Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] Value-Based Care’s Data Problem

From the 22 May 2015 post at The Healthcare Blog

I believe the concept of value-based care is good for healthcare. VBC encourages providers to make changes that put the patient at the center of care, so that different services can be provided across providers in a collaborative way. If all went according to the VBC vision, there would be fewer redundant tests, more emphasis on preventative care, and an effort to keep high-risk patients out of the emergency room. It’s also better for costs, something we desperately need in the US, where healthcare spending per capita is more than twice the OECD average.

But Lisa’s story, at the leading edge of the value-based experiment, is not good at all. ACOs and most other value-based models are new, constantly changing, and unproven. ACOs report on 33 metrics that are supposed to represent the quality of care provided by their networks of providers. While still extremely limited in scope, any more than 33 metrics would have made Lisa’s job impossible. So far, few ACOs have reported any savings. Worse — the metrics are unproven. What if they overemphasize standardized process over patient outcomes? And what if efficiency measures result in neglectful and impersonal care? A lot is riding on Lisa’s testing ground.

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The administrative challenge

By engaging with and learning from people like Lisa, I have begun to understand the problems frontier administrators face — the same problems countless others will face if we don’t address the administrative burden early on. Here are a few of the top headaches being rolled out in the name of value:

Selecting metrics

For ACOs, 33 metrics are tracked today. Inevitably, these will expand and change as accountable care evolves. There are also countless other systems of metrics encouraged by other incentive programs: the Physician Quality Reporting System measures, Meaningful Use metrics, Agency for Healthcare Research and Quality Indicators, the Consumer Assessment of Healthcare Providers and Systems for patient experience metrics, indicators for each specialty (Stroke and Stroke Rehabilitation Physician Performance Measurement Set, Endoscopy and Polyp Surveillance Physician Performance Measurement Set, and the Heart Failure Performance Measurement Set, to name a few). The document outlining protocols for the Physician Quality Reporting System is 18 pages long, with a mouthful of a title to match: “The 2015 Physician Quality Reporting System (PQRS) Measure-Applicability Validation (MAV) Process for Claims-Based Reporting of Individual Measures.” Got that? A new piece of legislation that passed the House of Representatives last week — the “doc fix” bill — is about to revamp many of these requirements once again.

Collecting data

Lisa had to fumble through different electronic systems and paper charts to extract the relevant data for each patient in her panel at dozens of different clinics. In many cases, it was clear that care had been provided (e.g. an unstable patient had been upgraded from a cane to a walker), but the documentation wasn’t there (to fulfill the “Screening for Future Fall Risk” metric, documentation must state whether the patient had no falls, one fall without major injury, two or more falls, or any fall with major injury.) Therefore, even though care was provided to prevent future falls, the documentation did not meet the CMS requirement and no credit was given.

For the next reporting year, Lisa is designing her own reporting mechanisms for clinics and doctors. She says that her first reporting experience “was invaluable in learning ways to improve the reporting for year 2015 and beyond,” and she is putting processes in place to facilitate reporting next year. But each clinic is different: some need a page at the front of their paper chart with check boxes, and some have templates in their electronic health records. Her new processes may improve the situation, but additional tracking could also cut into time doctors spend with patients and add to the squeeze they already feel.

Integrating data

Lisa integrated all the data from each clinic manually, and this is a problem for small institutions who are trying to communicate and coordinate with each other. Right now it takes a long time and is not very scalable. Even at larger institutions with leading electronic health record systems, the data is locked away within proprietary databases, often in incompatible formats. Clinical data is rarely integrated with financial and patient-reported data in the way required to tie outcomes and claims to reimbursements in a value-based model.

Reporting

After all of her data collection, Lisa still had to submit her data to a third part to produce reports, and she will wait many months for the results. The CMS websites are comically complex ; the instruction manual for using the CMS metric reporting interface is 127 pages long.


Putting patients at the center

If these problems aren’t addressed, we’re in for a long and painful healthcare reform. Administrative costs will continue to rise, along with another generation of frustrated physicians and admins. Moreover, value-based care could be deemed a failure not because it’s a bad idea but because of poor implementation. Instead of putting patients at the center of care, it could breed more bureaucracy and force doctors to spend more time reporting on metrics and less time with patients.

We can address these issues and we must — to give value-based care a chance at moving the US toward more patient-centered, less exorbitant healthcare.

 

May 23, 2015 Posted by | health care | , , , , , , , , , | Leave a comment

[Reblog] The disturbing confessions of a medical scribe

From the 9 March 2014 KevinMD article

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As a medical scribe working with a large, well-known scribe company, unnamed to protect my job, it makes me proud reading all the articles published about how much having a scribe benefits a physician, especially in the emergency department. I enjoy my job immensely and I am grateful for the opportunity to learn and engage in patient care. However, as a pre-medical student working next to several other doctor-hopefuls in a high stress environment, being a scribe frustrates me on an ethical level.

 

 

 

Let’s examine the structure and reasoning that has made medical scribe programs so successful. When EMR systems were first introduced, there was resistance, but it gave way to the push for efficiency. The biggest benefit of EMRs is easy: risk management. By allowing for documentation of every little part of a patient’s care, EMRs significantly decrease the risk of mistakes slipping through the cracks. It allows for better defense of the physician’s medical decisions, even months down the line.

 

For example, a physician I worked with was asked to go to court for a patient who had been assaulted by her boyfriend. The patient had been seen several months ago in the ED. Few physicians would be able to remember all the details of an encounter so long ago. His testimony was therefore entirely based on the medical chart, written by me and approved by him. The EMR allowed for comprehensive, detailed documentation of test results, discussions with the patient, and interactions with the police.

 

Unfortunately, such comprehensive medical records take time and effort to write. Physicians complain that they were becoming little more than data entry specialists, dedicating large portions of the time they should be spending with patients to clicking buttons. In comes the scribe. Usually students or recent graduates interested in becoming a medical provider, we become the physician’s right hand. Scribes are purported to decrease physician burnout considerably and increase ED efficiency. Better documentation also leads to better billing, so hospitals make more money. The physicians I work with, in a hospital who has been using scribes for over 3 years now, have all been grateful for the program.

 

Sounds great, right? The winning combination of EMRs and scribes. The road to increased efficiency, increased Press-Ganey scores, increased billing accuracy, increased fraud, increased profits for the administration. Happiness abounds.

 

How many of you missed the “increased fraud”?

 

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Read the entire article here

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March 13, 2014 Posted by | health care | , , , | Leave a comment

[Reblog] Are you a victim of patient profiling?

Very controversial, this posting has 113 comments as of Feb 4, 2014.
Two (or more! ) sides to this.
On a personal level, my medical record very boldly on the first page states two conditions
— Anxiety/Depression (have not needed medication for these conditions in 5 years)
— High Cholesterol ( have disputed the doctor on this, based on how I have read the scientific literature)

So, yes…I feel profiled!

Yet, the doctor is doing the best he can. He can only see patients for 15 minutes. His electronic records are
basically, well, dictated by the group he is in.

On another note, just as I am not defined by my job or resume…
I am also not defined by my medical record!

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From the 4 February 2014 Kevin MD article by Pamela Wible, MD

Ever felt misjudged by a doctor? Or treated unfairly by a clinic or hospital? You may be a victim of patient profiling.

Patient profiling is the practice of regarding particular patients as more likely to have certain behaviors or illnesses based on their appearance, race, gender, financial status, or other observable characteristics. Profiling disproportionately impacts patients with chronic pain, mental illness, the uninsured, and patients of color. Like racial profiling by police, patient profiling by physicians is more common than you think.

 

We rely on doctors to first do no harm–to safeguard our health–but profiling patients often leads to improper medical care, and distrust of physicians and the health care system, with potential lifelong consequences.

For the first time, people share their stories:

I was once denied pain meds after a fall off a 10-foot porch by the same doc who gave my pretty female friend pain meds after getting two stitches in her finger. I felt like my appearance had something to do with it.” ~ Jay Snider

 

Read the entire article (with 113+ comments) here

 

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February 4, 2014 Posted by | health care | , , , , , | Leave a comment

5 Trends For Health CIOs In 2014 – InformationWeek

5 Trends For Health CIOs In 2014 – InformationWeek.

From the 23 December 2013 article at Information Week Health Care

Patient portals, direct messaging, and medical identity theft will keep healthcare execs on their toes in the new year.

Hackers Outsmart Pacemakers, Fitbits: Worried Yet?

Hackers Outsmart Pacemakers, Fitbits: Worried Yet?

(click image for larger view)

As healthcare CIOs are well aware, 2014 promises to be the year of “the perfect storm.” The potential impact of ICD-10 and Meaningful Use Stage 2, coupled with the transition to value-based reimbursement and new-care-delivery models, promise to overwhelm their budgets and burn out their already overworked staffs.

Nevertheless, there are some other trends healthcare CIOs should pay attention to in 2014, partly because of their bearing on the main events. Here are five significant trends.

1. Patient portals
Because of rising consumer interest in health IT, the industry transition to accountable care, and most of all, Meaningful Use Stage 2, patient portals are hot. Nearly 50% of hospitals and 40% of ambulatory practices already provide patient portals, according to a Frost & Sullivan report. The firm predicted that the value of the portal business would soar to nearly $900 million in 2017, up 221% from its worth in 2012.

[ What Obamacare sites can learn from online retail stores: Health Insurance Exchanges Struggle To Charm Customers. ]

KLAS Research, in a poll of 200 healthcare organizations, found that MU Stage 2 had made patient portals a “must-have” technology for doctors and hospitals. The government EHR incentive program requires providers to allow patients to access their health records electronically. In addition, providers must send care reminders and education materials to at least 10% of their patients. All of these tasks are most easily done through portals attached to EHRs. But there’s also some interest in untethered, standalone portals that can help patients assemble their records from multiple providers in one place.

 

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Read the entire article here

 

January 2, 2014 Posted by | health care | , , , , , , | Leave a comment

Troubled Teens Could Benefit from Online Access to Health Records, Say Researchers

 

From the 22 October 2012 article at ScienceDaily

 

 Online health records could be surprisingly useful for at-risk teenagers who cycle through the juvenile justice system. A new study from the Stanford University School of Medicine and the Santa Clara Valley Medical Center found that these young people have high rates of Internet use and an unexpectedly favorable attitude toward accessing their health records online.

Teens who get in trouble with the law could particularly benefit from online health records because they generally have worse health than other adolescents — and no one keeping track of the health care they do receive. These teens’ health problems range from spotty immunization histories to chronic diseases such as asthma, sexually transmitted infections, mental illnesses and substance abuse. And not only do poverty, difficult relationships with their parents and frequent moves make it hard for them to get consistent health care, these problems also increase the chances that doctors who are treating them will not have access to their medical histories..

The teens were enthusiastic about the option, with 90 percent saying it would be useful to have their health information automatically put online so they could access it later.

“I didn’t expect this level of interest because they don’t typically think of health as something that’s part of their daily lives,” Anoshiravani said, adding that these teens engage in risky behaviors that make them seem cavalier about their health.

These teens’ need for reliable and accessible health records is made even more urgent because they often do not have family members overseeing health-related chores, such as tracking immunizations and medications, checking lab results or recording their medical history. The lack of records is a problem not just in the short term but also when these teens reach adulthood, especially for those who survived serious medical events in childhood. “They may turn 18 and not know they were born with a heart defect that was surgically repaired,” Anoshiravani said.

Contrast that situation to a typical teenager. “A parent or grandparent is going with them to the doctor and keeping their health records,” Anoshiravani said, noting that troubled teens don’t have that help. And it’s not realistic to expect these teens to keep a hard copy of their medical file. “Carrying around pieces of paper that they could lose did not make sense to them, but having a place to check this information online did make a lot of sense,” he added.

The researchers were surprised to find that the teenagers would also share online health records: The vast majority of the respondents were willing to share their records with doctors and half said they would want to share the information with their parents.

The next step, Anoshiravani said, is to implement and test online health records for at-risk teens. The biggest challenge will revolve around the issue of information-sharing, since minors’ parents are entitled to see some parts of their health records, while other types of records cannot be shared with parents without the patients’ consent….

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October 22, 2012 Posted by | Consumer Health | , , , , , , , | Leave a comment

Patience Patients – Are e-Patients Waiting for e-Docs?

Patience Patients – Are e-Patients Waiting for e-Docs? 

From the 25 January posting at Eye on FDA

Patients are changing.  They are accessing medical information differently, they are storing it differently and they are consuming it more voraciously.  This access to medical information and tools means that many patients are more medically conversant and knowledgeable than the patient of just five years ago.  Medical literacy is likely on the rise.

It also changes the way physician and patient communicate.  Five years ago, I never would have considered the need for email between my physician and myself, thinking it impractical.  Today, I think a physician needs to have some portal of access for the exchange of data and information.  Here are my readings – blood pressure, blood sugar, whatever… – for the week.  The medical record will reflect information not just gathered at an exam in the office, but that gathered by my apps when I am not in the office.  And when I’m diagnosed with a new condition, I fully expect either the physician or someone in his or her office to not only prescribe some medication, but to pull out an i-Pad to steer me to some good resources, including apps.  If the condition is one where there are few treatment options and I’m expected to consider a clinical trial, the i-Pad should have a clinical trials app that lets us look at what’s available together….

  • eHealth: patients are changing, but not (yet) the Physicians (scienceintelligence.wordpress.com)
  • From Pinterest and Septris to the Patient of the Future (Science Blog)
    “Are ePatients self diagnosing too much ? Too many people are not going to see their doctors on a regular basis and they need to be educated on why that is a bad idea.  No printed or interactive forum can replace a trained medical professional. The Patient of the Future Like many “self-quanters,” Smarr wears a Fitbit to count his every step, a Zeo to track his sleep patterns, and a Polar WearLink that lets him regulate his maximum heart rate during exercise. Stanford University’s Septris app …”

February 29, 2012 Posted by | health care, Uncategorized | , , , , , , , , | Leave a comment

   

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