Archive for May, 2010

Walking Physician Practices Through a Redesign

May 24th, 2010 by Patricia Donovan

As Dr. Lonnie Fuller says in a featured story in this week's Healthcare Business Weekly Update, "Practice transformation is a buzzword for change, and change is very hard." In recruiting physician practices for its multi-payor medical home pilot, Health TeamWorks (formerly Colorado Clinical Guidelines Collaborative) tries to determine where a practice is on its redesign journey by walking candidates through a readiness assessment.

In last week's webinar on the practice recruitment process, Health TeamWorks medical and executive director Dr. Marjie Harbrecht explained how the Improving Performance in Practice (IPIP) exercise is both an assessment opportunity and a teachable moment:

"We go into the practice with an hour-long brainstorming tool and talk about how they would take three steps for tobacco cessation: to make sure every patient in your practice is being asked about whether they smoked or not, is advised to quit and is then referred to our Colorado quit line for further counseling. We would ask them how they would build a process into their practice to accomplish that. We used that tool as an opportunity not only to teach these skills but also to see whether this practice was ready to start taking on quality improvement."

Dr. Harbrecht describes the financial impact of the medical home model and some of the practice selection criteria in this week's HealthSounds podcast.

Delivering Primary Care at Home

May 17th, 2010 by Patricia Donovan

It may have been Dorothy that said, "There's no place like home," but more healthcare organizations now view the home as an acceptable place to deliver primary care, particularly for elderly patients with multiple chronic conditions. In this week's Healthcare Business Weekly Update, learn how the Veterans Health Administration's Home-Based Primary Care model, which targets veterans with complex chronic disabling diseases, halved inpatient costs, reduced admissions by 28 percent and hospital days by 71 percent and delivered overall savings of $58 million over 12 months for the 9,400 elderly veterans in the study. This "hospital at home" model, established in 1972 and utilized in Europe for years, receives high marks from patients.

The pendulum has swung on the industry's thinking surrounding home visits, agrees Jessica Simo of the Duke Division of Community Health, who discusses the motivation for home visits for the Medicaid population with Duke's Dr. Larry Greenblatt in this week's HealthSounds podcast.

Closing Healthcare Gaps

May 10th, 2010 by Patricia Donovan

Improperly managed, the transition between leaving the hospital and returning home can turn into a dangerous care and communication void, particularly for patients with heart failure. A featured study this week from Duke University found that most hospitals have no formal follow-up procedures for these patients, with only about 40 percent seeing a healthcare provider within seven days of discharge.

Susan Shepard, director of patient safety education at The Doctors Company, shared a story during last month's webinar on coordinated discharge planning: The CMO of a large health system was hospitalized because of an emergency surgical procedure. While he was delighted with the care he received, he said that the biggest surprise was that when he went home, he felt alone, fearful, uninformed and disconnected. He had received no real education on how to take care of himself, had no way to reach out for that information and had no guidance or coordination of care.

Aetna's care transitions initiative, described in this week's issue of the Healthcare Business Weekly Update, is attempting to close care gaps for its Medicare patients. Our chart of the week on Home Visit Tasks, developed from our 2009 Care Transitions survey, illustrates other ways to put recently discharged patients on the path to self-management.

What’s Keeping Physicians Busy These Days?

May 3rd, 2010 by Patricia Donovan

While hundreds of physician practices nationwide are piloting the patient-centered medical home model, still at issue is a reimbursement formula that adequately compensates physicians for the medical home's care management components. In “What’s Keeping Us So Busy in Primary Care?," a study published in last week's New England Journal of Medicine, Dr. Richard Baron documents the daily duties of the five doctors in his Philadelphia practice that fall outside the scope of routine patient visits. On an average day, besides seeing 18 patients, each Greenhouse Internists physicians made 24 phone calls, wrote 17 e-mails, reviewed 20 lab reports and issued 12 prescription refills daily. While all of these tasks extend access to care, they consume a great deal of physicians' time outside of patient visits.

This week's Healthcare Business Weekly Update features Dr. Baron's recommended technology backbone to support evidence-based care delivery, taken from his presentation during our Medical Home Open House webinar series. If you missed the story, you can read it here.