ClickCare Café

Why Robots May Not Steal Your Job as a Medical Provider

Posted by Lawrence Kerr on Tue, Feb 26, 2019 @ 06:00 AM

franck-v-740555-unsplashIn a conversation with a young doctor recently, she sighed as she considered her future as a physician.

“I just don’t think my job is going to really exist in a decade or two,” she said. “It’s all going to be computers and nurse physician assistants.”

It’s a scary thought — that doctors as we know them  won’t have a role in providing medical care in the future. But is it true?

 

The applications to the U.S. Patent and Trademark Office are always illuminating as to what is on the horizon in the world of science and technology. Patents reflect those innovations that may or may not have a business plan or a market, but often reflect the direction that technology is headed more generally.

So I was interested to note that Google is developing an electronic health record (EHR) that uses machine learning to predict clinical outcomes.

As Fierce Healthcare reports, “Google appears to have plans to develop its own electronic health record (EHR) for clinicians that gathers patients’ medical records and then leverages machine learning to predict clinical outcomes, according to a patent application."

So is this patent application, backed by tech's behemoth, a harbinger of the inevitable phase-out of doctors?

I don't think so. True enough: it’s almost certain that the role of computers in our practice of medicine will continue to increase. But the truth is that doctors' core role is so much more essential and irreplaceable than any diagnosis, computer-assisted or otherwise. Ultimately, physicians are healers. And a computer can diagnose. A computer can perhaps even treat. But it takes a human being to truly heal another. 

That said, I believe that for medicine to be truly resilient -- for healthcare providers to continue to be relevant into the future, we need to lean into the art and humanity of medicine. The trend over the last couple of decades has been to reward providers who treat medicine like a complex factory -- the more efficiently and flawlessly you can move through the heap of patients, the more you are rewarded. But I believe that we are beginning to experience a shift. And into the future, simply being efficient and precise is not going to be our path forward. 

I believe that medical collaboration with our very human colleagues is a crucial part of leaning into that art and humanity. It's a tool that we can use to treat the whole patient, and do so with true thought. Our practice will likely be assisted by machine learning and artificial intelligence in the future. But if we're doing our jobs right, that assistance simply can't replace us. 

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Tags: telehealth, medical collaboration tool

Why Opioid Overdoses Spotlight Care Coordination Failures

Posted by Lawrence Kerr on Thu, Feb 21, 2019 @ 06:00 AM

tom-parsons-426898-unsplashThe US opioid epidemic is reaching unprecedented levels. Almost 48,000 people died of an overdose in 2017 and millions of people are affected by opioid abuse. 

One challenge in the treatment of opioid abuse and overdose is that they lie at the intersection of multiple disciplines, providers, and dynamics. Mental health, public policy, law enforcement, social work, housing, emergency care, and medication all play a role. But too often, only the immediate problem is addressed -- and care coordination fails -- which means that patients end up experiencing chronic repetition of that problem. 

A recent study looks at why opioid overdoses reveal the significant cracks in the care coordination that exist -- and endanger all patients.

You could say that West Virginia is Ground Zero for the opioid epidemic. The state has an opioid overdose rate more than three times the national average and the highest death rate from drug overdoses in the country. So the challenges that patients and providers face there are instructive for providers in states with less severely affected populations but who face similar dynamics.

In an effort to understand the trajectory of care for these patients, Fierce HealthCare looked at a recent West Virginia study of Medicaid claims. Researchers followed the treatment of patients after the overdose code to see whether follow-up care was billed. For instance, checking to see whether mental health visits, opioid counseling visits or prescriptions for psychiatric and substance abuse medications were billed after the initial Emergency Room care. 

Following ER care for an overdose, less than 10% of patients received a substance abuse drug and fewer than 15% received mental health counseling. Of course, it’s possible that the rate of referrals was higher and that many patients didn’t access the counseling. But realistically, follow-up may be as crucial a part of the care as the initial care itself. As one patient who was treated for an overdoes in the ER said, “There were a lot of times I could have gone down a better path, and I fell through the cracks."

I noticed several key insights from this study that I think are meaningful for any provider, regardless of how relevant opioid abuse in particular feels to them. 

4 key learnings from opioid overdose and care coordination failures:

  • The more complex the disease, the greater the risks for coordination.
    But "complexity" doesn't just come from the details of the disease itself. In opioid abuse, multiple parties, including healthcare providers and social services all need to come together to care for the patient effectively. And these providers must collaborate across institutional lines, across the continuum of care, and across a long time horizon. This complexity is where we start to see care coordination fall apart -- but really it just reveals the weakness in care coordination that exists for all patients.
  • Some diseases are associated with less sympathy than others. 
    The reality is that with drug overdoses, there may be an aspect of moral condemnation in the ways that healthcare approaches the problem. As healthcare providers, we know that opioid abuse is really a complex disease. But it's very possible that bias sneaks in and the complex coordination of providers, services, and care falls short because providers may feel less sympathetic about the particular aspects of this disease. Some of our most vulnerable populations may have healthcare challenges that are frustrating or overwhelming to providers -- and it's important that providers are able to collaborate with social services and colleagues that can support these patients in ensuring appropriate care.
  • All good care goes beyond acute care. 
    It’s never enough to simply treat the acute illness that is right in front of us. But as providers, we need the tools and collaboration to care for patients more broadly than that. Most emergencies require more than simply treating the situation in front of us. A baby's stitches in the ER require follow-up with the pediatrician. An overdose necessitates counseling and substance abuse drugs.

Our EHRs and systems simply don't support this more broad understanding of what it means to provide care in complex situations. And that means our patients are receiving subpar care, due to the limitations of our tools and workflows. Each healthcare provider is doing his or her job to the best of his or her ability. But the demands of caring for our patients mean that sometimes just "doing our job" isn't good enough -- we must also look at the big picture of that care. And we must demand tools to help us act well and care appropriately within that big picture. 

 

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Tags: care coordination, healthcare collaboration

The 3 EMR Interoperability Blindspots Your Hospital Has

Posted by Lawrence Kerr on Thu, Feb 14, 2019 @ 06:00 AM

rawpixel-782046-unsplashRecently, seven major hospital systems put out a bold call.

It is crucial, they contend, to improve data sharing and interoperability among EMRs and EHRs. As Fierce Healthcare reports, "In a 2017 AHA survey, 57% of respondents had experienced challenges sending the proper information to a different vendor platform. And 37% ran into challenges just matching patient identities between systems."

Any healthcare provider who works with Electronic Medical Records won't dispute that data sharing is lacking with these tools. But despite the importance of this report, I see 3 crucial blindspots that it has -- and that your hospital may have, too.

I agree that interoperability among EMRs and EHRs is something that we should all demand. The simple access to data about your patient is as fundamental as having a clean and private exam room to see that patient in... or as having the ability to record your own notes about that patient. 

So I was glad to see this hospital report come out. That said, I believe there are three crucial shortcomings to this report. And identifying them isn't so much to undermine the findings or importance of the report itself -- but to identify blindspots that your hospital may have as it begins to pursue interoperability of EMRs and EHRs.

 

3 crucial shortcomings to focusing on EMR interoperability:

  • EMRs / EHRs will never be true healthcare collaboration tools.
    No matter how sophisticated interoperability among medical records becomes, the truth is that these systems will never be true healthcare collaboration tools. The records simply aren't made to easily facilitate multidirectional care coordination and medical collaboration among all members of a care team. And so it's a mistake to believe that by solving interoperability, we might have improved care coordination or collaboration. 
  • Providers need better tools now. 
    The reality is that even if EMRs and EHRs become more interoperable, healthcare providers need better communication and collaboration in the meantime. The reality is that today, EMRs and EHRs consistently get in the way of sharing data and patient information. Until the day that EMRs/EHRs are interoperable, healthcare providers must take the burden on themselves of making sure that other members of the care team have HIPPA-secure access to patient information. 
  • We need collaboration among people, not computers. 
    The AHA report emphasized that "there is an urgent need to coalesce around improved standards that overcome the significant gaps making communication difficult between systems." In other words: we need our computers to communicate better. But the harder truth is that allowing computer systems to share data is just Step One. What is really needed in medicine is the ability of providers to collaborate and coordinate care. The data-sharing is just the foundation -- it doesn't necessarily facilitate the profound collaboration that needs to occur for good care to happen. 

As always, these organization-level initiatives -- like those to improve interoperability -- are crucial. They are long-term projects that affect key foundational aspects of what we do as providers. But these projects are often uni-dimensional and may not affect our work in the holistic ways we need them to. So even as hospital-level and nation-level work occurs, we as providers must create and demand tools that are immediate and holistic enough to support excellent care for our patients. 

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: care coordination, EHR, EMR, medical collaboration tool

The Healthcare Collaborators It's a Mistake to Overlook

Posted by Lawrence Kerr on Tue, Feb 12, 2019 @ 06:00 AM

ben-white-998822-unsplashMost healthcare providers struggle to collaborate with even the most essential of their colleagues. Many of us are stuck in the "dark ages" of phone tag or hoping that the EMR/EHR manages to coordinate different provider visits and perspectives. (I'll give you a hint: it doesn't.) 

While iClickCare is commonly used in hospital settings, private practices, or home healthcare, you might be surprised to know that iClickCare actually originated in elementary schools, with a school-based healthcare program. Our Founder is a pediatrician and she created the tool to collaborate with nurse practitioners at local low-income elementary schools. The goal was to use telemedicine to collaborate, coordinate care, and keep young students in class by resolving health problems more efficiently.

So when I heard about a recent program with similar goals, I was glad to know it is succeeding -- even as there are key aspects of it that fall short.

 

In 2012, Children's Hospital Colorado started a program with school and corporate collaborators -- it works with school nurses to train students to manage their asthma more effectively. 

The question asked in the article, "Are schools part of the healthcare system?” is an important one -- and I would answer with a resounding Yes. As Dr. Deterding said, “Even though schools may not want to be a medical healthcare delivery system, they are. ”In fact, I believe that “the healthcare system” includes far more collaborators than one would think. It’s not just doctors, nurses, and hospitals. Our collaborators in medicine include social workers, teachers, parents, kids, school nurses, home health aides… the list goes on and on and is unique for each patient.

According to Fierce Healthcare’s summary, participants in the Colorado program "experienced a 22% drop in school absenteeism and an 80% decline in hospitalizations and urgent care visits among pediatric asthma patients.”

While this is an exciting program, with strong results, I do think that we can do even better. Ultimately, this program doesn't create a foundation to improve the way we care for young patients overall -- it simply resolves one aspect of a complex care scenario. While results were excellent, I worry that the intervention isn't holistic enough or sustainable because it's not involving the full picture of these young patients' care. That said, I think there are several crucial learnings from this project that we can all take away. 

3 Key Care Coordination Learnings from a School-Based Health Program:

  • The people closest (geographically or emotionally) to our patients may have the strongest ability to support them.
    In this case, the people consistently close to these young patients are school nurses. School nurses are close in terms of physical access, are embedded in the students' community and cultural context, and likely know the students personally. Similarly, it's crucial to recognize the similar closeness of wound care nurses, home health aides, teachers, social workers, and others. Medicine can become very hierarchical, in which specialists are hyper-valued. But the reality is that for the best care to happen, we need to collaborate with the people closest to our patients as well. 
  • Working across the continuum of care can be a powerful way of achieving new results.
    The new world of healthcare requires that we expand our understanding of who is part of the care team. But I believe that it's not enough to simply engage school nurses to execute a program. We must truly collaborate across the continuum of care. We have seen over and over again that this approach yields a strong ROI and best-in-class patient care.
  • Tools used to bridge different aspects of the healthcare system must be robust and flexible. 
    What does that mean specifically? It means that our tools must do more than support us in treating a single disease, as with this asthma program. Rather, we need tools like telemedicine-based healthcare collaboration that help manage asthma today, a cancer scare tomorrow, and a complex broken leg next year. Healthcare is too complex, and our patients are too valuable, to settle for single-use tools.

With the inspiration of both the strengths and shortcomings of this program, I encourage you to look more broadly in your practice today. More broadly in terms of who you see as part of the care team... and more broadly in terms of what you expect from the tools you use in your practice of medicine. Our patients deserve more and better care coordination and healthcare collaboration -- and we deserve more and better satisfaction from the work we do.

 

Learn more about hybrid store-and-forward telemedicine and how it can help you do care coordination across the continuum of care:

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Tags: hybrid store and forward medical collaboration, nurse practitioners, nurse collaboration, healthcare collaboration software

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities

Posted by Lawrence Kerr on Wed, Feb 06, 2019 @ 06:00 AM

 

hush-naidoo-1170845-unsplashThe United Hospital Fund is a nonprofit that is embarking on an important initiative. Their Difficult Decisions series explores the challenges that hospital staff personnel face in planning discharge.

The third in the series looks at the transition to post-acute care, usually to a Skilled Nursing Facility (SNF). And the study itself brought to light important insights for all providers, in understanding discharge planning, as well as patient transitions, more generally.

The most salient point in the study is, as Fierce Healthcare summarizes, that discharge planning presents profound obstacles for the hospital staff personnel who carry it out. Both administrators and staff very much have a goal of continuity of care. But the tools and structures that staff personnel encounter make the outcome of discharge planning fall short, many times. 

For any of us who work in hospitals every day, none of this comes as a surprise. That said, there were several nuances in the study that were enlightening in exploring when balls get dropped in discharge planning -- and how we might improve that process. 

Why Balls Get Dropped in Discharge to Skilled Nursing Facilities: 

  1. Discharge plans are made without real input from the people carrying them out. 
    One thing that I loved about this study is that it was carried out by talking directly to the people who are actually doing the work, in order to understand the real challenges and opportunities they face. For that reason, I think the insights carry more weight than a study solely based on administrators, or findings from a think tank or conference. Similarly, discharge plans are sometimes coordinated "at the top" rather than allowing them to be shaped and reshaped by the medical team, across the continuum of care.
  2. Discharge plans are often static. 
    The status of a particular patient changes quickly and often without warning, which means that the discharge plan must change and evolve, too. A static plan won’t work. And one that’s created once and then executed by members of the care team, in their offices or even across institutions won’t work. That’s why a tool like iClickCare -- which uses telemedicine to support medical collaboration for care coordination -- is so crucial. As the patient's situation changes, the entire care team can continue to influence the discharge plan, communicate about status changes, and get multiple perspectives.
  3. There is little communication across institutions. 
    Although, in theory, a nurse at a Skilled Nursing Facility, or a doctor at a hospital can always "pick up the phone,"  the pace of medicine and the realities of scheduling makes telephone tag nearly impossible to do successfully. For that reason, there is often little communicate across institutions -- for instance, from a hospital to a Skilled Nursing Facility, or vice versa. That means that information is often fractured and things can get missed, not to mention that crucial nuances of patient care fall by the wayside altogether. 
  4. Patients are given information, not guidance. 
    In theory, patients are given the information they need (for instance, a list of skilled nursing facilities). But realistically, they’re not being given the guidance or support necessary to make high-quality decisions about "next steps" in their care. True guidance and support means their whole care team working with the patient collaboratively -- throughout the duration of their illness.

In exploring the findings of this study, it was so clear to me that "trying harder" is not the answer when it comes to healthcare providers doing care coordination and discharge planning effectively. Teams need excellent tools and strong processes to support them in actually creating the continuity of care they intend to. And telemedicine-based medical collaboration is one of those crucial tools. 

 

You can try iClickCare today to support your organization in doing care coordination as effectively as it intends:

 

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Tags: care coordination, medical collaboration tool, skilled nursing facility, telehealth in skilled nursing facilities

A Surprisingly Simple Way to Improve Birth Outcomes

Posted by Lawrence Kerr on Tue, Jan 29, 2019 @ 06:00 AM

julie-johnson-692218-unsplashIn Sweden, 28% of women who give birth were born in another country.

These women may be Syrian refugees or arrivals from Africa, or France, or Spain. They speak countless languages and may not be familiar with the medical protocols and cultural norms of their new home. 

And this reality is not without its challenges. Sweden has good rates of maternal complications and mortality, but immigrants face outcomes six times worse than their native-born counterparts. 

That said, a simple new initiative has been changing that for immigrant women giving birth -- and the practice is rooted very much in medical collaboration and care coordination.

A recent article in the New York times explores Sweden's immigrant maternal health challenge -- in which foreign-born women face outcomes six times worse than Sweden-born women. Of course, these women may have significant linguistic and cultural barriers, keeping them from accessing the same standard of care.

Interestingly, the solution to this problem isn't intensive prenatal interventions or better technologies -- it's simply improving collaboration and communication.

This collaboration intervention comes in the form of "doula culture interpreters" -- trained women who assist a pregnant woman in her labor, supporting her in communicating with her midwife or doctor as well as helping her understand the norms and practices in the birthing process. These doulas translate from the immigrant’s home language and culture into their adopted language and culture. But they also translate the medical system, culture, and jargon. 

Sometimes the participation of the doula is as simple as literally translating from Swedish to, say, Arabic. Other times, the "translation" is from medical-speak to plain language. “Good communication is listed as one of the best ways to improve outcomes,” Dr. Esscher, a Swedish obstetrician, said in an interview. And, indeed, the doulas' support of good communication, has been having an effect on outcomes. 

I found this doula project inspiring in its simplicity. It's an intervention that doesn't involve displacing or dramatically changing any current practices or providers. It simply improves communication, collaboration, and coordination with the assistance of one of the doula interpreters. I also think that this kind of approach spotlights the importance of having collaboration tools that are flexible enough to involve multiple kinds of collaborators.

For instance, the old telemedicine paradigm of a one-to-one videoconference or text message thread between two doctors simply isn't enough to support this kind of approach. Rather, a truly team-based approach in which, perhaps, the doula interpreter, the obstetrician, and the midwife could all collaborate on postpartum or antenatal care, that is the approach that is truly necessary. Knowing this need generally, iClickCare has been structured to enable medical collaboration among multiple members of the care team, regardless of medical training, across the continuum of care. In an age when our care team includes a range of providers, offering a range of perspectives, this kind of tool is not only helpful, it's indispensable. 

To me, this program brings up questions that apply to all of us in medicine. First: We’re in a time where immigration and refugees are one of the challenges and opportunities that many countries face. How might we ensure that all people in our country experience the same quality of care and outcomes? And perhaps even more crucially: we're in a time when medical care is increasingly team-based, with a diversity of training levels and perspectives. How might we make sure that all members are engaged to provide the most coordinated, nuanced care possible?

 

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Tags: telemedicine solutions, care coordination, medical collaboration tool

Holistic Medical Approaches Can Have Measurable Outcomes

Posted by Lawrence Kerr on Thu, Jan 24, 2019 @ 10:54 AM

rawpixel-659503-unsplashMy mentors in surgery never allowed us to view surgery as solely the surgical event.

Truly knowing the patient, preparing the patient mentally and physically, and working with other providers to ensure excellent post-operative care were all inherent parts of the job — not “extras.”

The truth is that the structure of the medical system has made this approach increasingly difficult to carry out. Ironically, though, many of our most pressing health issues demand this kind of approach. So I was inspired recently to hear about a new program using just this kind of holistic approach -- achieving tremendous success, in a major hospital system. 

As we know, recovering from surgery can be slow and complex, even in the best of times. In the midst of an opioid epidemic, however, there are even more reasons that surgical recovery can touch off opioid addiction. On the face of it, it doesn't sound like a problem you could do much about -- but Geisinger Health System, a major Pennsylvania-based hospital system, decided they could do something about it. 

Rather than trying to address opioid problems directly and after-the-fact, Geisinger's program uses a holistic model to prevent issues before they start.

As Fierce Healthcare explains, “Pennsylvania-based Geisinger Health System is launching a program to "redesign" the surgical experience aimed at improving the healing process following surgery while ultimately tackling one of the major sources of opioid addiction: postsurgical care. Officials said their Proven Recovery program rethinks the surgical experience by pushing patients to be healthier before surgery, which leads to fewer complications.”

Since June 2017, when the program began, opioid usage across the system has dropped 18%. Perhaps even more astounding, hospital stays for neurosurgery and colon surgery went down by a full 50%.

The program focused on pre-surgery and post-surgery approaches, like making it easy for patients to achieve proper nutrition, a focus on non-opioid and targeted pain approaches, as well as focusing on mobility after surgery.

In many ways, this program isn’t cutting-edge medicine. It’s appropriate pre- and post-surgical care. “Appropriate” care is always holistic in these ways — and at other points in the history of healthcare, this kind of approach wouldn’t be out of the ordinary.

That said, the frustrating truth is that this kind of holistic program is so rare that the results Geisinger is getting are truly exceptional. The way the medical system is structured, a program like this — which is preventative, collaborative, and holistic — simply isn’t easy to create or get support for.

We hope that models like this pave the way for more programs that tackle challenging problems in smart, holistic, collaborative ways. And we will continue to make sure that courageous healthcare providers like these have the tools they need to overcome silos and work in medical collaboration, together. 

 

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Tags: good medicine, medical collaboration tool

Do Changes in Healthcare Payment Change Attitudes About Collaboration?

Posted by Lawrence Kerr on Thu, Jan 17, 2019 @ 06:00 AM

rawpixel-570908-unsplash (1)The New England Journal of Medicine's Catalyst blog has been doing a really strong job recently -- and their post on value-based care captures the challenging, difficult, and opportunity-filled place we're at in medicine, right now. 

If, as a healthcare provider, you've ever felt like the definition of "value," and how your organization pursues it, is a moving target... or if you've wondered what direction the whole reimbursement system is moving in... then this piece may have some fascinating insights for you, especially as we start 2019.

There has been a remarkable change in how reimbursement happens, even in the last couple of years. Now, a full 25% of healthcare is based on value-based reimbursement, as reported in JAMA (with the other 75% remaining fee-for-service.)

As you're likely aware, this value-based reimbursement is done in two ways: 

  • 1. Capitated Payments. Accountable Care Organizations ACOs use capitated payments (“subscription” per covered life per month)
  • 2.  Bundled payments. One payment, based on the patient's condition, which is split up among whatever services or providers treated that condition.

The mechanics of value-based payment models aren't complicated. But the perceptions of these models, the differing levels of support, and our diverse abilities to meet the models' challenges, all vary dramatically. So JAMA's New Marketplaces Insight Report, exploring the understanding and thoughts of different players in the healthcare system around these shifts, is fascinating.

First and foremost, the report suggests deep ambivalence: "Nearly half (46%) of respondents — who are clinical leaders, clinicians, and executives at U.S.-based organizations that deliver health care — say value-based contracts significantly improve the quality of care, and another 42% say value-based contracts significantly lower the cost of care."  In other words, half of us believe value-based contracts are great for quality and half of us believe that they're very bad for quality. Perhaps not surprisingly, healthcare providers tend to be more skeptical about the model than executives and administrators.

Also, many, across organizations and despite their roles, don't know their organization's stance on value-based care. The authors indicate that respondent answers may show a lack of consensus on what value-based care really means. "While there is broad agreement that value in health care is represented by the balance between the patient-centered outcomes of care achieved with the costs to reach those outcomes, many individuals do not completely understand that concept." For instance, one clinician asserts that "value" isn't really a term that is useful or has a broadly understood meaning: "Right now, [value is] a convenient term that means whatever the speaker wants it to mean.”

Payers and providers are not aligned. And the high rate of salaried employment by healthcare systems adds to the confusion. Many clinicians tend to have the starting point that, "I am morally obligated to my patient, but there is no real contract between the patient and myself." 

Regardless of current perceptions, there also remain practical barriers to full adoption of value-based care models. The primary barriers to the proliferation of value-based models are primarily related to infrastructure, including Information Technology. But regulatory issues, data integration, patient engagement, and others all play a role.

Of course, many of these barriers can be addressed by new tools, like iClickCare. But adoption is an interesting challenge when so many providers are ambivalent about whether value-based care is the right direction... or even how their organization is currently reimbursed.

To me, these shifts emphasize the crucial importance of healthcare collaboration. Wherever you or your organization falls regarding reimbursement, healthcare collaboration has become increasingly critical for doing the care coordination and achieving the outcomes that reimbursement shifts demand. I thought that an executive at a large nonprofit hospital in the South articulated the challenge -- and the opportunity -- of healthcare collaboration well: 

"Physicians had been taught for decades that they were the final arbiter of everything that happens to their patient. When, and until, we change the culture to one of team-based care where the patient belongs to the team, we will continue to struggle with adopting value-based care. As an example, a physician with a length of stay that is 10 days longer than his peer average once told me that the hospital has a length of stay problem because the hospital gets paid a single fee for the entirety of care.”

Clinicians are decreasingly able to bury their heads in the sand when it comes to the big picture of reimbursement. But rising to the challenge of what's to come in healthcare doesn't have to be complicated. Simply working effectively with your colleagues to provide the best, most coordinated, most efficient care possible will ultimately be the best approach -- now, and in the future. 

 

To learn more about how telemedicine can support value-based payment models, download our free Quick Guide: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: healthcare collaboration, telemedicine reimbursement, value based care

3 Simple Ways to Improve Healing in Hospitals (and Length of Stay)

Posted by Lawrence Kerr on Thu, Jan 10, 2019 @ 06:00 AM

luis-melendez-530478-unsplashMany healthcare providers don’t use the healthcare system often. In fact, I’m sure many of us have heard doctors say, “I don’t need to go to the DOCTOR!”

For that reason, sometimes I think we have a limited sense of what it’s like to be a patient.

As a patient in the hospital, we turn our days and nights over to a system that intends to get us to a certain level of recovery and intends to keep us alive. The hospital, per se of course, isn’t always structured to support overall wellness or healing — that’s the job of others in the healthcare system, and of the patients themselves.

But sometimes information will confront us about just how hard a hospital stay can be on the health of a patient -- and we're forced to reconsider our approach.

One common complaint in hospitals is that you can't sleep because of all of the interruptions throughout the night -- vital checks, light, noise, early rounds, blood draws, etc. For many of us, this may sound like a tiny price to play for the crucial monitoring that happens through those hours. And perhaps it is. 

But a recent article in the New York Times reconsiders whether the price truly is small. We all acknowledge the profound value of sleep in our basic functioning and healing: "Short sleep durations are associated with reduced immune function, delirium, hypertension and mood disorders. Hospital conditions, including sleep disruptions, may contribute to 'post-hospital syndrome' — the period of vulnerability to a host of health problems after hospitalization that are not related to the reason for that hospitalization."

There are so many demands in medicine that we’re forced to do things that may not make sense in terms of healing, but are the only way to proceed, working within the structure of the medical system. As the New York Times says, the hospital is "an environment that, all too often, seems set up for everyone else’s convenience but the patient’s.”

As providers who want to truly care for our patients, and in this time of value-based care, these are concerning truths. So what are we to do?

First, I believe that the sooner we can get people home, the better. This is a combination of the efficacy of care within the hospital PLUS an expectation of a high level of support once the patient leaves the hospital. The more we can depend on sophisticated monitoring and care from the home environment, the sooner the patient can get home. Many times, that means we need to be enabling healthcare collaboration across the continuum of care. That way, aides and wound care nurses can tend to patients from where they're most comfortable, but have a moment's access to other providers, as needed.

Second, the more humane, the more holistic, we can make our healing environments, the better. A clinical study showed that even small changes to disruptions to sleep in hospitals cut patients’ sedative use by half. Yes, hospitals are places where we achieve a bare minimum of functioning. But thinking more comprehensively about whether they're also supporting health may be a wise investment for us to make. 

Finally, it's crucial that we let providers make commonsense decisions. Our checklist culture has sometimes reduced errors, but it may have also reduced the commonsense nature of what many of us do. Any nurse has an impeccable gut sense of how she might combine vital checks and blood draws so that no monitoring sensitivity is lost, but the patient is disrupted less frequently. But if she's told she MUST do these things on a set schedule, she begins to override her own sense of what's best for the patient. 

Metrics like Length of Stay can seem challenging or even excessively profit-motivated to consider. But when you think about the patient's experience in the hospital and the intersection of Length of Stay and the patient's quality of healing, it gets clearer how the "right" thing to do is also the "smart" thing to do. 

 

To learn more about how telemedicine can support shorter Length of Stay and improve outcomes, download our Quick Guide: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, decrease length of stay

Is the 2019 Outlook for Nonprofit Hospitals as Bleak as it Appears?

Posted by Lawrence Kerr on Thu, Jan 03, 2019 @ 06:00 AM

brooke-lark-194254-unsplashMoody’s Investors Service came out with their 2019 projections and predictions for nonprofit hospitals.

And unfortunately the summary is: things don’t look great.

Although I don’t put tons of confidence or stock in this type of projection, I do think that the report captures many of the challenges that nonprofit hospitals face.

Fierce Healthcare does a good job summarizing Moody’s report: Moody’s says that nonprofit hospitals are on an “unsustainable path” because of “soft revenue growth, weak inpatient volumes and single-digit reimbursement increases in the coming year.”

Other challenges in 2019 may include lower cashflow, an increase in bad debt, lower inpatient admissions, and pressures like nursing shortages and increasing wages.

So much of healthcare is conservative. We don’t change until we need to. And for many nonprofit hospitals, there has been a consistent tendency to maintain the status quo in an almost superstitious fashion — if I don’t change, then nothing will change around me.

Reports like this demonstrate that things are surely changing around us. Our only choice as healthcare providers, as hospital administrators, and as citizens is whether and how to act proactively so that the things that matter to our organizations and to ourselves can be supported and pursued.

Healthcare is changing around us -- for better and for worse. 2019 will bring new technologies, shifts in reimbursement, demographic changes, and developments in our own practice as healthcare providers. Our goal can't be to not change within that. Our goal has to be to change towards what we envision for ourselves and for our patients. And with the new year here already, I encourage all of us to take the opportunity to reflect on what that might look like this year.

 

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Tags: telehealth, good medicine, telemedicine reimbursement

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