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Hospitalists Should Prepare for the Patient-Centered Medical Home
In 2009, five of the primary-care health centers in Wisconsin-based Dean Health System began to transform into an increasingly popular—but, to many, still somewhat fuzzy—feature of the new healthcare landscape: the “patient-centered medical home.”
The goals are noble: Orient and guide the patient through the healthcare system. Don’t repeat tests already performed. Keep costs down. Prevent illnesses that are, in fact, preventable. And reward doctors for doing so rather than encouraging visit after visit and test after test.
The hospitalists in the Dean system were brought late into the patient-centered medical home, or PCMH, project, but are now more involved:
- They participate in discussions about impending hospitalizations for patients to determine whether hospitalization is really needed;
- They make every effort to assign the same doctor to a patient each time the patient is hospitalized; and
- They also are part of admissions and discharges that are smoother due to efforts to keep information flowing and keep patients in formed.
There have been hiccups, though. Dean hasn’t tracked readmission rates, so it isn’t known whether they’ve improved. And satisfaction ratings from patients haven’t improved—in part, says Kevin Eichhorn, MD, chief of the hospitalist division at Dean, because patients don’t fully appreciate the changes that have been made, although there is an effort to tell them.
—Ken Simone, DO, SFHM, principal, Hospitalist and Practice Solutions
“But we’ve also only been doing this routinely for about a year,” Dr. Eichhorn says. “My hope is that, as we get better at it, we will see some improvement in terms of patient satisfaction with their hospitalization and improvement in other quality metrics as well.”
If hospitalists already working in a PCMH model are struggling with the changes, imagine the question marks for hospitalists who aren’t familiar with the concept yet (see “The Patient-Centered Medical Home: A Primer,” below). Joseph Ming Wah Li, MD, SFHM, immediate past president of SHM, says most hospitalists are not.
“I think it’s fair to say that most hospitalists lack awareness and insight into what the patient-centered medical home will mean for patients and for hospitalists,” he says.
But it’s a concept HM as a whole should bone up on quickly. As attention to reducing healthcare costs intensifies and the PCMH model becomes more commonplace, hospitalists’ roles within such practices will increase.
Some say hospitalists will be hired by primary-care practices that previously did not employ hospitalists. They might provide extra help during transitions by following patients as they are discharged to skilled rehab units or nursing homes. They also might provide preoperative histories for elective surgeries.
“I believe the hospitalist will be right at the center of the model, along with the PCPs [primary-care physicians],” says Ken Simone, DO, SFHM, a national hospitalist practice management consultant and principal at Maine-based Hospitalist and Practice Solutions. “In my opinion, the PCMH model will expand the hospitalist’s role outside the four walls of the hospital.”
Time to Prepare
Dr. Simone and others say that now is the time for hospitalists to begin exploring the PCMH model and its implications in their locales. HM groups should:
Familiarize themselves with the PCMH concept.
Although the model continues to evolve, the main components can be found in a 2007 joint statement by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association.1 They include the principles of a personal physician with whom the patient has an ongoing relationship; coordinated care across all elements of the healthcare system; better quality and safety; enhanced access to doctors and their teams; and a payment system that factors in the role of physicians and nonphysicians alike, as well as the role of technology and rewards for good outcomes.
“In a patient-centered medical home, there is a strong emphasis on coordination of care and communication between all members of a patient’s healthcare team,” says Jeffrey Cain, MD, president-elect of the American Academy of Family Physicians (AAFP). “Patients receive the highest-quality, patient-centered care when the primary-care physician takes the lead in coordinating care. This means keeping patients, specialists, hospitalists, and other health providers informed of all test results, treatment plans, expectations, progress, and outcomes.”
Find out about the PCMH activity in their own communities.
Dr. Cain said that the degree of PCMH adoption depends on where you work.
“It is spotty throughout the United States,” he notes. “There are areas of tremendous growth and areas that are waiting to have that happen.”
Dr. Simone, a Team Hospitalist member, says the degree to which hospitalists are familiar with PCMH depends on the level of adoption in the area.
“I have found greater hospitalist awareness in communities that have integrated healthcare delivery systems,” he says. “This makes sense, because these are the communities that are aggressively pursing the patient-centered home.”
Forge relationships with primary-care providers.
Dr. Simone encourages hospitalist groups to make marketing visits to local PCP offices. During these visits, hospitalists should discuss the services they provide, their staffing model, admission and communication protocols—and, “most importantly, ask what the hospitalist practice can do to meet the needs of both the patient and the referring providers.”
Dr. Li says it’s always been important to have open lines of communication with your PCPs—but now more than ever.
“If you don’t have this already, you’re already behind in the ballgame,” he says. “But it’s never too late. It’s critically important to have those communication systems in place so that patients get the best care possible.”
Talk to hospital administrators about clinical and financial links with PCMH practices.
The time to do this, Dr. Simone says, is when a local PCMH is being created, or at contract renewal time, if a PCMH is already exists.
“Hospitalists will obviously need to have a voice within the organization and some autonomy for them to commit to such an integrated relationship,” Dr. Simone says.
Prepare for the demands of sicker patients.
If better primary care means fewer hospitalizations, the patients who are admitted will be sicker, posing more challenges to hospitalists.
“Make sure each individual provider has the skill set and schedule that allows them to take care of these patients,” Dr. Li says.
Embrace the possibilities this model offers.
In the PCMH model, the coordination between the hospitalist and the PCP can only help a hospitalist at the time of discharge.
“It will be easier to get their patients into a primary-care office,” says Dr. Cain of AAFP.
David Meyers, MD, director of the Center for Primary Care, Prevention and Clinical Partnerships at the federal Agency for Healthcare Research and Quality (AHRQ), which provides tools and information that support primary care’s redesign and the PCMH, says the model essentially adds a member to the hospitalist’s team.
“If done well, it gives the hospitalist a partner in the community with whom to establish joint accountability,” Dr. Meyers explains. “In addition to establishing accountability, the PCMH helps ensure information flows both into and out of the hospital.”
A Growth Spurt
As of March 1, the nonprofit National Committee on Quality Assurance had recognized 3,979 practices across the country as “patient-centered medical homes.” And that doesn’t include practices that function according to PCMH principles but are not officially recognized.
The Mayo Clinic recently began a three-year pilot PCMH project in Wisconsin, in conjunction with Group Health Cooperative of Eau Claire.
Crucially, insurance companies are coming on board. In January, Indianapolis-based benefits company WellPoint announced a new payment system designed to promote better primary care, with increases to regular fees, payments for “non-visit” services, and shared savings payments based on quality outcomes and reduced medical costs.
Blue Cross and Blue Shield has reported success with PCMH models.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is testing a PCMH model to see whether it generates higher quality of care and cost savings. So is the Department of Veterans Affairs.
—David Meyers, MD, director, Center for Primary Care, Prevention and Clinical Partnerships, Agency for Healthcare Research and Quality, Washington, D.C.
Primary-care doctors, hospitalists and government officials say the concept is likely here to stay. “We’re in a period of change,” Dr. Meyers says. “I don’t know where we’re going to be in five years from now, but forces are aligning such that this may really work.”
And hospitalists are vital to the success of any PCMH.
“The patient-centered medical home,” he says, “to be effective on what it can do, has to be integrated into a patient-centered medical neighborhood—the partnership between primary care or ambulatory care and inpatient care, and specifically the hospitalists and those folks working in nursing homes and skilled nursing facilities.”
Gordon Chen, MD, a cardiologist and senior vice president of medical affairs at Chen Medical in Miami, where a number of PCMH concepts have been in place for 10 years, says that he works both with hospitalists employed by Chen Medical and some not employed by Chen Medical. And he notices the difference.
“It can be a little bit more difficult to reach and to coordinate and collaborate with other physicians, but we can do it,” he says.
A tighter connection allows information to flow better between the PCPs and the hospitalists, he points out.
“One of the most frustrating things as a physician is to find out that your patient had a prolonged hospitalization and they come to see you in the clinic and you don’t have any information,” Dr. Chen says. “You look at this new medication list and you’re trying to put the pieces together. When a doctor doesn’t have all the information, and is guessing … it leads to poor decisions being made.”
Back at Dean Health System in Wisconsin, Dr. Eichhorn is confident that the concepts behind the patient-centered medical home can only be good for patients. Still, the project there—as at many other places—is a work in progress.
“Emphasizing wellness and preventative health certainly conveys significant benefits,” he says. “The challenge is defining what is a patient-centered medical home. It sounds like every group is struggling what that means and how to define it and then how to track your outcomes. And then does the patient have a sense of that? Are they appreciating something different in what’s happening to their healthcare?”
Thomas R. Collins is a freelance writer in South Florida.
Reference
In 2009, five of the primary-care health centers in Wisconsin-based Dean Health System began to transform into an increasingly popular—but, to many, still somewhat fuzzy—feature of the new healthcare landscape: the “patient-centered medical home.”
The goals are noble: Orient and guide the patient through the healthcare system. Don’t repeat tests already performed. Keep costs down. Prevent illnesses that are, in fact, preventable. And reward doctors for doing so rather than encouraging visit after visit and test after test.
The hospitalists in the Dean system were brought late into the patient-centered medical home, or PCMH, project, but are now more involved:
- They participate in discussions about impending hospitalizations for patients to determine whether hospitalization is really needed;
- They make every effort to assign the same doctor to a patient each time the patient is hospitalized; and
- They also are part of admissions and discharges that are smoother due to efforts to keep information flowing and keep patients in formed.
There have been hiccups, though. Dean hasn’t tracked readmission rates, so it isn’t known whether they’ve improved. And satisfaction ratings from patients haven’t improved—in part, says Kevin Eichhorn, MD, chief of the hospitalist division at Dean, because patients don’t fully appreciate the changes that have been made, although there is an effort to tell them.
—Ken Simone, DO, SFHM, principal, Hospitalist and Practice Solutions
“But we’ve also only been doing this routinely for about a year,” Dr. Eichhorn says. “My hope is that, as we get better at it, we will see some improvement in terms of patient satisfaction with their hospitalization and improvement in other quality metrics as well.”
If hospitalists already working in a PCMH model are struggling with the changes, imagine the question marks for hospitalists who aren’t familiar with the concept yet (see “The Patient-Centered Medical Home: A Primer,” below). Joseph Ming Wah Li, MD, SFHM, immediate past president of SHM, says most hospitalists are not.
“I think it’s fair to say that most hospitalists lack awareness and insight into what the patient-centered medical home will mean for patients and for hospitalists,” he says.
But it’s a concept HM as a whole should bone up on quickly. As attention to reducing healthcare costs intensifies and the PCMH model becomes more commonplace, hospitalists’ roles within such practices will increase.
Some say hospitalists will be hired by primary-care practices that previously did not employ hospitalists. They might provide extra help during transitions by following patients as they are discharged to skilled rehab units or nursing homes. They also might provide preoperative histories for elective surgeries.
“I believe the hospitalist will be right at the center of the model, along with the PCPs [primary-care physicians],” says Ken Simone, DO, SFHM, a national hospitalist practice management consultant and principal at Maine-based Hospitalist and Practice Solutions. “In my opinion, the PCMH model will expand the hospitalist’s role outside the four walls of the hospital.”
Time to Prepare
Dr. Simone and others say that now is the time for hospitalists to begin exploring the PCMH model and its implications in their locales. HM groups should:
Familiarize themselves with the PCMH concept.
Although the model continues to evolve, the main components can be found in a 2007 joint statement by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association.1 They include the principles of a personal physician with whom the patient has an ongoing relationship; coordinated care across all elements of the healthcare system; better quality and safety; enhanced access to doctors and their teams; and a payment system that factors in the role of physicians and nonphysicians alike, as well as the role of technology and rewards for good outcomes.
“In a patient-centered medical home, there is a strong emphasis on coordination of care and communication between all members of a patient’s healthcare team,” says Jeffrey Cain, MD, president-elect of the American Academy of Family Physicians (AAFP). “Patients receive the highest-quality, patient-centered care when the primary-care physician takes the lead in coordinating care. This means keeping patients, specialists, hospitalists, and other health providers informed of all test results, treatment plans, expectations, progress, and outcomes.”
Find out about the PCMH activity in their own communities.
Dr. Cain said that the degree of PCMH adoption depends on where you work.
“It is spotty throughout the United States,” he notes. “There are areas of tremendous growth and areas that are waiting to have that happen.”
Dr. Simone, a Team Hospitalist member, says the degree to which hospitalists are familiar with PCMH depends on the level of adoption in the area.
“I have found greater hospitalist awareness in communities that have integrated healthcare delivery systems,” he says. “This makes sense, because these are the communities that are aggressively pursing the patient-centered home.”
Forge relationships with primary-care providers.
Dr. Simone encourages hospitalist groups to make marketing visits to local PCP offices. During these visits, hospitalists should discuss the services they provide, their staffing model, admission and communication protocols—and, “most importantly, ask what the hospitalist practice can do to meet the needs of both the patient and the referring providers.”
Dr. Li says it’s always been important to have open lines of communication with your PCPs—but now more than ever.
“If you don’t have this already, you’re already behind in the ballgame,” he says. “But it’s never too late. It’s critically important to have those communication systems in place so that patients get the best care possible.”
Talk to hospital administrators about clinical and financial links with PCMH practices.
The time to do this, Dr. Simone says, is when a local PCMH is being created, or at contract renewal time, if a PCMH is already exists.
“Hospitalists will obviously need to have a voice within the organization and some autonomy for them to commit to such an integrated relationship,” Dr. Simone says.
Prepare for the demands of sicker patients.
If better primary care means fewer hospitalizations, the patients who are admitted will be sicker, posing more challenges to hospitalists.
“Make sure each individual provider has the skill set and schedule that allows them to take care of these patients,” Dr. Li says.
Embrace the possibilities this model offers.
In the PCMH model, the coordination between the hospitalist and the PCP can only help a hospitalist at the time of discharge.
“It will be easier to get their patients into a primary-care office,” says Dr. Cain of AAFP.
David Meyers, MD, director of the Center for Primary Care, Prevention and Clinical Partnerships at the federal Agency for Healthcare Research and Quality (AHRQ), which provides tools and information that support primary care’s redesign and the PCMH, says the model essentially adds a member to the hospitalist’s team.
“If done well, it gives the hospitalist a partner in the community with whom to establish joint accountability,” Dr. Meyers explains. “In addition to establishing accountability, the PCMH helps ensure information flows both into and out of the hospital.”
A Growth Spurt
As of March 1, the nonprofit National Committee on Quality Assurance had recognized 3,979 practices across the country as “patient-centered medical homes.” And that doesn’t include practices that function according to PCMH principles but are not officially recognized.
The Mayo Clinic recently began a three-year pilot PCMH project in Wisconsin, in conjunction with Group Health Cooperative of Eau Claire.
Crucially, insurance companies are coming on board. In January, Indianapolis-based benefits company WellPoint announced a new payment system designed to promote better primary care, with increases to regular fees, payments for “non-visit” services, and shared savings payments based on quality outcomes and reduced medical costs.
Blue Cross and Blue Shield has reported success with PCMH models.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is testing a PCMH model to see whether it generates higher quality of care and cost savings. So is the Department of Veterans Affairs.
—David Meyers, MD, director, Center for Primary Care, Prevention and Clinical Partnerships, Agency for Healthcare Research and Quality, Washington, D.C.
Primary-care doctors, hospitalists and government officials say the concept is likely here to stay. “We’re in a period of change,” Dr. Meyers says. “I don’t know where we’re going to be in five years from now, but forces are aligning such that this may really work.”
And hospitalists are vital to the success of any PCMH.
“The patient-centered medical home,” he says, “to be effective on what it can do, has to be integrated into a patient-centered medical neighborhood—the partnership between primary care or ambulatory care and inpatient care, and specifically the hospitalists and those folks working in nursing homes and skilled nursing facilities.”
Gordon Chen, MD, a cardiologist and senior vice president of medical affairs at Chen Medical in Miami, where a number of PCMH concepts have been in place for 10 years, says that he works both with hospitalists employed by Chen Medical and some not employed by Chen Medical. And he notices the difference.
“It can be a little bit more difficult to reach and to coordinate and collaborate with other physicians, but we can do it,” he says.
A tighter connection allows information to flow better between the PCPs and the hospitalists, he points out.
“One of the most frustrating things as a physician is to find out that your patient had a prolonged hospitalization and they come to see you in the clinic and you don’t have any information,” Dr. Chen says. “You look at this new medication list and you’re trying to put the pieces together. When a doctor doesn’t have all the information, and is guessing … it leads to poor decisions being made.”
Back at Dean Health System in Wisconsin, Dr. Eichhorn is confident that the concepts behind the patient-centered medical home can only be good for patients. Still, the project there—as at many other places—is a work in progress.
“Emphasizing wellness and preventative health certainly conveys significant benefits,” he says. “The challenge is defining what is a patient-centered medical home. It sounds like every group is struggling what that means and how to define it and then how to track your outcomes. And then does the patient have a sense of that? Are they appreciating something different in what’s happening to their healthcare?”
Thomas R. Collins is a freelance writer in South Florida.
Reference
In 2009, five of the primary-care health centers in Wisconsin-based Dean Health System began to transform into an increasingly popular—but, to many, still somewhat fuzzy—feature of the new healthcare landscape: the “patient-centered medical home.”
The goals are noble: Orient and guide the patient through the healthcare system. Don’t repeat tests already performed. Keep costs down. Prevent illnesses that are, in fact, preventable. And reward doctors for doing so rather than encouraging visit after visit and test after test.
The hospitalists in the Dean system were brought late into the patient-centered medical home, or PCMH, project, but are now more involved:
- They participate in discussions about impending hospitalizations for patients to determine whether hospitalization is really needed;
- They make every effort to assign the same doctor to a patient each time the patient is hospitalized; and
- They also are part of admissions and discharges that are smoother due to efforts to keep information flowing and keep patients in formed.
There have been hiccups, though. Dean hasn’t tracked readmission rates, so it isn’t known whether they’ve improved. And satisfaction ratings from patients haven’t improved—in part, says Kevin Eichhorn, MD, chief of the hospitalist division at Dean, because patients don’t fully appreciate the changes that have been made, although there is an effort to tell them.
—Ken Simone, DO, SFHM, principal, Hospitalist and Practice Solutions
“But we’ve also only been doing this routinely for about a year,” Dr. Eichhorn says. “My hope is that, as we get better at it, we will see some improvement in terms of patient satisfaction with their hospitalization and improvement in other quality metrics as well.”
If hospitalists already working in a PCMH model are struggling with the changes, imagine the question marks for hospitalists who aren’t familiar with the concept yet (see “The Patient-Centered Medical Home: A Primer,” below). Joseph Ming Wah Li, MD, SFHM, immediate past president of SHM, says most hospitalists are not.
“I think it’s fair to say that most hospitalists lack awareness and insight into what the patient-centered medical home will mean for patients and for hospitalists,” he says.
But it’s a concept HM as a whole should bone up on quickly. As attention to reducing healthcare costs intensifies and the PCMH model becomes more commonplace, hospitalists’ roles within such practices will increase.
Some say hospitalists will be hired by primary-care practices that previously did not employ hospitalists. They might provide extra help during transitions by following patients as they are discharged to skilled rehab units or nursing homes. They also might provide preoperative histories for elective surgeries.
“I believe the hospitalist will be right at the center of the model, along with the PCPs [primary-care physicians],” says Ken Simone, DO, SFHM, a national hospitalist practice management consultant and principal at Maine-based Hospitalist and Practice Solutions. “In my opinion, the PCMH model will expand the hospitalist’s role outside the four walls of the hospital.”
Time to Prepare
Dr. Simone and others say that now is the time for hospitalists to begin exploring the PCMH model and its implications in their locales. HM groups should:
Familiarize themselves with the PCMH concept.
Although the model continues to evolve, the main components can be found in a 2007 joint statement by the American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, and American Osteopathic Association.1 They include the principles of a personal physician with whom the patient has an ongoing relationship; coordinated care across all elements of the healthcare system; better quality and safety; enhanced access to doctors and their teams; and a payment system that factors in the role of physicians and nonphysicians alike, as well as the role of technology and rewards for good outcomes.
“In a patient-centered medical home, there is a strong emphasis on coordination of care and communication between all members of a patient’s healthcare team,” says Jeffrey Cain, MD, president-elect of the American Academy of Family Physicians (AAFP). “Patients receive the highest-quality, patient-centered care when the primary-care physician takes the lead in coordinating care. This means keeping patients, specialists, hospitalists, and other health providers informed of all test results, treatment plans, expectations, progress, and outcomes.”
Find out about the PCMH activity in their own communities.
Dr. Cain said that the degree of PCMH adoption depends on where you work.
“It is spotty throughout the United States,” he notes. “There are areas of tremendous growth and areas that are waiting to have that happen.”
Dr. Simone, a Team Hospitalist member, says the degree to which hospitalists are familiar with PCMH depends on the level of adoption in the area.
“I have found greater hospitalist awareness in communities that have integrated healthcare delivery systems,” he says. “This makes sense, because these are the communities that are aggressively pursing the patient-centered home.”
Forge relationships with primary-care providers.
Dr. Simone encourages hospitalist groups to make marketing visits to local PCP offices. During these visits, hospitalists should discuss the services they provide, their staffing model, admission and communication protocols—and, “most importantly, ask what the hospitalist practice can do to meet the needs of both the patient and the referring providers.”
Dr. Li says it’s always been important to have open lines of communication with your PCPs—but now more than ever.
“If you don’t have this already, you’re already behind in the ballgame,” he says. “But it’s never too late. It’s critically important to have those communication systems in place so that patients get the best care possible.”
Talk to hospital administrators about clinical and financial links with PCMH practices.
The time to do this, Dr. Simone says, is when a local PCMH is being created, or at contract renewal time, if a PCMH is already exists.
“Hospitalists will obviously need to have a voice within the organization and some autonomy for them to commit to such an integrated relationship,” Dr. Simone says.
Prepare for the demands of sicker patients.
If better primary care means fewer hospitalizations, the patients who are admitted will be sicker, posing more challenges to hospitalists.
“Make sure each individual provider has the skill set and schedule that allows them to take care of these patients,” Dr. Li says.
Embrace the possibilities this model offers.
In the PCMH model, the coordination between the hospitalist and the PCP can only help a hospitalist at the time of discharge.
“It will be easier to get their patients into a primary-care office,” says Dr. Cain of AAFP.
David Meyers, MD, director of the Center for Primary Care, Prevention and Clinical Partnerships at the federal Agency for Healthcare Research and Quality (AHRQ), which provides tools and information that support primary care’s redesign and the PCMH, says the model essentially adds a member to the hospitalist’s team.
“If done well, it gives the hospitalist a partner in the community with whom to establish joint accountability,” Dr. Meyers explains. “In addition to establishing accountability, the PCMH helps ensure information flows both into and out of the hospital.”
A Growth Spurt
As of March 1, the nonprofit National Committee on Quality Assurance had recognized 3,979 practices across the country as “patient-centered medical homes.” And that doesn’t include practices that function according to PCMH principles but are not officially recognized.
The Mayo Clinic recently began a three-year pilot PCMH project in Wisconsin, in conjunction with Group Health Cooperative of Eau Claire.
Crucially, insurance companies are coming on board. In January, Indianapolis-based benefits company WellPoint announced a new payment system designed to promote better primary care, with increases to regular fees, payments for “non-visit” services, and shared savings payments based on quality outcomes and reduced medical costs.
Blue Cross and Blue Shield has reported success with PCMH models.
Meanwhile, the Centers for Medicare & Medicaid Services (CMS) is testing a PCMH model to see whether it generates higher quality of care and cost savings. So is the Department of Veterans Affairs.
—David Meyers, MD, director, Center for Primary Care, Prevention and Clinical Partnerships, Agency for Healthcare Research and Quality, Washington, D.C.
Primary-care doctors, hospitalists and government officials say the concept is likely here to stay. “We’re in a period of change,” Dr. Meyers says. “I don’t know where we’re going to be in five years from now, but forces are aligning such that this may really work.”
And hospitalists are vital to the success of any PCMH.
“The patient-centered medical home,” he says, “to be effective on what it can do, has to be integrated into a patient-centered medical neighborhood—the partnership between primary care or ambulatory care and inpatient care, and specifically the hospitalists and those folks working in nursing homes and skilled nursing facilities.”
Gordon Chen, MD, a cardiologist and senior vice president of medical affairs at Chen Medical in Miami, where a number of PCMH concepts have been in place for 10 years, says that he works both with hospitalists employed by Chen Medical and some not employed by Chen Medical. And he notices the difference.
“It can be a little bit more difficult to reach and to coordinate and collaborate with other physicians, but we can do it,” he says.
A tighter connection allows information to flow better between the PCPs and the hospitalists, he points out.
“One of the most frustrating things as a physician is to find out that your patient had a prolonged hospitalization and they come to see you in the clinic and you don’t have any information,” Dr. Chen says. “You look at this new medication list and you’re trying to put the pieces together. When a doctor doesn’t have all the information, and is guessing … it leads to poor decisions being made.”
Back at Dean Health System in Wisconsin, Dr. Eichhorn is confident that the concepts behind the patient-centered medical home can only be good for patients. Still, the project there—as at many other places—is a work in progress.
“Emphasizing wellness and preventative health certainly conveys significant benefits,” he says. “The challenge is defining what is a patient-centered medical home. It sounds like every group is struggling what that means and how to define it and then how to track your outcomes. And then does the patient have a sense of that? Are they appreciating something different in what’s happening to their healthcare?”
Thomas R. Collins is a freelance writer in South Florida.
Reference
Guidelines Urge Transfer of Subarachnoid Hemorrhage Patients
The new “Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage,” published online May 3 in Stroke, call for hospitals treating fewer than 10 aneurysmal subarachnoid hemorrhage (aSAH) cases per year to consider their immediate transfer to facilities that handle at least 35 such cases annually.1 The recommendation is based on research suggesting that 30-day death rates were significantly higher in low-volume facilities (39%) vs. facilities treating more than 35 cases per year (27%), reflecting the latter’s greater access to cerebrovascular surgeons, endovascular specialists, and neuro-intensive-care services.
This type of hemorrhage accounts for 5% of all strokes and affects more than 30,000 Americans annually.
Reference
The new “Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage,” published online May 3 in Stroke, call for hospitals treating fewer than 10 aneurysmal subarachnoid hemorrhage (aSAH) cases per year to consider their immediate transfer to facilities that handle at least 35 such cases annually.1 The recommendation is based on research suggesting that 30-day death rates were significantly higher in low-volume facilities (39%) vs. facilities treating more than 35 cases per year (27%), reflecting the latter’s greater access to cerebrovascular surgeons, endovascular specialists, and neuro-intensive-care services.
This type of hemorrhage accounts for 5% of all strokes and affects more than 30,000 Americans annually.
Reference
The new “Guidelines for the Management of Aneurysmal Subarachnoid Hemorrhage,” published online May 3 in Stroke, call for hospitals treating fewer than 10 aneurysmal subarachnoid hemorrhage (aSAH) cases per year to consider their immediate transfer to facilities that handle at least 35 such cases annually.1 The recommendation is based on research suggesting that 30-day death rates were significantly higher in low-volume facilities (39%) vs. facilities treating more than 35 cases per year (27%), reflecting the latter’s greater access to cerebrovascular surgeons, endovascular specialists, and neuro-intensive-care services.
This type of hemorrhage accounts for 5% of all strokes and affects more than 30,000 Americans annually.
Reference
Win Whitcomb: Staying ... and Paying
Take a minute to recall your last credit-card statement. On it, say, is the hotel charge from your last out-of-town CME excursion. Below the total charge you were expecting is a separate line-item charge of $75 for a “recreational fee.” Puzzled, you call the hotel. They inform you that because you used the gym and pool—accessed with your room key—they levied the fee. No signs, alerts, or postings to denote such a policy, you innocently expected inclusive use of the facilities in the price of your visit.
Capture the emotion of that moment. It is likely your heart will race and you will think to yourself, “Get me the manager!”
Out of vigilance for penalties and fraud from recovery audit contractor (RAC) investigations, as well attentiveness to unnecessary readmissions, hospitals increasingly are categorizing Medicare patients under observation, rather than inpatient, status. This is to avoid conflict with regulators. Beneficiaries are in the crosshairs because of this designation change and, much in the same way as with our hotel charge, they also experience sticker shock when they get their bills. It is leading to confusion among providers, and consternation within the Medicare recipient community.
Why is this occurring? The dilemma stems from Medicare payments and the key distinction between inpatient coverage (Part A) and outpatient coverage (Parts B and D). When a patient receives their discharge notification—without an “official” inpatient designation—sometimes staying greater than 24 to 48 hours in the ED or in a specially defined observation unit can mean that beneficiary charges are different. This could result in discrete and sometimes jolting copayments and deductibles for drugs and services.
Worse, if beneficiaries require a skilled nursing facility stay (the “three-day stay” inpatient requirement), Medicare will not pay because they never registered “official” hospital time. Patients and caregivers are not prepared for the unexpected bills, and, consequently, tempers are rising.
The rules for Medicare Advantage enrollees, who make up 25% of the program, differ from conventional Medicare. However, commercial plans often shadow traditional fee-for-service in their policies, and, consequently, no exemplar of success in this realm exits.
Hospitals have increased both the number of their observation stays, as well as their hourly lengths (>48 hours). Because the definition of “observation status” is vague, and even the one- to two-day window is inflating, hospitals and hospitalists are often left to navigate without a compass. Again, fear of fraud and penalties places hospitals—and, indirectly, hospitalists, who often make judgments on admission grade—in a precarious position.
The responsibility of hospitals to notify beneficiaries of their status hinges on this murky determination milieu, which might change in real time during the stay and makes for an unsatisfactory standard. Understandably, CMS is attempting to rectify this quandary, taking into account a hospital’s need to clarify its billing and designation practices as well as beneficiaries’ desire to obtain clear guidance on their responsibilities both during and after a stay.
Hospitalists, of course, want direction on coding and an understanding of the impact their decisions will have on patients and subspecialty colleagues. To that end, Patrick Conway, MD, SFHM, chief medical officer for the Centers for Medicare & Medicaid (CMS), offers some enlightenment on this matter:
Q: Is it tenable to keep the current system in place? However, as a fix, require payors and providers to inform beneficiaries of inpatient versus observation status at time zero in a more rigorous, yet-to-be determined manner?
A: Current regulations only require CMS to inform beneficiaries when they are admitted as an inpatient and not when they are an outpatient receiving observation services. There are important implications for coverage for beneficiaries post-hospital stay, coverage of self-administered drugs, and beneficiary coinsurance from this distinction. As a hospitalist, I think it is best to inform the patient of their status, especially if it has the potential to impact beneficiary liability, including coverage of post-acute care. CMS prepared a pamphlet in 2009, “Are You a Hospital Inpatient or Outpatient? If You Have Medicare, Ask!” to educate beneficiaries on this issue. The pamphlet can found at http://www.medicare.gov/Publications/Pubs/pdf/11435.pdf.
Q: Due to the nature of how hospital care is changing, are admission decisions potentially becoming too conflicted an endeavor for inpatient caregivers?
A: We want admission decisions to be based on clinical considerations. The decision to admit a patient should be based on the clinical judgment of the primary care, emergency medicine, and/or hospital medicine clinician.
Q: Before the U.S. healthcare system matures to a more integrated model with internalized risk, can you envision any near-term code changes that might simplify the difficulties all parties are facing, in a budget-neutral fashion?
A: CMS is currently investigating options to clarify when it is appropriate to admit the patient as an inpatient versus keeping the patient as an outpatient receiving observation services. We understand that this issue is of concern to hospitals, hospitalists, and patients, and we are considering carefully how to simplify the rules in a way that best meets the needs of patients and providers without increasing costs to the system.
I expect we will hear more from Medicare in the near-term on this matter. Stay tuned.
For more about the patient’s perspective on this issue, please see Brad’s blog: www.hospitalmedicine.org/pmblog.
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at [email protected].
Take a minute to recall your last credit-card statement. On it, say, is the hotel charge from your last out-of-town CME excursion. Below the total charge you were expecting is a separate line-item charge of $75 for a “recreational fee.” Puzzled, you call the hotel. They inform you that because you used the gym and pool—accessed with your room key—they levied the fee. No signs, alerts, or postings to denote such a policy, you innocently expected inclusive use of the facilities in the price of your visit.
Capture the emotion of that moment. It is likely your heart will race and you will think to yourself, “Get me the manager!”
Out of vigilance for penalties and fraud from recovery audit contractor (RAC) investigations, as well attentiveness to unnecessary readmissions, hospitals increasingly are categorizing Medicare patients under observation, rather than inpatient, status. This is to avoid conflict with regulators. Beneficiaries are in the crosshairs because of this designation change and, much in the same way as with our hotel charge, they also experience sticker shock when they get their bills. It is leading to confusion among providers, and consternation within the Medicare recipient community.
Why is this occurring? The dilemma stems from Medicare payments and the key distinction between inpatient coverage (Part A) and outpatient coverage (Parts B and D). When a patient receives their discharge notification—without an “official” inpatient designation—sometimes staying greater than 24 to 48 hours in the ED or in a specially defined observation unit can mean that beneficiary charges are different. This could result in discrete and sometimes jolting copayments and deductibles for drugs and services.
Worse, if beneficiaries require a skilled nursing facility stay (the “three-day stay” inpatient requirement), Medicare will not pay because they never registered “official” hospital time. Patients and caregivers are not prepared for the unexpected bills, and, consequently, tempers are rising.
The rules for Medicare Advantage enrollees, who make up 25% of the program, differ from conventional Medicare. However, commercial plans often shadow traditional fee-for-service in their policies, and, consequently, no exemplar of success in this realm exits.
Hospitals have increased both the number of their observation stays, as well as their hourly lengths (>48 hours). Because the definition of “observation status” is vague, and even the one- to two-day window is inflating, hospitals and hospitalists are often left to navigate without a compass. Again, fear of fraud and penalties places hospitals—and, indirectly, hospitalists, who often make judgments on admission grade—in a precarious position.
The responsibility of hospitals to notify beneficiaries of their status hinges on this murky determination milieu, which might change in real time during the stay and makes for an unsatisfactory standard. Understandably, CMS is attempting to rectify this quandary, taking into account a hospital’s need to clarify its billing and designation practices as well as beneficiaries’ desire to obtain clear guidance on their responsibilities both during and after a stay.
Hospitalists, of course, want direction on coding and an understanding of the impact their decisions will have on patients and subspecialty colleagues. To that end, Patrick Conway, MD, SFHM, chief medical officer for the Centers for Medicare & Medicaid (CMS), offers some enlightenment on this matter:
Q: Is it tenable to keep the current system in place? However, as a fix, require payors and providers to inform beneficiaries of inpatient versus observation status at time zero in a more rigorous, yet-to-be determined manner?
A: Current regulations only require CMS to inform beneficiaries when they are admitted as an inpatient and not when they are an outpatient receiving observation services. There are important implications for coverage for beneficiaries post-hospital stay, coverage of self-administered drugs, and beneficiary coinsurance from this distinction. As a hospitalist, I think it is best to inform the patient of their status, especially if it has the potential to impact beneficiary liability, including coverage of post-acute care. CMS prepared a pamphlet in 2009, “Are You a Hospital Inpatient or Outpatient? If You Have Medicare, Ask!” to educate beneficiaries on this issue. The pamphlet can found at http://www.medicare.gov/Publications/Pubs/pdf/11435.pdf.
Q: Due to the nature of how hospital care is changing, are admission decisions potentially becoming too conflicted an endeavor for inpatient caregivers?
A: We want admission decisions to be based on clinical considerations. The decision to admit a patient should be based on the clinical judgment of the primary care, emergency medicine, and/or hospital medicine clinician.
Q: Before the U.S. healthcare system matures to a more integrated model with internalized risk, can you envision any near-term code changes that might simplify the difficulties all parties are facing, in a budget-neutral fashion?
A: CMS is currently investigating options to clarify when it is appropriate to admit the patient as an inpatient versus keeping the patient as an outpatient receiving observation services. We understand that this issue is of concern to hospitals, hospitalists, and patients, and we are considering carefully how to simplify the rules in a way that best meets the needs of patients and providers without increasing costs to the system.
I expect we will hear more from Medicare in the near-term on this matter. Stay tuned.
For more about the patient’s perspective on this issue, please see Brad’s blog: www.hospitalmedicine.org/pmblog.
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at [email protected].
Take a minute to recall your last credit-card statement. On it, say, is the hotel charge from your last out-of-town CME excursion. Below the total charge you were expecting is a separate line-item charge of $75 for a “recreational fee.” Puzzled, you call the hotel. They inform you that because you used the gym and pool—accessed with your room key—they levied the fee. No signs, alerts, or postings to denote such a policy, you innocently expected inclusive use of the facilities in the price of your visit.
Capture the emotion of that moment. It is likely your heart will race and you will think to yourself, “Get me the manager!”
Out of vigilance for penalties and fraud from recovery audit contractor (RAC) investigations, as well attentiveness to unnecessary readmissions, hospitals increasingly are categorizing Medicare patients under observation, rather than inpatient, status. This is to avoid conflict with regulators. Beneficiaries are in the crosshairs because of this designation change and, much in the same way as with our hotel charge, they also experience sticker shock when they get their bills. It is leading to confusion among providers, and consternation within the Medicare recipient community.
Why is this occurring? The dilemma stems from Medicare payments and the key distinction between inpatient coverage (Part A) and outpatient coverage (Parts B and D). When a patient receives their discharge notification—without an “official” inpatient designation—sometimes staying greater than 24 to 48 hours in the ED or in a specially defined observation unit can mean that beneficiary charges are different. This could result in discrete and sometimes jolting copayments and deductibles for drugs and services.
Worse, if beneficiaries require a skilled nursing facility stay (the “three-day stay” inpatient requirement), Medicare will not pay because they never registered “official” hospital time. Patients and caregivers are not prepared for the unexpected bills, and, consequently, tempers are rising.
The rules for Medicare Advantage enrollees, who make up 25% of the program, differ from conventional Medicare. However, commercial plans often shadow traditional fee-for-service in their policies, and, consequently, no exemplar of success in this realm exits.
Hospitals have increased both the number of their observation stays, as well as their hourly lengths (>48 hours). Because the definition of “observation status” is vague, and even the one- to two-day window is inflating, hospitals and hospitalists are often left to navigate without a compass. Again, fear of fraud and penalties places hospitals—and, indirectly, hospitalists, who often make judgments on admission grade—in a precarious position.
The responsibility of hospitals to notify beneficiaries of their status hinges on this murky determination milieu, which might change in real time during the stay and makes for an unsatisfactory standard. Understandably, CMS is attempting to rectify this quandary, taking into account a hospital’s need to clarify its billing and designation practices as well as beneficiaries’ desire to obtain clear guidance on their responsibilities both during and after a stay.
Hospitalists, of course, want direction on coding and an understanding of the impact their decisions will have on patients and subspecialty colleagues. To that end, Patrick Conway, MD, SFHM, chief medical officer for the Centers for Medicare & Medicaid (CMS), offers some enlightenment on this matter:
Q: Is it tenable to keep the current system in place? However, as a fix, require payors and providers to inform beneficiaries of inpatient versus observation status at time zero in a more rigorous, yet-to-be determined manner?
A: Current regulations only require CMS to inform beneficiaries when they are admitted as an inpatient and not when they are an outpatient receiving observation services. There are important implications for coverage for beneficiaries post-hospital stay, coverage of self-administered drugs, and beneficiary coinsurance from this distinction. As a hospitalist, I think it is best to inform the patient of their status, especially if it has the potential to impact beneficiary liability, including coverage of post-acute care. CMS prepared a pamphlet in 2009, “Are You a Hospital Inpatient or Outpatient? If You Have Medicare, Ask!” to educate beneficiaries on this issue. The pamphlet can found at http://www.medicare.gov/Publications/Pubs/pdf/11435.pdf.
Q: Due to the nature of how hospital care is changing, are admission decisions potentially becoming too conflicted an endeavor for inpatient caregivers?
A: We want admission decisions to be based on clinical considerations. The decision to admit a patient should be based on the clinical judgment of the primary care, emergency medicine, and/or hospital medicine clinician.
Q: Before the U.S. healthcare system matures to a more integrated model with internalized risk, can you envision any near-term code changes that might simplify the difficulties all parties are facing, in a budget-neutral fashion?
A: CMS is currently investigating options to clarify when it is appropriate to admit the patient as an inpatient versus keeping the patient as an outpatient receiving observation services. We understand that this issue is of concern to hospitals, hospitalists, and patients, and we are considering carefully how to simplify the rules in a way that best meets the needs of patients and providers without increasing costs to the system.
I expect we will hear more from Medicare in the near-term on this matter. Stay tuned.
For more about the patient’s perspective on this issue, please see Brad’s blog: www.hospitalmedicine.org/pmblog.
Dr. Whitcomb is medical director of healthcare quality at Baystate Medical Center in Springfield, Mass. He is a co-founder and past president of SHM. Email him at [email protected].
Minnesota Readmissions Initiative Breaks Down Silos
In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.
The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.
"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.
Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.
"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."
In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.
The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.
"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.
Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.
"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."
In less than four months CMS' Hospital Readmissions Reduction Program will start penalizing hospitals with higher-than-projected readmissions rates. But as the Oct. 1 program launch looms for many hospitals, one readmission initiative is making significant progress to reduce unnecessary hospitalizations.
The Minnesota Reducing Avoidable Readmissions Effectively (RARE) campaign set a goal of preventing 4,000 avoidable readmissions among commercial health plan patients by the end of 2012, a 20% reduction from 2009 baseline data. The campaign was launched last September by three operating partners: the Minnesota Hospital Association (MHA); the Institute for Clinical Systems Improvement (ICSI), a nonprofit collaborative of 55 medical groups and hospitals; and Stratis Health, the state's QI organization. RARE's partners include more than 80 hospitals, which according to the MHA already have prevented 1,011 avoidable readmissions in 2011 and expect to surpass the target goal by the end of 2012.
"We had a specific process for each partner to follow, including a commitment by leadership to support and provide needed resources and development of a guidance team and a working team at each site," says Kathy Cummings, RN, MA, project manager at ICSI.
Each participating hospital was invited to join one of three quality collaboratives: one based on Project RED; one based on Dr. Eric Coleman's Care Transitions model; and one focused on safe transitions-of-care communication developed by the MHA.
"Everyone is rallying around the goals. They are all talking at the table, and starting to break down the silos between hospital, nursing home, clinic, and the chasms in between," says hospitalist Howard Epstein, MD, FHM, ICSI's chief health systems officer. "One of the key attributes of hospitalists is collaboration and systems improvement within their hospitals. Working with RARE is broadening their perspectives on the workings of the healthcare system as a whole."
Early Returns: ACOs Improve Management of Patient Populations, Offer Short-Term Savings
Several years ago, Presbyterian Medical Group in Albuquerque, N.M., decided to integrate three elements of its healthcare system: its health plan, the employed medical group, and the hospital delivery system. Knitting those parts into a cohesive whole helped the group realize that “lowering the cost of care by improving efficiency, by improving coordination, and by enhancing collaboration between payor and physicians made a lot of sense,” executive medical director David Arredondo, MD, says.
When the accountable care organization (ACO) concept came along, Dr. Arredondo says, “it really was just a natural extension of what we were doing.”
By year’s end, though, the final rules had assuaged many of the biggest concerns, and the April 10 announcement of 27 participants for the program’s first round—more than half of which are physician-led organizations—has rekindled much of the enthusiasm. According to CMS officials, the agency is reviewing more than 150 applications for the program’s next round, which will begin in July.
Keys to Success
In December, CMS selected 32 organizations to participate in an even more ambitious initiative called the Pioneer ACO Model. That separate but related experiment in shared accountability launched Jan. 1, and it may be months before enrolled organizations can say whether the rewards outweigh the risks. Interviews with Presbyterian’s Dr. Arredondo and two other Pioneer participants about why they took the plunge, however, have highlighted some potential keys to success.
—David Arredondo, MD, executive medical director, Presbyterian Medical Group, Albuquerque, N.M.
All three agree that the ACO model offers a better match for their long-term, patient-centered goals and that the fee-for-service model is gradually becoming a thing of the past.
“In some ways, it was actually kind of a relief that the system was going this way because we, probably like many systems, were beginning to be caught between the budgeted model and a fee-for-service model,” Dr. Arredondo says. “When you’re heavily one way or heavily the other way, then it makes things a little easier to manage and understand. When you’re right in the middle, it becomes a little uncomfortable.”
Penny Wheeler, MD, chief clinical officer for Minneapolis-based Allina Hospitals & Clinics, says organizations in that precarious position need to carefully examine their capabilities and consider how best to pace their transition. Otherwise, they might prematurely give up too much revenue that could be used to reinvest in care improvements.
“We can tolerate it if we shoot ourselves in one foot, but we can’t tolerate it if we shoot ourselves in both feet, in this new world,” Dr. Wheeler says.
If caution is warranted, she says, the ACO model still aligns well with a strategy of building toward outcome-based healthcare. Despite the likelihood of “lumps and bumps and warts along the way,” Dr. Wheeler says, “we really wanted to be part of the shaping of that outcome-based delivery, and receive market rewards for what we were creating for our community.”
Austin, Texas-based Seton Health Alliance, a third Pioneer participant, is a collaborative effort between a hospital delivery system known as Seton Health Care Family and a multispecialty physician group called Austin Regional Clinic. Greg Sheff, MD, president and chief medical officer of the ACO, says the partnering organizations were separately moving toward more population health initiatives and more proactive, coordinated, and accountable care.
“The Pioneer ACO, for us, really provided an opportunity to light the fire and motivate the organizations to put the entity together and start doing the work,” he says, adding PCPs and hospitalists will be critical to his organization’s ongoing integration efforts.
—Greg Sheff, MD, president, chief medical officer, Seton Health Alliance, Austin, Texas
“The areas where there are opportunities to be more efficient are largely under the care of the hospitalists,” he says, citing in-house utilization as well as care transitions, comprehensive post-acute placement, and readmission prevention efforts. To support those providers, Pioneer participants say well-designed electronic medical records are paramount, while separate efforts, such as patient-centered medical homes and unit-based rounding, might offer timely assists. (Click here to listen to more of The Hospitalist’s interview with Dr. Sheff.)
No one’s expecting the next few years to be seamless, but Dr. Sheff views his newly formed ACO as a long-term endeavor in which success isn’t necessarily defined by whether the group achieves shared cost savings.
“We define success by whether we are able to move our delivery system to a place where we’ll be much more adept at going forward, continuing to manage populations,” he says. “We really see this as a strategic organizational decision more than, ‘Boy, that contract looks like something that we can leverage in the short term.’”
Bryn Nelson is a freelance medical writer in Seattle.
Several years ago, Presbyterian Medical Group in Albuquerque, N.M., decided to integrate three elements of its healthcare system: its health plan, the employed medical group, and the hospital delivery system. Knitting those parts into a cohesive whole helped the group realize that “lowering the cost of care by improving efficiency, by improving coordination, and by enhancing collaboration between payor and physicians made a lot of sense,” executive medical director David Arredondo, MD, says.
When the accountable care organization (ACO) concept came along, Dr. Arredondo says, “it really was just a natural extension of what we were doing.”
By year’s end, though, the final rules had assuaged many of the biggest concerns, and the April 10 announcement of 27 participants for the program’s first round—more than half of which are physician-led organizations—has rekindled much of the enthusiasm. According to CMS officials, the agency is reviewing more than 150 applications for the program’s next round, which will begin in July.
Keys to Success
In December, CMS selected 32 organizations to participate in an even more ambitious initiative called the Pioneer ACO Model. That separate but related experiment in shared accountability launched Jan. 1, and it may be months before enrolled organizations can say whether the rewards outweigh the risks. Interviews with Presbyterian’s Dr. Arredondo and two other Pioneer participants about why they took the plunge, however, have highlighted some potential keys to success.
—David Arredondo, MD, executive medical director, Presbyterian Medical Group, Albuquerque, N.M.
All three agree that the ACO model offers a better match for their long-term, patient-centered goals and that the fee-for-service model is gradually becoming a thing of the past.
“In some ways, it was actually kind of a relief that the system was going this way because we, probably like many systems, were beginning to be caught between the budgeted model and a fee-for-service model,” Dr. Arredondo says. “When you’re heavily one way or heavily the other way, then it makes things a little easier to manage and understand. When you’re right in the middle, it becomes a little uncomfortable.”
Penny Wheeler, MD, chief clinical officer for Minneapolis-based Allina Hospitals & Clinics, says organizations in that precarious position need to carefully examine their capabilities and consider how best to pace their transition. Otherwise, they might prematurely give up too much revenue that could be used to reinvest in care improvements.
“We can tolerate it if we shoot ourselves in one foot, but we can’t tolerate it if we shoot ourselves in both feet, in this new world,” Dr. Wheeler says.
If caution is warranted, she says, the ACO model still aligns well with a strategy of building toward outcome-based healthcare. Despite the likelihood of “lumps and bumps and warts along the way,” Dr. Wheeler says, “we really wanted to be part of the shaping of that outcome-based delivery, and receive market rewards for what we were creating for our community.”
Austin, Texas-based Seton Health Alliance, a third Pioneer participant, is a collaborative effort between a hospital delivery system known as Seton Health Care Family and a multispecialty physician group called Austin Regional Clinic. Greg Sheff, MD, president and chief medical officer of the ACO, says the partnering organizations were separately moving toward more population health initiatives and more proactive, coordinated, and accountable care.
“The Pioneer ACO, for us, really provided an opportunity to light the fire and motivate the organizations to put the entity together and start doing the work,” he says, adding PCPs and hospitalists will be critical to his organization’s ongoing integration efforts.
—Greg Sheff, MD, president, chief medical officer, Seton Health Alliance, Austin, Texas
“The areas where there are opportunities to be more efficient are largely under the care of the hospitalists,” he says, citing in-house utilization as well as care transitions, comprehensive post-acute placement, and readmission prevention efforts. To support those providers, Pioneer participants say well-designed electronic medical records are paramount, while separate efforts, such as patient-centered medical homes and unit-based rounding, might offer timely assists. (Click here to listen to more of The Hospitalist’s interview with Dr. Sheff.)
No one’s expecting the next few years to be seamless, but Dr. Sheff views his newly formed ACO as a long-term endeavor in which success isn’t necessarily defined by whether the group achieves shared cost savings.
“We define success by whether we are able to move our delivery system to a place where we’ll be much more adept at going forward, continuing to manage populations,” he says. “We really see this as a strategic organizational decision more than, ‘Boy, that contract looks like something that we can leverage in the short term.’”
Bryn Nelson is a freelance medical writer in Seattle.
Several years ago, Presbyterian Medical Group in Albuquerque, N.M., decided to integrate three elements of its healthcare system: its health plan, the employed medical group, and the hospital delivery system. Knitting those parts into a cohesive whole helped the group realize that “lowering the cost of care by improving efficiency, by improving coordination, and by enhancing collaboration between payor and physicians made a lot of sense,” executive medical director David Arredondo, MD, says.
When the accountable care organization (ACO) concept came along, Dr. Arredondo says, “it really was just a natural extension of what we were doing.”
By year’s end, though, the final rules had assuaged many of the biggest concerns, and the April 10 announcement of 27 participants for the program’s first round—more than half of which are physician-led organizations—has rekindled much of the enthusiasm. According to CMS officials, the agency is reviewing more than 150 applications for the program’s next round, which will begin in July.
Keys to Success
In December, CMS selected 32 organizations to participate in an even more ambitious initiative called the Pioneer ACO Model. That separate but related experiment in shared accountability launched Jan. 1, and it may be months before enrolled organizations can say whether the rewards outweigh the risks. Interviews with Presbyterian’s Dr. Arredondo and two other Pioneer participants about why they took the plunge, however, have highlighted some potential keys to success.
—David Arredondo, MD, executive medical director, Presbyterian Medical Group, Albuquerque, N.M.
All three agree that the ACO model offers a better match for their long-term, patient-centered goals and that the fee-for-service model is gradually becoming a thing of the past.
“In some ways, it was actually kind of a relief that the system was going this way because we, probably like many systems, were beginning to be caught between the budgeted model and a fee-for-service model,” Dr. Arredondo says. “When you’re heavily one way or heavily the other way, then it makes things a little easier to manage and understand. When you’re right in the middle, it becomes a little uncomfortable.”
Penny Wheeler, MD, chief clinical officer for Minneapolis-based Allina Hospitals & Clinics, says organizations in that precarious position need to carefully examine their capabilities and consider how best to pace their transition. Otherwise, they might prematurely give up too much revenue that could be used to reinvest in care improvements.
“We can tolerate it if we shoot ourselves in one foot, but we can’t tolerate it if we shoot ourselves in both feet, in this new world,” Dr. Wheeler says.
If caution is warranted, she says, the ACO model still aligns well with a strategy of building toward outcome-based healthcare. Despite the likelihood of “lumps and bumps and warts along the way,” Dr. Wheeler says, “we really wanted to be part of the shaping of that outcome-based delivery, and receive market rewards for what we were creating for our community.”
Austin, Texas-based Seton Health Alliance, a third Pioneer participant, is a collaborative effort between a hospital delivery system known as Seton Health Care Family and a multispecialty physician group called Austin Regional Clinic. Greg Sheff, MD, president and chief medical officer of the ACO, says the partnering organizations were separately moving toward more population health initiatives and more proactive, coordinated, and accountable care.
“The Pioneer ACO, for us, really provided an opportunity to light the fire and motivate the organizations to put the entity together and start doing the work,” he says, adding PCPs and hospitalists will be critical to his organization’s ongoing integration efforts.
—Greg Sheff, MD, president, chief medical officer, Seton Health Alliance, Austin, Texas
“The areas where there are opportunities to be more efficient are largely under the care of the hospitalists,” he says, citing in-house utilization as well as care transitions, comprehensive post-acute placement, and readmission prevention efforts. To support those providers, Pioneer participants say well-designed electronic medical records are paramount, while separate efforts, such as patient-centered medical homes and unit-based rounding, might offer timely assists. (Click here to listen to more of The Hospitalist’s interview with Dr. Sheff.)
No one’s expecting the next few years to be seamless, but Dr. Sheff views his newly formed ACO as a long-term endeavor in which success isn’t necessarily defined by whether the group achieves shared cost savings.
“We define success by whether we are able to move our delivery system to a place where we’ll be much more adept at going forward, continuing to manage populations,” he says. “We really see this as a strategic organizational decision more than, ‘Boy, that contract looks like something that we can leverage in the short term.’”
Bryn Nelson is a freelance medical writer in Seattle.
ONLINE EXCLUSIVE: A neurohospitalist fellowship program director talks about the rise of the neurohospitalist model.
Click here to listen to Dr. Barrett
Click here to listen to Dr. Barrett
Click here to listen to Dr. Barrett
Project BOOST Helps California Hospital Improve Care
Soon, hospitals with unnecessary 30-day readmissions will be penalized. Some proactive hospitals are already tackling care transitions to reduce readmissions, improve patient care, and reduce costs.
Lodi Memorial Hospital in Northern California is one such hospital. The 214-bed facility has made preventing readmissions a key strategic goal for improving care, especially for vulnerable, frail elderly patients.
Lodi executives say readmissions are a challenge at the hospital because many different specialties and house staff are involved in the discharge process.
With many options from which to choose, Lodi selected SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions). Project BOOST, unlike other programs, focuses on first identifying system deficiencies, then building cohesive multidisciplinary teams.
“If you layer a clinical intervention onto a broken system,” says BOOST mentor Stephanie Rennke, MD, “success isn’t likely. Project BOOST helps the team map current processes, find deficiencies, assess resources, and redefine a culture of safety.
“BOOST starts with an assessment of how the system functions, and identifies its strengths and weaknesses so you can focus your efforts on critical areas for improvement and tailor the BOOST intervention to fit the unique dynamics of an institution,” she says.
Search for a Solution
No two institutions are exactly the same, especially when analyzing patient-safety culture. Project BOOST is customized to the needs of each BOOST site, which has proven useful to Lodi, as it found it had different needs than other hospitals.
“We chose Project BOOST because it seemed workable and implementable, while offering a less expensive and less complicated solution than competitors’ products,” says Valerie Cronin, Lodi’s director of utilization.
The BOOST mentor, key to this customization, provided Lodi with the reassurance that comes with working directly with someone who has faced similar challenges—not just theoretically, but also on the floor—and was willing to work with Lodi to develop practical solutions. The mentor provided reassurance, support, and perspective as Lodi walked through the BOOST implementation process.
Keys to Success
—Valerie Cronin, director of utilization, Lodi Memorial Hospital, California
Team-focused care, clear communication, and administrative support were keys to successful BOOST implementation at Lodi, says Cronin.
The house staff was overwhelmed, and adding a quality-improvement (QI) project to implement and manage might have seemed like an impossible challenge. By developing multidisciplinary teams, however, Lodi was able to distribute the tasks of implementation and began to recognize the value and benefit of Project BOOST, which already had strong support from hospital executives.
A 14-member multidisciplinary team was formed to oversee the Project BOOST implementation. The team then was divided into sub-groups to work on the main components of Project BOOST: Passport to Care Form, Target Assessment Tool, the Teachback process, and Follow-Up Phone Calls. The sub-groups’ main objectives were to ensure that BOOST effectively changed processes and work practices for a stronger and safer discharge process.
To support these teams and foster communication laterally among healthcare providers and vertically with hospital administration, Lodi established a structured meeting format, delegated task assignments for accountability, and appointed an implementation champion.
Capitalizing on the experience of its BOOST mentor, the Lodi multidisciplinary teams mapped out the process to assess threats to the system and opportunities for improvement, and began moving forward with implementable solutions for sustainable change.
“Evaluating the whole discharge process allowed us to see the gaps and discrepancies in the discharge process,” Cronin says. “Each discipline had their own set of procedures and materials, which proved lacking and inconsistent for our patients. It was an essential and eye-opening experience for Lodi to make change.”
One of the biggest revelations was learning how broken the discharge process was for the nurses. When Lodi looked at its current process of using case managers to handle high-risk patients and leaving the remaining patient discharges to the nurses, they found that the process was not strong enough to support patient load.
Knowledge Is Power
Cronin says Lodi has standardized its patient educational materials and started the patient education process as soon as patients are admitted. This step optimizes a patient’s understanding of diagnoses and care instructions when the time comes for discharge.
Through the Project BOOST assessment, Lodi ascertained that many of its patients were being discharged to skilled-nursing facilities, which heightens the complexity of post-care and introduces the potential for increased risks. Lodi is now working to better communicate with the skilled-nursing facilities using its Project BOOST training to streamline the discharge process.
The implementation of the Teach Back communication strategy has been critical in increasing patient knowledge and adherence to care instructions, official say. Based on the success of Project BOOST implementation, Teach Back has been incorporated into mandatory nurse training throughout the hospital.
Improved Care
More than 80 patients were discharged through the BOOST process in the first 90 days of implementation. Lodi is already experiencing the benefits of Project BOOST organizationally and
expects to see the financial impacts soon through a lower 30-day readmission rate.
“Lodi has experienced a shift in patient safety culture with improved communication through a team approach to care,” Cronin says. “Lodi expects high success through Project BOOST with the goal of implementing Project BOOST across all disease states and every discipline using Teachback.
“Project BOOST has been the ideal program to align with our strategic organizational goals to improve transitions of care and re-create the patient safety culture to make systemwide sustainable change,” she says.
For more information about Project BOOST, visit www.hospitalmedicine.org/boost.
Jacqui Petock, marketing project manager
Soon, hospitals with unnecessary 30-day readmissions will be penalized. Some proactive hospitals are already tackling care transitions to reduce readmissions, improve patient care, and reduce costs.
Lodi Memorial Hospital in Northern California is one such hospital. The 214-bed facility has made preventing readmissions a key strategic goal for improving care, especially for vulnerable, frail elderly patients.
Lodi executives say readmissions are a challenge at the hospital because many different specialties and house staff are involved in the discharge process.
With many options from which to choose, Lodi selected SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions). Project BOOST, unlike other programs, focuses on first identifying system deficiencies, then building cohesive multidisciplinary teams.
“If you layer a clinical intervention onto a broken system,” says BOOST mentor Stephanie Rennke, MD, “success isn’t likely. Project BOOST helps the team map current processes, find deficiencies, assess resources, and redefine a culture of safety.
“BOOST starts with an assessment of how the system functions, and identifies its strengths and weaknesses so you can focus your efforts on critical areas for improvement and tailor the BOOST intervention to fit the unique dynamics of an institution,” she says.
Search for a Solution
No two institutions are exactly the same, especially when analyzing patient-safety culture. Project BOOST is customized to the needs of each BOOST site, which has proven useful to Lodi, as it found it had different needs than other hospitals.
“We chose Project BOOST because it seemed workable and implementable, while offering a less expensive and less complicated solution than competitors’ products,” says Valerie Cronin, Lodi’s director of utilization.
The BOOST mentor, key to this customization, provided Lodi with the reassurance that comes with working directly with someone who has faced similar challenges—not just theoretically, but also on the floor—and was willing to work with Lodi to develop practical solutions. The mentor provided reassurance, support, and perspective as Lodi walked through the BOOST implementation process.
Keys to Success
—Valerie Cronin, director of utilization, Lodi Memorial Hospital, California
Team-focused care, clear communication, and administrative support were keys to successful BOOST implementation at Lodi, says Cronin.
The house staff was overwhelmed, and adding a quality-improvement (QI) project to implement and manage might have seemed like an impossible challenge. By developing multidisciplinary teams, however, Lodi was able to distribute the tasks of implementation and began to recognize the value and benefit of Project BOOST, which already had strong support from hospital executives.
A 14-member multidisciplinary team was formed to oversee the Project BOOST implementation. The team then was divided into sub-groups to work on the main components of Project BOOST: Passport to Care Form, Target Assessment Tool, the Teachback process, and Follow-Up Phone Calls. The sub-groups’ main objectives were to ensure that BOOST effectively changed processes and work practices for a stronger and safer discharge process.
To support these teams and foster communication laterally among healthcare providers and vertically with hospital administration, Lodi established a structured meeting format, delegated task assignments for accountability, and appointed an implementation champion.
Capitalizing on the experience of its BOOST mentor, the Lodi multidisciplinary teams mapped out the process to assess threats to the system and opportunities for improvement, and began moving forward with implementable solutions for sustainable change.
“Evaluating the whole discharge process allowed us to see the gaps and discrepancies in the discharge process,” Cronin says. “Each discipline had their own set of procedures and materials, which proved lacking and inconsistent for our patients. It was an essential and eye-opening experience for Lodi to make change.”
One of the biggest revelations was learning how broken the discharge process was for the nurses. When Lodi looked at its current process of using case managers to handle high-risk patients and leaving the remaining patient discharges to the nurses, they found that the process was not strong enough to support patient load.
Knowledge Is Power
Cronin says Lodi has standardized its patient educational materials and started the patient education process as soon as patients are admitted. This step optimizes a patient’s understanding of diagnoses and care instructions when the time comes for discharge.
Through the Project BOOST assessment, Lodi ascertained that many of its patients were being discharged to skilled-nursing facilities, which heightens the complexity of post-care and introduces the potential for increased risks. Lodi is now working to better communicate with the skilled-nursing facilities using its Project BOOST training to streamline the discharge process.
The implementation of the Teach Back communication strategy has been critical in increasing patient knowledge and adherence to care instructions, official say. Based on the success of Project BOOST implementation, Teach Back has been incorporated into mandatory nurse training throughout the hospital.
Improved Care
More than 80 patients were discharged through the BOOST process in the first 90 days of implementation. Lodi is already experiencing the benefits of Project BOOST organizationally and
expects to see the financial impacts soon through a lower 30-day readmission rate.
“Lodi has experienced a shift in patient safety culture with improved communication through a team approach to care,” Cronin says. “Lodi expects high success through Project BOOST with the goal of implementing Project BOOST across all disease states and every discipline using Teachback.
“Project BOOST has been the ideal program to align with our strategic organizational goals to improve transitions of care and re-create the patient safety culture to make systemwide sustainable change,” she says.
For more information about Project BOOST, visit www.hospitalmedicine.org/boost.
Jacqui Petock, marketing project manager
Soon, hospitals with unnecessary 30-day readmissions will be penalized. Some proactive hospitals are already tackling care transitions to reduce readmissions, improve patient care, and reduce costs.
Lodi Memorial Hospital in Northern California is one such hospital. The 214-bed facility has made preventing readmissions a key strategic goal for improving care, especially for vulnerable, frail elderly patients.
Lodi executives say readmissions are a challenge at the hospital because many different specialties and house staff are involved in the discharge process.
With many options from which to choose, Lodi selected SHM’s Project BOOST (Better Outcomes for Older Adults through Safe Transitions). Project BOOST, unlike other programs, focuses on first identifying system deficiencies, then building cohesive multidisciplinary teams.
“If you layer a clinical intervention onto a broken system,” says BOOST mentor Stephanie Rennke, MD, “success isn’t likely. Project BOOST helps the team map current processes, find deficiencies, assess resources, and redefine a culture of safety.
“BOOST starts with an assessment of how the system functions, and identifies its strengths and weaknesses so you can focus your efforts on critical areas for improvement and tailor the BOOST intervention to fit the unique dynamics of an institution,” she says.
Search for a Solution
No two institutions are exactly the same, especially when analyzing patient-safety culture. Project BOOST is customized to the needs of each BOOST site, which has proven useful to Lodi, as it found it had different needs than other hospitals.
“We chose Project BOOST because it seemed workable and implementable, while offering a less expensive and less complicated solution than competitors’ products,” says Valerie Cronin, Lodi’s director of utilization.
The BOOST mentor, key to this customization, provided Lodi with the reassurance that comes with working directly with someone who has faced similar challenges—not just theoretically, but also on the floor—and was willing to work with Lodi to develop practical solutions. The mentor provided reassurance, support, and perspective as Lodi walked through the BOOST implementation process.
Keys to Success
—Valerie Cronin, director of utilization, Lodi Memorial Hospital, California
Team-focused care, clear communication, and administrative support were keys to successful BOOST implementation at Lodi, says Cronin.
The house staff was overwhelmed, and adding a quality-improvement (QI) project to implement and manage might have seemed like an impossible challenge. By developing multidisciplinary teams, however, Lodi was able to distribute the tasks of implementation and began to recognize the value and benefit of Project BOOST, which already had strong support from hospital executives.
A 14-member multidisciplinary team was formed to oversee the Project BOOST implementation. The team then was divided into sub-groups to work on the main components of Project BOOST: Passport to Care Form, Target Assessment Tool, the Teachback process, and Follow-Up Phone Calls. The sub-groups’ main objectives were to ensure that BOOST effectively changed processes and work practices for a stronger and safer discharge process.
To support these teams and foster communication laterally among healthcare providers and vertically with hospital administration, Lodi established a structured meeting format, delegated task assignments for accountability, and appointed an implementation champion.
Capitalizing on the experience of its BOOST mentor, the Lodi multidisciplinary teams mapped out the process to assess threats to the system and opportunities for improvement, and began moving forward with implementable solutions for sustainable change.
“Evaluating the whole discharge process allowed us to see the gaps and discrepancies in the discharge process,” Cronin says. “Each discipline had their own set of procedures and materials, which proved lacking and inconsistent for our patients. It was an essential and eye-opening experience for Lodi to make change.”
One of the biggest revelations was learning how broken the discharge process was for the nurses. When Lodi looked at its current process of using case managers to handle high-risk patients and leaving the remaining patient discharges to the nurses, they found that the process was not strong enough to support patient load.
Knowledge Is Power
Cronin says Lodi has standardized its patient educational materials and started the patient education process as soon as patients are admitted. This step optimizes a patient’s understanding of diagnoses and care instructions when the time comes for discharge.
Through the Project BOOST assessment, Lodi ascertained that many of its patients were being discharged to skilled-nursing facilities, which heightens the complexity of post-care and introduces the potential for increased risks. Lodi is now working to better communicate with the skilled-nursing facilities using its Project BOOST training to streamline the discharge process.
The implementation of the Teach Back communication strategy has been critical in increasing patient knowledge and adherence to care instructions, official say. Based on the success of Project BOOST implementation, Teach Back has been incorporated into mandatory nurse training throughout the hospital.
Improved Care
More than 80 patients were discharged through the BOOST process in the first 90 days of implementation. Lodi is already experiencing the benefits of Project BOOST organizationally and
expects to see the financial impacts soon through a lower 30-day readmission rate.
“Lodi has experienced a shift in patient safety culture with improved communication through a team approach to care,” Cronin says. “Lodi expects high success through Project BOOST with the goal of implementing Project BOOST across all disease states and every discipline using Teachback.
“Project BOOST has been the ideal program to align with our strategic organizational goals to improve transitions of care and re-create the patient safety culture to make systemwide sustainable change,” she says.
For more information about Project BOOST, visit www.hospitalmedicine.org/boost.
Jacqui Petock, marketing project manager
Six Ways You Can Help Reduce HAIs in Your Hospital
- Encourage good hand hygiene. This should be obvious, but hospitals are struggling to achieve compliance rates of even 50%. One study has found significant improvement by appealing to medical providers’ altruistic sense: “Hand hygiene prevents patients from catching diseases.”1
- Embrace checklists. If they work for airline pilots, they can work for you. Study after study has supported their effectiveness, particularly in preventing CLABSIs and CAUTIs when well-integrated into a multifaceted approach.
- Bundle up. A bundled approach that emphasized proper hand hygiene, disinfection, catheter avoidance, and timely removal cut CLABSI rates by morethan half, on average, in Veterans Administration ICUs throughout the U.S.2
- Team up. For a C. diff-reduction effort at Kaiser Permanente Medical Center in Santa Clara, Calif., success meant getting doctors, nurses, specialists, and administrators on board, both to brainstorm and to sustain momentum.
- Be a role model. Consistently following HAI-prevention protocols, such as contact precautions, can make adherence contagious—in a very good way.
- Be an innovator. By virtue of being ubiquitous in inpatient wards, hospitalists know what works and what doesn’t; your insight can be particularly valuable for a team-based, HAI-reduction effort.
References
- Grant AM, Hofmann DA. It’s not all about me: Motivating hospital hand hygiene by focusing on patients. Psychol Sci. 2011;22:1494-1499.
- Render ML, Hasselbeck R, Freyberg RW, Hofer TP, et al. Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf. 2011;20(8):725-732.
- Encourage good hand hygiene. This should be obvious, but hospitals are struggling to achieve compliance rates of even 50%. One study has found significant improvement by appealing to medical providers’ altruistic sense: “Hand hygiene prevents patients from catching diseases.”1
- Embrace checklists. If they work for airline pilots, they can work for you. Study after study has supported their effectiveness, particularly in preventing CLABSIs and CAUTIs when well-integrated into a multifaceted approach.
- Bundle up. A bundled approach that emphasized proper hand hygiene, disinfection, catheter avoidance, and timely removal cut CLABSI rates by morethan half, on average, in Veterans Administration ICUs throughout the U.S.2
- Team up. For a C. diff-reduction effort at Kaiser Permanente Medical Center in Santa Clara, Calif., success meant getting doctors, nurses, specialists, and administrators on board, both to brainstorm and to sustain momentum.
- Be a role model. Consistently following HAI-prevention protocols, such as contact precautions, can make adherence contagious—in a very good way.
- Be an innovator. By virtue of being ubiquitous in inpatient wards, hospitalists know what works and what doesn’t; your insight can be particularly valuable for a team-based, HAI-reduction effort.
References
- Grant AM, Hofmann DA. It’s not all about me: Motivating hospital hand hygiene by focusing on patients. Psychol Sci. 2011;22:1494-1499.
- Render ML, Hasselbeck R, Freyberg RW, Hofer TP, et al. Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf. 2011;20(8):725-732.
- Encourage good hand hygiene. This should be obvious, but hospitals are struggling to achieve compliance rates of even 50%. One study has found significant improvement by appealing to medical providers’ altruistic sense: “Hand hygiene prevents patients from catching diseases.”1
- Embrace checklists. If they work for airline pilots, they can work for you. Study after study has supported their effectiveness, particularly in preventing CLABSIs and CAUTIs when well-integrated into a multifaceted approach.
- Bundle up. A bundled approach that emphasized proper hand hygiene, disinfection, catheter avoidance, and timely removal cut CLABSI rates by morethan half, on average, in Veterans Administration ICUs throughout the U.S.2
- Team up. For a C. diff-reduction effort at Kaiser Permanente Medical Center in Santa Clara, Calif., success meant getting doctors, nurses, specialists, and administrators on board, both to brainstorm and to sustain momentum.
- Be a role model. Consistently following HAI-prevention protocols, such as contact precautions, can make adherence contagious—in a very good way.
- Be an innovator. By virtue of being ubiquitous in inpatient wards, hospitalists know what works and what doesn’t; your insight can be particularly valuable for a team-based, HAI-reduction effort.
References
- Grant AM, Hofmann DA. It’s not all about me: Motivating hospital hand hygiene by focusing on patients. Psychol Sci. 2011;22:1494-1499.
- Render ML, Hasselbeck R, Freyberg RW, Hofer TP, et al. Reduction of central line infections in Veterans Administration intensive care units: an observational cohort using a central infrastructure to support learning and improvement. BMJ Qual Saf. 2011;20(8):725-732.
Dartmouth Atlas: Little Progress Reducing Readmissions
The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.1 The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.
National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.
The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.
The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.
Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.
Reference
The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.1 The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.
National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.
The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.
The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.
Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.
Reference
The newest Dartmouth Atlas report, released Sept. 28, documents striking variation in 30-day hospital readmission rates for Medicare patients across 308 hospital-referral regions.1 The authors found little progress in decreasing 30-day readmissions from 2004 to 2009, while for some conditions and many regions, rates actually went up.
National readmission rates following surgery were 12.7% in both 2004 and 2009; readmissions for medical conditions rose slightly, from 15.9% to 16.1%, over the same period. Only 42% of hospitalized Medicare patients discharged to home had a PCP contact within 14 days of discharge, according to the report.
The Dartmouth Atlas Project (www.dartmouthatlas.org) documents geographic variation in healthcare utilization unrelated to outcome. It offers an extensive database for comparison by state, county, region and facility.
The new report is the first to identify an association nationally between readmissions rates and “the overall intensity of inpatient care provided to patients within a region or hospital,” with patterns of relatively high hospital utilization often corresponding with areas of higher readmissions. “Other patients are readmitted simply because they live in a locale where the hospital is used more frequently as a site of care,” the authors note.
Without continuous, high-quality care coordination across sites, the authors write, discharged patients can repeatedly bounce back to emergency rooms and hospitals.
Reference
You've Got (Post-Discharge) Mail
An automated email system that notifies both hospitalists and PCPs about post-discharge test results can help ensure results don’t “fall through the cracks,” according to an abstract presented at HM11.
The report, “Design and Implementation of an Automated Email Notification System for Results of Tests Pending at Discharge,” suggests that by providing an automatic email when results are completed, inpatient physicians will be more responsible for the patient, and create a dialogue with primary-care physicians (PCPs) as well. The authors estimate that physicians are aware of 40% of the final results of tests pending at discharge.
“Things fall through the cracks,” says Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. “This is a method to make sure these test results don’t fall through the cracks.”
Dr. Dalal’s team created the automatic emails across five services—chemistry, hematology, microbiology, pathology, and radiology—in the past two years. Preliminary data show that the system helps ensure physicians are aware of more test results, but additional research is needed.
Still, Dr. Dalal believes creating an email system at a given institution helps if only by drawing attention to the issue of pending results once a patient has left the hospital. And even if the implementation of the system at a less-wired hospital is difficult, the omnipresence of email should help with adopting.
“Everyone has email today,” he adds.
An automated email system that notifies both hospitalists and PCPs about post-discharge test results can help ensure results don’t “fall through the cracks,” according to an abstract presented at HM11.
The report, “Design and Implementation of an Automated Email Notification System for Results of Tests Pending at Discharge,” suggests that by providing an automatic email when results are completed, inpatient physicians will be more responsible for the patient, and create a dialogue with primary-care physicians (PCPs) as well. The authors estimate that physicians are aware of 40% of the final results of tests pending at discharge.
“Things fall through the cracks,” says Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. “This is a method to make sure these test results don’t fall through the cracks.”
Dr. Dalal’s team created the automatic emails across five services—chemistry, hematology, microbiology, pathology, and radiology—in the past two years. Preliminary data show that the system helps ensure physicians are aware of more test results, but additional research is needed.
Still, Dr. Dalal believes creating an email system at a given institution helps if only by drawing attention to the issue of pending results once a patient has left the hospital. And even if the implementation of the system at a less-wired hospital is difficult, the omnipresence of email should help with adopting.
“Everyone has email today,” he adds.
An automated email system that notifies both hospitalists and PCPs about post-discharge test results can help ensure results don’t “fall through the cracks,” according to an abstract presented at HM11.
The report, “Design and Implementation of an Automated Email Notification System for Results of Tests Pending at Discharge,” suggests that by providing an automatic email when results are completed, inpatient physicians will be more responsible for the patient, and create a dialogue with primary-care physicians (PCPs) as well. The authors estimate that physicians are aware of 40% of the final results of tests pending at discharge.
“Things fall through the cracks,” says Anuj Dalal, MD, FHM, a hospitalist at Brigham and Women’s Hospital in Boston. “This is a method to make sure these test results don’t fall through the cracks.”
Dr. Dalal’s team created the automatic emails across five services—chemistry, hematology, microbiology, pathology, and radiology—in the past two years. Preliminary data show that the system helps ensure physicians are aware of more test results, but additional research is needed.
Still, Dr. Dalal believes creating an email system at a given institution helps if only by drawing attention to the issue of pending results once a patient has left the hospital. And even if the implementation of the system at a less-wired hospital is difficult, the omnipresence of email should help with adopting.
“Everyone has email today,” he adds.