archive-org.com » ORG » H » HOSPITALIMPACT.ORG

Total: 785

Choose link from "Titles, links and description words view":

Or switch to "Titles and links view".
  • Hospital Impact - The Supreme Court and the ACA contraception mandate: Déjà vu all over again
    notifying their insurers third party administrators or the government Several religious organizations such as Little Sisters of the Poor and the Roman Catholic Archdiocese of Washington D C argue that this makes them complicit in violation of their religious beliefs More Defendants assert that filling out a two page form does not impose a substantial burden Six of the seven appeals court decisions found in favor of the government s policy and threw out the cases however in September the U S Court of Appeals for the 8th Circuit in St Louis Missouri ruled against the government and the Obama administration strongly urged the Supreme Court to take up the seven cases to resolve the issue definitively The issue is complex Whereas churches and purely religious institutions are often made up of individuals who share deeply and commonly held religious beliefs religious based universities healthcare organizations and charities typically attract more diverse individuals whose beliefs may or may not be consistent with those of their employers The legal question at hand is whether the Religious Freedom Restoration Act RFRA entitles religious organizations to not only opt out of contraceptive coverage but to also block the provision of such coverage by the government or third party payers to its employees The RFRA was passed in 1993 and protects the religious rights of individuals and organizations by restricting the government s right through law or regulation to impose upon their religious freedom unless there is a compelling government interest that cannot be achieved through less stringent means The seven cases will probably be consolidated into a single case Zubik Bishop of the Catholic Diocese of Pittsburgh v Burwell Secretary of the Department of Health and Human Services This case pits religious freedom against the freedom to access healthcare services and the rights of employers versus the rights of employees to exercise their personal and religious beliefs Plaintiffs feel that third party payers should offer birth control through other means e g community health centers public clinics whereas defendants feel that it is a moral and ethical right to be able to purchase healthcare services that promote economic security and a sense of well being and autonomy The case will be heard this coming winter spring and should be decided by June It represents another important step toward supporting the rights of an increasingly diverse citizenry to access healthcare services for themselves and their families Jonathan H Burroughs M D is president and CEO of The Burroughs Healthcare Consulting Network He s also a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox Healthcare Industry news Final Obama budget takes aim at opioid addiction superbugs Zika outbreak White House seeks 1 8B to respond to virus More hospitals replace nurseries with rooming

    Original URL path: http://www.hospitalimpact.org/index.php/2015/11/12/p5691 (2016-02-10)
    Open archived version from archive


  • Hospital Impact - ICD-10: Collaborative ways to reduce operating costs
    individual vendors to accomplish the same goal to reinforce training efforts Giving physicians and healthcare practitioners access to electronic references for the other DRGs they are likely to encounter is essential so that they have an immediate 24 7 reference guide to consult from any venue that will support better documentation support II Software support Many vendors have developed ICD 10 software to support clinical documentation Typically clinicians do a good job of documenting the patient s primary condition and a poor job of documenting co morbidities as that was not the reason he or she was admitted thus leaving significant reimbursement on the table With software support clinicians are far more likely to document a more realistic reflection of the true acuity they are managing as opposed to the shorthand version thus improving clinical communication documentation and ultimately how much is paid III CDI personnel support Many vendors provide CDI personnel who can blue note electronic charts and provide onsite consultation For example one health system worked with a vendor to provide five onsite coaches for its clinical staff and increased its case mix index from 1 45 to 2 21 netting millions in additional revenue without seeing an additional patient thus providing a significant ROI for a relatively modest investment IV Scribes It is estimated that by 2020 there will be more than 100 000 scribes working in healthcare organizations throughout the country How does the use of these personnel lower operating costs They do so by decreasing the per unit cost of the service as physician productivity typically increases by 15 percent to 25 percent based upon the study Initially scribes were only used in emergency departments however they are spreading to hospitalist services ICUs and now clinics V Scribes who are clinically trained and certified coders Organizations that invest greater resources into their scribe programs reap significant rewards by supplementing advanced practice nurses and physician assistants training to include coding programs so that they are certified in the same specialty in which they work This gives organizations the opportunity to use lower cost individuals who work with the physicians clinically but who now bring a higher level of clinical documentation expertise to the team to help optimize care documentation and cost Organizations that provide this support for clinical staff enjoy greater physician nursing morale higher productivity and better revenue cycle management performance They use the reality of ICD 10 to unite physicians and management toward the common goals of enhancing care reducing costs and freeing physicians to be the clinical specialists they trained so long to be Jonathan H Burroughs M D is president and CEO of The Burroughs Healthcare Consulting Network He s also a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox

    Original URL path: http://www.hospitalimpact.org/index.php/2015/10/29/icd_10_collaborative_ways_to_reduce_oper (2016-02-10)
    Open archived version from archive

  • Hospital Impact - ICD-10: Collaborative ways to reduce operating costs
    individual vendors to accomplish the same goal to reinforce training efforts Giving physicians and healthcare practitioners access to electronic references for the other DRGs they are likely to encounter is essential so that they have an immediate 24 7 reference guide to consult from any venue that will support better documentation support II Software support Many vendors have developed ICD 10 software to support clinical documentation Typically clinicians do a good job of documenting the patient s primary condition and a poor job of documenting co morbidities as that was not the reason he or she was admitted thus leaving significant reimbursement on the table With software support clinicians are far more likely to document a more realistic reflection of the true acuity they are managing as opposed to the shorthand version thus improving clinical communication documentation and ultimately how much is paid III CDI personnel support Many vendors provide CDI personnel who can blue note electronic charts and provide onsite consultation For example one health system worked with a vendor to provide five onsite coaches for its clinical staff and increased its case mix index from 1 45 to 2 21 netting millions in additional revenue without seeing an additional patient thus providing a significant ROI for a relatively modest investment IV Scribes It is estimated that by 2020 there will be more than 100 000 scribes working in healthcare organizations throughout the country How does the use of these personnel lower operating costs They do so by decreasing the per unit cost of the service as physician productivity typically increases by 15 percent to 25 percent based upon the study Initially scribes were only used in emergency departments however they are spreading to hospitalist services ICUs and now clinics V Scribes who are clinically trained and certified coders Organizations that invest greater resources into their scribe programs reap significant rewards by supplementing advanced practice nurses and physician assistants training to include coding programs so that they are certified in the same specialty in which they work This gives organizations the opportunity to use lower cost individuals who work with the physicians clinically but who now bring a higher level of clinical documentation expertise to the team to help optimize care documentation and cost Organizations that provide this support for clinical staff enjoy greater physician nursing morale higher productivity and better revenue cycle management performance They use the reality of ICD 10 to unite physicians and management toward the common goals of enhancing care reducing costs and freeing physicians to be the clinical specialists they trained so long to be Jonathan H Burroughs M D is president and CEO of The Burroughs Healthcare Consulting Network He s also a certified physician executive and a fellow of the American College of Physician Executives and the American College of Healthcare Executives Leave a comment Please enable JavaScript to view the comments powered by Disqus Enter your search terms Submit search form Web www hospitalimpact org Get Hospital Impact in your inbox

    Original URL path: http://www.hospitalimpact.org/index.php/2015/10/29/p5686 (2016-02-10)
    Open archived version from archive

  • Hospital Impact - Medical overuse and why fee for service must go
    hence why the Leapfrog Group and other corporate coalitions are driving healthcare transformation The average American family s healthcare costs have risen to almost 25 percent of disposable income from out of pocket expenses that have resulted in more than 2 000 000 personal bankruptcies annually making it the leading cause of such filings in our country Wrong incentives wrong care Thirty to 50 percent of what providers do is medically unnecessary and 50 percent of what they should do e g preventive healthcare services has no reimbursement tied to it according to a 2003 New England Journal of Medicine study hence the mismatch between what we spend and what we get The significant opportunity is to change the reimbursement system from pay for volume to pay for value and this is what is causing disruptive innovation such as non physicians ambulatory services retail medicine outlets and e health platforms solutions to provide affordable accessible alternatives to a healthcare system with legacy incentives that are not tied to outcomes What will finally lead to appropriate utilization of healthcare services is a reimbursement system that is aligned with optimizing healthcare outcomes for populations such as quality adjusted life years This requires some form of capitation per member per month incentivized for quality safety service and cost effectiveness Such a reimbursement model requires the following changes in our healthcare system Standardization of best practice high volume low risk care with clinical pathways and algorithms For instance the use of the World Health Organization s Safe Surgery Checklist has led to a decline of surgical morbidity by 45 percent and a decline in surgical mortality by 55 percent according to Atul Gawande s The Checklist Manifesto Widespread use of palliative care and disease management for high cost high risk clinical conditions Many studies have demonstrated that the early implementation of palliative care through multidisciplinary teams reduces costs by more than 30 percent and extends quality adjusted life years significantly Widespread use of post acute care programs that significantly reduce hospital readmissions emergency department visits and physician office visits Such programs such as one employed by St Luke s Healthcare System Boise Idaho have decreased readmission rates by up to 85 percent and reduced ED visits by up to 65 percent Clinical Business predictive analytics that enable early interventions for those individuals most likely to require high risk high cost healthcare services Many large corporate healthcare plans and large healthcare systems such as the Mayo Clinic use this technology to benefit both beneficiaries and system alike These innovations will enable healthcare organizations and aligned physicians to benefit from high quality low cost clinical outcomes in a capitated environment while these initiatives would be self defeating in fee for service or even a shared savings bundled payment program Fee for service must go and be replaced by some form of incentivized capitation so that we can eliminate the overutilization of non value added healthcare services and replace them with value added preventive healthcare services that

    Original URL path: http://www.hospitalimpact.org/index.php/2015/09/03/medical_overuse_and_why_fee_for_service (2016-02-10)
    Open archived version from archive

  • Hospital Impact - Medical overuse and why fee for service must go
    hence why the Leapfrog Group and other corporate coalitions are driving healthcare transformation The average American family s healthcare costs have risen to almost 25 percent of disposable income from out of pocket expenses that have resulted in more than 2 000 000 personal bankruptcies annually making it the leading cause of such filings in our country Wrong incentives wrong care Thirty to 50 percent of what providers do is medically unnecessary and 50 percent of what they should do e g preventive healthcare services has no reimbursement tied to it according to a 2003 New England Journal of Medicine study hence the mismatch between what we spend and what we get The significant opportunity is to change the reimbursement system from pay for volume to pay for value and this is what is causing disruptive innovation such as non physicians ambulatory services retail medicine outlets and e health platforms solutions to provide affordable accessible alternatives to a healthcare system with legacy incentives that are not tied to outcomes What will finally lead to appropriate utilization of healthcare services is a reimbursement system that is aligned with optimizing healthcare outcomes for populations such as quality adjusted life years This requires some form of capitation per member per month incentivized for quality safety service and cost effectiveness Such a reimbursement model requires the following changes in our healthcare system Standardization of best practice high volume low risk care with clinical pathways and algorithms For instance the use of the World Health Organization s Safe Surgery Checklist has led to a decline of surgical morbidity by 45 percent and a decline in surgical mortality by 55 percent according to Atul Gawande s The Checklist Manifesto Widespread use of palliative care and disease management for high cost high risk clinical conditions Many studies have demonstrated that the early implementation of palliative care through multidisciplinary teams reduces costs by more than 30 percent and extends quality adjusted life years significantly Widespread use of post acute care programs that significantly reduce hospital readmissions emergency department visits and physician office visits Such programs such as one employed by St Luke s Healthcare System Boise Idaho have decreased readmission rates by up to 85 percent and reduced ED visits by up to 65 percent Clinical Business predictive analytics that enable early interventions for those individuals most likely to require high risk high cost healthcare services Many large corporate healthcare plans and large healthcare systems such as the Mayo Clinic use this technology to benefit both beneficiaries and system alike These innovations will enable healthcare organizations and aligned physicians to benefit from high quality low cost clinical outcomes in a capitated environment while these initiatives would be self defeating in fee for service or even a shared savings bundled payment program Fee for service must go and be replaced by some form of incentivized capitation so that we can eliminate the overutilization of non value added healthcare services and replace them with value added preventive healthcare services that

    Original URL path: http://www.hospitalimpact.org/index.php/2015/09/03/p5661 (2016-02-10)
    Open archived version from archive

  • Hospital Impact
    challenges of our healthcare profession is to measure actual costs in real time All payers e g the Centers for Medicare Medicaid Services employers consumers patients etc are willing to pay for healthcare services based upon our real costs with a reasonable margin however our inability or now unwillingness to do so is leading to reference based pricing by payers and a take it or leave it approach that is frustrating for everyone concerned A better approach is to embrace the tools and techniques available to look at real direct indirect fixed variable costs in real time so that not only can we see what they are but so we can manage and contract for them in a more transparent and dynamic way Cost accounting has come a long way from the rudiments of capacity determination costs calculated based upon the percent utilization of a cost center to direct costs costs associated with a specific service or production to activity based costing ABC that accounts for indirect costs costs allocated to all services productions such as administration utilities overhead etc to time driven activity based costing that takes into account direct indirect costs over the continuum of a service or production This concept was introduced in the November 2004 issue of the Harvard Business Review and updated for healthcare in the November December 2014 edition of the Journal of Healthcare Management by none other than Robert S Kaplan and Steven R Anderson who introduced the concept of ABC decades earlier Read more Leave a comment Strategies to survive a brave new value based world April 1st 2015 by Jonathan H Burroughs Population health is not possible in a discounted fee for service world and the significant healthcare business challenge is how to transition from fee for service to risk based capitation in a sustainable way The following represents an outline for how this transition can be staged so that early steps exploit the benefits of fee for service while the latter ones exploit a more capitated model 1 Engage and align with all key stakeholders The foundation for any integrated healthcare network is aligned stakeholders whether they be physicians nursing homes skilled nursing facilities long term care facilities or home health agencies Everyone must have a stake in both healthcare outcomes and cost efficiencies and this can only occur with risk based contracts in which all parties have significant commitment to mutually beneficial goals and objectives At risk contracts should be compatible with payer contracts patient needs and provider management objectives Read more Leave a comment Are you ready for the e health invasion February 19th 2015 by Jonathan H Burroughs Disruptive innovation may be described as the introduction of a new technology or paradigm that while not as good as the original provides easier lower cost accessibility to services that many cannot or will not obtain due to economic or other restraints Think of the hotel industry The Marriott Corporation has different brands that provide a hotel experience to

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=2 (2016-02-10)
    Open archived version from archive

  • Hospital Impact - Patient experience vs. patient care: Healthcare isn't Disney World
    H and his work at Vanderbilt University Medical Center to learn more And I am so glad I did In the piece Undone in the ICU by Kathy Whitney Dr Ely highlights a specific disconnect between patient experience and care in a very vivid and profound way If a patient comes into the ICU and is dramatically sick he is put on a ventilator The old way of thinking was You are so sick we don t want you to remember any of this We are going to sedate you with drugs tie you down protect you from yourself and when we think you re better we ll wake you up in six or seven days In the meantime the patient has now acquired brain disease and body disease his muscles brain and nerves are all screwed up and it s not just because of the disease he came in with We created more of a disease for him by immobilizing him with both chemical and physical restraints We actually poured kerosene on the fire and made things worse This is an example of a good intention and yet both poor execution and bad outcome The good intention is the goal of we don t want you to remember any of this patient experience The poor execution includes the lack of engaging the patient and family to ensure their preferences were made known and honored And the bad outcome is the ICU delirium experienced by the patients the harm to families watching their family member restrained and the damage to the muscles and nerves all due to the sedation and physical restraints Improved patient experience That was a goal And if the patient was truly sedated and unaware perhaps even achieved but only in the short term And yet the care was not optimal and true harm was done Improved patient experience must not be the end goal Improved health CARE healthCARING must be And to achieve that We must develop authentic relationships and trust with patients and families We must engage with them We must hear their whole stories We must understand their preferences We must develop implement and measure the impact of evidence based protocols such as the delirium protocol referenced below that serve to achieve optimal CARE outcomes And we must not lose focus on care as we seek to improve experience Thank you Doug for sharing as always such engaging and informative information Thank you Dr Blackwelder for sharing such great wisdom Thank you Roberta for educating me on ICU delirium and directing me to the work of Dr Ely And thank you Dr Ely and your team at Vanderbilt for all your efforts to improve the care for ICU patients There are brilliant flames within the broken healthcare system that we need to fan so that they do not go out And this is a wonderful example Now let s all set our aim on healthCARING and ensure we support one another to stay the

    Original URL path: http://www.hospitalimpact.org/index.php/2015/12/10/title_147 (2016-02-10)
    Open archived version from archive

  • Hospital Impact
    touch e g handshake hug or pat on the back Communicating friendliness warmth and respect See Best relationship practices for patient centered care Sitting down to speak with the patient Engaging in active listening asking open ended and or pointed questions Establishing rapport Empathizing Read more Leave a comment Enhance patient experience with volunteers April 3rd 2014 by Doug Della Pietra Patient experience is among the top three hospital priorities today Caregiver engagement is one of the most essential strategies for improving the patient experience Within caregivers volunteers represent a large population we should not forget but rather leverage to deliver better experiences Next week April 6 12 the United States celebrates National Volunteer Week s 40th anniversary Since the 1980s most evidence based studies on healthcare volunteers focused on the financial and productivity implications to healthcare organizations Specifically two recent studies link healthcare volunteerism to organizational performance patient satisfaction and the overall experience of patients and their families In honor of the generous contribution and dedication that volunteers bring to healthcare I d like to shine a light on the human touch that volunteers offer patients and families Read more Leave a comment Embed patient experience advisors hospital wide January 29th 2014 by Doug Della Pietra There s a genuine sense that we re all in this together We are being heard and acknowledged We are valued around the table Whether staff or patients or family members we all want improved outcomes and that s only possible when caregivers and patients and their families are in partnership and work together Those are just two testimonials from patient experience advisors on Kingston General Hospital s Patient and Family Advisory Council PFAC that four of us three patient family advisors and I heard when we traveled to Kingston Ontario a couple of weeks ago For starters KGH s mission is compelling and clear Outstanding Care Always The hospital s strategy is explicit in its commitment to transform the patient s experience through a relentless focus on quality safety and service Moreover KGH has developed a simple and memorable definition for patient and family centered care Respect Me Hear Me Work With Me Read more Leave a comment Think just like me to improve patient experience January 6th 2014 by Doug Della Pietra Since we are human beings taking care of human beings perceiving others as just like me affects caregiver empathy and shapes patient perceptions and overall experience When I attended the Search Inside Yourself workshop led by Google s Chade Meng Tan in September I learned many science based attention training and mindfulness tools for increasing emotional intelligence and sustaining peak performance One of those was a combination of the just like me mindfulness practice and a variation of the loving kindness meditation LKM practice which aims to explicitly cultivate positive feelings generating an emotional state that is full of unconditional love compassion and empathy toward the self and others Salzberg 1995 1 Growing evidence 2 demonstrates the positive effects

    Original URL path: http://www.hospitalimpact.org/index.php?s=Doug+Della+Pietra&sentence=AND&submit=Search (2016-02-10)
    Open archived version from archive



  •