Archive for the ‘Physician Practices’ Category

Infographic: Healthcare Consumer Loyalty Trends

November 1st, 2017 by Melanie Matthews

Almost half (40.37 percent) of consumers are not loyal to a hospital or health system, according to a new infographic by NRC Health.

The infographic examines healthcare consumer loyalty drivers, the top reasons consumers switch doctors and hospitals, digital consumer health trends and the hospital and physician website information ranked as most useful to consumers.

UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Banking the Upside from Value-Based Reimbursement

October 11th, 2017 by Melanie Matthews

As healthcare reimbursement shifts toward paying for value, there’s significant revenue at stake for physician practices, according to a new infographic by athenahealth, Inc.

The infographic examines five different types of physician practices and how participation in value-based reimbursement models would impact practice revenue.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS’s “Pick Your Pace” announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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Infographic: Physician Health and Patient Care Impacted by Practice Demands

October 6th, 2017 by Melanie Matthews

The demands of practicing medicine are negatively impacting primary care doctors and their patients, according to a new infographic by MDVIP.

The infographic examines how stress is impacting physicians and how this affects patients, along with details on what’s contributing most to physician stress.

UnityPoint Health has moved from a siloed approach to improving the patient experience at each of its locations to a system-wide approach that encompasses a consistent, baseline experience while still allowing for each institution to address its specific needs.

Armed with data from its Press Ganey and CAHPS® Hospital Survey scores, UnityPoint’s patient experience team developed a front-line staff-driven improvement action plan.

Improving the Patient Experience: Engaging Front-line Staff for a System-Wide Action Plan, a 45-minute webinar on July 27th, now available for replay, Paige Moore, director, patient experience at UnityPoint Health—Des Moines, shares how the organization switched from a top-down, leadership-driven patient experience improvement approach to one that engages front-line staff to own the process.

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Infographic: Are Specialty Practices Prepared for MACRA?

September 18th, 2017 by Melanie Matthews

A growing number of specialty physicians, comprised mainly of oncologists and urologists, recognize that clinical, financial and operational changes are needed to be successful under value-based healthcare reimbursement models stemming from MACRA regulations. However, the majority has not yet invested in organizational, IT, or service improvements needed to achieve them, according to a new study by Integra Connect.

A new infographic by Integra Connect highlights the survey findings, including details on the barriers to MIPS success and practices’ plans to optimize MIPS success.

Under CMS’s “Pick Your Pace” choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019 by simply submitting some data in 2017.

However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices’ performance and laying a path now toward performance improvement.

Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal–Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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Food for Thought: Nutrition Programs Reduce Hospital Visits and Readmissions by Vulnerable Populations

August 18th, 2017 by Patricia Donovan

Malnutrition is a social determinant of health that negatively impacts health outcomes.

It’s a difficult statistic to digest: one in three people enter the hospital malnourished or at risk of malnutrition, a state that impacts their recovery and increases their risk of health complications and rehospitalizations.

Two studies this week highlight the clinical benefits of addressing patients’ nutrition needs before and during hospital stays as well as savings that can result from identification of social determinants of health (SDOH) like access to nutrition that drive 85 percent of health outcomes.

In the first, a study of elderly Maryland residents by Benefits Data Trust, a national nonprofit based in Philadelphia, found that when it comes to low-income seniors, access to quality food via food stamps can also save money by reducing the number and duration of hospital visits and nursing home admissions.

In the second, research published in American Health & Drug Benefits journal and supported by Abbott found that when Advocate Health Care implemented a nutrition care program at four of its Chicago area hospitals, it showed more than $4.8 million in cost savings due to shorter hospital stays and lower readmission rates.

The Benefits Data Trust research found that participation by low-income seniors in the federal Supplemental Nutrition Assistance Program (SNAP) cut their odds of hospital admissions by 14 percent. The food stamps also reduced the need for ER visits by 10 percent, and cut their likelihood of going into a nursing home by nearly one quarter.

Finally, SNAP participation also led to an 8 to 10 percent drop in the number of days a patient who was admitted remained in one of these facilities.

As a result, hospitals and health care systems such as Advocate Health Care are looking at the value of nutrition to improve care and help patients get back to living a healthier life.

Starting in 2014, Advocate Health Care, the largest health system in Illinois and one of the largest accountable care organizations (ACO) in the country, implemented two models of a nutrition care program for patients at risk of malnutrition. The nutrition-focused quality improvement program, which targeted malnourished hospitalized patients, consisted of screening patients with a validated screening tool at admission, rapidly administering oral nutritional supplements, and educating patients on supplement adherence.

The leader in population health found that by doing so, it reduced 30-day readmission rates by 27 percent and the average hospital stay by nearly two days.

More recently, to evaluate the cost-savings of the Advocate approach, researchers used a novel, web-based budget impact model to assess the potential cost savings from the avoided readmissions and reduced time in hospital. Compared to the hospitals’ previous readmission rates and patients’ average length of stay, researchers found that optimizing nutrition care in the four hospitals resulted in roughly $3,800 cost savings per patient treated for malnutrition.

Given the healthcare industry’s appetite for value- and quality-based programs, SDOH screenings and the fortification of nutrition programs in both community and inpatient settings appear to be just what the doctor ordered. However, while a 2017 study on Social Determinants of Health identified widespread adoption of SDOH screenings by providers, it also documented a scarcity of supportive community services for SDOH-positive individuals.

5 Practitioner Tactics for Tackling the Opioid Epidemic

August 15th, 2017 by Susan Butterworth, PhD, and Amanda Sharp, MPH, Q-Consult LLC
opioids

There is promising evidence that motivational interviewing can successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids.

Despite evidence and guidelines to the contrary, including significant risk of addiction, there remains a widespread belief among many clinicians and patients alike that opioid medication is a viable and effective first option for multiple chronic pain conditions. Practitioners feel pressure to provide opioids upon patient request, yet many have neither the resources nor the skill set to manage the physiological and psychological complications that can arise when treating a patient with opioids long-term.

As one qualitative study found, it can be awkward at best, and confrontational at worst, when refusing a patient’s request for opioids. Thus, clinicians are faced with the challenging balancing act of providing pain relief for their patients while simultaneously managing the potential for addiction and misuse – with most clinicians ill-equipped for the herculean task.

“Not providing the [opioid] prescription is very hard. It takes time to do the research on the patient. Confronting the patient with a problem is emotionally draining. Doing it 5-10 times in one shift is not only a reality, it is downright crippling. It sucks out [sic] last bit of energy out of your soul. Rather than confronting patients and arguing, it’s far easier to write a prescription for narcotics and move on to the next patient. This is the mindset of thousands of physicians.”
Anonymous Physician, April 25, 2013

Along with knowledge about alternative treatments, a valuable skill set for clinicians in this situation is an effective communication approach to address the possible scenarios that emerge:

  • Engaging patients in discussions about the risks of opioids;
  • Validating the frustration of chronic pain;
  • Evoking commitment to try alternative modalities;
  • Eliciting honesty about unhealthy/drug-seeking behaviors; and

Sharing concerns and resources for opioid addiction.

Motivational Interviewing (MI) is an evidence-based communication approach that has been adapted for the brief healthcare setting to address many lifestyle management issues, including chronic pain. There is one promising clinical trial that used a single MI session in an emergency department to successfully reduce both the use of non-medical opioid use and overdose risk behaviors for prescription opioids as compared to a control group. Even beginning proficiency in MI equips practitioners with the confidence and skills needed to engage patients in conversations that generally lead to outcomes of being able to maintain rapport and successfully incorporate best practice guidelines for chronic pain treatment.

Consider the following two scenarios:

Scenario 1: Your patient has recently hurt their back and has requested strong pain medication.

Scenario 2: You suspect your patient may have an addiction to opioids.

In both cases, a practitioner, competent in the MI approach, would be able to use the following strategies to successfully navigate these challenging waters. These principles and strategies are based on Miller and Rollnick’s description of MI practice.

Engage and Partner

Taking a minute or two to build rapport with the patient may be counter-intuitive to a busy clinician. However, consider the time that is spent in unproductive arguments and power struggles. Research has shown that taking a more patient-centered approach is more time-efficient in the long run. Although the clinician is an expert in clinical aspects, the patient is the expert of their life, and the only one with the ability to commit to the suggested treatment plan. By stepping out of the authoritarian role, ideally, the clinician can partner with the patient in a collaborative way to problem-solve together. When a person helps to identify the best treatment course for themselves, they feel more ownership and are more committed; thus, are more likely to follow through.

Express Empathy

A core component of engaging is being able to express empathy, or the ability to convey accurate understanding through the eyes of the patient. This takes compassion, effort, genuine interest, and reflective listening. The clinician does not need to become a counselor to provide a meaningful statement that lets the patient know that the practitioner “gets it”. When the patient feels understood and accepted, they are more receptive to the clinician’s advice and guidance.

Share Concerns while Supporting Autonomy

In MI, the clinician is not simply following the patient but is a full partner. After establishing rapport and trust, it is not amiss to share any concerns that the provider has, if patient autonomy is concretely verbalized. The patient can always go to another doctor to get what they want; by acknowledging that it is the patient’s choice to pursue what they feel is best for them, the patient relaxes. This allows the clinician to share their concern in a way that does not elicit defensiveness.

Manage Expectations

It is important to manage the expectations of the patient. By clearly and transparently stating up front what the clinician feels is best practice and ethically viable, the patient is not disappointed later. Openly share that alternative treatment options may not address the pain as completely as opioids might initially, or, in the case of addiction, that there may be withdrawal symptoms when discontinuing the medication. Honesty preserves trust and conveys the clinician’s desire to support the patient as fully as possible, while still maintaining his integrity of practice.

Provide Decision Support with Menu of Options

Now the patient is ready for a menu of options with the pros and cons succinctly laid out. These include therapies such as non-opioid meds, stretching, and alternative treatments. Some of these options may be those that the clinician is not prepared to provide; e.g., if the patient is still favoring the option of more opioids. The clinician has been transparent about which options he feels are best and is willing to provide; however, the patient is in the driver’s seat to choose the best treatment course for himself. In most cases, the clinician can positively influence the patient’s decision. If not, the discussion remains professional, rapport is not lost, and the patient will feel comfortable returning to this provider. This keeps the door open to further dialogue about the situation.

There are many resources available for those who are interested in getting trained in MI, and the approach can be used for any lifestyle management or treatment adherent situation. However, a fair warning that MI is a complex skill set and cannot be learned in a one-and-done workshop. Just like learning to speak a foreign language or play a musical instrument, it takes practice and feedback from an expert over time to develop a meaningful proficiency. As many clinicians can attest though, this is one hard-earned competency that is more than worth it — for the practitioner, the patient and society!

Susan Butterworth, PhD

Amanda Sharp, MPH

About the Authors: Susan Butterworth, PhD, is principal and Amanda Sharp, MPH is program manager for Q-Consult LLC. Both are both members of the Motivational Interviewing Network of Trainers. Please visit Q-Consult, LLC their blog and find out more about patient-centered initiatives that increase patient engagement and improve clinical outcomes.

HIN Disclaimer: The opinions, representations and statements made within this guest article are those of the author and not of the Healthcare Intelligence Network as a whole. Any copyright remains with the author and any liability with regard to infringement of intellectual property rights remain with them. The company accepts no liability for any errors, omissions or representations.

Montefiore SDOH Screenings Leverage Learnings from Existing Pilots

August 3rd, 2017 by Patricia Donovan

Montefiore Health Systems screens patients for social determinants of health, which drive 85 percent of a person’s well-being.

Montefiore Health System’s two-tiered assessment screening program to measure social determinants of health (SDOH) positivity in its predominantly high-risk, government-insured population is inspired by existing initiatives within its own organization. Here, Amanda Parsons, MD, MBA, vice president of community and population health at Montefiore Health System, describes the planning that preceded Montefiore’s SDOH screening rollout.

I’d like to explain how we came to implement the social determinants of health screening. Many of us in New York State participate in the delivery system or full-on incentive program. It is that program that has enabled us to step back and think about using Medicaid waiver dollars to invest in the things that make a difference.

I need not tell anybody in this industry: many studies have looked at what contributes to health. We know that clinical health in and of itself contributes somewhere between 10 to 15 percent of a person’s well-being; however, so much more of their health and well-being is driven by other factors, like their environment and patient behaviors. And yet, we had not had a chance in the healthcare system to really think about what we wanted to do about that. It was really the Delivery System Reform Incentive Payment (DSRIP) program that has allowed us to start exploring these new areas and think about how we want to collectively address them in our practices.

The way we structured our program was quite simple. We said, “If we’re going to do something about social determinants of health, let’s recognize that they are important and must be addressed, and that we have many different community-based organizations that surround or are embedded in our community that stand poised and ready to help our patients. We’re just not doing a very good job of connecting them to those organizations, so let’s backtrack and say, ‘First, we have to screen our patients using a validated survey instrument.’”

There were different sites at Montefiore that had already launched various pilots. We said, “Let’s make sure we leverage the experience and the learnings from these pilots. Then let’s think about who’s going to deal with those patients, which means we have to triage them.” For example, if somebody screens positive for domestic violence that is occurring in their home right now in the presence of children, that might require a different response from us than someone who says, “I have some difficulty paying my utilities.”

Source: Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services

sdoh high risk patients

Assessing Social Determinants of Health: Screening Tools, Triage and Workflows to Link High-Risk Patients to Community Services outlines Montefiore’s approach to identifying SDOH markers such as housing, finances, healthcare access and violence that drive 85 percent of patients’ well-being, and then connecting high-need individuals to community-based services.

HINfographic: During Annual Wellness Visit, Screen for Social Health Determinants

June 12th, 2017 by Melanie Matthews

Seventy percent of health outcomes are determined by social determinants of health­—areas that involve an individual’s social and environmental condition as well as experiences that directly impact health and health status, according to the Pew Research Center in its report, Chronic Disease and the Internet.

A new infographic by HIN examines the impact of SDOH on health status, why the Medicare annual visit is an ideal time to screen for SDOH and the correlation between technology and social isolation.

The move from fee-for-service to value-based healthcare is driving the need for increased capabilities in population health management, including addressing all of the areas that may impact a person’s health. There is growing recognition that a broad range of social, economic and environmental factors shape an individual’s health, according to the New England Journal of Medicine. In fact, 60 percent of premature deaths are due to either individual behaviors or social and environmental factors. Healthcare providers who adopt value-based reimbursement models have an economic interest in all of the factors that impact a person’s health and providers must develop new skills and data gathering capabilities and forge community partnerships to understand and impact these factors.

During Social Determinants and Population Health: Moving Beyond Clinical Data in a Value-Based Healthcare System, a December 8th webinar, now available for replay, Dr. Randall Williams, chief executive officer, Pharos Innovations, shares his insight on the opportunity available to providers to impact population health beyond traditional clinical factors.

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Infographic: Why Centralized Patient Access Matters for an Ideal Patient Experience

June 9th, 2017 by Melanie Matthews

As patients become more accustomed to taking care of so many things online, it’s more important than ever to provide a convenient patient access experience for patients, according to a new infographic by SCI Solutions, Inc.

The infographic highlights the five stages of frustration patients experience and the five stages of satisfaction they experience when patient access is centralized. The infographic also examines how centralized patient access impacts providers.

Patient-centric interventions like population health management, health coaching, home visits and telephonic outreach are designed to engage individuals in health self-management—contributing to healthier clinical and financial results in healthcare’s value-based reimbursement climate.

But when organizations consistently rank patient engagement as their most critical care challenge, as hundreds have in response to HIN benchmark surveys, which strategies will help to bring about the desired health behavior change in high-risk populations?

9 Protocols to Promote Patient Engagement in High-Risk, High-Cost Populations presents a collection of tactics that are successfully activating the most resistant, hard-to-engage patients and health plan members in chronic condition management. Whether an organization refers to this population segment as high-risk, high-cost, clinically complex, high-utilizer or simply top-of-the-pyramid ‘VIPs,’ the touch points and technologies in this resource will recharge their care coordination approach.

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Infographic: Physician Appointment Wait Times; Medicare and Medicaid Acceptance Rates

May 5th, 2017 by Melanie Matthews

The average wait time for a physician appointment in 15 mid-sized metropolitan areas was nearly 8 days longer than in l5 major metropolitan areas, according to a new infographic by Merritt Hawkins.

The infographic also examined rates of Medicare and Medicaid acceptance by physicians in these markets.

No matter which level of participation physician practices choose for the first Quality Payment Program performance period beginning January 1, 2017, CMS’s “Pick Your Pace” announcement means practices should proactively prepare for the impact of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) on physician quality reporting and reimbursement.

MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

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