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  • Hospital Impact - Reducing readmissions: It's harder than it looks
    for management to invest in a disease management infrastructure Equally important is to incentivize healthcare organizations to keep patients healthy and not merely to provide disease related services The current DRG reimbursement methodology rewards organizations that take care of a higher number of patients with defined conditions and provides little incentive for the organization to continue its care of patients following discharge where it can have the greatest impact on potential long term outcomes and readmissions There are few financial incentives for management to investment in a robust disease management program once the patient is discharged to assure patients receive good follow up care good handoffs to community practitioners or good home based care and teaching all of which are key preventive tactics for readmissions The reimbursement system should provide capitated incentives to keep the patient healthy post discharge and for the healthcare organization to spend the same care and resources on ambulatory as it does on inpatient care 3 Implement rigorous disease management for high risk populations According to CMS 5 percent of Medicare beneficiaries make up 35 percent of its costs and the rate of readmissions is 50 percent higher for uninsured and Medicaid patients than for privately insured individuals Thus to make a significant dent in readmissions healthcare organizations will need to identify the small percent of our population that take up a disproportionate share of healthcare costs This requires a more intensified disease management program for individuals with significant chronic disease e g chronic obstructive pulmonary disease congestive heart failure diabetes etc that is disease specific and focused on keeping selected individuals with specific co morbidities as healthy as possible An investment in these individuals will significantly reduce the cost of care 4 Horizontally integrate case and risk management beyond the hospital s walls For healthcare organizations to properly care for individuals post discharge they may need to invest in community based infrastructure that includes home healthcare services nursing homes free clinics and patient registers with case management so that these services are reliably available upon discharge Too often these resources have finite capacity or are simply not available and the patient must fend for him or herself with little support Just as hospitals used to fund and build nursing schools to provide a steady influx of qualified nursing graduates today they must build a community infrastructure to be horizontally integrated to provide evidence based preventive services throughout the continuum of care 5 Utilize evidence based pathways both in and out of the hospital The National Quality Forum the Institute for Healthcare Improvement and the Agency for Healthcare Research and Quality all have demonstrated that applying evidence based approaches to commonly occurring conditions reduces the cost and optimizes the quality of care Today there is little resistance to utilizing these practices on hospitalized patients however clinical pathways still are not consistently used in the ambulatory setting where it is more difficult to track and monitor patients Current reimbursement methodologies encourage comprehensive case management in a hospital

    Original URL path: http://www.hospitalimpact.org/index.php/2012/09/13/reducing_readmissions_it_s_harder_than_i (2016-02-10)
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  • Hospital Impact - More of what health reform doesn't do
    have by borrowing from the Medicare and Social Security trust funds the largest line items in the federal budget and then endorsing the federal budget to reflect that the money was never spent Based on this Medicare will need to be reformed so that it has sufficient funds to provide for the elderly who are unemployed and don t receive healthcare coverage elsewhere and demand prudent fiscal oversight and management by Congress 5 Enable patients to become true partners in their care We give a great deal of lip service to patients partnering with physicians and healthcare organizations without much meaningful accountability For instance in an accountable care organization ACO model if a patient is non compliant with medical advice choses to smoke or engage in self destruction behaviors the ACO will be held accountable by Medicare and receive less reimbursement whereas the patient has no economic skin in the game If patients are going to be true healthcare partners they should have the same rights and responsibilities as their providers to make good healthcare decisions that improve their outcomes and reduce the costs for everyone Treating the patient as a passive participant does little to promote optimum care and is a vital missing link to creating affordable care for all 6 Create a medical jurisprudence system W Edwards Deming noted that due to the complexity of our healthcare system most errors come from systemic and not individual actions Unfortunately our tort system of individual liability is based upon a 17th century British system that is becoming increasingly irrelevant and both drives up healthcare costs through approximately 300 billion in defensive testing and has no impact on reducing errors or improving outcomes Many thoughtful pundits advise creating a medical jurisprudence system that focuses on providing no fault coverage to protect patients who are the inadvertent victims of a less than optimum outcome when evidence based practices are followed balancing individual and systemic accountability enhancing processes that enable fewer medical errors improvement opportunities individual and system elimination of punitive actions in all but egregious cases All of these measures will be challenging due to years of vested interests to maintain the status quo the polarization of our two party political system and the lack of a perceived burning platform to do what every other industrialized nation has already accomplished to reduce costs and improve outcomes Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive and a fellow of the American College of Physician Executives He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation s top healthcare consulting organizations to provide best practice solutions and training to healthcare organizations 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

    Original URL path: http://www.hospitalimpact.org/index.php/2012/07/31/what_the_affordable_care_act_doesn_t_do (2016-02-10)
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  • Hospital Impact - What the Affordable Care Act doesn't do
    artery bypass graft surgery and not pay for smoking cessation when smoking is the number one risk factor for coronary artery disease Keeping people healthy makes good clinical sense and will save us a lot of money as well 2 Create a rational and humane way to ration healthcare No healthcare system has the infinite resources necessary to provide all of the care that people want However we can prioritize healthcare needs based upon medical necessity studies and economic analysis so that everyone has access to the care they need and that will provide the greatest benefit Some states such as Oregon have done just that and provide Medicaid beneficiaries with cost efficient care based upon the rank ordering of diagnosis related groups DRGs with regard to cost effectiveness studies and the state s Medicaid budget for that year Many people baulk at the idea of rationing However we already ration care economically by denying individuals access to essential healthcare services based upon inability or lack of willingness to pay thus driving up the cost of care for everyone Rationing care so that it provides the greatest good for the greatest number with the least expense makes far more sense If individuals are not satisfied with the amount of healthcare provided through the public sector they are always free to supplement their coverage through the private sector 3 Reform our reimbursement system Our current reimbursement system is uniquely political based upon return on investment and not return on outcome How this works is that once a company has produced a healthcare product e g cardiac pacemakers manufactured by Medtronic it will lobby it congress representatives for favorable reimbursement through the Medicare Payment Advisory Commission MedPAC Favorable reimbursement means that physicians will be incentivized to put in more pacemakers and Medtronic will receive a good return on investment ROI for its stockholders and investors Unfortunately this system affectionately known as the medical industrial complex does not reward physicians or healthcare organizations that keep patients well provide excellent service except through HCAHPS scores adhere to evidence based quality standards or help patients avoid medically unnecessary testing or procedures Obviously this has to change if we are going to incentivize physicians and organizations to do the right thing for patients and to optimize their outcomes and their perceptions of their care Look for part 2 of the post in the Aug 2 newsletter Jonathan H Burroughs MD MBA FACHE FACPE is a certified physician executive and a fellow of the American College of Physician Executives He is president and CEO of The Burroughs Healthcare Consulting Network and works with some of the nation s top healthcare consulting organizations to provide best practice solutions and training to healthcare organizations 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

    Original URL path: http://www.hospitalimpact.org/index.php/2012/07/26/what_the_affordable_care_act_did_not_do (2016-02-10)
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  • Hospital Impact
    but we have a way to go Thus as a follow up I would like to move from past to present and share two best practices that some healthcare organizations have begun to implement and perhaps you would be willing to share some of your own Read more Leave a comment Have physician nurse relationships improved April 11th 2012 by Jonathan H Burroughs My daughter Serena will graduate from Oregon Health Science University School of Nursing in September and I wonder if things will be different for her than for the nurses I worked with more than thirty years ago when I entered the healthcare industry When I was a new emergency department medical director at Valley Regional Hospital in Claremont N H I was running a code and asked for epinephrine and atropine we used atropine in those days and the new nurse told me she didn t know what those were or where they were kept In my most caustic and superior tone I told her so that everyone could hear If you don t know what epinephrine and atropine are you should not be here please send me a nurse who knows what s he is doing She left the unit in tears and we completed the code without her Read more Leave a comment Previous Page 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 hospitals can foster family centered care Pediatric ER seeks

    Original URL path: http://www.hospitalimpact.org/index.php?blog=1&s=Jonathan%20Burroughs&page=1&disp=posts&paged=9 (2016-02-10)
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  • hospital impact - Innovative thinking in healthcare
    steps staff members used to walk to expensive medical procedures for a loss If that weren t enough they have partnered with gasp payers as well as local employers Yes Virginia Mason is losing money by eliminating more expensive procedures but amazingly Aetna has agreed to pay them more for less expensive procedures Even though the hospital is getting the smaller slice of the pie this seems to be a rare example in which incentives are more aligned And maybe this provides long term benefits that we ve yet to identify better reimbursement for a whole slew of activities e g diabetes education patient education prevention screening that could really make a tangible impact on an entire community Add on top of that these new insurance plans that financially reward healthy living and we could be on our way to a drastically different health culture The risk of death typically won t change our lifestyle but maybe 2 000 will 9 comments 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 hospitals can foster family centered care Pediatric ER seeks to limit stressors for autistic patients Nurses hospital groups clash on Massachusetts bill to improve response to violence Superbug linked scopes Feds failed to act on earlier outbreak 8 developing healthcare trends Hottest Products Compare Top Solutions in Hospital Management Electronic Medical Billing Software Healthcare Revenue Cycle Management

    Original URL path: http://www.hospitalimpact.org/index.php/leadership/2007/07/11/innovative_thinking_in_healthcare (2016-02-10)
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  • hospital impact - Bringing Toyota's Kaizen Operational Philosophy to Our Hospitals
    paperwork and inventory to waiting room delays and extraneous surgical tools Four years after he made his first trip to study under Japanese sensei or teacher Chihiro Nakao Virginia Mason chief executive Gary S Kaplan points to measures of success few American hospitals can boast In adopting the Toyota mind set Kaplan said the 350 bed hospital has saved 6 million in planned capital investment freed 13 000 square feet of space cut inventory costs by 360 000 reduced staff walking by 34 miles a day shortened bill collection times slashed infection rates spun off a new business and perhaps most important improved patient satisfaction Read how this hospital applied Kaizen to their ER reducing patient wait time to depart after service by 71 You start getting a sense of what Kaizen is all about it seems very common sense yet few seem to think this way simply because things have always been done a certain way 66 comments 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 hospitals can foster family centered care Pediatric ER seeks to limit stressors for autistic patients Nurses hospital groups clash on Massachusetts bill to improve response to violence Superbug linked scopes Feds failed to act on earlier outbreak 8 developing healthcare trends Hottest Products Compare Top Solutions in Hospital Management Electronic Medical Billing Software Healthcare Revenue Cycle Management Practice Management Software

    Original URL path: http://www.hospitalimpact.org/index.php/leadership/2006/03/21/bringing_toyota_s_kaizen_operational_phi (2016-02-10)
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  • hospital impact - Change Agent 102: Don't give others a new picture, give them a new frame
    we re sort of on the topic of smoking teen smoking is down How did it happen Check out this Slate article on how this advertising campaign got teens to stop smoking Similar to Ornish s strategy they didn t appeal to the fear of death what teenager doesn t feel invisible they appealed to their emotional need to be hip For teenagers the fear of being uncool and unaware is greater than the fear of dying Both of these examples help us see that when we want to change someone s behavior we have to appeal to their most poignant emotions It s the same facts information just re framed in a way that connects with them Whether you re a doc trying to get a patient to change his life or you re an administrator trying to implement a new system or process for docs the question becomes do we know people well enough to identify the emotional aspects of any change we desire Maybe we re getting ahead of ourselves do we know ourselves well enough Change Agent Series 101 Why preventative health doesn t work 102 Give people a new frame not a new picture 103 Revolutions easier than evolutions 104 Learn to play the accordian 8 comments 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 hospitals can foster family centered care Pediatric

    Original URL path: http://www.hospitalimpact.org/index.php?blog=6&title=change_agent_102_don_t_give_others_a_new&more=1&c=1&tb=1&pb=1 (2016-02-10)
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  • Hospital Impact - What do patients really want ... and do docs care?
    dispensers that is all a person ever gets or so they say regardless of why they went in And if you go back to the center the next day youâ ll see a completely different set of healthcare providers So much for personalized service The lack of consideration for their time Everyone had a story about taking time off from work only to sit for far too long even hours in a physician s office waiting to be seen for only 15 minutes or less The abuse as it was described was insulting and injurious to their health because by the time they got to see the doctor they really just wanted to get out of the office and get better on their own The physician is not engaged with them These are people Yet doctors don t look them in the eye don t spend time trying to understand what is bothering them and are quick to prescribe medications but not interested in exploring other options And it is not only the doctors but often the entire staff as well So much for feeling good about the experience about being treated special and important I probably could go on but I think you get the drift As an anthropologist interested in culture change I sit back and listen trying to help our clients find ways to bring together the doctor and the patient in those unmet needs that people are searching for With high deductibles consumers all expressed how they are less likely to go to the doctor unless they are really sick A number of them spoke about preempting the healthcare system altogether and instead using their personal network to speak with friends who are nurses about their situation or that of their child before going to the physicians Most interesting was the degree to which these consumers all of whom were between 25 and 54 in age were anxious to get mobile applications that they could use themselves to help diagnose and manage their conditions DIY healthcare is going to be very hot if we can get it right After hearing all this what became overwhelmingly obvious was that it s time to do something To empower the patient create relationships that will reduce utilization of healthcare facilities and improve outcomes and reverse the lack of engagement with physicians But how Maybe if there is an alternative that is grounded in science but made available through iPhones we won t care so much about the doctor That outdated model is ready for a retooling anyway It s time for us to stop doing what we have done the same way for 80 years Why be stuck with the same processes today that were established for our parents when health insurance began Once the doctor stopped his house calls the office became his fiefdom There he controlled the setting the patient played the sick role and medicine became more efficient but not necessarily more effective certainly much less

    Original URL path: http://www.hospitalimpact.org/index.php/2013/03/11/what_do_patients_really_want_and_do_docs (2016-02-10)
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