No Satisfaction
May 26, 2012
“I can’t get no satisfaction,” the Rolling Stones famously crooned. Hospitals are finding ways to improve patient satisfaction scores, but are these efforts also lowering costs and improving quality of care?
Apparently not. An article in Friday’s Hospitals and Health Networks reported on an study published in the Archives of Internal Medicine that found “happier patients cost more.”
The generated a lot of discussion at the recnet Patient Safety Congress. One critic of the article noted that it relied on data from an AHRQ (Agency on Health Care Research and Quality) household survey which was not tied to specific provider encounters.
Patient satisfaction, long a theoretical concern, has suddenly come into focus for hospitals because consumer satisfaction data will soon influence Medicare payments.
At the Congress, a RAND statistician said that (despite the recent study) in general “a better patient experience is linked to better technical quality, better outcomes and lower 30-day readmission rates.”
Neeraj Arora, a research scientist with the National Cancer Institute, who spoke about his 20-year battle with Non-Hodgkins lymphoma, noted that patients are often looking for emotional support at a time of crisis and may look beyond clinical expertise.
Last year USA Today reported that the Disney Institute has been hired by a number of hospitals to improve customer satisfaction. The newspaper noted
Training cost ranges from about $1,300 for a few days of workshops to several hundred thousand dollars for intensive, year-long consulting work, Disney spokeswoman Stacey Thomson and hospital administrators say.
Hospitals and businesses that sign on with Disney are not necessarily looking to give their campuses a theme park makeover. Rather, the training focuses on more prosaic workplace issues, such as improving staff morale and learning to treat patients more as customers, hospital administrators and Disney representatives say.
“Patients don’t know if the MRI machine you’re using is the newest,” said Patrick Jordan, health care industry consultant for the Disney Institute. “But they can absolutely tell you the experience they had with the technician.”
It’s not just the MRI machine that patients don’t understand, it is the whole range of complicated, expensive diagnostic tests that are now available and which our risk-averse health system adopts and prescribes at will.
At some point, technologic complexity and individual service must give way to standardization to lower costs. We can look to Southwest Airlines and Toyota for examples in that area.
Patients Can’t Violate HIPAA
May 21, 2012
Q. Can a patient violate HIPAA privacy laws?
A. No, according to an article in the current AMA News. The article, “Should doctors stop patients from taking smartphone pictures?” focuses on the emerging problem of photo-taking in physician offices.
The article is available in the AMA News under BUSINESS.
The article reports that some physicians are putting up signs stating that no cell phone conversations or picture-taking is allowed in their offices.
“Though the ban on telephone conversations was motivated by an attempt to keep down the annoyance factor, the implications of snapping pictures inside a practice can go beyond other patients getting a little irritated. If picture-taking is left unfettered, patients could feel violated and sense that a practice doesn’t take patient privacy seriously.”
The article also notes
“How a practice is held accountable when one patient violates another patient’s privacy can be tricky because, technically, patients cannot violate the Health Insurance Portability and Accountability Act. Ultimately, practices are duty-bound to do all they can to create an environment that respects patients and their privacy, experts say. If a patient’s waiting-room picture that gets posted on Facebook happens to include other patients, HIPAA violation or not, those patients might not be too happy.”
The statement that patients cannot violate HIPAA caught my attention. I had never heard of this before and frankly, it sounded inaccurate. Some clarity is provided in a later paragraph.
“Blustein said that if a patient’s privacy has been violated, regardless of whether the violation was caused by a fellow patient, he or she has every right to file a complaint with the Dept. of Health and Human Services Office for Civil Rights. The department will not know whether the violation was caused by another patient until it investigates the situation. Even so, investigators will look for patient privacy policies and evidence of training and policy enforcement.”
Some practices may want to create a “no cell phone” area, much like high school classrooms. However there are drawbacks to that.
“While it is prudent to prohibit taking pictures inside a practice, he wouldn’t recommend that practices ban smartphone use altogether. When patients are sitting in waiting rooms, the wait will seem shorter if they can surf the Web, watch videos and check emails from their smartphones. Preventing them from doing so will just alienate or anger them, as well as create a high sense of anxiety for patients who already are nervous.”
It is much easier to enforce a “no cell phone rule” than just banning photos, since it is easy to take a picture from a smart phone clandestinely.
Docs Rate EHR Benefits
May 12, 2012
Are EHR vendors using the best approach to reach physicians? What do physicians really want in an EHR anyway?
Certainly affordability is a major concern. However, EHRs aren’t marketed like cars or shoes, so price is rarely mentioned – unless it’s Practice Fusion which constantly boasts that it is provided free (with ads).
An interesting article in the May 7 issue the AMA News reports that charge capture ranks high on physicians’ list of EHR benefits.
With an EHR in place, charge capture improves, “which means more money.”
The article quotes an internist who said that while his exams are just as thorough as always, the EHR has helped him document their completeness.
“In the past, I would ask all the questions and only document half of them because of having to write it all out. The EHR allows me to document more thoroughly, which is good for a number of reasons.”
The medical director of a mid-size hospital noted
“I know that we were missing a boatload of charges on the nursing side on things like start and stop times for IVs, which we could never keep track of.”
All this is fine for the provider – and the patient whose quality of care is improved – but the more billed charges means higher costs for payers. That is not going to lower medical costs in the long run and it may be one of the reasons health insurers have never been strong advocates of EHRs.
Many EHR vendors with cloud-based systems have pointed to the ability to access medical data remotely and indeed, a number of physicians cited that capability.
“Physicians say ‘I can get the data in from my home office, from my PDA, from iPhone or my iPad, and it becomes a truly networked scenario that we have not really had before in health care.’”
Finally, another EHR feature cited by physicians is the patient portal. Physicians whose systems have this capability report an increase in productivity because “the patients are now taking responsibility for doing some of the administrative work that front desk staff used to do.”
While the article didn’t specify which tasks the patients are doing, it is probably self-reporting of demographic information and later downloading of the summary-of-care.
Save Me the Money
May 6, 2012
“Show me the money” said the NFL player looking for a new contract in the movie Jerry McGuire.
In the healthcare industry today, many people are demanding “save me the money.”
Example #1 is Massachusetts. The Wall Street Journal reported last week that the state will soon introduce some of the strictest health-cost containment legislation in the U.S. The new bill, which has bipartisan support, will cap how much expenses can rise annually at hospitals.
The Journal reported
The rate of growth in spending on health…would be enforced by a regulatory authority. Health-care providers and health plans that the regulator found to be pushing spending above the goal would have to submit improvement plans to bring expenses down. Institutions would still be able to challenge their findings by showing extenuating circumstances…The authority, which will include government, industry and consumer representatives, would ultimately have the power to force them to renegotiate their contracts.
Will placing a lid on hospital rates work? Some experts have said this is like pushing down on one side of a balloon – the costs will simply expand in another area.
Simply looking at money (i.e. rates) may be the wrong approach, according to a commentary piece in Friday’s iHealthbeat.
The article notes that the healthcare industry (and its supporting IT systems) is now “optimized for the ‘do more, bill more’ model of reimbursement. However, that model is rapidly being replaced by a focus on value and outcomes — a 180 degree shift.”
The commentary points out
Providers who have demonstrated outstanding results with challenging patient populations recognize that there are two main care approaches. In a setting such as a hospital, many leading hospitals have successfully adopted a manufacturing-based model borrowed from Toyota. However, with chronic disease, a service-based approach is necessary to effect behavioral change.
Since 75% of health care spending is currently directed toward chronic disease, adopting a service-based approach to engage individuals is paramount. The article cites telemedicine, particularly, secure messaging, as a technology that can successfully engage patients and save money.
Whatever happened to Jerry McGuire?
The LA Times reported recently that sports agent Leigh Steinberg, who represented many of the NFL’s biggest stars and was the inspiration for the movie “Jerry Maguire,” filed for bankruptcy protection earlier this year.
Let’s hope we can avoid that path.
ATA Show Draws 4,500
May 1, 2012
The telemedicine industry is undergoing rapid growth with many new companies, much like the EHR industry six-eight years ago.
The American Telemedicine Assn. (ATA) annual conference, which wrapped up today in San Jose, attracted 4,500 attendees and 220 vendors, a record crowd.
Jasper Zu Putlitz, MD, the president of Bosch Healthcare, noted in a Monday panel discussion that until recently telemedicine had been held back by the “business model problem.” In the past, it has been difficult to obtain reimbursement for telemedicine services. Health plans general did not reimburse physicians for telemedicine consultations, based on the fact it was not a “face-to-face encounter.”
That is changing, however, due to new emphasis by Medicare and private payers on preventing hospital readmissions and adoption of ACO payment models. Now a number of organizations including insurers, hospitals, retail pharmacists and self-insured employers are willing to pay for telemedicine services.
Telemedicine has been proven effective in several areas. One of the most cost-effective cases can be made for placement of in-home monitoring devices for patients with chronic heart disease. Daily monitoring of blood pressure and weight can trigger a nurse call and prevent an ER visit.
The Bosch CEO noted that in the future, 20-40% of all medical consultations could be conducted via telemedicine.
At another panel discussion, Frost & Sullivan analyst Zach Bujnoch outlined the four primary telemedicine markets that currently exist.
1. Remote monitoring market
Submarkets include home and disease management monitoring, diabetes management, activity monitoring and wellness programs.
2. mHealth
Submarkets include professional/clinical apps, wellness apps, fitness apps and texting informational services.
3. Video telemedicine
Submarkets include video diagnostic consultation, remote doctor/specialist services and distance learning/simulation.
4. Healthcare information management systems
Submarkets include EHRs, health information exchange, tele-imaging, patient portals and hosted cloud infrastructure.
Several speakers noted the lack of standards for communication and data storage, what one called “the air traffic control problem.” One speaker said the industry is “in danger” of becoming like the EHR industry, where different vendors cannot exchange information with each other.