Archive for the ‘HIN Blog’ Category

Less is More When it Comes to Healthcare

August 19th, 2011 by Cheryl Miller

Less is more, at least when it comes to certain medical procedures.

That was the conclusion of a recent study by the American Heart Association (AHA) and reported here in a recent issue of Healthcare Business Weekly Update. Researchers compared the use of drug-eluting stents (DES) in 2004-06 to 2007, when their use decreased by nearly 25 percent. Using data from the Evaluation of Drug-Eluting Stents and Ischemic Events registry, the study found that limiting the use of DES did not increase the risk of death or heart attack, and only slightly raised the need for repeat angioplasty procedures. In fact, because the stents were reserved for use on higher risk patients, healthcare costs were reduced by an average of $410 per patient. When multiplied by the estimated 1 million angioplasty procedures performed annually, the United States is able to save nearly 400 million a year.

A recent story in Newsweek corroborates this research, and suggests that the use of DES weren’t the only medical procedures being overused. The article goes on to state that some common tests and procedures aren’t just expensive, but can do more harm than good.

“There are many areas of medicine where not testing, not imaging, and not treating actually result in better health outcomes,” says Dr. Rita Redberg, professor of medicine at the University of California, San Francisco, and editor of the Archives of Internal Medicine.

The problem is that “in otherwise healthy people,” screenings can lead to false positives, and cascading tests and procedures for possible problems that might have been harmless, or gone away on their own, the article says.

From PSA tests for prostate cancer (which more than 20 million U.S. men undergo every year) to surgery for chronic back pain to simple antiobiotics for sinus infection, a remarkable number and variety of tests and treatments are now proving either harmful or only as helpful as a placebo.

The article doesn’t dismiss the benefits of progressive medicine; instead, it lists the procedures that have saved lives and eased suffering for millions:

Screening tests like mammograms…can lead to early treatment of breast cancer, especially for women with hereditary risk or a strong family history of the disease. For cancer patients who report back pain, MRIs can prove invaluable for spotting tumors that have metastasized to the bones, allowing doctors to intervene before it’s too late. The years between 1980 and 2004 saw a 50 percent decline in the death rate from coronary heart disease thanks to better treatments and drugs that reduce cholesterol and blood pressure. At least 7,300 lives are saved every year thanks to colonoscopies.

But the flip side is that procedures are being overprescribed, like colonoscopies for the elderly, which can often harm them, and CT scans for the injured. A study published by John Hopkins noted the rise in MRIs and CT use in emergency departments over a 10 year period, from 1998 to 2007. The Hopkins team found that patients with injury-related conditions were three times more likely to get a CT or MRI scan in 2007 than they were in 1998. But the team also found that diagnosis of life-threatening conditions, such as a cervical spine fracture or liver laceration, rose only slightly.

Part of the problem is compensation: according to the Newsweek article, Medicare pays physicians more than $100 million a year for screening colonoscopies; still other procedures, like angioplasty, bypass surgery and stenting are not improving cardiac patients’ lives; but instead costing Medicare more than $1.6 billion a year.

The solution? The study published by the AHA didn’t directly identify which patients are the best candidates for DES, although other studies are currently underway using similar patient registries to address it. And research shows that low risk heart patients can benefit more from noninvasive treatments like drugs (beta blockers, cholesterol-lowering statins, and aspirin), exercise, and a healthy diet.

With the push for reducing healthcare costs while improving care, it’s an issue that will most probably continue to be explored.

Geisinger, Dartmouth-Hitchcock in CMS PGP Transition Demo

August 15th, 2011 by Cheryl Miller

Congratulations to all CMS PGP Demonstration participants, especially Geisinger Health Systems and Dartmouth-Hitchcock, both of whom have shared their strategies for population health management with HIN.

Early on in the PGP demo, DH targeted patients with CHF, CAD, and diabetes; it then developed two ‘super registries‘ to monitor both chronic disease markers and preventive care needs in its population. It created training for new roles for nurses and case managers, focusing on health coaching, motivational interviewing and bridging care across transitions. DH then created reports comparing its MDs’ performance with those of their peers. In the end, they received about $13 million in shared savings from CMS.

Says Barbara Walters, senior medical director, “What did we do to make a difference? It was our admission rate, cost of care for CHF patients and our clinical quality compared to the comparison group. We didn’t even realize it but we had created a medical home, which is a very important cornerstone for all of this.”

And Geisinger achieved 100 percent on the PGP program’s quality measures, the only one of the 10 organizations to do so for the last four years of the demonstration. “By focusing on improving quality, we were able to reduce the total costs of treating Medicare beneficiaries. Our costs at Geisinger rose only 1.4 percent, compared to the typical 4 to 6 percent increase observed nationwide,” said Thomas Graf, M.D., associate chief medical officer, Population Health; chairman, community practice, Geisinger Health System.

We look forward to charting the progress of all of the organizations involved in the transitional program.

You can read more about this and other healthcare issues in this week’s Healthcare Business Weekly Update.

10 Ways to Engage Physicians in Appropriate ER Utilization

July 29th, 2011 by Jackie Lyons

About a third of unnecessary ER use is categorized as “avoidable,” followed by visits from high utilizers, often referred to as ‘frequent flyers,’ who generate 29 percent of avoidable use, according to a recent HIN survey on reducing avoidable ER use. Survey respondents include physicians in many strategies to reduce avoidable ER use. For example, 63 percent of respondents alert primary care physicians (PCPs) to ED visits by recently discharged patients.

Here are 10 ways to engage physicians in efforts to reduce avoidable ER utilization as suggested by survey respondents:

  • Establish an alliance of hospital and post-hospital providers to address avoidable readmissions and ED visits. Collaborate between cross-spectrum of services to break down silos of healthcare providers;
  • Perform in-person reviews of ED utilization profiles comparing PCP to others in network – encourage PCPs to offer rapid appointment availability when requested by case manager, use e-notification of PCP re: ED visit occurrence and encourage PCP open access hours;
  • Allow PCP to cover absence of an employee from the first day off work, not from first day seen in medical office. EDs are a tool of convenience prior to PCP appointment;
  • Use a transfer call center with the hospitalist assuming admission on unassigned patients;
  • Work with providers to have “walk-in” or urgent care slots built into daily appointment templates;
  • Facilitate PCP group relationships with the Regional Health Information Organization (RHIO), in which ERs of various hospitals collaborate;
  • Introduce coaching module follow-up for 30 days post-discharge;
  • Develop community care plans that involve the frequent flyer patient, PCP and ED. Then develop an agreed-upon coordinated plan of care. The first priority is that the patient contacts the PCP before entering the ED. If the patient still presents to the ED, it is the goal of the ED case manager to contact the PCP and discuss better options;
  • Establish a medical home with risk-sharing reimbursement if office-specific ER rates for ambulatory care sensitive conditions (ACSC) or multiple visits improve;
  • Identify PCPs that encourage ER visits through a mailout survey;

    More ways to engage physicians in Appropriate ER Utilization.

  • No Place Like a Medical Home for Patients with Diabetes

    July 18th, 2011 by Jackie Lyons

    Two recent studies focused on diabetes patients reveal that the saying “There’s no place like home” may be true — in this case, it’s a patient-centered medical home (PCMH).

    The PCMH model of care has always focused on improving care quality and reducing costs for the chronically ill. Now, the PCMH has been found to increase the percentage of diabetes patients who achieve goals that reduce their sickness and death rates, according to health researchers.

    A report from the eHealth Initiative found that using electronic health records (EHRs) in medical homes to coordinate care resulted in numerous process improvements for patients with Type 2 diabetes and heart disease in a medical home.

    The initiative reported improvements in provider-patient communications, intra-office coordination, EHR use, care planning, patient coaching, specialist referrals and several other areas. The care plan enabled by the EHR allowed researchers to streamline the care process for the patients and more efficiently track their progres:

    At one site, six separate cardiology referral forms were used before the project began. Following the intervention a single form was developed and formatted within the EHR, said Victor Villagra, MD, president of Health and Technology Vector.

    In a second study, Pennsylvania researchers say the key of the PCMH is to make physicians not only look at individuals, but at their patient population in general.

    In PCMH, medical practices learn to work together as a team, coordinating care centered on the patients’ needs. The researchers report a significant improvement in adherence to evidenced-based care guidelines and in clinical outcomes. In one year, the number of patients with better LDL levels, better blood pressure and or lower A1c levels increased. The number of patients receiving yearly foot exams, eye exams and pneumonia and influenza vaccines also increased, according to a Penn State College of Medicine press release.

    Pennsylvania leads the nation in implementing the PCMH, based on the chronic-care model (CCM) of care, which promises to improve health and reduce costs of care. This type of care attempts to move from a reactive approach to a focus on long-term problems in healthcare delivery.

    The Case Management Monitor is Here!

    June 17th, 2011 by Cheryl Miller

    Yes, it’s here – our inaugural Case Management Monitor. It’s HIN’s newest bi-weekly e-newsletter, dedicated to providing the latest news, tools and trends in the healthcare case management arena.

    And it’s arrived not a moment too soon. The role of today’s healthcare case manager is constantly evolving, moving beyond the health plan office to co-location with primary care physicians, hospital discharge planners and long-term providers.

    Not only are more healthcare organizations using case managers, but the practice of embedding them at the point of care is becoming the norm, as we saw in our second annual Healthcare Case Management survey, conducted in January 2011. In just the last year alone, the number of case managers working in hospital admissions offices nearly doubled. And embedding case managers in emergency departments is becoming a critical part of many hospitals’ case management programs, proving beneficial both clinically and financially. The embedded case manager can act as the first line of defense, determining medical necessity, and also helping to reduce patient visits and the number of claims denials for a hospital stay, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center, whom we profiled in a recent podcast that is featured in our newsletter.

    And the contemporary case manager’s job description has evolved: it is much more likely to include home visits, crisis management and quality improvement responsibilities in 2011 than it did in 2010. Today’s case manager often helps patients to understand what their treatment is and what their goals of care are. The case manager acts as a liaison between the patient, family, healthcare delivery team and community, enabling their clients to achieve their goals more effectively and efficiently. This includes everything from helping with insurance to medication adherence to home care follow ups, subjects we cover in our newsletter.

    And the role of today’s patient is changing as well. With round the clock access to the web, on-line medical records, mobile applications and connected devices, there is a new kind of health delivery system in place — a system that gives patients far more information, and control than they’ve had in the past. What are the implications, risks and opportunities for case managers and case management organizations?

    So, please take a moment to read the first Case Management Monitor, and don’t forget to subscribe to the second one, set to arrive in email boxes on June 21st. In the meantime, please provide us with feedback on our newsletter, and share with us any subjects you’d like us to address.

    We also have a wealth of information on our Case Management Monitor web site: interviews, podcasts, white papers, videos, blogs, and much more. Again, any feedback on this site is also welcome.

    Because interaction is key, isn’t it, to successful case management?

    Keeping Kids Heart-Healthy

    December 19th, 2007 by Melanie Matthews

    A recent study from University of Michigan found that babies born with severe heart defects are much less likely to die before leaving the hospital if they are treated at the centers that treat the largest numbers of these patients.

    And another report from the University of Florida found that some stimulant medications used to treat children with attention-deficit hyperactivity disorder (ADHD) may be landing more kids in the ER due to cardiac symptoms.

    Heart health is paramount for children, and here are some tips from the American Heart Association (AHA) that medical professionals can pass onto their patients to keep kids heart healthy.

  • Monkey see, monkey do: Advise parents to help their children develop good physical activity habits at an early age by setting a good example themselves.
  • Too much of a good thing: Suggest that parents limit their children’s television, movies, videos and computer games to less than two hours a day to help to increase physical activity.
  • Make exercise a family affair: Encourage family outings and vacations that involve vigorous activities such as hiking, bicycling, skiing, swimming, etc.
  • Don’t be lazy: Suggest walking or riding bikes to nearby destinations whenever possible as well as using stairs instead of elevators and escalators when at shopping malls.
  • Playtime first: Discourage homework immediately after school to let children find some diversion from the structure of the school day. Kids should be active after school and before dinner.
  • No more boring sweaters for birthday gifts: Recommend that parents choose fitness-oriented gifts — a jump rope, mini-trampoline, tennis racket, baseball bat, a youth membership at the local YMCA or YWCA.

    Click here for a complete list of tips from the AHA.

  • Exercise is Pivotal in Disease Management

    November 14th, 2007 by Melanie Matthews

    Over two-thirds of patients would be more interested in exercising to maintain good health if they received advisement from their doctors and were given additional resources, according to a new study from the American College of Sports Medicine. And while 41 percent of physicians talk about the importance of exercise with their patients, they don’t always offer suggestions on the best ways to be physically active.

    Exercise isn’t all about looking great — in fact, the benefits of exercise are far greater than fitting into your favorite pair of jeans. According to the Mayo Clinic, daily exercise can improve one’s mood, help fight chronic diseases, help manage weight, strengthen one’s heart and lungs and more.

    However, possibly the hardest part of exercise is sticking with it. Often times people are discouraged when they do not see instant results from their efforts. Here are some tips from the American Heart Association that healthcare providers can suggest to their patients to keep them looking — and more importantly feeling — great!

  • Choose activities that are fun, not exhausting. Add variety. Develop a repertoire of several activities that you can enjoy. That way, exercise will never seem boring or routine.
  • Wear comfortable, properly fitted footwear and comfortable, loose-fitting clothing appropriate for the weather and the activity.
  • Find a convenient time and place to do activities. Try to make it a habit, but be flexible. If you miss an exercise opportunity, work activity into your day another way.
  • Use music to keep you entertained.
  • Surround yourself with supportive people. Decide what kind of support you need. Do you want them to remind you to exercise? Ask about your progress? Participate with you regularly or occasionally? Allow you time to exercise by yourself? Go with you to a special event, such as a 10K walk/run? Be understanding when you get up early to exercise? Spend time with the children while you exercise? Try not to ask you to change your exercise routine? Share your activity time with others. Make a date with a family member, friend or co-worker. Be an active role model for your children.
  • Don’t overdo it. Do low- to moderate-level activities, especially at first. You can slowly increase the duration and intensity of your activities as you become more fit. Over time, work up to exercising on most days of the week for 30-60 minutes.
  • Keep a record of your activities. Reward yourself at special milestones. Nothing motivates like success!
  • If you’ve been sedentary for a long time, are overweight, have a high risk of coronary heart disease or some other chronic health problem, see your doctor for a medical evaluation before beginning a physical activity program.
  • Heart Health

    October 25th, 2007 by Melanie Matthews

    This week’s Disease Management Update focuses on healthy hearts and presents two possible techniques for maintaining heart health in your patients. Visit this blog entry to read (and hear) about two nurses from Hackensack University Medical Center who are pursuing perfect care with their award-winning heart failure team.

    Breast Cancer Awareness Continues

    October 11th, 2007 by Melanie Matthews

    As Breast Cancer Awareness Month continues, this week’s DM Update focuses on a newly discovered link to early onset of the disease, and how treatment of the disease can vary by race. In an effort to create more breast cancer awareness this month, the HIN blog is posting daily entries on breast cancer throughout the month of October.

    Related Posts:
    Reading Between the Lines of the “Abnormal Mammogram” Letter
    Benefits of Hypnosis before Surgery for Breast Cancer
    Breast Cancer Facts and Figures 2007-2008

    Healthcare Reform in 2008

    October 4th, 2007 by Melanie Matthews

    Fellow healthcare blogger Steve Beller, Ph.D., recently blogged about presidential hopefuls and determining the best healthcare reform plan — what factors need to be considered and what needs to change in the healthcare industry.

    What approaches are working for your organization and what changes would you like to see in the coming year? Take HIN’s Healthcare Trends and Forecasts in 2008 survey and let us know!

    Related Posts:
    Healthcare Trends and Forecasts in 2008