ClickCare Café

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: care coordination, healthcare collaboration, value based care

The Best Way to Help Young Patients? Get Them Back to Playing Faster

Posted by Lawrence Kerr on Thu, Sep 20, 2018 @ 06:00 AM

jelleke-vanooteghem-578746-unsplashAs you probably know, our cofounder is a pediatrician.

As someone who has treated children across socioeconomic groups for decades, she found that having a playhouse in the waiting room created a sense of normalcy, fun, and respect for the children she saw. She found that patients looked forward to their visits, since they could play in the playhouse -- and parents had a few unexpected moments of respite.

Of course, that was just one detail out of thousands as to how she cares for children in ways that are deeply effective and respectful of who they are as children -- but it highlights the ways that play are important in medicine.

Perhaps it’s eye-rollingly obvious, then, that the American Academy of Pediatrics would release a statement affirming the role of play in children’s lives. Perhaps their suggestion that doctors need to write a “prescription for play” is a good one.

But I also wonder whether, as healthcare providers, we should think less about prescribing play to parents who are already likely doing the best they can. And we should think more about how we, and the medical system, can get out of the way so that our patients can get back to play and learning.

Children have important work to do — learning and playing being two big parts of it. And one part of the tragedy of sickness — and the hospital stays, doctors' visits and long car rides that accompany it — is that children are removed from that important work of play. If play is so important, it’s crucial for our pediatric patients that we limit time in the hospital so they can spend more time “doing the work of childhood”

Sometimes the simplest solution is the most effective. In fact, I was reminded of this story of a terminally ill 2-year-old who loves Christmas. Realizing that he wasn't going to live until December 25th, his parents decided to recreate Christmas early that year. His neighbors, hearing the idea, decided to join suit. So the little boy's neighborhood became filled with lights, decorations, good cheer, gifts, and even a Christmas parade, even though it's only September. 

To me, allowing children to get back to play means different things in different situations -- sometimes a playhouse; sometimes a neighborhood teaming up for Christmas. But most of the time, in a medical setting, it means that we are doing care coordination and healthcare collaboration effectively enough that our young patients are spending less time in the doctor's office, waiting room, car-ride, and hospital. That means coordinating care so they can be released from the hospital 6 hours sooner. It means a team approach to care so that they're not bouncing from doctor's visit to doctor's visit with no resolution. It means using telemedicine to get a consult so that the child doesn't need to leave school to see yet another specialist. It means school-based health centers (linked to specialists by telemedicine) so that kids can get healthcare during the school day. 

Our view as providers must be broad enough to include an understanding of care that isn't simply about curing disease -- but about cultivating health in our patients (young and old). And that starts with getting patients back to their lives as quickly as possible. 

For stories of how medical collaboration can work in the real world, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: good medicine, care coordination, healthcare collaboration

Surprising Study Shows Doctor’s Race Crucial in Health Outcomes

Posted by Lawrence Kerr on Wed, Sep 12, 2018 @ 07:00 AM

rawpixel-744343-unsplash

Black men have the lowest life expectancy of any ethnic group in the United States. Chronic disease — like diabetes and hypertension — play a big role. But the path to reducing rates of those maladies can seem unclear.

A new study by researchers in California showed a shocking finding in one parameter that could dramatically influence outcomes — the race of the doctor. 

The study itself was pretty simple and looked at the likelihood of patients to accept preventative measures, comparing the likelihood with a white doctor and with a black doctor. The study participants were 702 black men in Oakland, California, who came to a clinic for a free health screening. They were randomly assigned to a black male doctor or one who was white or Asian.

The results were pretty stark (as elucidated by The New York Times):

— 63 percent of the black men assigned to a black doctor agreed to a diabetes screening. Just 43 percent of those assigned to a doctor who was white or Asian consented to be screened.
— Some 62 percent of black men with a black doctor agreed to cholesterol tests, compared to 36 percent assigned to a doctor who was not black.

These rates might not sound world-changing, but the consequences of them are. If black patients were to agree to preventive care at these rates in the real world, researchers estimate that the gap in cardiovascular mortality between black men and the rest of the population could be reduced by 20 percent.

So was it the race of the provider itself that made the difference? Or was it something that black doctors were doing differently, or more effectively, than the white doctors?

There’s no hard evidence to answer that question, but one telling component of the findings are the comments written by both patients and doctors in the study. Black patients had equally positive comments of doctors, regardless of their race. But of black doctors, their comments skewed more emotional and effusive. Similarly, the notes on  the white doctors tended to be shorter and dryer. Black doctors’ notes were more detailed and more holistic, including comments on elements of the patient’s experience and overall life.

One of the black doctors in the study really affirmed that ultimately, it’s not about race — it’s about good care. “It’s something they don’t teach you in medical school — taking that extra step because you appreciate there have been barriers in the past,” Dr. ChaRandle Jordan said, saying that white doctors can reach out just as well and that a lot depends on how familiar a doctor is with black patients.

From our perspective, there are several key implications of this study for our work with medical collaboration and care coordination:

— A team approach is important. Sometimes the background of the provider can make a difference, and where that's true, having a diverse team working together closely, is a key asset. 

— Good care is about more than the facts. Simply offering the appropriate preventative screening isn't enough. In this study, it appears that the black doctors' efforts to build rapport and even to push back on patients' initial reticence were a big part of their good outcomes. Having the perspective and tools to work with a more holistic sense of the patient is key.

Obviously, we believe that great care can happen among providers and patients of any race. But looking at race and differences in engagement and interaction shouldn't be taboo. We often say that "no one of us is a smart as all of us."  And this is one more example of how our colleagues down the hall may have a lot to teach us — if we are open to learning. 

For stories of medical collaboration, download our Quick Guide: 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, good medicine, care coordination

Is Medicine Today Shift Work, Team Work, or Solo Work?

Posted by Lawrence Kerr on Thu, Aug 23, 2018 @ 06:00 AM

john-price-380340-unsplashIt’s increasingly rare in everyday life to have someone take responsibility for caring for you or serving you.

If you sign up for a new account at a bank, the smiling salesman doesn’t end up being the person you interact with when you stop in to make a deposit. Most of us no longer have personal relationships with our grocers or butchers or farmers.

And the field where this change seems the most dramatic is medicine. As we’ve all experienced, the last few decades have shown a shift in medicine from everyone having a family doctor to… almost the opposite of that. Hour caps for residents, the rise of hospitalists, an emphasis on advanced practice nurses, and a change from medicine-as-a-calling to medicine-as-a-career-path have all contributed to a more fragmented, less personal relationship between patient and doctor.

So do these changes mean that medicine is now shift work?  And are the outcomes of these changes negative across the board?

As a surgeon, I always believed that the person who does the surgery is the person who checks on the patient after surgery. In my life, that sometimes meant my kids waiting in the hallway while I checked on a patient right on the way to a restaurant for Saturday night spaghetti. The generation before me might have done house calls and likely knew whole families, over generations.

A recent New York Times article looks at the shifts that have occurred recently.  These shifts have pushed medicine dramatically away from each person “having their doctor” to care being provided in a way that’s agnostic of who is giving the care and is more about who is responsible during any given hour, or for any given problem. The interaction described by the doctor and author of the article is emblematic of precisely these changes:

“Will you be my regular doctor?” a new patient seeing me in my primary care clinic asked.

“Sort of,” I honestly answered.

She looked back at me quizzically.

“Technically speaking I will be your doctor,” I explained. “But you may have trouble scheduling an appointment with me and may have to see another doctor here at our group clinic at times. And if you need to get admitted to this hospital, other doctors who work there will take care of you.”

 

Although I think that this change is positive in many ways -- and ultimately necessary -- I also worry about some of the "side effects" of the shift to shift work.

Specifically, I think that there are a few specific negative consequences of the change from medicine being a calling, with ultimate personal responsibility, to medicine being a career path, made up of people primarily doing a kind of shift work:

  • Lower satisfaction for healthcare providers. If you're handing off patients to a colleague once you complete your shift or role in care, you don't see the "welcome home party", hear about the happy return to a hobby, or see the relief in a daughter's eyes. Frequent handoffs in medicine often make it less satisfying to doctors because you don’t see the real life outcomes of your patients.
  • Less holistic care. The more we know about our patients' lives, families, circumstances, goals, and passions, the more we can make their care smart and holistic. The more fragmented care becomes, the less holistic it becomes -- the third provider in the handoff chain may have no idea about a key personal circumstance that could affect care or compliance.
  • More coordination mistakes. More handoffs mean more cracks for things to fall between. So often, signing out to a colleague is the crucial link in the chain to avoid problems -- but this step doesn't always or can't always happen.
  • Decreased trust in healthcare system. I've noticed that one reason patients trust medicine, and doctors specifically, less than they used to is that there isn't any one person to trust. 

So is good care possible within this fragmented system? I think it is -- but it involves a key shift in perspective. And I believe that the shift in perspective is this: 

We must evolve from shift work to team work. 

We can't go back to the old model of medicine as solo work. It looks like, for most of the population, we're not going back to house calls or family doctors. But even within the current medical framework, we can change from a handoff mentality, to a team mentality – we can evolve from shift work to team work. On a team, each of us is not always carrying the ball or responsible for the patient. But we're all always responsible for the outcome as a whole. That means that as medicine has changed, healthcare collaboration and care coordination has become not a "nice to have" but an absolute "must have" in order to provide adequate care to our patients. Ultimately, team work is about taking responsibility for the outcome of every single person we care for, even if we collaborate with colleagues on portions of that care.

It's not about handoffs, it's about collaboration. 

 

To try iClickCare for collaboration today, get it free here: 

Try the iClickCare 14-day evaluation

Tags: medical collaboration, care coordination, healthcare collaboration

Why Telemedicine Can Help You Make Better Medical Decisions

Posted by Lawrence Kerr on Thu, Aug 02, 2018 @ 07:00 AM

michal-parzuchowski-43274-unsplashAnnie Duke is an author, consultant, and former professional poker player. In other words, she studies good decisions for a living.

Medicine, of course, is about far more than good decisions. It’s about compassion, leadership, science, and training. But excellent decisions — in both diagnosis and treatment plans — are absolutely crucial for providing excellent care. So I was intrigued to read an article recently, in my investment journal of all places, that made me think a lot about decisions and how we can make them better as healthcare providers.

The article, "Making Better and More Rational Decisions. An interview with Annie Duke," in the American Association of Individual Investors Journal, is a compelling piece with applications for life and investment, certainly. 

But what fascinated me were the implications for healthcare providers, trying to make the best possible decisions they can. Further, I noticed that many of Annie's points boiled down to getting better information or bringing others in on your decision -- both of which are deeply supported by hybrid store-and-forward telemedicine, when it comes to medical decisions. 

3 Fascinating Decision-Making Tips for Healthcare from Decision Expert and Pro Poker Player Annie Duke:

1. Remove emotion from the decision. 
We don't think about medical decisions as having an emotional component, but the truth is that they do. It's not unusual to get caught up in all of the details of a case, feel an emotional reaction to a patient, or otherwise let emotion creep into the decision-making process. Annie Duke says that predicting downsides is core to the decision-making process. And that predicting downsides is easier when you’re not emotionally involved -- which means that our colleagues' unbiased opinion is often crucial to a good decision. It's the reason that "bouncing an idea off" someone is such a common way to approach a decision -- but we have to have the tools in place to quickly and easily bounce ideas off colleagues, even when they're not just down the hall. That's what a consult via a telemedicine solution can do for you.


2. Bring in people with different experiences and views than you have.
That will lead to a better decision. “It’s especially important to seek out opinions that disagree with you. This is because we naturally notice things that do agree with us, and we already know why we think that way.”  Hybrid store-and-forward telemedicine is the most powerful way of truly engaging a team approach to telemedicine. Since you can quickly, easily, and asynchronously collaborate with people on the medical team across the continuum of care, it's not hard to bring in people with diverse experiences, views, and expertise than you have. These providers, who may not agree with your initial ideas, can help us make dramatically better decisions on behalf of our patients. 

3. Learn from past decisions. 
Learning from past decisions is crucial. It lets you take in new information, learn lessons from cases that didn't have the outcome you anticipated, as well as help our students or colleagues make better decisions by learning from our experiences. That's why every case in iClickCare is archived and searchable -- it's a realtime learning tool for making better medical decisions, now and in the future. 

 

Ultimately, good medical outcomes come from good medical decisions. These decisions may be large or small, but their sum contributes to the patient's outcome. So any tool that can help us make better decisions, may be critical to good care. That's one reason we're so passionate about our work with iClickCare -- and a reason to try it if you haven't already. 

 

Try the iClickCare 14-day evaluation

 

Tags: care coordination, healthcare collaboration, medical education

Your Medical Team is Changing, Whether You Like It or Not

Posted by Lawrence Kerr on Tue, Jul 31, 2018 @ 07:00 AM

rawpixel-577480-unsplashOne of my favorite parts of medicine is the experience of working across the continuum of care, with providers from a variety of backgrounds. Certainly, colleagues like nurse practitioners and RNs are deeply valued but people like orderlies and administrators are also passionate parts of the healthcare system that form key parts of the team. 

In my practice, one of the most successful parts of the what we did was to demonstrate in word and action that every single person, who is part of the medical team, is deeply valued and has a unique contribution that only he/she can bring. This approach was brought into our lauded Cranio-facial Team, as well, through which providers from social workers to plastic surgeons to oral surgeons, each of whom collaborated on complex cases like cleft palate and cleft lip care. In short: much of the richness I find in medicine comes from the diversity in our medical teams. 

That said, it can feel unmooring or even alarming to notice the ways that our medical teams are changing, especially when it comes to a relative decrease in the importance of physicians and the boom in numbers of providers like nurse practitioners. 

A recent article in the New England Journal of Medicine, Growing Ranks of Advanced Practice Clinicians — Implications for the Physician Workforce, looks at the boom in advanced practice registered nurses (APRNs), relative to the almost imperceptible growth of physicians in the US.

To start, one simple fact stood out to me: “Throughout the history of modern medicine, physicians have made up the vast majority of professionals to diagnose, treat, and prescribe medication to patients.”  This, of course is changing. An increasing part of healthcare is done by advanced practice registered nurses (APRNs), including nurse practitioners and physician assistants. Even with the current numbers, 41% of physicians work with nurse practitioners.

While the number of physicians in the US is growing very slowly (projected at 0.5% per year 2016-2030), the number of APRNs is growing quickly. Training times for these providers are shorter and there are fewer institutional constraints. The article authors did a rigorous projection of expected physician growth alongside expected APRN growth, based on census data, growth rates, and other key data. The result is that comparing 2001 to 2030, the percentage of APRNs relative to the pool of providers and APRNs together will go from 13% to 35%.

As doctors, we can bemoan these changes. We are all too familiar with the depth and rigor of the training we’ve received and it’s hard to fathom how an APRN can provide care that is as good as training that is less sophisticated.

But the reality is that, as the study authors assert, "These dynamics will have lasting effects on the composition of the health care workforce and working relationships among health professionals.”  Our medical team is changing -- our choice is how we adapt our work so that our medical teams can be as effective and satisfying to us as possible. 

The authors state unequivocally that “The changing composition of the workforce will have implications for provider teams.”  They point out that primary care providers are tending to work in larger groups with varying backgrounds and types of training. But this doesn't always go smoothly. Alarmingly, a recent study of NPs and physicians working on primary care teams “found that physicians, other staff, and patients often confused the roles and skills of various providers and that these misunderstandings often led to practices undermining the productivity and efficiency of NPs.”

This is where I believe my colleagues who are innovating in the field of care coordination, medical collaboration, and hybrid store-and-forward telemedicine have some crucial insights to share. By using telemedicine-supported healthcare collaboration, we fundamentally change the orientation of medicine from a sole provider giving the best care she can to a team of providers offering the best care they can. If we are individual providers working on our own, APRNs are a threat to physicians, and vice versa. Further, their very existence muddles things, creating confusion in care plans and complicating care coordination. In many instances, this is how things are right now.

On the other hand, if we have a consistent system to use telemedicine-based healthcare collaboration to work as a team -- like iClickCare -- then APRNs and physicians can work together smoothly, each contributing his/her unique perspectives in a way that doesn't detract from the work of the other. 

And ultimately, that's a more satisfying, effective, easeful way to work, regardless of what the healthcare landscape looks like now, or in the future.

You can try iClickCare without cost or implementation challenges. Get it free here:

Try the iClickCare 14-day evaluation

Tags: nurse practitioners, care coordination, telemedicine technology, Physician Assistant, healthcare collaboration software

Hospital Consolidation May Not Improve Data Sharing or Interoperability

Posted by Lawrence Kerr on Thu, Jul 26, 2018 @ 07:00 AM

helloquence-61189-unsplashThere has been an increasing trend towards consolidation in the healthcare field. Hospital systems buy other hospital systems, with the promise of cost-savings, improved results, and better data-sharing and interoperability.

In many ways, this is common sense. If we’re all part of the same organization, or even under the same roof, it stands to reason that we will be able to share data and collaborate more effectively.

Unfortunately, though, this doesn’t appear to be the case.

Using data from the 2014 American Hospital Association (AHA) annual survey and the 2015 IT supplement that included more than 2,000 hospitals, researchers found that consolidation enough wasn’t enough to improve interoperability.

In fact, it took several additional circumstances for interoperability to improve: centralized organizational governance, a specific business model, and an integrated insurance offering. 

Of course, achieving interoperability and data sharing is a hugely complex endeavor that can take time to come to fruition. It's not a race, and there are many precautions and complications that arise.

That said, I find it fascinating that even merging with another organization doesn't necessarily make it more streamlined for healthcare providers to collaborate, for data sharing to happen, or for interoperability to be a reality. 

My take on why? I believe that true data sharing and healthcare collaboration only come about through intention and through workflow changes on the part of healthcare providers. Yes, the organizational structure affects it. Yes, EHR interoperability plays a role. Yes, being under the same roof can make collaboration simpler than being in separate buildings. But ultimately, healthcare collaboration comes down to the choices that individual healthcare providers make. It's the choice to ask a question of a colleague, regardless of how that question gets asked. 

That's why we're so passionate about hybrid store-and-forward telemedicine® (like iClickCare) as a tool for healthcare collaboration. It doesn't require being under the same roof, or in the same organization, or even using the same EMR/EHR to collaborate, share information, and coordinate. It doesn't require that everyone in your organization use it or that everyone is "on board."  It just requires a 30-second download and then as-you-have-time consults with colleagues. Everything is archived so you can find it later -- and it won't conflict with your EHR. 

The above study certainly demonstrates that we can't wait for large structural shifts to practice medicine in ways that we think are right, and useful. We have access to the tools and structures we need now -- it's just a matter of acting on that.

 

Try the iClickCare 14-day evaluation

Tags: hybrid store and forward medical collaboration, care coordination, EHR

Migrant Children Highlight a Care Coordination Problem We All Have

Posted by Lawrence Kerr on Wed, Jul 25, 2018 @ 07:00 AM

chinh-le-duc-132753-unsplashOne truth that we don't acknowledge often enough is that the healthcare system often depends on caregivers to coordinate care. True, we have other members of the care team who do care coordination also, and we have tools that help us, but in many situations, it is the patient's caregiver that is doing the bulk of the caregiving. 

Healthcare depends on caregivers remembering care history, advocating for providers to collaborate, and reminding providers of key conditions when that information gets lost in the shuffle. This becomes exponentially more true, the more chronic, complex, or multidisciplinary a patient’s situation is.

The truth, of course, is that this isn’t always possible or feasible. Some patients don’t have an advocate or caregiver that is able to play this coordinating role. We do have team members like social workers and patient advocates, but sometimes the coordination of the care itself falls between the cracks.

I realized recently that there is an extreme case in which patients don't have a solid medical history and don't have a dependable caregiver able to coordinate care on their behalf. The situation is the medical care provided to the migrant children separated at the US border. It's interesting because it highlights the dangers inherent in the medical system for someone who might not have the same social supports and networks as many patients do.

A recent article in the New York Times looked at the situation in New York City, in which providers at public hospitals are seeing children who were detained at the border and separated from their parents. Brought in by foster parents, “The children who come in with medical issues such as asthma are without adult family members who can provide medical history.”  Further, therapists are endeavoring to provide emotional care for the children, along with the fact that they’re in the midst of an ongoing traumatic experience.

It's an obviously challenging situation and both foster families and healthcare providers are scrambling to help. But the broad strokes of the care don't different significantly from anyone without family to help, or caregivers to coordinate. These situations expose the cracks and weaknesses that affect all patients.

The truth is that to truly provide excellent care to all patients, we as healthcare providers need to be able to do care coordination and healthcare collaboration without the support of caregivers and family. We must identify and develop the tools we need to make this possible -- to allow us to communicate across the medical team, access key medical history, and consult with other providers efficiently and appropriately. The stakes are simply too high not to. 

 

ClickCare Quick Guide to Medical Collaboration

Tags: medical collaboration, care coordination, healthcare collaboration

Long Term Care Staffing Woes Demand Care Coordination

Posted by Lawrence Kerr on Tue, Jul 17, 2018 @ 07:00 AM

eberhard-grossgasteiger-255502-unsplashLong Term Care is complex — and it’s no secret that providers have long been doing a lot with a little — providing the best care they possibly can, with limited resources.

The nurses, aides, and other healthcare providers are generally committed, savvy, deeply caring people who provide sophisticated care to people with chronic conditions. And, usually, they receive less support than they should from the broader medical community. Our Long Term Care colleagues report feeling more isolated than they'd like to. 

So, a new report by the New York Times felt a bit blindsiding for our colleagues in the community. 

According to the piece, “Most nursing homes had fewer nurses and caretaking staff than they had reported to the government for years, according to new federal data.” A spotlight was put on facilities that could possibly be "gaming" the Medicare system by over-reporting staffing. And a serious look was given to facilities that have provider shortages on nights and weekends  a serious potential cause of issues like falls.

These issues are serious. And the reality is that skilled nursing facilities need oversight, especially because of the population they serve. These issues certainly shouldn't be downplayed or minimized. As David Stevenson, an associate professor of health policy at Vanderbilt University School of Medicine commented, “Volatility means there are gaps in care. It’s not like the day-to-day life of nursing home residents and their needs vary substantially on a weekend and a weekday. They need to get dressed, to bathe and to eat every single day.”

That said, this New York Times article is written like an exposé. It's written as if the nursing facilities are trying to “pull one over” on Medicare and the public. And, surely — some facilities probably are being dishonest in how they run. But most are trying to do the best possible work they can in an era when there is a shortage for great providers.

For instance, the New York Times references David Camerota, Chief Operating Officer of Upstate Services Group, who said that many nursing homes are in "a constant battle to recruit and retain employees even as it has increased pay to be more competitive."

In our opinion, Long Term Care and skilled nursing facilities would improve more by being offered better tools and more support  rather than more oversight or more scrutiny. We've found that hybrid store-and-forward telemedicine can be transformative in supporting providers in connecting with collaborators outside the walls of their institution  effectively amplifying the manpower of their healthcare providers. When there is a dearth of healthcare providers, care coordination becomes essential. For someone who may be caring for more patients than they should, the ability to ask a question of a specialist or an RN, regardless of the time of day, can mean the difference between a great outcome and a sad one.

Further, in addition to the substantive impacts on patient care, a tool like iClickCare can be powerful for lessening the sense of isolation and alienation that overworked Long Term Care providers can feel. And ultimately, that sense of connection is what we all need  the providers and the patients, alike.

 

ClickCare Quick Guide to Medical Collaboration

 

 

Tags: long term care, care coordination, healthcare collaboration, skilled nursing facility

Can Telemedicine Yield Results of High Intensity Without the High Cost?

Posted by Lawrence Kerr on Thu, Jun 14, 2018 @ 06:00 AM

hush-naidoo-535092-unsplashIt's a simple but troublesome truth that, as The New York Times puts it, “How much you spend on medical care depends on what you get, but also where you get it.”

And in an age when the whole medical community is pushed to increase efficiency, this reality is challenging to providers and to hospital systems. How are we to cut costs and provide high-value and high-efficiency care when costs vary not only by the care provided, but by where it’s provided, and who pays for it?

Costs of the same operation or care can vary dramatically in different places. This is due to different prices (and costs), of course, but it also has to do with the "intensity" of care. 

If you deliver a baby in a teaching hospital, it costs $2,000 more (on average) than delivering at a community hospital. Part of that is because of the difference in prices, but part of it is because the "intensity" of care (number of providers, specialization of providers, services provided) is greater at the teaching hospital. 

As the healthcare system struggles to provide care that is high-value for patients and efficient for providers and hospital systems, it's hard to know whether and when high-intensity care is worthwhile and when it's just, well, expensive.

So a recent study of Medicare hospitalizations -- led by Laura Burke and Ashish Jha at Harvard -- is interesting. It analyzed about 11 million Medicare hospitalizations and found that almost all patients had lower mortality rates at teaching hospitals.

But, as the New York Time synthesizes, "Among patients admitted for operations like hip replacements, the patients with the most health problems over all were the ones likeliest to benefit from a teaching hospital. On the other hand, among people admitted with conditions like pneumonia or heart failure, though all groups did better at the teaching hospitals, the difference was greatest for the relatively healthy patients."  So, interestingly, the high intensity care lead to better outcomes overall, but there are situations in which the difference is not significant. 

This led us to wonder whether there are ways that community hospitals or individual providers could provide the advantages of teaching hospitals, but at a lower cost, and in their care setting. As the study shows, "The more advanced technologies available at teaching hospitals explained some, but not all, of the difference. Other factors like subspecialty expertise, more clinicians involved in care, and greater availability of ancillary services may also be playing a role.”

The importance of subspecialty expertise and the inclusion of more providers in care points to the potential of healthcare collaboration, especially where supported by a tool or technology like iClickCare. If a community hospital can loop in sub-specialists that are not based at that hospital (but on their schedule, asynchronously)... and if the tool supports team collaboration in a meaningful way... it raises the question whether telemedicine-based healthcare collaboration could provide the benefits of the intense care at teaching hospitals, but at a much lower cost. 

Of course, this will need to be studied on a large scale for conclusive results -- but anecdotal results from our colleagues indicate this does work. You can get the benefits of high-intensity care, but from a community hospital, at a lower cost.

 

Looking for a low-cost way to implement a telemedicine program? Download our Quick Guide to explore hybrid store-and-forward telemedicine:

ClickCare Quick Guide to Hybrid Store-and-Forward

 

Tags: care coordination, healthcare collaboration software, cost effectiveness

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