ClickCare Café

New Medicare Proposed Rule to Expand Telehealth Benefits

Posted by Lawrence Kerr on Thu, Nov 15, 2018 @ 06:00 AM

rawpixel-487102-unsplashMedicare is a crucial part of our healthcare system. Although some providers feel themselves unwilling or unable to accept Medicare, the reality is that 44 million people are beneficiaries. It impacts those people, as well as our healthcare system as a whole. This is important because the whole healthcare system tends to lean towards Medicare's policies.

So a new proposed rule affecting telehealth is practical, crucial, and fascinating to explore. 

Just recently, Medicare announced a new proposed rule for public comment and review that would greatly expand payment for telehealth. 

The full proposed rule change can be found here, but the general shift leans heavily on Medicare Advantage plans and is summarized as follows: "Under this proposal, MA plans would be permitted to offer – as part of the basic benefit package – additional telehealth benefits beyond what is currently allowable under the original Medicare telehealth benefit. In addition, we propose to continue authority for MA plans to offer supplemental benefits (that is, benefits not covered by original Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for additional telehealth benefits."

The explanation and rationale for the shift includes this insight: "The healthcare industry has made significant advances in technology that enable secure, reliable, real-time, interactive communication and data transfer that were not possible in the past. Moreover, the use of telehealth as a care delivery option for MA enrollees may improve access and timeliness of needed care, increase convenience for patients, increase communication between providers and patients, enhance care coordination, improve quality, and reduce costs related to in-person care."

Not only is this a powerful positive development for medicare beneficiaries as well as healthcare providers who use telehealth -- we believe this represents an important philosophical shift. Telehealth is not an "an additional benefit" -- it's one of the many tools that healthcare providers have at their disposal to provide excellent care to all patients. This proposed rule is an important step away from that "special benefit" status of telehealth -- and towards it being just one more tool in our toolbox. 

Further, it is recognized that significant savings can come from the use of telehealth, as well as increased access by people who may be in rural, underserved, or hard-to-reach areas.  

The commonsense of telehealth seems to be slowly eroding the granite barrier of Medicare’s policy toward payment for telehealth.  As you know, there are significant restrictions about who, where and how a patient could benefit from technology applied to day-to-day care. Currently, live video conferencing from specific sites is the only reimbursable use of telehealth for Medicare recipients. We, of course, are strong believers in using technology to shift time as well as shift place. Hybrid Store-and-Forward Telemedicine®, for instance, uses asynchronous collaboration -- you respond on your own schedule -- so that both the patient and provider can solve problems without always using expensive hardware and having the interruption of scheduled appointments.

We understand CMS’s concerns about the potential for fraud and agree with the concerns. However, in our modern society with a fragmented health care system, collaborative and coordinated care has benefits that outweigh the risks.

For providers who care about good medicine and thoughtful healthcare, this new rule is an important development -- and likely shows the direction that reimbursement and medicine in general is headed. 

 

To learn more about Hybrid Store-and-Forward Telemedicine, including reimbursement issues, download our white paper: 

 ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, telemedicine reimbursement

What Helps Doctors Understand Patients' Stories?

Posted by Lawrence Kerr on Thu, Nov 08, 2018 @ 06:00 AM

vlad-bagacian-634061-unsplashStories are sewn into every part of medicine. 

The way we are trained to talk to patients is about drawing their story out of them. The way we share cases with colleagues is about describing the narrative of a patient. 

But modern medicine, especially in this age of EHRs and silos, tends to reduce patients to treatments and boils stories down to a series of interventions. And this weakness might feel more "efficient" at first but does tend to erode the quality of care our patients receive -- as well as the results they may experience from that care. 

That said, there are programs and tools that intend to reintegrate patient stories into our work. A recent article in the New York Times told of a program at Weill Cornell Medicine in New York. To combat ageist biases and practices, the program brings in older people to speak to medical students about their experience. Like all people, older patients have a diversity of experiences, strengths, and challenges. And for doctors to care for them well, they need to be able to understand this diversity, and create a care plan within that knowledge. 

As Dr. Adelman, the coordinator of the program, says, "Unfortunately, most education takes place within the hospital. If you’re only seeing the hospitalized elderly, you’re seeing the debilitated, the physically deteriorating, the demented. It’s easy to pick up ageist stereotypes.”  This program aims to complement this more hospital-based perspective with the other facets of patients' experiences. 

Unfortunately, this type of program is still rare. And rarer still are tools that support the full, holistic story of patients as the center of care -- especially once healthcare providers are outside of an academic setting and in the flow of practice. 

Electronic Medical Records, text messaging, and other intervention-focused tools only serve to create a further lack of "story" in patient care. But when you don't have the full story of a patient -- including their dreams, goals, daily habits, health goals and other "ancillary" aspects -- you don't necessarily have the full picture of how best to treat them. 

Certainly, many aspects of medicine pull us, as providers, away from stories and towards interventions. But when we use a telemedicine-based medical collaboration tool -- like iClickCare -- to have fulsome conversations with other providers about patients and share the holistic picture of whom the patient is, we provide better care and experience more satisfaction. So whatever our medical education provided or did not provide in this way, we always have the choice to use tools to practice medicine in the way that best fits our values. And for me, that has meant a tool that helps me do medical collaboration and see patients as full people. 

 

Tags: healthcare collaboration, medical collaboration software

Health Care Power-Users Point to Collaboration as Key to Care

Posted by Lawrence Kerr on Tue, Nov 06, 2018 @ 06:00 AM

rawpixel-577480-unsplash (1)

Frequently, “power users” of healthcare are seen negatively.

Whether because they are seen as more “demanding” patients or because of their relatively larger “burden” on the healthcare system, there is often a bias against these patients.

But a recent study — a collaboration among the New York Times, The Commonwealth Fund, and the Harvard TH Chan School of Public Health — looked in depth at these patients, both putting a spotlight on their behavior and experience, as well as sharing the wisdom they have about how to interact effectively with the healthcare system. Interestingly, much of what they shared advocated for a more collaborative, connective way of doing medicine.

In this study, “power users” of healthcare are defined as “people who have been hospitalized multiple times and are seeing multiple physicians, related to a serious illness, medical condition, injury, or disability.”

Of course, their perspective holds a lot of important insights for healthcare providers, for a few reasons. They: 

  • Have experienced more facets of the healthcare system. 
  • Necessarily developed skills and habits to deal with the shortcomings and strengths of the system. 
  • Are sicker and so may tax the system more, revealing faults that go less noticed otherwise. 

So this study of their experience, problems, and advice is enlightening. Among the findings: 

  • 30% say they were sent for duplicate tests by different healthcare providers.
  • 23% have had to wait too long for appointments, treatments, and tests.
  • Overall, they offer the following advice for navigating the medical system:
    • Show your doctor a list of medications you are taking (78%)
    • Bring a list of things to discuss with your doctor (70%)
    • Bring a family member, friend or someone else to all of your medical appointments to serve as a coordinator (55%)
    • Seek advice or help from a family member or friend who is a doctor, nurse or other health professional (34%)
    • Seek advice or help from a former patient who had a similar health condition (23%)

 

Our take on these results? People who use the medical system a lot experience the delays, confusion, and duplication caused by healthcare providers that aren't able to coordinate care or do healthcare collaboration. For that reason, the advice these patients offer tends to revolve around creating their own solutions to ensure care coordination on their behalf.  

Instead of patients trusting doctors and other providers to coordinate care, they do it themselves or involve friends or relatives to support them in doing it. This behavior certainly makes sense. And it's a wise way to approach a well-intentioned system that doesn't always work. But it does concern us, since patients have only a limited ability to truly coordinate care on their own behalf. For instance, a patient can bring a list of medications they are taking, but they can't bring a list of providers who should collaborate on a case. They can ask a friend to offer advice, but they can't necessarily facilitate meaningful conversations among all of the members of their care team. 

That's why we believe it's necessary for healthcare providers to have the tools they need to truly effect care coordination and healthcare collaboration. Sure, patients may fill in the gaps. But their ability to identify all of the possible gaps and truly fill them effectively is limited.

 

Try the iClickCare 14-day evaluation

Tags: healthcare collaboration, care coordination, medical collaboration tool

One Simple Thing that Makes Patients Happier & Drops Healthcare Provider Burnout

Posted by Lawrence Kerr on Thu, Nov 01, 2018 @ 06:00 AM

rawpixel-674079-unsplashMost doctors I know can’t conceive of doing any more of anything.

Their patient visit slots are completely maxed out. Lunch is nonexistent. Every day, it seems like managers and administrators have a new request, demand, or memo to share about yet another thing that must happen during the visit, during the workday or at home.

So a recent article in Fierce Healthcare made me both nod in recognition and cringe with concern.

The takeaway of the article is that patients wished their doctors would talk to them about — and perhaps even support them with  more non-medical or quasi-medical issues. The Harris Poll surveyed over two thousand adults. Those adults shared that doctors (of course), tend to focus on physical health, even though the most common health issues were actually depression, anxiety, chronic pain, and diabetes. According to the poll, however, doctors touched on the mental, behavioral, or spiritual components of health, less than half as frequently (sometimes as little as 10% of the time), as more cut-and-dried physical components of health.

Of course, these “soft” elements — mental, behavioral, or spiritual components of health — are often the things (like exercise, sleep, etc) that can prevent illness or treat chronic conditions. Also, they often relate more intimately to issues like addiction or suicide which are, of course, epidemic in the US. So it could be deeply helpful to patients if doctors were able to broach more of these subjects.

“With what time?!”  I can hear doctors exclaiming in my head. I know from experience that within the visit time allotted by our bosses and by the healthcare industry, it’s difficult to cover even the basics of the patient's complaint and to satisfy all of the EMR’s buttons and requests. When we read an article like this, we feel like one more thing is being demanded from us that may as well just be deducted directly from our sanity.

Interestingly, an article in the New York Times that came out around the same time looked at doctor burnout and may indicate different conclusions. Dr. Mukherjee reminds us that burnout can be predicted by three things (termed the “Maslach Inventory”):

  • Emotional exhaustion (being “chronically overextended”)
  • Depersonalization (“becoming disconnected from the recipient of your services”)
  • Lack of personal accomplishment “a feeling that nothing is being achieved.”
I think many of us tend to talk about and experience the first one — that of being chronically overextended. But the truth is that depersonalization and lack of personal accomplishment are equally important to remaining satisfied and having longevity in our work.

Ironically (or perhaps predictably), the very things that our patients want more of from us — more engagement, more deep interaction, more holistic care — are the very things that would keep us from getting burned out. And so perhaps there is a bit of a chicken-and-egg situation. We feel overworked (emotional exhaustion), so we pull away from the personalization and sense of personal accomplishment that would keep us from getting drained. In the process, we miss the very things that could treat our patients more meaningfully.

It's true that most elements of the medical system right now do not support us in this pursuit. Productivity metrics, EMRs, and decreasing visit times all hinder us in this kind of approach. But the truth is that we still have the autonomy to take an extra 45 seconds and ask that softer question. Or to try a new medical collaboration tool for a week, if we think it would help us feel supported by our colleagues and give us some followup. The changes, perhaps, don't need to be as dramatic as one might initially think -- to be deeply satisfying to both our patients and to ourselves.

 

Get Started

Tags: good medicine, healthcare provider burnout

Believe It or Not, There is a Human Behind Every Part of the Healthcare System

Posted by Lawrence Kerr on Fri, Oct 19, 2018 @ 06:00 AM

rawpixel-600792-unsplashMy daughter has a particular pet peeve. She’s noticed that in so many movies, when there is a doctor in the story line, he or she (usually he) tends to be arrogant, insensitive, and uncaring — in so many ways, inhuman.

As doctors ourselves, we tend to see our colleagues — whether doctors, nurses, or aides — as very much human because we know them and interact with them every day. But it’s easy to see insurance carriers or drug companies or other parts of the healthcare system as faceless monsters that make our patients’ lives difficult.

Which is why I was really interested to read a series of articles that turned all of that on its head, and definitely warmed my heart.

A couple of weeks ago, Gina Kolata wrote an article in the New York Times about the new class of drugs, PCSK9 inhibitors, that slash cholesterol levels for patients that aren’t seeing results on statins, or with diet or exercise, but have serious risk of early heart attack or stroke.

She told the story of the hyper-expensive drugs, the $14,000 price tag that the drug manufacturers have set, and the insurance carriers that create a byzantine maze for any patients trying to access the drug.

It’s a well-known story — evil drug companies and evil insurers make it impossible for patients to access the care they need. When I read it, I didn’t think much of it.

Then, about a week later, another story came out.  In this one, the New York times reporter tells a story that pretty much upends all of my assumptions about the players in the story.

The evening her story was published, the founders of Regeneron — the manufacturer of the PCSK9 inhibitors — emailed her.  Dr. George D. Yancopoulos and Dr. Leonard S. Schleifer wrote:

“If you can, please put Mackenzie and Rodney in touch with us, and we will try and help them get covered, or we can arrange to give them the drug for free… While we can’t give everyone free drugs, we can help Mackenzie and Rodney, especially as they had the courage to step forward and share their experiences.”

He then gave his personal phone number and asked the journalist to give it to the patients in the story, “explaining that he can be slow answering emails.” 

In her story detailing her conversations with Dr. Yancopoulos, Kolata told the story of Regeneron. It was founded by the two doctors in 1988. 20 years after that, Regeneron got its first drug approved. 5 years after that, they made a profit. 25 years of a business isn’t exactly a “get rich quick” scheme. The total cost to develop the drug was $1.6 billion and last year they made just $195 million (a tiny fraction of the total investment.) In reading the article, it's clear that Dr. Yancopoulos has battled for decades to create a drug that he truly believes will save lives -- and that his heart is very much invested in making sure people have access to it.

Certainly, it's great that these two patients got access to the drug -- although that doesn't change the challenges that most patients will encounter in obtaining it. That said, it's a fascinating article and shows that even the most "inhuman" elements of the healthcare system -- for instance, drug manufacturers -- may have real people behind them who are doing their best to chart a course forward in a challenging system. 

The truth is that none of us are as smart as all of us, working together, are. (We say that a lot.) And for us all to work together, we must continue to see everyone in the healthcare system as human. 

 

ClickCare Quick Guide to Medical Collaboration

Tags: healthcare collaboration, medical collaboration

Medical Collaboration has More Regulatory Flexibility than Direct-to-Patient Telehealth

Posted by Lawrence Kerr on Thu, Oct 18, 2018 @ 06:00 AM

victoria-heath-367303-unsplashAs the world changes, our regulations and laws often scramble to keep up.

Whether it’s Uber being challenged in individual cities or schools struggling to adapt to children owning cellphones, the legal side of life often lags behind our technology, our culture, and our needs.

So it shouldn’t be surprising that telehealth regulations face similar challenges across states — but the consequences are indeed challenging for those who do direct-to-patient telehealth.

A recent article in Fierce Healthcare looked at a few examples of recent telehealth challenges arising from state-to-state regulatory differences.

As they report, “Whether a medical professional can treat someone via telehealth—and if so, how—varies widely by jurisdiction, since medical practice is regulated at the state level.”

For instance, court cases involving doctors seeing patients via telehealth touched on:

  • The administration of medical abortions
  • Prescription of controlled substances
  • Etc.

Further, doctors and patients often run into challenges when the intended telehealth patient didn’t have access to the Broadband internet needed to access an electronic visit with a doctor (thus limiting care in the very places that telemedicine could be most useful.)

These challenges are real, and important to explore. That said, it's not necessarily the case that the challenges are inherent in using telemedicine across state borders.

The regulatory issues presented in the Fierce Healthcare article all boil down to the challenges inherent in a doctor seeing a patient electronically.  But “telehealth” is NOT synonymous with doctor-to-patient online visits. As we’ve written about extensively, the umbrella term "telehealth" includes the use of many different kinds of technology to care for patients. A doctor seeing a patient via an online platform is only one version of that.

In fact, the challenges of videoconferencing or electronic visits are the very reasons that we created iClickCare to revolve around medical collaboration among healthcare providers, NOT between a single medical provider and a patient. There are many reasons that a short, technology-supported visit between a healthcare provider and a patient via videoconferencing may not be adequate to provide strong, holistic care of that patient. There isn't a useful archive of the visit; other members of the care team can't be involved; there is often little longitudinal knowledge of the patient; and care is infrequently holistic. The regulatory issues inherent in a “visit” like that are only one aspect of the shortcomings involved.

As an alternative, telemedicine-based medical collaboration allows providers — regardless of location — to collaborate on a case. It also means that if a provider in California is consulting with a provider in New York about a patient in California, the provider in California remains responsible for that patient. And that is “responsible” in all senses, legally and otherwise. Telemedicine-supported medical collaboration allows the flexibility and location independence that telehealth promises. But it doesn’t put the sole responsibility for a patient in the hands of a provider who is 300 miles away and has interacted with them, once, on Skype.

As we step forward into this new age of telehealth, telemedicine, and technology, it's important that we don't simply replace our old system (one-on-one doctors' visits, for instance) with a technological version of that old system. Our patients deserve more imagination than that. And we deserve the ease that can come from a tool that really works to help us deliver great care. 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, medical collaboration tool, telehealth and hipaa

Is an In-Person Visit Always Preferable to Telehealth Options?

Posted by Lawrence Kerr on Thu, Oct 11, 2018 @ 06:00 AM

rawpixel-743067-unsplashA new article in the New England Journal of Medicine takes a controversial stance on the topic of whether an in-person doctor's visit is always "Plan A."

Perhaps, the author argues, we are moving towards a time when patients will be better served by a model in which in-person visits are actually the "last resort" of care. 

Our take? Yes and no. Read on...

In "In-Person Health Care as Option B", Sean Duffy and Dr. Thomas H. Lee advocate for a new framework for healthcare visits. Rather than seeing telehealth visits or other virtual options as "in the meantime" approaches or ways to cut costs, they argue that perhaps patients can be cared for better when in-person visits become much rarer, only used when absolutely necessary.   

They describe the analogy of a tech support ticketing system, as might be used at your favorite software company. Perhaps a patient would submit a "ticket" with their concern or medical issue... it would be handled first via telehealth means (even automated or low level support at first)... only being "escalated" to an in-person visit if absolutely necessary. And the ticket wouldn't be closed out until or unless the initial complaint was resolved.

The technology is there, the authors contend. “Smartphone penetration of the mobile-phone market increased from 17% to 81% between 2009 and 2016.” And the reality is that in many ways, our medical system is already moving in this direction: "At Kaiser Permanente, for example, 52% of the more than 100 million patient encounters each year are now “virtual visits.”

One important point that the authors make is that doctors are often approaching care this way currently -- but with improvised methods that aren't really meeting the provider's or the patient's needs. True enough: “Virtual visits are more convenient, but there’s a difference between recreating an in-person approach with digital tools and designing the safest and most efficient way to achieve an optimal outcome." Further, if doctors are simply using text messaging, email, or informal photos to replace a visit, that's not a safe or sustainable way to replace the richness and HIPAA-compliance of a real visit. Also, improvised approaches tend to be lesser replacements for in-person care, rather than innovative ways to save money AND get a better result.

Although we agree that there is a lot of potential to rethink how we approach clinical visits in healthcare, we also worry that the authors' approach isn't appreciating some of what can be lost if telehealth approaches aren't designed thoughtfully.

For instance, the example of the tech support "ticketing" analogy would fall severely short of our goals for any medical visit. Sure, the patient's complaint needs to be addressed. But medicine is more complex than software.

So any approach to increasing the use of telehealth solutions also must:

  • Support medical education.
    This means that simple videoconferencing or "e-visits" likely aren't sufficient, as they don't create an archivable, searchable, teachable record of the encounter.

  • Provide holistic care to the patient. 
    Support not just solving the immediate problem, but truly caring for the patient -- which doesn’t always just mean solving only the problem the patient presents with.

  • Enable providers to collaborate effectively.
    It would be a tragedy if telehealth caused a further silo-ing of providers across specialities and across the continuum of care.

Healthcare needs innovation, certainly. And technology will be a crucial part of any solution that stands a chance of survival moving forward. But we advocate for approaches that truly support access, education, and collaboration -- not just completing a ticket and checking off a box for a patient.

 

To learn more about alternative technologies for telehealth, download our Quick Guide to Hybrid Store and Forward Telemedicine®: 

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

 

Tags: hybrid store and forward medical collaboration, telehealth and hipaa

3 Things We Learned About Healthcare Collaboration From a Shocker of a Story

Posted by Lawrence Kerr on Thu, Oct 04, 2018 @ 06:00 AM

ani-kolleshi-640938-unsplashSometimes, healthcare collaboration can sound mundane.

It sounds like a bit of a “flourish” — something that’s ideal to do if we have time, but not crucial to the care we give. I think many providers picture it as useful for “double checking” a diagnosis or getting some second-level insight.

But a recent story in the New York Times shows that a lack of healthcare collaboration can have permanent impacts on our patients’ lives. And that what we can get from healthcare collaboration is far from basic — it’s crucial to the fundamental care we give.

A six-year-old boy in Texas, called Mason Motz, has been nonverbal his whole life. His parents believed that it came from a stroke he had when he was 10 days old. And while he could speak at the level of a one-year-old for his entire life, he had never been able to communicate much beyond beginnings of basic words — a kind of communication that only his parents could understand.

In the last few years, Mason started going to a dentist that focuses on care for kids with special needs. His dentist, Dr. Amy Luedemann-Lazar, started with some basic procedures, getting to know Mason over the course of many visits, and making sure he felt comfortable at the office.

In April, Dr. Luedemann-Lazar was performing an unrelated procedure and realized that the band under his tongue was shorter than normal — he was tongue-tied. She dashed to the waiting room and got permission from the Motzes to do the corrective procedure. She was able to perform the procedure in 10 seconds, with a laser — and within hours, Mason was talking dramatically more understandably than before.

We know that there is controversy about the detrimental effects of ankyloglossia as noted in the article and even about the technique of repair, but in this case at this age, it was clearly an appropriate avenue to go down. Mason has a road of speech therapy ahead but is expected to be caught up to his peers’ speaking ability by age 13.

While this is certainly a simple story of a medical provider who really got things right, we think that the story also holds some lessons about healthcare collaboration that are important to capture.

 

3 Things We Learned About Healthcare Collaboration from this Story:

  • When providers from different specialties aren’t part of the conversation, huge mistakes happen.
    Although Dr. Luedemann-Lazar made a tremendous diagnosis, we still regret that the insight didn't happen when Mason was still a baby. On our interdisciplinary Cleft & Cranio-facial team, we treated children with cleft palates and cleft lips -- and the team included dentists, teachers, social workers, plastic surgeons and others. This meant that foundational insights from one specialty didn't get missed in care from a different specialty. 

  • Relationships with our patients allow insights.
    In this story, I found it interesting that the dental practice that Mason had been going to specialized in caring for patients with special needs -- and that part of what they do is develop trusting relationships with their patients. I believe this approach may have played a role in facilitating the diagnosis -- without the background relationship, it's possible that the dentist wouldn't have noticed the issue. Healthcare collaboration enables doctors to have stronger, more holistic relationships with their patients. Rather than the constant handoffs, the team approach to care means that the patient and who they are as a person is front-and-center.

  • Sophisticated insights don’t always mean complicated interventions.
    Often, telemedicine and medical collaboration are conflated with fancy interventions and high-flying specialists. But as this story shows, crucial insights don't always mean complicated interventions (in this case, it was a 10-second cut with a laser.) 

 

We certainly applaud Mason's parents for hanging in there, and getting him the support he needed as soon as it was available -- and we hope that Mason's dentist gave herself a good pat on the back at the end of that day. We also know that these simple miracles of healthcare collaboration happen every day -- and for many creative and caring providers, it's a matter of the routine magic they make happen. 

 

For more stories of medical collaboration, download our quick guide: 

ClickCare Quick Guide to Medical Collaboration

 

Why Overall Well-Being is as Important as Medical Intervention for Cost Savings

Posted by Lawrence Kerr on Tue, Oct 02, 2018 @ 06:00 AM

rawpixel-678092-unsplashHealthcare is such a potent combination of art, science, social work, and hard economics. And where these varying approaches touch each other, there can be friction.

So many healthcare providers view what they do as a combination of art, science, and social work — with hard economics never (or rarely) entering their mind.

But many times, healthcare economists come from a perspective that assumes something very different about how healthcare functions and how providers make decisions. Many times, healthcare economists use as a fundamental premise the idea that: providers are self-interested and will bill for as many services as they can; and it’s crucial to focus on hard outcomes of services, not on overall well-being of patients. Their perspective tends to be that hard economics reign and that these other approaches are dreamy intangibles.

A new study in JAMA challenges all of that.

JAMA published a study described as a “US national, population-based cross-sectional study [examining] the association between county well-being and Medicare fee-for-service (FFS) spending.”

In other words, researchers looked at whether Medicare spending was lower when people’s overall (non-medical) well-being was better. The results?  Medicare spent almost $1,000 less per patient for those in the 20% of well-being scores, compared to the bottom. And this is after adjusting for independent factors like income, urbanity, educational level, etc.

As the JAMA study explained, “Well-being is a positive state of being beyond the absence of disease, measured by not only physical health but also other dimensions, such as emotional, social, and economic health. Well-being may be modifiable by a broad range of interventions across different sectors.”  It’s all the stuff that we tend to see as “outside the scope” of a given medical intervention.

We think this is an incredibly important insight and study highlighting something not commonly spotlighted. Certainly, new models have gone up one level to reward fee-for-performance rather than fee-for-service. But the truth is that this measure of overall well-being is up several levels beyond that. And to capture the economic value of our patient's overall health and happiness is important. 

The whole goal of what we do as doctors is to support our patient’s well-being. But if you really needed another reason to pursue that measure, this is evidence that a broader view, a more holistic approach, is cost-effective too.

One of the challenges that we get into with iClickCare utilization is that it might be more efficient to just allow secure text-messaging, rather than having a fulsome, team-based, archivable healthcare collaboration system. The very reason we do what we do is because we believe that this kind of more holistic, team-based approach may not be the fastest way to get a simple, discrete answer — but it is the most efficient, effective, and cost-conscious way of approaching the whole patient. The "whole patient" includes all aspects of their medical condition as well as the other factors in their life that interrelate with that condition. 

The components of well-being in the study that decreased cost-per-patient so dramatically were largely non-medical. That means that any collaboration system that doesn’t allow non-medical caregivers and providers (social workers, teachers, caregivers, etc) to collaborate is misguided and ultimately wasteful in terms of ROI. 

We're glad that this kind of study is being done. And we continue to applaud the efforts of all of those healthcare providers who take the holistic view of their patient's well-being -- rather than simply addressing the malady in front of them. 

 

Try the iClickCare 14-day evaluation

Tags: healthcare collaboration, medical collaboration, care coordination

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet

Posted by Lawrence Kerr on Thu, Sep 27, 2018 @ 06:00 AM

jordan-rowland-716475-unsplashMost healthcare providers let “innovations around reimbursement” come and go.

The majority of us — whether we’re aides, nurses, specialists, or generalists — try to provide the best care possible, in as reasonable a way as possible. And we let the reimbursement and payment fall however it does, after the fact.

That said, there are certainly big shifts that affect how we care for patients — and certainly how we’re paid to do so. And “bundled payments” are one of those shifts that are big enough to pay attention to.

A New York Times article did a thoughtful review recently of Medicare’s bundled payments programs. Currently, these programs are effectively pilots, with hospitals able to opt into the program, rather than making them mandatory.

As I’m sure you’re aware, bundled payment programs create a single payment for every health care service associated with an event. (Rather than paying for the healthcare services individually.) The idea, of course, is that this approach would decrease costs: “In theory, if doctors and hospitals get one payment encompassing all this, they will better coordinate their efforts to limit waste and keep costs down.”

Of course, anyone who has ever gotten a “meal deal” because it was a better value — even though they weren’t originally planing on buying chips or a drink — understands why this may not be the best idea.

That said, some data shows that at least for hip and knee replacements, overall costs are slightly lower than with fee-for-service models. But different types of healthcare are different. And data on hip and knee replacements may not relate at all to other areas of healthcare — especially when the data is coming entirely from hospitals who have opted into the program (rather than taking part in it mandatorily.

But we have some broader concerns about programs like bundled payments.

5 Reasons Bundled Payment Programs May Not Be a Silver Bullet:

  • Most waste isn’t coming from doctors pursuing profit over smart care.
    One core concept in the formulation of this type of program is that providers are seeking profit first and safe, considerate care second. My honest take? This happens, but not very often. And so it's possible that one of the framing ideas is false.
  • Savings from bundled payments necessitate collaboration — and collaboration needs tools.
    Bundled payments benefit greatly from collaboration that can be empowered by healthcare collaboration tools like iClickCare. But simply changing how things are paid for may not provide the tools necessary to make that collaboration -- and thus the savings -- possible.
  • Savings from bundled payments necessitate care coordination — and care coordination demands support.
    This type of integrated payment depends on the interdependency of the providers. As with healthcare collaboration, however, providers are often attempting to coordinate care against all odds. And so it may make more sense to make care coordination more effortless than simply to change payment structures.
  • The “bundle” might not be the right combination of services.
    The bundling structure assumes that it is known what’s needed for a given healthcare event. The reality?  Healthcare “events” can be unpredictable and complex -- every patient is different.
  • Savings are good but rationing usually isn’t.
    The author of the Times article makes a point about steering patient access. While it certainly makes sense to guide patients towards the most appropriate treatments, I worry that this structure can raise the spectre of rationing -- which usually means that people with the least resources end up getting the worst care. Plus, in these programs, quality is generally not taken into account, at least not in very sophisticated ways — especially tracking quality across different groups.

 

All of the above isn’t to say that an overall shift to value-based care isn’t desirable (plus, it’s likely inevitable.) But we do think that it’s important to advocate for supports for shifts in care and reimbursement — not just change how doctors are paid.

 

Looking for ways to save costs in your hospital system? Hybrid Store-and-Forward may be the simplest way towards great ROI: 

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: value based care, healthcare collaboration, care coordination

Subscribe By Email

Recent Posts

Posts by Topic

see all