Uncategorized•
on June 18th, 2010•
By John Whittlesey
(Part one of a two-part blog)
When I was in grad school – oh so many moons ago – I learned the history of the early healthcare system in the United States. There was the Hill-Burton Act to build hospitals in rural and under-served areas; the social safety nets of Medicare and Medicaid; the evil for-profit models; the even scarier “DRG” classification and reimbursement models about to be implemented; and the then-emerging managed care products, etc.
The one fact that completely surprised and dismayed me was that there were two separate and parallel health delivery networks outside of the general private health system: the Department of Veterans Affairs (VA) system, and the military health system. Over the past 25 years, my mantra has been that if I were in charge of the national health system – and it’s a good thing I’m not! – the first thing I would do would be to get rid of the VA and integrate it into the private health systems we all use. We’d use vouchers or whatever to make sure that veterans still get the full service they deserve.
Now, I’m not so sure.
Two recent developments caught my eye and have made me think differently about the situation (yes, it is possible for me to change my mind). We’ve all heard the horror stories about the mistreatment of veterans (remember Tom Cruise in Born on the 4th of July?), along with big access and quality problems, have created a general impression that the VA system just isn’t as good as the private health system. Well, over the years it seems that the government and VA leaders have stepped up their game, and cleaned up many of the structural, facility, and clinical messes.
Phillip Longman, senior fellow at the New America Foundation and author of a book about the VA called “Best Care Anywhere,” discusses how the VA has been developing a model of integrated care delivery along the continuum of care (primary, outpatient, inpatient, aftercare, and preventive medicine). He holds that the VA is now the model of choice for the country to follow under healthcare reform. “The rest of the health-care system doesn’t have a business case for quality,” Longman says.
Most of this is being accomplished through one of the largest and most comprehensive electronic medical record projects to date. It’s a way of capturing longitudinal patient information and integrating it into patient care practices. This uniform, standardized, integrated, and theoretically efficient system will sound like a good business to some; to others it may sound like socialized medicine. Score one for the VA.
(Read a related article MarketWatch article by Kristen Gerencher here.)
John Whittlesey is a Principal at HMC
Uncategorized•
on June 14th, 2010•
By Shelley Burns
Do you know …
- How many hospital-acquired pressure ulcers you had last year?
- How much additional care, in dollars, did patients with hospital-acquired pressure ulcers require?
- What are the top three DRGs contributing to your pressure ulcers?
- Which three DRGs are the biggest losers (i.e., payment is less than cost) for your hospital?
- How much money, in total, did these three DRGs lose?
These answers and more are available in the HMC Clinical Analyzer. Take the HMC Clinical Analyzer quiz to test your skills and discover more about your hospital. Participants with 100 percent correct on the quiz will be recognized in next month’s newsletter and receive a cup of coffee (Starbucks gift card) on HMC.
Want a refresher before you take the quiz? Join us on Thursday, July 24 for a Clinical Analyzer overview.
Shelley Burns is head of knowledge management at HMC.
Uncategorized•
on June 10th, 2010•
By John Whittlesey
We have a facility – that will remain nameless – which has gone through a major physical transformation over the past three years. It recently built a brand-new, state-of-the-art tertiary facility to replace its older facility, but essentially keeping the same services intact. Now prior to the move, they certainly didn’t have what I would consider to be a cost-effective model of delivering healthcare.
So, when they were planning and building this facility, I advised one of the key planner-implementers of the project to take advantage of this singular opportunity to redesign the staff’s processes, productivity, utilization patterns, clinical protocols, etc. This could allow the facility, in effect, to “reset” its cost position in a new environment. He assured me the managers were working those things into the plans. I crossed my fingers and hoped for the best.
So we’ve just finished the facility’s 2009 clinical benchmark, and I was curious to see what major changes occurred. I went back to the 2007 report to see what its cited excess was at the old facility, and compared it to the first full data set under the new facility (FY 2009). Interestingly enough, the excess was 5 percent greater in the new facility than before, its cost/case was nearly the same, and most of the same DRGs were cited for similar variation.
So, to my eye nothing really changed, except they have a new, pretty facility. Is that really good stewardship of healthcare resources?
John Whittlesey is principal at HMC
Uncategorized•
on June 7th, 2010•
By John Whittlesey
So, recently I’m talking to one of our best program coordinators, and we’re reviewing their facility’s clinical benchmark results for 2009. I comment that Dorsal and Lumbar Spinal Fusion is their highest excess DRG this year and has increased its excess over the previous year. We drill into the data and find that the cost per case in Surgical Services is very high and increasing – hence, the driver of the excess.
Volume has also increased over the past two years, exacerbating the problem. Then the program coordinator tells me the new neurosurgeon is the one driving the volume and cost increase. The coordinator also discovered, well after the neurosurgeon was in place, that he was a part owner of the implant vendor he was using at their facility! So I ask if they bothered to do any due diligence to check out the neurosurgeon’s practice patterns or background, and the coordinator said the facility was so happy just to get neurosurgery coverage that it didn’t bother.
Really! This happens so often when it comes to surgeons. For some reason, hospitals don’t think they can/should/have the obligation to check out anything more about a physician than if they have a license, any outstanding lawsuits, or have had any disciplinary actions taken against them. I say: “What’s wrong with adding clinical and economic credentialing to the professional credentialing?”
More, now than ever, hospitals have a fiduciary responsibility to make sure their physicians will manage clinical resources effectively and efficiently.
John Whittlesey is a principal at HMC
Uncategorized•
on June 3rd, 2010•
By Michelle Gray-Bernhardt
(Part two of a two-part blog)
A wide-ranging sample of nurses from various facilities’ units participated in HMC’s survey. Their responses for the greatest time wasters fell into these broad categories:
1. Charts and documentation
These topics are interrelated. Frustrations around charts include missing or incomplete charts, the necessity of charting excess information, and/or duplicating information. It also includes the difficulty in finding necessary information.
Online documentation is the number one source of inefficiency and hybrid (half paper/half electronic) systems are singled out as particularly frustrating. Nurses also noted problems with incompatible computer systems and the crashing of glitch-prone systems, which required information technology staff intervention.
2. Finding and gathering supplies and equipment
Whether supplies or equipment, time spent searching equals time spent away from patients.
3. Patient flow
Transporting, admitting, and waiting for patients is a frequently-cited inefficiency. This includes lack of exam or treatment rooms or anomalous patients in units.
4. Physician interaction
Waiting for communication with physicians (return phone calls, post-round information, medication orders, discharge orders, etc.) creates frustration among nurses.
5. Communicating with families and patient complaints
Nurses find it challenging when families call frequently and unexpectedly, particularly when there is no clear family spokesperson. The result is that multiple family members call in with the same questions, status requests, etc.
For more information
HMC clients may check out the Nursing Obstacles and Inefficiencies Survey to see a bar chart of the results and see the nurses’ comments. They’ll also learn which nurses are doing well with time management and in maximizing patient time.
Michelle Gray-Bernhardt is an HMC knowledge manager
Uncategorized•
on June 1st, 2010•
By Michelle Gray-Bernhardt
(Part one of a two part blog)
The March 16 edition of the the industry publication HealthLeaders featured an article by Rebecca Hendren titled “Ten ways to increase nurses’ time at the bedside.” This article notes that “the easiest way to know what will save nurses time is to ask them. Stop nurses in the hallway and ask about inefficiencies and they will name umpteen things that drive everyone nuts. Saving five minutes here and there all add up. Removing obstacles that hinder nurses not only saves time, it also saves frustration.”
HMC asks the questions
So, what do nurses at HMC partner facilities think? We asked what tasks take them away from the patient bedside and feel like time wasters. Soon, we’ll be sharing the results.
Stay tuned.
Michelle Gray-Bernhardt is an HMC knowledge manager
Uncategorized•
on May 28th, 2010•
By Karen Jorge
The New York Times just ran an interesting article on hospitals’ increasing use of hospitalists. These specialists, as a sort of “physician-administrator,” handle cases in the hospital from admission to discharge, and can significantly reduce length of stay (from 17 percent to 30 percent) and costs (13 percent to 20 percent) according to The Journal of the American Medical Association. They are also focusing on improving communication with patients, which is crucial not only to patient satisfaction, but also to preventing readmission through confusion about medications or other instructions.
Perhaps the most exciting part of the uptick in hospitalist use is that many of these specialists are intentionally working toward controlling costs and making workflows more efficient. We often see a disconnect between physicians and the finance/performance improvement folks, but all parties need to work together in order to tackle these issues. I was thrilled to see the article discuss hospitalists’ focus on “preventable adverse events,” “cost-effective delivery of care” (yes!), teamwork, and making decisions for cost-cutting. Great!
Too often there is a struggle between how physicians want to practice medicine and how finance teams want to control costs. Both have worthy goals, but they’ve got to work together, and it appears that if hospitalists are used effectively, they might provide a bridge between the two to deliver better care at a lower cost.
Karen Jorge is an HMC analyst.
Uncategorized•
on May 26th, 2010•
According to a recent press release, the American Customer Satisfaction Index (ACSI) noted that while overall customer satisfaction is on the rise, hospital patient satisfaction is declining.
The ACSI, updated quarterly, is a national indicator of customer evaluations of products’ and services’ quality. “Hospitals are taking it on the chin as the quality of inpatient healthcare and emergency room services declines,” states the release. “The hospital industry plunges 5 percent to 73, its lowest level in five years. Outpatient care at hospitals remains steady, but sharp drops for inpatient and ER services has taken a big toll. By contrast, patient satisfaction with office visits to healthcare professionals such as doctors, dentists, and optometrists is steady and scores much higher at 81.”
HMC has initiated a call series about hospital patient satisfaction. The first discussion was held on May 25 and focused on patient satisfaction in the ED. Clients interested in learning more can log on here.
Uncategorized•
on May 24th, 2010•
By Shelley Burns
(This is part two of a two-part blog)
This eye-catching article reports that Google is highly regarded as a source of health information. Doctors are still number one, by quite a bit, but my bet is that their influence is going to erode further because of the difficulty inherent in accessing a physician. I experienced this myself.
Unknown to us, my mother-in-law quit taking a prescription drug. We, and her physician, were baffled by her deteriorating mental state. She was becoming unsafe in her apartment and we were frantic. It took us about 10 days to figure it out. After we did, we were relieved, but had concerns about how to restart her medication – bolus? ramp-up? I called the physician – he was on vacation, but I explained it to the nurse. She refused to help, even though I had a healthcare power of attorney, and had been conversing with the physician about Mom’s status almost daily.
“You’ll have to discuss this with Dr. Z.”
I pleaded: “Can’t one of the other physicians just tell me if it’s safe to start this med up at her previous level?”
No, there was no one in the office who was going to talk to me over the phone, and the next appointment that was available for my mother-in-law was weeks out. She would have to be hospitalized before she’d make that appointment. So I went online, and Googled “restarting drug X.”
I found several sites and felt confident enough to restart Mom’s medication. It was successful, although I realize we were lucky, and we would have preferred communicating to a doctor about it. It was only because I was desperate that I turned to Google.
Now, if the results of these two polls, corroborated by my own ubiquitous experiences, don’t demonstrate the importance and necessity of electronic communication and interaction, I don’t know what would. Doctors cannot be available 24/7, but they can sure expand their reach with e-mail, online scheduling, accessible electronic records, and some basic care information.
Hospitals can provide services such as online registration, basic discharge instructions, family communications, and even “traffic” reports in the ED in a more timely fashion and for lower cost (who doesn’t want lower cost in healthcare?). Fair warning, doctors and hospitals, if you want to keep the top spot for health information influence, you’d better be on the ‘Net in ways that benefit your patients.
Shelley Burns is head of knowledge management at HMC.
Uncategorized•
on May 21st, 2010•
By Shelley Burns
Part one of a two-part blog
As I scanned my e-mail messages this morning, my eye caught two articles, posted side by side, from HealthLeaders Media Marketing Weekly. The first was titled “Parents want e-communication with doctors but few have it.” It reported that the C.S. Mott Children’s Hospital National Poll on Children’s Health found that less than 15 percent of people have electronic communication with their children’s pediatricians, but more than 50 percent want it. I feel their pain!
Our family physician’s office allows me to have an electronic chart, but not my children. My workaround? I send my doctor queries about the kids via MY electronic chart (“JoEllen has had a slight cough for 10 days. No fever and she seems fine. Something going around or do you want to see her?“). My doctor chastises me every time, but…I don’t care. She answers my query first and then chastises, so it works for me. I often need my kids’ immunization records for school, sports, the band, the chess club, for juggling, you name it. The physician’s office is very prompt – they’ll fax it right away – as long as I need it between 8:30 a.m. and 4:30 p.m., Monday through Friday.
My children – like all children – hand me the permission slip on Sunday evening at 9 p.m., with the wailing declaration that they must return it tomorrow at 7:30 a.m. So, I have an immunization record problem. I’ll leave a message on the doctor’s tortuously long office voice mail that evening, but they must call me back to ensure I’m not requesting immunization records for nefarious purposes. Then I’m in a meeting when they call.
I return the call, but the nurse is with a patient…you KNOW how this goes. My workaround is to keep a record of their immunizations in the notes section of their Outlook contact record. Voila – it’s accessible and can be updated by me, the payer, 24/7 at work, at home, or on my iPhone. (And, so, doctor, when I am frantically typing away on my phone during my kids’ physicals, I’m not answering e-mails. I’m updating their PHRs).
Shelley Burns is director of knowledge management at HMC.
