ClickCare Café

Medical Collaboration Tips From a Typhoon-Ravaged Hospital

Posted by Lawrence Kerr on Fri, Mar 07, 2014 @ 08:59 AM

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Collaboration in Response to Disaster


It's hard to imagine the devastation of a large-scale disaster like that of Typhoon Yolanda in November of last year.

As the New England Journal of Medicine reports, an Israeli medical team that arrived in the days following the storm found a pretty desperate situation. Throughout the Philippines, more than 5,000 people were confirmed dead and 22,000 were still reported missing. Upon reporting to the hospital, where the Israeli team was to work, they found 120 hospitalized patients, no electricity, no running water, and an Operating Room with a staff of 2.

The World Health Organization guidelines suggest that a team like this one should set up their own hospital, not integrating or collaborating with teams on the ground. But the Israeli team had a strong sense that an unintegrated path wouldn't be the best course of action. Within hours, they worked with the Philippine hospital and local resources to create an integrated plan for medical collaboration.

And within 10 days, this collaborative, transnational team of medical providers deftly dealt with 2,686 cases.

What allowed them this kind of success in such difficult conditions?

This brave team gives medical collaboration takeaways anyone can learn from:

  • Accepting resource limitations. We all have limited resources, and sometimes these limitations can seem insurmountable. For this team, however, giving up was not an option, so they accepted their resources and did whatever they could within them. 
  • Being willing to go against protocol. Despite the WHO guidelines, this team decided to collaborate and integrate. It was a risk, but it seemed like the right thing to do for the patients, so they went with it. Their success was their reward.
  • Open communication and quick decisions. One of the most important pieces of this story is the way that decisions were made quickly, but with transparency, and good communication. Sometimes people think that communication has to be sacrificed for speed. But this high-pressure situation shows that good communication actually facilitated a speedy response.
  • Clear lines of responsibility. We've covered the ways that clear lines of responsibility decrease length of stay and drop readmissions. Similarly, having very clear roles and responsibilities helped this team quickly triage and treat, without duplication or gaps in care.

As the team said, reflecting on the experience: "Following a cooperative model may pose some challenges… In this instance, however, by relinquishing our well-established habit of operating as a highly independent unit, we found that, when feasible, a cooperative model can have additional and important benefits for the victims of a disaster."


For more medical collaboration stories and strategies, get our Quick Guide to Medical Collaboration:

ClickCare Quick Guide to Medical Collaboration



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Tags: medical collaboration, medical responsibilities, care coordination, decrease readmissions, decrease length of stay, emergency first responders

7 Ways Telemedicine Helps Compliance with Accountable Care

Posted by Lawrence Kerr on Wed, Feb 26, 2014 @ 08:52 AM

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Barely a day has gone by recently, that the Affordable Care Act (ACA), Accountable Care Organizations (ACO), or the Centers for Medicare & Medicaid Services (CMS) have not been in the news.

In the broadest strokes, the Accountable Care movement attempts to shift the health payment system from a pay-for-service (fee based) system, to a pay-for-performance (outcomes based) system. Of course, for hospitals that want to accept Medicare and Medicaid, these reforms are mandated. But the overall approach affects almost all practices, regardless of status or whether you are an ACO.

Part of the reason that these policies aren't going anywhere is that early data shows they're working. In 2012, ACOs established in the Medicare's Shared Savings Program generated nearly $400 million in savings, the Centers for Medicare & Medicaid Services said in a statement released last week. 

Despite the laws, it's not always clear how to use telemedicine to improve outcomes in a pay-for-performance system. Interestingly, telemedicine and telehealth has been identified as a key tool in compliance with Accountable Care. It is even written into CMS' final rule for the Medicare Shared Savings Program: accountable care organizations must "define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.

So here are 7 ways telemedicine can help you comply with Accountable Care: 

  1. Telemedicine makes care coordination possible and effective. Just changing incentives is not enough to improve outcomes. As the New England Journal of Medicine reports, "Merely aligning financial incentives will not improve quality and reduce costs for episodes of care... True coordination of care is required to ensure the best possible outcomes." Telemedicine makes this kind of care coordination possible and effective, particularly in a hybrid store-and-forward context that adapts to provider parameters.
  2. Telemedicine makes transportation less necessary. Whether home monitoring or distance consults, telemedicine can save costs of unnecessary visits and lengthy transportation. When payment is linked to outcomes, even saving a patient or provider a single trip can make a big difference over an organization.
  3. Telemedicine leverages provider time. In an age of provider shortages, telemedicine can make each provider's minutes count as much as possible. Through consults, collaboration, and even remote patient visits, provider time is leveraged. 
  4. Telemedicine can decrease readmissions. Because telemedicine can help the right at-home care to happen, clarify which provider is responsible, and make sure patients follow through, telemedicine has been shown to have a strong effect on decreasing readmissions.
  5. Telemedicine can drop length of stay. Data shows that care coordination, especially the kind of collaboration supported by telemedicine, is one of the strongest ways to drop length of stay. And length of stay is a key outcome in Accountable Care.
  6. Telemedicine improves access to care. Telemedicine can improve access for the underserved in rural, urban, or Veteran populations. Especially as provider shortages worsen in different parts of the country, and for different specialities, this kind of access to care is proving crucial in keeping costs down and meeting patient needs.
  7. Telemedicine supports good patient care, regardless of political climate and payment changes. Truth be told, many of our colleagues have been using telemedicine to improve the ways they care for patients -- regardless of whether it's rewarded by the current political context. We think that's good practice, in every election cycle.


Click here for our free guide on the pros, cons, and ROI of telemedicine options:


ClickCare Quick Guide to Telemedicine



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Tags: coordinated care, collaboration, accountable care, telemedicine roi, communication with patients, telemedicine solutions, decrease readmissions, decrease length of stay, ACO, affordable care act

4 Easy Ways to Try Telemedicine Before Lunchtime

Posted by Lawrence Kerr on Fri, Feb 07, 2014 @ 09:15 AM

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We've been hearing from a lot of people that they want to give telemedicine a try. Many providers have been noticing the overall thriving of the field. Others are drawn in by data showing collaboration (especially using telemedicine) can decrease length of stay, cut readmissions, and improve rates of healthcare provider burnout. 

But despite the interest in medical collaboration with telemedicine, many people aren't sure where to start. We're the first to admit that it can feel overwhelming to pick up a new tool or adopt a new habit!

So here are 4 easy ways you can try telemedicine before the day is over:

  • Start with someone you know and trust. Think of the last colleague -- it might be a nurse, doctor, or other provider -- that you had a great conversation with or who solved a problem with you. That's the person with whom to try telemedicine and collaboration. Start with people you already know and trust, and grow your collaborative circle from there. 
  • Keep it simple. Even chatting with a colleague about their day can open the door to problem-solving, so that is a great place to start. And when you are ready to collaborate using telemedicine, start with a simple case. You can always build up to consults on your most complex case, but getting a consult or two on more basic issues lets you build up confidence. That way, when you do reach out about a tricky patient, you're not worried about the telemedicine piece of it.
  • Organize a “cool case” breakfast or lunch. We used to take medical students out to egg sandwiches before work to discuss unusual cases and share stories. While this isn't technically telemedicine, it is definitely collaboration -- and that is the important part. 
  • Try iClickCare for free. You can start inviting colleagues, sharing cases, and connecting for a couple of weeks with no cost and no complicated set-up.

Plus, we put together a couple of "quick guides" to telemedicine and medical collaboration, and we're offering them for free -- so take your pick and get started.


ClickCare Quick Guide to Telemedicine

ClickCare Quick Guide to Medical Collaboration



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Tags: collaboration, hybrid store and forward medical collaboration, medical collaboration software, healthcare provider burnout, telemedicine solutions, collaboration leadership, care coordination, healthcare collaboration, decrease readmissions, decrease length of stay

Can Telemedicine Lower the Cost of Healthcare?

Posted by Lawrence Kerr on Thu, Jan 23, 2014 @ 08:14 AM

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Telemedicine is thriving these days -- there is even an ad on prime-time featuring it -- and a key reason are the ways telemedicine lowers the cost of healthcare. One indicator of this is the political support: "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio). And there is certainly anecdotal evidence from around the country, like this tele-dermatology program in Nantucket saving nearly $29,000 a year.

In fact, we've found that the people and organizations that use iClickCare experience such significant and immediate cost savings that we've even incorporated an ROI calculator on our website. Dr Michael Moore, director of a wound care program, reported that "During a 3 month period, 70 patients were treated solely using iClickCare with an overall healing rate of 93% and an estimated savings of $24,000 in transportation costs alone."

Of course, despite its clear potential and proof points, telemedicine doesn't always cut costs. It's important to look at projects like this one for lessons from the front lines about what really works, and what doesn't.

So if you're considering a telemedicine program in your hospital, practice, or region... 

5 things to keep in mind to ensure telemedicine lowers the cost of healthcare:

  1. As we shared in this post, you are not setting yourself up for success if you make huge investments in hardware. We recommend investing in software (which can be updated, and is generally the lowest portion of costs) rather than hardware which gets obsolete quickly. Use the equipment you already have, the spaces already available to you, and just start. 
  2. Give special attention to readmissions and length of stay. Readmissions within a month of discharge cost $16 billion per year. And as we all know, readmissions and length of stay are big parts of the ACA shared outcomes focus. So we're interested in data showing that medical collaboration may be one of the strongest ways to decrease length of stay... and in this Connected Cardiac Care program, which has achieved a 51% decrease in readmissions with telehealth monitoring.
  3. Prioritize rural areas or very urban areas. Geographically removed areas (whether rural or inner-city) find the most cost-cutting benefits from telemedicine. "By decreasing the importance of location for healthcare provision, telemedicine can help increase competition and further lower healthcare spending for primary care and specialist consultations... using technology to allow health care workers to quickly serve those where there is the greatest demand will create a more efficient health care system overall," says Ben Miller of the WFS.
  4. Use your people effectively. Because of the provider shortage, the leveling of access helps cut costs and use our provider workforce most efficiently. As Dr. Brian Rosenfeld, Chief Medical Officer at Philips Healthcare, said, "Telehealth offers the opportunity to provide the access, quality and cost that will be necessary to increase prevention and leverage our current workforce."
  5. Work in coordination with the Affordable Care Act. Telemedicine may prove to be the linchpin in controlling costs and outcomes as the Affordable Care Act comes into being more broadly, according to Mario Gutierrez, executive director for the Center for Connected Health Policy.

Overall, we've seen over and over again the cost savings that can be experienced through telemedicine. But we do suggest keeping it simple, start small, and start today.

For an overview of choices in telemedicine, download the Quick Guide to Telemedicine

ClickCare Quick Guide to Telemedicine



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Tags: telemedicine, accountable care, telemedicine roi, telemedicine solutions, decrease readmissions, decrease length of stay, affordable care act

5 Medical Collaboration Tips from Military Vets

Posted by Lawrence Kerr on Wed, Sep 25, 2013 @ 08:40 AM

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A few months ago, a young veteran was struggling to get the therapy he needed. He drove 45 minutes each way, fighting traffic. By the time he arrived, he was frustrated, upset, and not in the best frame of mind for a productive session.

Unfortunately, this vet was not alone. However, these struggles in vets' access to the healthcare they needed prompted the VA Hospitals to use telemedicine to solve it -- at least for vets with mental health needs. Now this vet participates in the VA's tele-mental health program, meaning that he does his therapy from home, feeling relaxed, prepared, and ready to heal.

This piece on the VA's program is a rare bright spot in news on the VA. The much-embattled department has been struggling to keep up with claims and services. So the fact that they've been able to integrate telemedicine is even more impressive.

Clearly, there is an opportunity for a more comprehensive and thoughtful usage of telemedicine (particularly Hybrid Store-and-Forward Telemedicine) throughout the VA. But we think that the fact that military vets are accessing the service and the VA is administering it demonstrates a number of key medical collaboration and telemedicine insights:

  1. Start small. The VA created a pilot program first, them expanded to multiple hospitals. They're still only using telemedicine in mental health so they're still "starting small" but the impacts remain important.
  2. Consider the reputational effect. The fact that this article was written is strong proof that even incremental innovations can have a strong and positive effect on organizations' reputations and goodwill in the community.
  3. See it as an investment, not an expense. The VA says the telehealth program has reduced veterans’ bed days by 58 percent and admissions by 38 percent. It's very possible that they're already seeing a net profit from the program. 

Want the "cliff notes" to telemedicine options? Click here for our Quick Guide: 

ClickCare Quick Guide to Telemedicine

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

Is Your Compensation Structure Causing Provider Burnout?

Posted by Lawrence Kerr on Tue, Sep 03, 2013 @ 08:10 AM

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New compensation structures start with the best of intentions: keep costs down and patients healthy. But healthcare providers can become a casualty on the road to lower costs.

So, is your pay system causing provider burnout? The short answer is: probably.

Exhibit 1: Pay for volume.
Volume-related incentives were the compensation fad of the last decade. However, since provider burnout is exacerbated by feeling disconnected to patients and not having enough time to spend with them, this short-sighted policy contributes to many frustrated providers. As Dr. Robert Centor said at the Medscape Roundtable, "Too often the current finances of medicine force physicians to spend inadequate time with patients… I would argue that our payment system, especially for outpatient internists and family physicians, is a leading cause of burnout." 

Exhibit 2: Pay for performance.
A recent New York Times article shows how the Affordable Care Act is prompting hospitals to link provider pay with performance (measured by patient outcomes, cost containment, and patient satisfaction.) It sounds like a plan that makes sense, but physicians tend to resent this time of micro-level intervention in how they care for patients. And some point out that they're held responsible for things they can't influence (like whether a hospital floor is clean.) In fact, experts say that this plan of "carrots for doctors" is unlikely to work, even outside of physician considerations. 

What works?
There is no doubt that healthcare has to be more accountable and costs need to come down. But when it comes to designing a compensation plan that works, healthcare provider needs have to be front and center. The big problem with igorning provider needs and stressing them out? Well, it doesn't work. Patient satisfaction starts with happy healthcare providers. And research shows that doctors with lower incomes, more debt, and less savings tend to be more burned out than their peers. So if your compensation structure is burning out your providers, it's very possible that you're gouging patient outcomes and even elevating costs at the same time.


Compensation is a headache, but coding doesn't have to be. Get our free guide to ICD-10:  

ICD-10 Primer

Tags: accountable care, healthcare provider burnout, provider burnout, decrease readmissions, decrease length of stay, affordable care act

3 Length of Stay Mistakes You Don't Know You're Making

Posted by Lawrence Kerr on Sun, Aug 18, 2013 @ 08:46 AM

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 Decreasing length of stay has become a focus for providers and administrators, in no small part because Medicare's payment system focuses on it.  It's certainly about more than following the regulation du jour, however. A decreased length of stay remains crucial in cutting costs, freeing up providers, and getting folks home to recover.

That said, we've noticed that in the rush to decrease length of stay, some hospitals and providers are getting in their own way. Good intentions are even leading to longer lengths of stay in some cases. Plus, healthcare provider burnout can be exacerbated when providers don't have the tools to shift the metrics they're responsible for. And burned-out providers can't help anyone in the ways they want to. So, to help keep you working happily, simply, and well…

3 length-of-stay mistakes to avoid (that you may not even know you're making):

  1. Focusing on length of stay. As important as decreasing length of stay can be, the truth is that dropping length of stay is not nearly as important as avoiding readmissions. And there may even be a tradeoff -- a decrease in length of stay is often linked to an uptick in readmissions. So keep the whole picture in mind when discharging a patient, and never let a single metric (or administrators' initiative) rule the day.
  2. Doing it all yourself. Care coordination and efficient medical collaboration may be one of the strongest ways to decrease length of stay. It turns out that the lack of coordination and planning among collaborators on a case can be one of the strongest influences on how long the patient stays in the hospital. 
  3. Treating all patients equally. The Mayo Clinic dropped their length of stay by 20% with a simple initiative: treat different people differently. In other words, rather than a doctor treating all of their patients the same (either being very conservative about discharge or discharging liberally), what works best is for patients with certain risk indicators to go through a more intensive discharge process, while the others can pretty much go straight home.  That means that whether it is a hospital-wide policy or not, providers may benefit from using different discharge protocols, depending on the patient.  

Using iClickCare to coordinate care and encourage efficient medical collaboration may be one of the most effective ways to decrease length of stay. Give it a try for free by clicking on the button below and let us know how it worked: 

Try the iClickCare 14-day evaluation

Tags: medical collaboration, healthcare provider burnout, provider burnout, care coordination, decrease length of stay

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