Archive for 2010

A Look Back at 2010’s Top Healthcare Stories

December 29th, 2010 by Patricia Donovan

Without a doubt, the March 2010 passage of the Patient Protection and Affordable Care Act (PPACA) — a.k.a. healthcare reform — was the biggest healthcare story of the year. The effect of the November midterm elections on this legislation, its ability to withstand dozens of legal challenges and its continued rollout and implementation will be among the stories we’ll monitor for you in the year ahead.

But in this second annual “Best Of” issue of the Healthcare Business Weekly Update, we present the stories that resonated most with you, our readers. Our top story of the year was one that ran only two weeks ago: 5 Key Trends That Will Shape Healthcare. (It must have been those glucose-monitoring tattoos.) To this list I add an innovation lauded in the New York Times 10th annual Year In Ideas issue: taking your pulse by webcam.

Our other top stories covered the United States’ dismal ranking in healthcare quality as well as standout efforts to curb readmissions, improve medication adherence and employ a case manager to more closely and efficiently coordinate care.

The staff of the Healthcare Intelligence Network and the Weekly Update wish you, your colleagues and your families a healthy, peaceful and profitable 2011.

Why Do People Use the ED?

December 22nd, 2010 by Jessica Fornarotto

Kaiser Foundation Health Plan of Colorado uses a number of strategies to find out why individuals use the ED, explains Sara Tracy, senior manager of emergency services for Kaiser.

There is a fair amount of literature that talks about why people use the ED — people truly think that they have an emergency, an individual may not have access to primary care or they can not get in a timely manner, they may not have received a phone call back if they had called in to see what to do about their condition, primary care wasn’t open when they needed it or they couldn’t access it. Then some individuals may say, “I didn’t know my care options.” Many of our members said they don’t realize that they have other options outside of the ER. We also have our resource-intensive members who use the ED excessively.

In one of our core facilities, we conducted a post-discharge survey of our ED patients to understand why they went to the ED. Part of the survey was a satisfaction survey to understand the patient’s satisfaction with the service that we had provided, and the second half asked them why they went to the ED. The survey found that 46 percent of them stated that they would have gone to their primary care office instead of the ED if they could have. Of that 46 percent, 81 percent cited the office being closed as the reason why they didn’t go. We’re currently delving further into this particular subset of patients to identify the time of day and the day of the week that patients cited the office as being closed, to understand if this is an education component or if it’s truly 2:00 AM and the member has no other options but the ED.

Additionally, we manage a nurse advice service for our members that’s 24 hours a day, seven days a week. We send out written surveys to our members who use the after-hour service to determine the satisfaction with the service and the outcomes. Because we have an inbound and outbound model, we found that if we don’t call them back within 60 minutes, those members were more likely to go to the ED. They wanted an answer about their condition and they wanted it quickly.

Our strategies to get members to the appropriate care include understanding how, why and when they’re accessing ED care. We wanted to know how often they are calling Kaiser Permanente medical offices and their physicians before they go to the ED. We found that approximately 45 percent of our members called us before they went in to either try to seek advice, to get an appointment or to understand where to go. As we address those members who call us, we are working on scripting with our medical office staff that includes where to send the members as well as what their alternate care options are. Our goal is to move further upstream to intercede and redirect that member prior to the ED visit, which is what we call “pre-patriation” — to attempt to get the member to the correct venue for their care the first time.

Tis the Season for Constitutional Challenges to PPACA

December 22nd, 2010 by Patricia Donovan

‘Tis the season to discuss the constitutionality of the healthcare reform bill, according to developments in Virginia and Florida last week. The bill was dealt a legal blow last Monday when a Virginia federal judge ruled unconstitutional the bill’s mandate for health insurance for all Americans beginning in 2014. Last Thursday, a federal judge in Florida began hearing arguments on the constitutionality of the same key provision, in response to a lawsuit filed on behalf of 20 states.

Meanwhile, a new Commonwealth Fund report featured in this week’s Healthcare Business Weekly Update looks ahead to 2014, detailing how more than 18 million men and women of a certain age will benefit once the Patient Protection and Affordable Care Act (PPACA) kicks in completely.

More immediately, three of the four most critical aspects of PPACA are tied to finances, according to healthcare organizations responding to our 2011 Healthcare Trends & Forecasts e-survey in October. I encourage you to download the complimentary executive summary of these survey results, which should greatly assist you in your planning for the year ahead.

Five Keys to Workplace Clinic Success

December 17th, 2010 by Jessica Fornarotto

This week’s issue of the DM Update provides a look at the increase in workplace clinics, the many benefits such clinics can offer employers and their staff, and five keys to clinic success. Also, find out which condition dropped from third to fourth place in leading causes of death, and the link between biological diversity of ovarian cancer and screenings.

Emerging Technologies That Will Reshape Healthcare

December 13th, 2010 by Patricia Donovan

Tattoos that monitor glucose levels? Smart pills that send notifications when swallowed? Video games that hone medical decision-making? These emerging technologies are in development and will reshape healthcare, according to a Computer Sciences Corporation report featured in this week’s Healthcare Business Weekly Update.

Health IT is already improving the quality of care for some Medicare beneficiaries with chronic conditions, according to results from three CMS Medicare demonstrations released last week and detailed here. The CMS data also illustrates how provider incentives can drive benchmark performances.

And finally, I encourage you to download our newly compiled performance benchmarks in telehealth and telemedicine, based on our second annual survey on this topic. You’ll get the top technologies, targeted populations, prevalence of remote monitoring and much more.

Quit Smoking and Improve Your Mental Health

December 10th, 2010 by Jessica Fornarotto

Quitting smoking can help to improve mental health by reducing symptoms of depression, according to a study highlighted in this week’s issue of the DM Update. Learn more about this study as well as another population at risk for depression.

What are the three main influences of high blood pressure? Find the answer in this week’s issue.

Registered Dietitians Help Manage Diabetes

December 6th, 2010 by Jessica Fornarotto

Even though the CDC reported last month that diabetes could affect one in three Americans by 2050, the American Diabetes Association says mortality rates for Type 1 diabetes are decreasing. Find out the mortality rates by gender and ethnic population, as well as the possible reasons behind this decrease in this week’s issue of the DM Update. Also this week, learn more about the role of registered dietitians in diabetes management, and the types of cancers diagnosed late despite available screenings.

5 Questions to Assess ACO Readiness

December 6th, 2010 by Jessica Fornarotto

An accountable care organization (ACO) raises several strategic questions that must be answered quickly before healthcare organizations decide how they may want to participate in an ACO, says John Harris, principal with the consulting firm of DGA Partners:

  • Are we ready to be an ACO? What will it take to get ready?
  • For hospitals: If we succeed clinically as an ACO, will we drive down volume and suffer financially? And if we do, could we attract more market share to make up for the reduced utilization?
  • Can we pursue this on our own, or should we partner?
  • What will the financial impact be (investments, impact on operations, cash flow, etc.)?
  • What are the competitors planning, and how will that affect our plans?

Some will pursue ACOs as a defensive strategy to avoid having competitors take the lead and market share from them. This is true for hospitals in particular, but probably applies to physician groups as well. ACOs have to be considered with other key strategic initiatives, such as market share development, clinical integration, physician-hospital alignment and others. ACOs don’t stand on their own but rather tie in to these strategic initiatives. ACOs can be a vehicle for moving several of them forward in significant ways.

Three Principal Goals for an ED Case Management Program

December 6th, 2010 by Melanie Matthews

Emergency department case managers serve three principal goals in a comprehensive case management program, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center. ED case managers can make sure that the right patients are admitted to inpatient beds, assist in reducing readmissions and provide for alternatives to admission when appropriate.

By meeting all of these goals, ED case managers can have a bottom line impact on a hospital by ensuring that the hospital is appropriately reimbursed, Cesta added.

Cesta shared with participants in this month’s webinar Embedded Case Managers in the Emergency Department, how an ED case management program can reduce commercial admission denials, assure compliance for medical necessity, facilitate and initiate care and improve clinical documentation.

E-Tools Update ER Wait Times

November 29th, 2010 by Patricia Donovan

ER wait times: is there an app for that? If not, there soon will be. A group of nine Texas hospitals uses digital tools, including a planned iPhone app, to update average ER wait times — a tactic profiled in this week’s Healthcare Business Weekly Update. The hope is that patients with non-life-threatening conditions will review the average waits at local ERs and decide which ER to use.

It’s a great idea, but one that could be taken a step further. Why not link to a health advice line so patients could determine the most appropriate venue for care, which may be the ER but could also be an urgent care center or next-day physician visit? Nurse advice lines such as the one operated by Optima Health are helping to reduce avoidable ER use and rehospitalizations, according to Patricia Curtis, Optima’s director of operations, clinical care services, while boosting patient and physician satisfaction scores. Stay tuned. We’ll have an interview with Ms. Curtis in next week’s issue, or follow us on Twitter to access the interview as soon as it ‘s available.