healthcare. A new IT boom in that sector means there are billions of dollars to be made.
This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News.