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  • Hospital Impact
    matter entirely to attempt to navigate the healthcare system and experience the lack or at least perceived lack of care coordination first hand My family s tale began earlier this month when a relative who falls in one of Medicare s most vulnerable populations needed emergency surgery After six hours of tests and consultations in a local hospital emergency room he was transported by ambulance to a facility further away that had the resources and critical care team better equipped to handle the operation The ER doctor who first examined him wasn t sure he d survive the surgery and we all prayed for a positive outcome The situation was especially frightening for our loved one who is mentally challenged has a limited vocabulary and often uses sign language to communicate But he couldn t use his hands as they were put in restraints so he wouldn t pull out the tubes to his IV Although the ER medical team initially resisted they eventually understood why he needed a familiar caregiver to stay with him constantly to provide him with reassurance Read the full commentary at FierceHealthcare Leave a comment Disruptive and dangerous behavior caught on tape Time to finally stop misbehaving docs July 9th 2015 by Ilene MacDonald In all the furor leading up to the Supreme Court s ruling to uphold federal subsidies you may have missed a story in FierceHealthcare late last month about a lawsuit involving an anesthesiologist s shocking behavior in the operating room Shocking because the tirade which was accidentally caught on tape featured an outrageous and frankly disgusting exchange between Tiffany Ingham M D and her surgical team in which she called the unconscious patient a retard and a wimp and also speculated that he was gay due to his alma mater the University of Mary Washington a former women s college The patient an unnamed Virginia man didn t intend to record the conversation He had hoped to capture the doctor s post discharge instruction via a cellphone recording but accidentally taped the entire examination because his clothing was put under the operating table Imagine his surprise when he fully awoke from his stupor to hear the physician and surgical team he entrusted would care for him instead insult him express a desire to punch him in the face and deliberately misdiagnose him The incident is appalling on so many levels but the idea that a provider would falsify medical reports and the patient safety risks that are inherent in this kind of disruptive and distracted behavior are especially so Why does the industry put up with it Last year FierceHealthcare reported that many hospitals don t do anything about the problem because troublesome physicians often generate a lot of revenue Read the full commentary at FierceHealthcare Leave a comment Surgical never events How to stop these preventable medical errors once and for all June 18th 2015 by Ilene MacDonald As a longtime healthcare reporter I am shocked every time I read

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=ilene%20macdonald&page=1&disp=posts&paged=2 (2016-02-10)
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  • Hospital Impact - Medicare Physician Fee Schedule Final Rule: A must-read for hospital leaders
    increase in the conversion rate for 2016 One would logically assume the 2016 conversion rate would be 37 7302 and therefore the payment for a code with 1 5 RVUs would be 56 60 in 2016 Here is where it gets complicated according to Ross The Protecting Access to Medicare Act of 2014 sets a target for adjustments to misvalued codes equal to 0 5 percent of estimated Medicare Physician Fee Schedule expenditures each year Congress also passed the Achieving a Better Life Experience Act of 2014 which increased the above target to 1 0 percent for 2016 Because of the above laws the 2016 conversion factor must be reduced by 0 77 percent and the RVU budget neutrality rule requires an additional reduction of 0 02 percent All of these overlapping laws mean that the 2016 conversion factor will be 35 8279 which is about 0 29 percent less than the 2015 conversion factor Whether one can follow the complicated mathematical manipulations or not the bottom line is that payments under the Medicare Physician Fee Schedule will be 0 29 percent less than 2015 payments And we thought we were getting a raise There is a lot of other important information in the 2016 Medicare Physician Fee Schedule Final Rule and I urge all hospital leaders to read the entire document One cannot plan for the future if one does not understand how policies are changing the rules of physician reimbursement Kent Bottles M D is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics 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

    Original URL path: http://www.hospitalimpact.org/index.php/2015/11/19/medicare_physician_fee_schedule_final_ru (2016-02-10)
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  • Hospital Impact - Behavioral economics provides clues for how to engage physicians
    basic understanding of this relatively new social science field include Thinking Fast and Slow by Nobel prize winner Daniel Kahneman Predictably Irrational by Dan Ariely Nudge by Richard Thaler and Cass Sunstein The use of behavioral economic theory to get physicians to change behaviors to respond to the evolving healthcare delivery system is in its infancy A recent article in the New England Journal of Medicine offered advice on how to change physician compensation by using knowledge of the heuristics described in the above three books Massachusetts General Hospital recognized that the loss aversion heuristic holds that losses have twice the psychological impact of commensurate gains By using a strategy of up front incentive payments the hospital was able to improve hand hygiene increase electronic prescribing and reduce emergency department visits Recognizing that decisions are influenced by context and reference point the authors conclude the utility gained from 10 payments of 100 each is greater than that from a single 1 000 payment because we reset our point of reference after each payment A recent Health Affairs blog post offered several other suggestions on how to apply behavioral economics insights into physician incentive programs By understanding the power of the social comparison heuristic Pennsylvania found that peer comparative reports were four times more effective than profit incentives in improving mortality rates by cardiac surgeons performing coronary artery bypass procedures The mental accounting heuristic teaches that people treat money differently depending on how when and where it comes from Advocate Healthcare found that mailing performance based bonus checks to physician homes or handing them out in front of peers was more effective in changing behaviors than including the bonus in the regular paycheck These four examples barely scratch the surface of applying behavioral economic insights to the problem of engaging and incentivizing physicians By my informal analysis of the above three books I have identified more than 50 heuristics and cognitive biases that human beings employ when they make decisions Some that seem especially relevant to changing behaviors by physicians include the anchoring availability cheerleading framing negativity and Semmelweis biases Applying these insights may help us to better engage physicians to practice medicine in a way compatible with the transformed clinical delivery system It may also help explain why sometimes physician report cards and pay for performance incentive programs produce unwanted and unanticipated results Kent Bottles M D is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics 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 in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St Louis hospital creates unit to improve outcomes through innovation 4 ways

    Original URL path: http://www.hospitalimpact.org/index.php/2015/09/24/title_139 (2016-02-10)
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  • Hospital Impact - How to walk the extra mile for population health management
    to healthy low cost food options I try to walk for 90 minutes every day because I enjoy it and it helps me maintain an optimistic attitude in a world I often find depressing and hard to understand A useful review titled The Benefits of Regular Walking for Health Well Being and the Environment describes the benefits of walking on physical and mental health the barriers that prevent us from walking how environments can be designed to support walking and case studies of unique successful programs The personal and environmental barriers to regular walking include Health problems Lack of time Lack of family support Unsafe fear of crime high speed traffic etc Lack of attractive places to walk Too many steps Few places to sit Weather Case studies provide concrete examples of how communities have addressed these challenges to create successful walking programs In Auckland New Zealand a walking school bus program has been popular with students who assemble at the same time and place every day to walk as a group to school In Hillcrest Heights Maryland 450 senior citizens have been meeting three times a week to walk at the Iverson Mall and this group has also participated in many charity walking events Ted Eytan M D is another physician who is passionate about the benefits of walking He recently described how the Kaiser Permanente Center for Total Health in the District of Columbia brought together real estate developers architects health system facilities mangers green belt experts community activists and doctors to explore how to create urban environments that support walking Hospital leaders and physician executives who truly want to make their community healthier should emulate Preston Maring M D who introduced the Friday Fresh Farmers Market at Kaiser Permanente Oakland Medical Center in May 2003 since then it has grown to include a system that supplies locally grown fruits and vegetables for 23 Kaiser hospital kitchens as well as the weekly farmers markets Philabundance a charity food program created the nation s first nonprofit grocery store Fare Square to address the food desert problem in Chester Pennsylvania Hospital and medical leaders need to co create unique population health solutions by interacting with a cast of community players rarely included in hospital planning retreats An incomplete list would include police departments schools transportation agencies urban planners real estate developers architects economic development agencies religious groups gyms malls restaurants farmers food distributors and community activists Population health management needs to be much more than merely planning for how to identify and stratify patients so that integrated delivery systems can do well when assuming risk contracts Kent Bottles M D is a lecturer at the Thomas Jefferson University School of Population Health and chief medical officer of PYA Analytics 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

    Original URL path: http://www.hospitalimpact.org/index.php/2015/02/11/walking_the_extra_mile_in_population_hea (2016-02-10)
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  • Hospital Impact
    should look like in the United States we will continue to stumble around in confusion Two recent back to back New England Journal of Medicine perspective articles provide insight into the growing tension between practicing physicians and policy experts In early 2014 the American Board of Internal Medicine ABIM started differentiating between physicians who are certified meeting maintenance of certification MOC requirements and those who are certified not meeting MOC requirements MOC programs include assessments every two years of medical knowledge practice processes and patient safety projects as well as successful completion of an examination every 10 years Read more Leave a comment Look past uncertainty surrounding ACA to improve healthcare December 11th 2014 by Kent Bottles Let go of certainty The opposite isn t uncertainty It s openness curiosity and a willingness to embrace paradox rather than choose up sides Tony Schwartz The Energy Company The quest for certainty blocks the search for meaning Uncertainty is the very condition to impel man to unfold his powers Erich Fromm As we head toward the New Year it s hard not to be confounded and confused about the Affordable Care Act ACA Viewed through one prism the law seems to be in terrible shape Read more Leave a comment What the Philadelphia Eagles can teach hospitals about culture November 6th 2014 by Kent Bottles Culture eats strategy for lunch Peter Drucker Culture wins football Culture will beat scheme every day Chip Kelly Physician executives trying to respond to healthcare reform are bombarded by conferences and experts imploring them to change their organization s culture What is culture What culture worked best in the old fee for service healthcare environment and what changes should hospitals implement in the new value based payment world Edgar Schein of MIT defined organizational culture as a product of joint learning that is a pattern of shared basic assumptions learned by a group as it solves its problems of external adaptation and internal integration He goes on to expand our modern understanding about corporate culture by distinguishing three levels Observable artifacts values and basic underlying assumptions Read more Leave a comment How the ACA forces payers to reinvent their business models October 2nd 2014 by Kent Bottles The implementation of the Affordable Care Act ACA with its payment reform components that champion the transition from fee for service to global value based payments continues to stir up the healthcare insurance industry Insurers recognizing that the ACA outlaws traditional industry practices attempt to reinvent their business models Three recent news articles highlight the difficulty of this reinvention process Emphasizing the national nature of this challenge two of the developments came out of the Pittsburgh region and one out of Los Angeles The bitter battle between the University of Pittsburgh Medical Center UPMC and Highmark has captured the attention of health policy analysts from all over the country Both organizations have their own insurance products and the decision by Highmark to create a competing health system Allegheny Health Network

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=kent%20bottles&page=1&disp=posts&paged=2 (2016-02-10)
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  • Hospital Impact - Partnerships help Humana reap better 'Return on Health'
    we need to design healthcare differently Through businesses like Humana at Home and partnerships with organizations like the American Diabetes Association and Omada Health we re learning a lot about highly personalized care and it s brought us a lot of insights We re turning those insights into action and we re starting to see how new services can be integrated and aligned to fundamentally change the individual healthcare experience We ve developed three foundational elements to keep us on track Trust Trust is critical in a healthcare system that works for everyone We know that building trust especially where little has existed is a two way street and that it takes time And we are painfully aware that health insurance companies have been among the least trusted organizations in the system With a focus on individuals having the best experience and health outcomes possible we are becoming a company focused on partnerships with all players in the system doctors caregivers scientists technologists and the friendly interface for people the ultimate consumers of health services By listening to our members through thousands of hours of conversations we are bringing their views inside learning about their needs and barriers to well being and seeing how they want healthcare to fit into their lives Personalization Why don t we have health solutions teed up just before people need them How can we understand that a person is about to make poor health decisions and have the system primed to step in and help We believe it s possible with shared trust and great data to make healthcare personal and holistic immediate and adaptive and very easy to access For example we have a partnership with Omada Health which helps people engage digitally in diabetes management programs Omada s Prevent program provides personalized evidence based behavioral interventions for those at risk for diabetes and other chronic conditions It integrates information provided by participants with daily biometrics in a technology enabled program designed to help people reduce body weight by 5 to 7 percent Early pilot results with our Medicare Advantage members are yielding encouraging results with 85 percent of participants active at the six month mark and an average weight loss of 8 7 percent after six months for Prevent graduates dramatically reducing their risk of progression to diabetes Community As one of our members put it Why can t I build a relationship with providers and caregivers when I m well so they can be fully there for me when I m ill Research shows that keeping people in familiar settings and structures within their communities and near family friends when possible is important to their well being It is also cost effective Today our Humana at Home team composed of nearly 20 000 care managers nurse practitioners home health aides and other professionals makes it possible for nearly one million chronically ill and disabled people to live safely at home even when faced with medical or functional challenges People who received

    Original URL path: http://www.hospitalimpact.org/index.php/2015/12/17/title_148 (2016-02-10)
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  • Hospital Impact
    other factors germane to medical innovation They must be savvy creative and patient to perform the tedious research required to determine if a new product is viable They must take pains to identify the best targets for adoption of a new technology and then provide them with a compelling medical and financial value proposition Read more Leave a comment Healthcare IT and the lack of security hygiene December 3rd 2015 by Aaron Miri We ve all been there It s a bright and muggy day and you ve been outside playing kickball with your elementary school friends Suddenly you notice something particularly pungent so you turn to your buddy and let them know hey man you stink The healthcare IT sector unfortunately has a distinctively unsavory practice of security hygiene and it s time that we act swiftly and decisively toward dealing with the issue that s fowling up the industry After many years of leading multiple IT organizations I have seen more examples of poor IT security hygiene than I could care to recount I have been the unfortunate recipient of multiple brand new direct from the factory medicine dispensing cabinets that once connected to my network came with the joyful early Christmas present of the Gimmiv A Server Service Vulnerability Trojan Surprisingly the medicine dispensing cabinets ran on top of an antiquated operating system that had long been out of support There are numerous other security hygiene mistakes that people also invariably make when using technology such as an employee trying to plug in a USB stick that they happened to find in the parking lot and other cringe worthy activities Read the full commentary at FierceHealthIT Leave a comment The real outcomes of patient experience excellence in healthcare December 3rd 2015 by Jason A Wolf For those who have followed my thoughts over the last few years you may not be surprised to hear me suggest that patient experience matters in healthcare today It matters for those we care for and serve and it matters to all those working each and every day to provide the best in care at all touch points across the healthcare continuum I also maintain that we need to change our mindset about patient experience itself I believe when we address the topic of patient experience we are talking about something much broader than the experience of care as identified in the triple aim I suggest the idea of experience reflects our biggest opportunity in healthcare where experience encompasses quality safety and service moments is impacted by cost and the implications of accessibility and affordability is influenced by the health of our communities and populations and by both private the public health decisions that have systemic implications I also believe it is reflective of what we found in our research at The Beryl Institute on the state of patient experience itself that the drivers of experience excellence are grounded not just in process excellence but also in the very fibers that comprise

    Original URL path: http://www.hospitalimpact.org/?blog=1&page=1&disp=posts&paged=6 (2016-02-10)
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  • Hospital Impact - 3 factors for an optimal healing environment
    Do you use visuals Did you ever move into a condo or home with a friend or loved one and start drawing what it can be That s creating the vision As a person who has lived in his fair share of apartments condos and homes Jenny my spouse creates that vision each time Then our family members become more engaged to share how we can get there and what factors contribute to making this a reality Put your vision on paper and show it 1 Physical space Make intentional changes to reflect the environment you want to represent For our campus we are designing an integrated wellness and therapy garden for patients our community and educational purposes We will enhance the healing garden outside our Women s Care Birthing suites facility A heart healthy pond trail will include exercise stations a shaded tree line and shades over the stations Inside we are making renovations over time and painting daily to keep the place looking better You do not need a lot of money although it would help to make things happen even faster Don t forget to consider ways to involve the community in your efforts 2 Programs Look at how you integrate the medical social and behavioral Define what clinical and non clinical programs you provide and which ones you need to provide to better serve your defined community This could include your open heart program and your walking trails Show how you are transforming the existing traditional model towards a future care model 3 Leadership Be proud of what you and your leadership stand for and represent Too many leaders waffle over this Ask yourself whether your healthcare organization serves as a role model for health Should it Do your products from medical services to the food to the physical environment to the people represent a healthy community Should they If so then talk about what you expect and represent as a leadership team and organization Trust me I get my fair share of heat over healthier choices in our cafeteria and enhanced physical environment The same holds true for pushing all areas to reach for exceptional and that is not easy In fact it can be exhausting But you cannot go at it alone We are all part of a team sport so we need to help each other when one gets tired and support our tireless crusade to be exceptional Scott Kashman serves as the Chief Administrative Officer of Cape Coral Hospital part of the Lee Memorial Health System in southwest Florida 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 in with moms Hospitals must train millennial nurse leaders in empathy frontline engagement St

    Original URL path: http://www.hospitalimpact.org/index.php/2013/10/15/3_factors_to_create_an_exceptional_heali (2016-02-10)
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