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Time to make patient experience surveys matter

[preamble]yes – the new concept of listening to your patients and finding our what they really want – shocking – unbelievable – revelation[backtopost]
January 10, 2013 | By Alicia Caramenico
With reimbursement tied to patient satisfaction, hospitals increasingly are administering patient experience surveys to gauge how patients perceive their care and hospital visit.

But as FierceHealthcare reported earlier this week, some industry experts are questioning whether patient experience surveys accurately measure quality. Previous research that found no link between patient satisfaction and quality outcomes doesn’t help clarify the issue.

The topic has generated some discussion in our LinkedIn group, where readers are encouraging the use of patient experience surveys as one component of measuring a hospital’s quality. I agree that patient experience surveys can provide some valuable intel on how a hospital delivers care. But as some readers pointed out, they’re not the be-all, end-all.

So how can hospitals make these questionnaires more useful? To find out, I reached out to two healthcare leaders who serve on the FierceHealthcare Editorial Advisory Board and are well-versed in patient experience.

It’s important to remember the surveys are less about whether patients are happy, James Merlino, chief experience officer at the Cleveland Clinic, told me. Rather, it’s about getting to what drives the overall  experience, which includes measuring how hospitals deliver safety, quality and satisfaction.

And while not every survey question is perfect, the surveys work and capture the right information, he added.

For example, the HCAHPS survey includes several categories related to how caregivers communicate with patients. Once Cleveland Clinic started paying attention to experience ratings, its physician communication scores jumped from the 5th percentile three years go to the 70th percentile today. “So I know that people can improve and I know that it matters to patients,” Merlino said.

But don’t get caught up in the numbers. Hospitals that only focus on increasing their score miss out on the real value with patient experience feedback, warned Jeremy D Tucker, medical director of the emergency department at MedStar St. Mary’s Hospital in Leonardtown, Md., who oversees patient experience for Medical Emergency Professionals.

Valuable insight can come from information found in patient comments, for example, which can reveal what your patients consider a great patient experience, he said.

So it seems patient feedback can help hospitals figure out what it takes to deliver an exceptional experience. But patient experience surveys are meaningless if hospitals don’t act on the information. An important next step is to analyze the answers and identify opportunities for improvement.

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Beyond Disney and Tinkerbell: Moving the needle on stuck patient satisfaction scores

[preamble]SHOCKING new discovery – take care of patients like customers and they will come back.! Yes thy doctors, you are not unique. You are in a service industry – learn from the masters.
I have been telling you this for years now – wake up – smell the stethoscope![backtopost]
March 8, 2013 | By Gienna Shaw
I’ve heard countless hospital executives say it: They worked their butts off to improve patient satisfaction scores at their organization and those efforts paid off. They moved the needle … until the needle got stuck.

If you want to go (if you’ll pardon the business cliché), from good to great, the key is not to focus primarily on patient satisfaction or service excellence, argues Fred Lee, a patient relations and service consultant and author of “If Disney Ran Your Hospital.”

You read that right: The author of one of the best-known books on service excellence in the healthcare industry says you should not focus solely on service excellence in your quest to improve patient satisfaction scores.

Lee, who spoke at the College of Healthcare Information Management Executives at its CIO forum in New Orleans earlier this week, said hospitals that “hardwire” patient satisfaction and service excellence and concepts such as courtesy have maxed out the potential of these efforts.

“A service of courtesy is not enough in our business if we are not also meeting people’s emotional needs,” Lee said.

We’re all stuck in the same paradigm of the courteous hard-wired behaviors patients have come to expect, he added. Once something is expected, you have to do it. But doing so doesn’t make the patient a fan–rather, “you’ve only avoided disappointment [and] dissatisfaction.”

Think about it: Any fast food chain worker can follow a service excellence script. Greet the customer, look him or her in the eye, smile, ask them how you can best serve them today, thank them for their business. Burger King and its employees do just as good a job at following a script as you and your employees do. Maybe even better.

But ordering a burger and getting your blood drawn, for example, are two very different experiences. A nurse can come into a patient’s room, look the patient in the eye, smile and call him by name, introduce herself and explain why she’s there. She’s followed the script perfectly.

But that’s not enough.

“Patient perceptions are based on nonverbal cues that the patient doesn’t even know they’re picking up on,” Lee said. A nurse who’s frowning as she concentrates on finding a vein? That tells the patient that if this nurse finds a vein it will be pure luck.

A nurse who lets silence fill the room after the script is delivered? That just gives the patient time to start thinking about everything that could go wrong. “No one can stop that thought unless someone distracts you,” Lee said.

On the other hand, a nurse who comes in and, as she’s looking for that vein, assures the patient that she’s accomplished and that although it might hurt a bit she’s going to be as gentle as possible? That patient’s perception will be quite different–and his outcome and experience will be more positive, too.

“The best nurses tend to say something just before an invasive procedure such as a blood draw–it reduces the anxiety of the patient, which affects their pain threshold,” Lee said. “They don’t have to gush the whole time–just the instant before.”

Sometimes, Lee said, nurses are a little skeptical of the whole Tinkerbell thing.

“But I didn’t get that from Disney, I got it from clinical trials,” he said. “There’s a high correlation between lower pain ratings with your best nurses than with average nurses and they’re doing they exact same thing … How can there be that big a difference in pain perception when they’re all doing the exact same thing in the same way? You can see the results but you don’t know what caused it unless you have it on video.”

To that end, Lee said, one study took a group of nurses who frequently receive patient compliments and a group of nurses who either get no compliments or get complaints. They all gave patients shots using the same technique. Afterwards, the patients rated their pain on a scale of 1-5. Guess who had the lowest pain scores? The higher-rated nurses were not more technically competent. They didn’t have more experience. And they certainly didn’t just follow a script. But their patients’ perception of pain was lessened.

“Your best nurses didn’t learn that in a textbook,” he said. “They wanted to be true blessing to patients.”

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Readmission calculations unfair to hospitals

[preamble]Does not matter the why – all that matters is that you broke the rules. Its akin to Ebay or Amazon building new rules for retail that simple make no sense (customers can cheat retailers but who cares, you did not respond to customers on sunday u are penalized!, you did not ship on saturday/sunday – penalized!). The environment of the “new” world order is backwards and non sustainable.[backtopost]
25% of spine surgery re-admissions not caused by quality-of-care issues
October 11, 2012 | By Karen Cheung-Larivee
Readmission rates can hurt hospitals’ reputations and, starting this month, reimbursements. But new research suggests the readmission calculation is flawed, as 25 percent of the readmissions of spine surgery patients were not due to true quality-of-care issues.

According to researchers at Loyola University Medical Center and University of California San Francisco Medical Center, the standard method used to calculate readmission rates is a misleading indicator of hospital quality, according to the research presented at yesterday’s Congress of Neurological Surgeons in Chicago.

Under the 2010 Affordable Care Act that triggered the Readmissions Reduction Program, hospitals with excess readmissions see Medicare penalties of up to 1 percent. However, current calculations may not account for other factors that affect readmission rates, according to researchers.

Although some readmissions are genuinely related to poor quality, such as infections, surgical complications, blood clots and surgical hardware failures, a quarter of cases are not, researchers said. For instance, if a scoliosis patient requires two surgeries performed about 15 days apart–a planned readmission–that is counted against the 30-day window. If that spine surgery patient comes back for a hip surgery–an unrelated readmission–the hospital could be penalized. If the operation is canceled or rescheduled for an unpreventable reason, say, if the spinal surgery is postponed due to an irregular heart rate, the hospital could pay for that, as well.

Of the 281 patients readmitted within 30 days of discharge, 25 percent (69) of those readmissions should not have been counted against the hospital–39 cases that were planned readmissions for staged procedures, 16 cases that were unrelated and 14 cases that were canceled or rescheduled due to unpreventable reasons. The 4.9 percent readmission rate was more like 3.7 percent, according to HealthDay News.

To combat the “pitfalls in the current calculation of readmission rates,” Loyola University Medical Center neurosurgeon Beejal Amin said they are working on modifying the algorithm to make it more clinically relevant.

“Readmissions should be determined not only by hospital readmission but also require the presence of a diagnosis code that indicates a spine-related complication. This will help prevent false-positive readmission classification,” study authors wrote.

On the flip side, the exaggerated readmission rates also mean that spinal surgeries may be more successful than reported in public statistics, according to a UCSF statement in April.

“Publicly reported ‘all-cause’ readmission rates may not be realistic,” said Praveen Mummaneni, codirector of the Spinal Surgery and UCSF Spine Center.

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Pay for performance fails to improve mortality rates

[preamble]3rd article in the Obama care debacle – incentives to make patients “healthier” not working – of course not![backtopost]
March 29, 2012 | By Karen Cheung-Larivee
Flying in the face of the government’s national pay-for-performance initiatives, new research finds that hospital incentives failed to achieve their goal of improving patient outcomes, specifically, 30-day mortality rates. The New England Journal of Medicine study published yesterday found little evidence pay-for-performance programs actually helped keep patients alive longer.

“It really didn’t move the needle very much on patient outcomes,” study lead author Ashish Jha, a professor at the Harvard School of Public Health, told Reuters. “There was no evidence that patient outcomes got better under this different financing scheme.”

Researchers looked at 252 hospitals participating in the Medicare Premier Hospital Quality Incentive Demonstration (HQID), a partnership between the Centers for Medicare & Medicaid Services and nonprofit hospitals, compared to other 3,363 nonparticipating hospitals. Hospitals in the top 20 percentile earned 1 or 2 percent bonuses in Medicare payments, while those in the bottom 20 percent were penalized 1 percent to 2 percent.

However, mortality rates were similar regardless of whether hospitals were in the bonus program. The mortality rates for patients who had heart attacks, congestive heart failure or pneumonia, or who underwent coronary-artery bypass surgery dropped slightly in both groups.

But mortality rates aren’t the only goal of the Premier demonstration, according to Premier Senior Vice President Blair Childs.

“The goal of HQID was to determine whether incentives would improve care processes in hospitals and it did do that, there’s no question,” Childs told Kaiser Health News.

Although Jha said the research findings don’t discount the pay-for-performance concept, the study undermines its current structure, which could force health policy experts back to the drawing board, according to Reuters.

“Expectations of improved outcomes for programs modeled after Premier HQID should therefore remain modest,” the authors wrote in the study.

CMS said in a statement, “The Premier demonstration was an effort under the last Administration, separate from the value-based purchasing model that we’re implementing into Medicare’s hospital payment system. Our model for improving quality in hospitals is much more aggressive, covering all hospitals and including both incentives for hospitals that do well on quality metrics, and consequences for hospitals that do not improve,” according to KHN.

In the first year of Medicare’s value-based program, process measures will account for 70 percent of incentives for hospitals, while patient satisfaction makes up 30 percent. In the second year in 2013, Medicare will include mortality rates for heart failure, heart attack and pneumonia too.

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Hospital readmissions not linked to mortality

[preamble]2nd article in the series of Obama care failures – CMS off target – i have an idea – just lower the capitation reimbursements by 15%. In 1 simple adjustment to a %, you will save billions.[backt post]
JAMA study: Hospital ownership structure, teaching status have no effect
February 13, 2013 | By Alicia Caramenico

How well hospitals keep patients alive isn’t associated with how well they do at keeping patients from bouncing back to their facilities, concludes a study in yesterday’s Journal of the American Medical Association.

Researchers looked at Medicare patients who had heart attacks or pneumonia between 2005 and 2008 and found no link between hospital readmission rates and mortality rates.

Moreover, hospital factors, such as ownership structure and teaching status, had little to no effect on the relationship between readmissions and deaths, MedPage Today reported.

The study also indicted hospitals should be tracking both measures of readmissions and mortality to gauge quality.

“I feel we’ve dispelled the notion that your performance in mortality will dictate your performance in readmission,” lead study author Harlan Krumholz of Yale University School of Medicine told Kaiser Health News. “This result says they appear to be measuring different things, they’re not strongly related to each other, and you can clearly do well on both.”

Such findings are important given the Centers for Medicare & Medicaid Services uses both readmission and mortality rates to determine Medicare reimbursements.

But for some healthcare leaders, the study reinforced doubts about using readmissions and mortality rates as CMS quality indicators at all.

“It may be a good way to promote greater accountability for what happens to patients after they leave. But, as a measure of hospital quality, not as much,” Ashish Jha, a professor at the Harvard School of Public Health, told KHN.

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Computerized discharge tool cuts readmissions for heart failure patients

[preamble]NO link between readmission and mortality rates – the harder you look, you can make any numbers work i nyoru favor. The actual issue here that you will see over the next few articles is that all this work is not truly effecting any quality of care. All we here are buzz words – “safety”, “quality”, “satisfaction”, “cost savings” with no real relevance . Its like facebook and twitter – millions and million of people use them and advertisers are scrambling and spending millions on the sites to promote their products BUT the sales are dismal with truly almost zero return on investment” BUt it sounds good![backtopost]
March 11, 2013 | By Susan D. Hall
Hospitals that used a computerized system for discharge of heart failure patients found 30-day readmission rates fell 2.5 percent compared with hospitals that did not use the system, according to research from Intermountain Healthcare. The study also found 10-fold increase in compliance with quality care measures.

In the study, researchers looked at whether the computerized tool made a difference, based on the records of heart failure patients discharged from 11 hospitals across Utah between January 2011 and September 2012, reports Cardiovascular Business.

With the government fining hospitals for their readmission rates, attention has focused on how to best reduce them, including adopting standardized discharge orders. Little is known, however, about how standardized discharge orders affect clinical quality measures, according to an announcement. The research was presented yesterday at the American College of Cardiology’s 62nd Annual Scientific Session in San Francisco.

“The tool was designed by our most skilled cardiovascular practitioners to mirror the workflow of the physician and provide evidence-based decision support for cardiovascular care,” said lead investigator Jose G. Benuzillo, a senior outcomes analyst at Intermountain Healthcare in Salt Lake City. “Use of this tool reduces variation in practice between the most skilled and experienced specialists in cardiovascular care, and more general practitioners who see cardiovascular patients more infrequently.”

The study also tracked adherence to three quality measures for best practices with heart failure patients: providing discharge instructions to patients; appropriate assessment of heart pumping ability; and the prescription of medications or documentation of contraindication.

Benuzillo said the tool also improved communication between physician and patient by providing a clear document outlining instructions and medications.

Though the Centers for Medicare & Medicaid Services has ramped up efforts to reduce readmissions, a recent report from the Robert Wood Johnson Foundation found little progress between 2008 and 2010. Since October 2012, however, Medicare began penalizing hospitals that have higher-than-average rates of heart failure, pneumonia or heart attack readmissions.

A study of readmission rates for Medicare patients between 2005 and 2008, however, found no link between readmission and mortality rates. The authors urged hospitals to be tracking both.

Meanwhile, Marin General and Novato Community hospitals in California have focused on those at highest risk of readmission, with plans to hire nurses as transitional coaches who meet with patients before discharge, and again after they go home to help keep them on track. Glendale, Calif., hospitals also are taking patients’ living situations into account, including whether they’re homeless or foreign-born, which might affect their ability to care for themselves.

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ACO affiliation to lower doc productivity, increase costs Read more: Commentary: ACO affiliation to lower doc productivity, increase costs

[preamble]Exactly as i predicted when i first heard about ACO’s. They are DESIGNED to de-evolve physicians into employees. They get in the way of patient-doctor care. When doctors look at teh “numbers” instead of the patient you will see a decline in satisfaction and quality of care. Already doctors are prescribing “fake” generic drugs with diminished results. When the “doctor” simply becomes generic and nurses are elevated to doctor status because they can read a “smart system” and think they are providing care, when we “push” people to clinics and away from hospitals and real doctors, when the government knows that doctors can save money do you really think they will continue to pay those capitated rates?

Health care is in a decline – spiraling way out of control because doctors  – Obama cannot control individual doctors hence he wants them in a controlled environment – total government control at the expense of health care – when this folly ends.[backtopost]
March 15, 2013 | By
he Affordable Care Act is pushing more physicians out of private practice and into hospital employment in a bid to better regulate doctors, a resident fellow at the conservative American Enterprise Institute contends in a commentary published in today’s Wall Street Journal.

Although the move is intended to lower healthcare costs by funneling patients to hospitals and hospital-owned practices through hospital-owned accountable care organizations, costs instead will rise, writes Scott Gottlieb, M.D. That’s because physician productivity plummets by more than 25 percent when doctors work for hospitals, he writes, citing research by the Medical Group Management Association.

He also cites a recent study by the Medical Group Management Association showing a 75 percent increase in active doctors employed by hospitals since 2000. By next year, Gottlieb says, 50 percent of U.S. physicians will work for a hospital or a hospital-owned health system.

“Once they work for hospitals, physicians change their behavior in two principal ways. Often they see fewer patients and perform fewer timely procedures. Continuity of care also declines, since a physician’s responsibilities end when his shift is over,” Gottlieb writes.

He argues that hospitals aren’t buying doctors’ practices so they can reform healthcare delivery, but to gain market share and develop monopolies. When working for a hospital, Gottlieb says, a physician changes his or her behavior–seeing fewer patients, performing fewer procedures.

Becker’s Hospital Review recently interviewed Randal Dabbs, M.D., about ways to “engage, retain and recruit physicians.” He stressed the importance of having a medical director other physicians can look to as a leader, rather than just a CEO without a clinical background. He cited experience gained through his own Knoxville, Tenn.-based physician management firm TeamHealth.

Constant communication among all levels of staff, compliments and coaching are all important ways to make physicians feel heard and appreciated, Dabbs said. Additionally, he recommended training in risk management, which he said builds confidence in physicians who fear being sued.


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IRS unlawfully seized 60M medical records

[preamble]Of course the IRS is above the laws we all must follow. Think if this was a hospital or doctor – the NY Times would be ripping them apart stating how bad they are and look how careless they are with our personal data. The power of the IRS is already expanding with the Obama care and in tracking if we are paying for health insurance – imagine the power and helplessness we will have once all this truly takes effect next year. Whats next sleep police making sure we all sleep 8 hours a day.  When this folly ends…..[backtopost]
BY Susan D. Hall – Firecehealthit 3/18/2013
An unnamed HIPAA-covered entity in Southern California is suing the U.S. Internal Revenue Service, alleging that agents executing a warrant stole medical records for 10 million Americans. Those affected could include every state judge in California, as well as “prominent citizens in the world of entertainment, business and government, from all walks of life,” according to the complaint.

Fifteen IRS agents executed a search warrant on March 11, 2011, for financial data pertaining to a former employee of the company, however, “it did not authorize any seizure of any healthcare or medical record of any persons, least of all third parties completely unrelated to the matter.”

IT personnel, a HIPAA warning on the building and company executives explained that the records were privileged; however the agents “threatened to ‘rip’ the servers containing the medical data out of the building if IT personnel would not voluntarily hand them over,” Courthouse News Service quotes the complaint. It alleges that the agents made no effort to confine their search to information specified in the warrant, and claims the IRS still has the records.

Plaintiff’s attorney Robert E. Barnes told the news service that he’s still investigating, but had to file the lawsuit now due to statute of limitations issues. He said he will have more information “in a few months.”

The number of records involved–60 million–would include roughly one of every 25 American adults, according to the complaint, including records on psychological counseling, gynecological counseling, sexual/drug treatment and other medical treatment.

The lawsuit seeks $25,000 “per violation per individual” in compensatory damages, as well as punitive damages. It also seeks the return of the data, an injunction to prevent the IRS from sharing the data and the purging of all the information from government databases.

Large-scale healthcare data breaches were on the decline in 2012 as organizations doubled down on privacy and security safeguards, according to IT security audit firm Redspin. Yet stories of lost or stolen laptops remain common, as well as other ways that health information leaks out–such as through unencrypted wireless networks. Google recently agreed to pay a $7 million fine for scooping up personal information while collecting data for its Street View project.

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With e-prescribing, doctors choose cheaper drugs

[preamble]The system doing exactly what it was meant to do – generic, lower cost drugs. Lower cost healthcare will ALWAYS come at a cost to the patient. You can thank the government for this – mediocrity is now the norm. This is only the beginning[backtopost]
By Susan D. Hall
Physicians who have electronic access to their patients’ formularies, including copays, are more likely to prescribe a less-expensive drug for Type 2 diabetes and hypertension, according to a survey from research and advisory firm Decision Resources.

Seventy primary care physicians, 70 endocrinologists, and 25 managed-care organization (MCO) pharmacy directors were polled for the report “E-Prescribing and Electronic Health Records: Impact of Technology on Prescribing for Hypertension and Diabetes.”

“Physicians are now more acutely aware of MCOs’ formularies and are therefore more likely to prescribe more favorably reimbursed drugs as well as better identify undiagnosed patients, sharply impacting their prescribing decisions for diabetes and hypertension therapies,” the report states.

Physicians said they use e-prescribing for 76 percent of their Medicare patients and 79 percent of their non-Medicare patients. Roughly 60 percent of physicians said they have access to their patients’ formularies through their e-prescribing program.

Eighty-four percent of MCO pharmacy directors said that with the information provided in e-prescribing solutions, physicians are prescribing drugs that cost patients less and have fewer restrictions.

The findings pose a challenge to makers of more expensive drugs, but through aggregating data from EHRs, pharmaceutical companies could win docs over with clinical evidence of their drugs’ effectiveness, a company announcement says.

Nearly half of all U.S. physicians are using e-prescribing features in an electronic health record using the Surescripts network, the Office of the National Coordinator for Health IT reported in November. Just seven percent of U.S. physicians used e-prescribing in December 2008.

The Centers for Medicare & Medicaid Services instituted a new set of payment rules for hospitals, physicians and others by adding two hardship exemptions to the electronic prescribing program to recognize potential conflicts between that program and the Meaningful Use incentive program.

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OB/GYN group: Robotic surgery not the best choice for routine hysterectomies

[preamble]Technology for technology sake is not always good. These fancy machines do not guarantee better outcomes. They costs the hospital; a lot of money in maintenance, training, and consumables for minimal benefit. What is missing and needed for better patient outcomes is the art of doctoring. Looking, listening and feeling the patient – good surgeons like good mechanics, “know” their profession and do not rely on fancy machines – the art of doctoring, the elegance of the doctor-patient relationship is the only true cost saving measure. I am a large advocate for technology and these machines do have their place and in time will only get better but a machine is ONLY as good as its operator it does not take the place of a good surgeon.[backtopost]
By Susan D. Hall
Robotic surgery for hysterectomies shouldn’t be the first–or even second–choice for women undergoing routine procedures, the American Congress of Obstetricians and Gynecologists said in a statement.

“Expertise with robotic hysterectomy is limited and varies widely among both hospitals and surgeons. While there may be some advantages to the use of robotics in complex hysterectomies, especially for cancer operations … studies have shown that adding this expensive technology for routine surgical care does not improve patient outcomes. Consequently, there is no good data proving that robotic hysterectomy is even as good as–let alone better than–existing, and far less costly, minimally invasive alternatives,” wrote ACOG President James T. Breeden, M.D.

There’s a learning curve with the system, and patients of surgeons learning it may have more complications, the group added.

The Food and Drug Administration is surveying hospitals on complications, outcomes and dangers with Intuitive’s da Vinci robot. The FDA says it’s conducting the probe in response to an uptick in adverse event reports, including organ damage and device failure, and the agency wants to figure out if they result from user error or design problems with da Vinci, FierceMedicalDevices reported earlier this month.

A spokesperson for Intuitive Surgical, which makes the da Vinci robotic system, told Bloomberg News that “evidence supports that robotic surgery has dramatically decreased the number of open hysterectomies in the U.S.” and that the company’s website “is fully sourced with clinical outcomes data.”

Meanwhile, hospitals have embraced the system for its ability to attract top surgeons and market the technology aggressively. Twenty-five bed Pullman Regional Hospital in Washington, for example, spent $2 million on the system in 2011. The hospital’s CEO told The Seattle Times that was the price to lure a new urologist to practice at the tiny facility.

And Lois Hole Hospital for Women in Edmondton recently launched a campaign to raise $3 million in hopes of becoming the first hospital in Canada that uses the technology exclusively for women’s health, according to CTV News.

In the Bloomberg article, Mario Leitao, a robotic gynecology surgeon at Memorial Sloan-Kettering Cancer Center in New York, called the ACOG statement “misguided,” one that “reflects a lack of desire to move the surgical field forward.”

He expressed similar views in an editorial accompanying a study in the Journal of Clinical Oncology that found  no significant differences in the rate of complication rates for robotic hysterectomies versus laparoscopic hysterectomies.  Rather, the big difference was in price: nearly $1,300 more for the robotic surgery.

Meanwhile, the mainstream media has also come under fire for gushing about the technology, as outlined in a blog post at healthnewsreview.