Archive for August, 2011

Standardizing Shift-to-Shift Patient Handoffs Could Reduce Medical Errors

August 9th, 2011 by Patricia Donovan

Faulty or incomplete handoffs of patients between provider shifts in teaching hospitals may be responsible for more medical errors occurring in hospitals than overworked, sleep-deprived medical residents, suggests an article in the August 7, 2011 New York Times Magazine.

The solution may be startingly simple: adopt a universal patient handoff protocol and train the entire staff in its use.

Author Darshak Sanghavi points to a small but significant pilot conducted at Boston’s Children’s Hospital, in which the shift-to-shift patient handoff process was standardized: computerized patient summaries were created and used, a structured verbal handoff was developed, and hospital staff was trained in all aspects of the initiative. At the end of the three-month pilot, medical errors among this pediatric population had dropped 40 percent.

This pilot has tremendous implications for an issue that has become a major focus of the healthcare industry. For the last few years, healthcare organizations have been working to tighten transitions between care sites, such as from hospital to home or hospital to skilled nursing facility. This management is principally the responsibility of a dedicated case manager, who is charged with the ultimate goal of reducing hospital readmissions and ER visits, particularly by high-utilizing Medicare beneficiaries.

While the bulk of efforts to improve patient handoffs are aimed at new young doctors, it makes sense that shift-to-shift patient handoff protocols should be examined and standardized in tandem with site-to-site patient transitions in any initiative to improve care transitions, such as the CMS Community-Based Care Transitions Program.

The numerous discussions of care transition management strategies hosted by the Healthcare Intelligence Network over the last few years have mainly focused on site-to-site transfers of patients rather than handoffs of patients between shifts of providers. However, more recently in the case management arena, we are hearing more about the “daily huddle” at the physician practice level.

The results of a study reported in the Association of Program Directors in Surgery’s Journal of Surgical Education also found that simplifying and standardizing the instrument used for patient handoffs improved resident perceptions of accuracy, completeness, and number of tasks transferred.

Also, an article in the November 2007 issue of infocus, The Quarterly Journal for Health Care Practice and Risk Management, described several tools in use around the country to standardize patient handoffs. “Handoff Communications: Heeding the Call to Change,” reports on a range of sign-out systems designed to help ensure safe handoffs at shift changes.

Have you reduced medical errors and/or avoidable utilization by standardizing internal patient handoff protocols? Please share any tools you have developed in this area.

7 Quality of Care Investments That Earned Marshfield Clinic $15.83 Million in Shared Savings

August 9th, 2011 by Patricia Donovan

Marshfield Clinic, one of 10 participants in the CMS Physician Group Practice Demonstration, invested in seven key areas to improve quality of care delivered to patients. Marshfield Clinic was one of four participants to generate significant savings under the terms of the demonstration that resulted in a $15.83 million performance payment.

The key quality of care investment areas are:

  • A well-developed electronic health record (EHR). All clinic physicians have access to patient records from all clinic centers through the EHR, which helps to eliminate duplication of services, like lab tests and imaging. The EHR helps plan visits, addresses care at the time of the visit, and assures that appropriate monitoring of chronic conditions is performed.
  • 24-7 telephone nurse line for advice and triage for patients who have their primary care provider within the Marshfield Clinic system;
  • Anticoagulation clinic;
  • Congestive heart failure clinic programs;
  • Cholesterol management programs;
  • Well-established telemedicine initiative;

Marshfield Clinic was one of four to generate significant savings under the terms of the demonstration that resulted in a performance payment. Marshfield Clinic is one of only two out of the 10 large physician group practices to achieve shared savings in each of the five performance years.

The Marshfield Clinic system provides patient care, research and education with 54 locations in northern, central and western Wisconsin, making it one of the largest comprehensive medical systems in the United States.

Rate of Stroke Increasing Among Women During, Soon After Pregnancy

August 8th, 2011 by Cheryl Miller

An alarming new statistic has been released by the American Heart Association: the rate of women having strokes while pregnant and immediately afterwards has increased by more than 50 percent over the past dozen years. Risk factors like high blood pressure and obesity are the culprits. This finding maps to our recent story from the Robert Wood Johnson Foundation and the Trust for America’s Health revealing that almost a third of people in 12 states were obese in 2010.

In other news in today’s Healthcare Business Weekly Update, prescription drug spending has slowed by almost 2 percent in 2010, according to new data released by CMS and reported in Health Affairs. Increases in generic dispensing rates is just one of the reasons for the slowdown.

In a move designed to improve quality and reduce healthcare costs, Blue Shield of California and SJHS are launching an ACO. The healthcare entities will work together to share clinical and case management information and coordinate comprehensive healthcare services.

And, midway through our Patient Registries Survey we find that three-fourths of our respondents see diabetes patients as the principal targets of registries. Want to weigh in on your organization’s use of registries? You have a few more days to complete the survey online, and you’ll receive a free executive summary of the survey results once they are compiled, providing key benchmarks and metrics for using registries to improve reimbursement and patient outcomes.

mHealth: There’s a Grant for That

August 5th, 2011 by Cheryl Miller

By 2015 more than 500 million smartphone users worldwide will be using healthcare applications, research studies show. So it’s not surprising the FDA is taking a closer look at some of these apps, specifically, those whose misuse could endanger its users.

These “medical mobile apps,” as the FDA is calling them, are specific to medicine or healthcare and are designed for use on smartphones and other mobile computing devices and will offer everything from blood sugar monitoring to ECG machines.

As we reported in a previous HBWU issue about IBM, the benefits of these health and medical apps are immeasurable, not just here, but in underserved, frequently rural communities around the globe, especially where patients have no access to doctors, these devices can save lives.

And they can save billions of dollars as well. According to studies from Juniper Research using mobile health, or mHealth, technologies for health monitoring could save from $1.96 billion to $5.83 billion in healthcare costs by the year 2014. So the Center for Technology and Aging (CTA) (, with funding from The SCAN Foundation, has awarded nearly $500,000 in one-year grants to five organizations that will demonstrate the best ways to implement mHealth technologies for older, chronically ill adults, ironically, the population least likely to own a smartphone. The grants will help the CTA to meet its four areas of opportunity that it feels can best transform lives: medication optimization, remote patient monitoring, care transitions, and mobile health. And in a recently published paper the agency discusses how

cell phones, smart phones, laptop and tablet computers, and other mobile enabled devices are being used to help millions of older Americans as well as their physicians and caregivers manage chronic disease, use their medications properly, avoid safety risks (e.g. fall detection), access online health information, and stay well.

With the exploding growth of mHealth technology it seems that smartphones will eventually be used for everything but plain old talking. Hopefully the dialogue between a patient and physician won’t be relegated to a tiny FaceTime screen on an IPhone.

Meet Health Coach Mary Grazen-Browne: Follows Consistency, Commitment and Mindfulness

August 4th, 2011 by Jessica Fornarotto

This month’s inside look at a health coach, the choices he or she has made on the road to success, and the challenges ahead.

Excerpted from the August 2011 HealthCoach Huddle.

Mary Grazen-Browne, owner at Wellness by Choice, holistic nutritionist/lifestyle educator at Manchester Athletic Club, and wellness coach/consultant and registered holistic nutritionist at Wellness by Choice.

HIN: What was your first job out of college and how did you get into health coaching?

Mary Grazen-Browne: My first job was physical education and health teacher/special education for 35 years. In my mid-40’s, I had a bad irritable bowel syndrome (IBS) and I was ‘cured’ via a holistic nutritionist. Then, I pursued certifications as a health educator and registered holistic nutritionist. Then, I was certified as a wellness coach to help my clients with behavioral change.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road.

Yes. After I was working part-time as a nutritionist, I realized that all of my teaching did not matter but that the behavioral change and support is what people needed to make the changes they wanted to make and keep.

In brief, describe your organization.

I am the sole owner of Wellness by Choice. I offer holistic nutrition consults, lifestyle education for weight management, and age-related disease and energy combined with wellness coaching.

What are two or three important concepts or rules that you follow in health coaching?

I follow consistency, commitment and mindfulness.

What is the single most successful thing that your company is doing now?

We are offering a program titled “Mindful Weighs.” It is a 12-session program including bioelectrical impedence analysis (BIA) screenings.

Do you see a trend or path that you have to lock onto for 2011?

To reach out more. Market to as many people as possible and be visible. Word of mouth is the best advertising.

What is the most satisfying thing about being a health coach?

Seeing people change and improve their health, and the gratification they have from their efforts.

Where did you grow up?

New York and Connecticut.

What college did you attend? Is there a moment from that time that stands out?

I attended Keene State College in New Hampshire. The moment that stands out to me is that I knew I was an educator and that I needed to be active. Therefore, being a physical education and health major was perfect for me.

Are you married? Do you have children?

Yes I have been married for 33 years and I have two children.

What is your favorite hobby and how did it develop in your life?

I like gardening, which I learned from my mom, and I like sewing, which I learned from Home EC in seventh grade. I like to kayak since I live on the water, and I like to golf — I had to give up tennis due to a low back injury — and I like being with my family as well.

Is there a book you recently read or movie you saw that you would recommend?

I loved the “Girl with the Dragon Tatoo” series and I am reading “Primal Body, Primal Mind.” This is an excellent book and it reinforces what I do now.

Any additional comments?

This is an evolving career. People who value their health will invest in it and I hope that someday there will be insurance to support the lifestyle coaching and nutrition information I offer to others.

5 Steps to Reduce 30-Day Readmissions for Heart Attack, Heart Failure and Pneumonia

August 3rd, 2011 by Patricia Donovan

How to reduce rehospitalizations for the “big 3” to improve core measure ratings? “Hit them hard and hit them big time,” says Dr. Steve Berkowitz, president at SMB Health Consulting and former chief medical officer for the central and west Texas division of HCA at St. David’s HealthCare.

Dr. Berkowitz shared five of St. David’s strategies for reducing 30-day readmissions during the Q&A of a recent webinar on Healthcare Performance Improvement: Exceeding Core Measure Targets for Value-Based Reimbursement.

“We have seen in our pilots enormous improvement in rehospitalization rates. We were cruising along before our program at about 18 to 20 percent on heart failure and pneumonia, which is around the national average. Our pilots have gotten it down to 2 or 3 percent. So, there is no question that we can do this. We can hit it hard and we can hit it big time.

“What it really amounts to is the whole idea of the continuity of care. The patient goes to a nursing home. Make sure that the nursing home gets the medications. Make sure that there is good communication between the physicians. Make sure that patient is getting daily weights and all the things that they need to do this. If the patient is going home, provide individual patient education. Establish good communication with the attending physician. All these steps have dramatically reduced readmissions.”

There is a flip side, however:

“I’ll tell you where the rub is right now. though. Presently, readmissions generate a lot of revenue so that our hospital administration wants us to reduce them. But maybe not to reduce them too much, and maybe to not reduce them too fast. That is one of our challenges.”

Reasons to Light a Fire Under Smoking Cessation Efforts

August 2nd, 2011 by Patricia Donovan

A recent study published in the American Journal of Preventive Medicine found that obesity is statistically a greater threat to overall public health than tobacco. However, there is still a burning need for programs to reduce tobacco use, according to findings from HIN’s 2010 survey on tobacco cessation and prevention efforts.

The percentage of respondents with programs focused on tobacco cessation and prevention remained constant (75 percent) from 2008 to 2010. However, 2010 respondents from more than 80 healthcare organizations are both planning future programs and adopting smoke-free policies in greater numbers, a trend perhaps fueled by federally mandated reimbursement of these programs.

There’s also another reason to light a fire under smoking cessation efforts: metrics on these preventive measures are increasingly included in value-based reimbursement models. In a recent interview, Dr. Mark Shields, senior medical director with Advocate Physician Partners, explained the business case behind the dedication of three of Advocate’s 41 physician performance measures to smoking cessation and prevention as part of its clinical integration effort:

“Smoking cessation is one of the very hot interventions. Our doctors know that it’s important, but don’t appreciate the major financial impact of this effort. We have documented that in our value report. Smoking cessation is a big deal as far as our ability to be successful at the bargaining table with managed care organizations. We point this out to our clinicians.

We have formal ways to gather the information about our performance and point this out. We have disease registries and patient and professional information that is Web-based and online for our providers, as well as face-to-face education programs for our providers.”

While 2010 survey respondents mostly rely on the honor system and self-reports to monitor relapses, 18 percent of respondents are reporting quit rates of 0 to 10 percent. That’s enough to extinguish some of the exorbitant healthcare costs associated with tobacco use.

New Study Documents Dissatisfaction with Patient Satisfaction Scores

August 1st, 2011 by Cheryl Miller

Almost 85 percent of healthcare executives are dissatisfied with their patient satisfaction scores, according to our “Improving Patient Experience and Satisfaction” survey conducted in May 2011. But more than 80 percent of survey respondents said they have programs in place to improve satisfaction levels. We surveyed 146 healthcare organizations, and identified areas for improvement, providing details on patient satisfaction surveys, estimating the impact of programs designed to improve patient satisfaction, among other areas. Download an executive summary of the results.

Healthcare costs for U.S. employers have slowed from last year. According to the Thomson Reuters Healthcare Spending Index for Private Insurance, medical costs for people in employer-sponsored health plans decreased by nearly 3 percent from the previous year. Hospital costs showed the steepest growth, with physician costs reflecting a 3 percent year-over-year hike, and drug costs increasing by less than one percent. More in this issue of the Healthcare Business Weekly Update.

By 2015, more than 500 million smartphone users worldwide will be using mobile health and medical applications, research studies show. So it’s not surprising that the FDA is taking a closer look at some of these apps; specifically, those whose misuse could endanger their users. The FDA is currently seeking public input on its proposed approach.

It’s not too late to complete this month’s e-survey on patient registries. Respond by August 15 and you’ll receive a free executive summary of the survey results once they are compiled to learn key benchmarks and metrics for using registries to improve reimbursement and patient outcomes. You may complete the survey online. Thanks for participating!