Friday, May 24, 2013

The Next Generation of “Patient-Centered”

5/24/2013 – By Kameron Gifford, CPC

Imagine a sustainable model of healthcare that could “touch” and engage every consumer. A system created for the patient and delivered on their own terms; a continually evolving structure that could simultaneously satisfy all the needs of patients, providers and payers. A design in which each stake holder adds value to the next. This next generation of care will continue to be centered around the patient’s individual needs, but directed by them as well.

Shifting From Patient Centered to Patient Directed

Every small business owner in America intimately understands the inherent connection between their customers and success. There is an art to successfully being able to predict and meet consumer needs. This consumer knowledge is powerful and history has proven that enough power in the right environment, will disrupt.

Close your eyes for a moment and think about the last time that you, a family member or friend was sick or injured. Do you remember trying to navigate through the current system? Perhaps you were seen in the Emergency Room or were admitted to the hospital. Either way, if you are eligible for Medicare, you were probably given strict instructions to follow up with your PCP and probably had an appointment before leaving the hospital.

Just as you were instructed (or your friend, or relative were), you made your follow up appointment and even remembered your discharge papers. When the nurse calls you in and asks, “What brings you in today?” You don’t tell her about how your son had to call in sick to bring you in because he will get fired if he misses another day; or about how you had to leave the house 2 hours early because you can only make it a few feet in your walker before having to take a quick break on the seat or about the stress of the medical bills that you won’t be able to pay. Ten minutes later, when the Doctor finally comes in he tells you that he has no notes from the hospitalist and without those, he has nothing to reconcile. After quickly scribbling a note for the girls to get records he says, “See you next week.”

Four hours after leaving you are finally back home. Exhausted and turned off by the system.

Managed Care plans attempt to reduce cost by “tightening” the network. This 3 day follow up rule is meant to reduce cost and improve outcomes through medication reconciliation. Great idea; in theory. Medicine is not one size fits all. This “72 hour rule” may work great for a 45 year old diabetic who is admitted for elective surgery, but what about the 96 year old who was just discharged from rehab after open heart surgery or the 73 year old that fractured their hip?

How will this negative experience influence the Consumer’s interaction with the system in the future? Will the patient feel up to making the journey again next week? Will transportation be an issue?

More times than not, this experience does have an effect on the consumer and when they do return, it won’t be for 2-3 weeks; thus perpetuating the cycle of readmissions.

Medication reconciliation is a great solution to reducing hospital readmissions, but if the solution is not meaningful to the patient then it will never be effective.

Now, close your eyes again and think about this same visit, but this time in the context of the future… directed by the patient.

This follow up visit could have taken place in the patient’s home, from their desk at the office, from their smart phone or in the PCP’s office. The consumer’s “personal” health team would already know the patient’s history because her admit to the hospital would have alerted the on-call “Transition Specialist” who worked with her PCP. And if the patient still decided to go into the office, the visit would have included a live comprehensive follow up with the “whole team.” One where the cardiologist and the hospitalist would be included in the visit. Real time, shared decision making across the entire continuum of care – all in the presence of the patient.

The magic of all this does not lie in the LCD screens that vividly display the multiple specialist coordinating care in unison from around the world.

It doesn’t lie in the better outcomes, greater engagement or tremendous savings, but instead it is in the simplicity of the solution.

This transparent care coordination translates to knowledge, and this knowledge then becomes the power that drives the system. True Innovation.

Medicare withholds $1M from metro Omaha, Lincoln hospitals over readmissions

Medicare withholds $1M from metro Omaha, Lincoln hospitals over readmissions - LivewellNebraska.com

bobglissmann

Metro Omaha, Lincoln hospitals assessed penalties

Medicare readmission

Hospital, funds and penalty withheld (up to 1%)

Bellevue Medical Center $30,000* . 32%

Bergan Mercy Medical Center $12,907 0.03

Creighton University Medical Center $2,185 0.01

Immanuel Medical Center $18,373 0.11

Lakeside Hospital $1,667 0.01

Methodist Hospital,

Methodist Women's Hospital $269,435 0.42

Midlands Hospital $55,334 1

Nebraska Medical Center $350,000* 0.38

St. Elizabeth Regional Medical Center $284,000 0.6

* approximate totals

Omaha, Lincoln hospitals not assessed penalties

In Omaha: Midwest Surgical Hospital,

Nebraska Orthopaedic Hospital, Nebraska Spine Hospital.

In Lincoln: Bryan Medical Center,

Lincoln Surgical Hospital and Nebraska Heart Hospital.

Sources: The hospitals, Kaiser Health News

Metro Omaha, Lincoln hospitals assessed penalties
Medicare readmission
Hospital, funds and penalty withheld (up to 1%)

Bellevue Medical Center	$30,000*	. 32%
Bergan Mercy Medical Center	$12,907	0.03
Creighton University Medical Center	$2,185	0.01
Immanuel Medical Center	$18,373	0.11
Lakeside Hospital	$1,667	0.01
Methodist Hospital,
Methodist Women's Hospital	$269,435	0.42
Midlands Hospital	$55,334	1
Nebraska Medical Center	$350,000*	0.38
St. Elizabeth Regional Medical Center	$284,000	0.6
* approximate totals

modelH - Passionate Innovation... Meaningful Change

CINCINNATI, OH--(Marketwired - Apr 3, 2013) - Batterii the enterprise platform for creative collaboration is announcing design updates to its Projects capability for structured team-based collaboration as well as the addition of Walls to its Inspiration Curation and Collection space. In addition, Batterii announces the launch of its new Android app; now users of both Android and iOS devices can take advantage of better interactions and convenient mobile capture and upload to the Batterii Platform.

Since December 2011, the Batterii product development team has been building out a platform around a creative process that empowers team and ensures collaboration. Nike, ConAgra Foods, S.C. Johnson, Octagon and other clients have successfully implemented Batterii into their innovation process, and their feedback has led to the newest features.

Similar to Pinterest boards, Inspiration Walls empower employees to capture and collect ideas, insights, and things they find interesting while at home, work, or on-the-go using Batterii's mobile app. They can share their walls with teammates, helping to supplement the traditional research and ideation process that happens in the workplace.

"We provide a platform that allows our clients to capture the passion and energy of teams across the globe to deliver successful projects," says Batterii CEO Kevin C. Cummins.

"Enhanced evaluation allows teams to measure the ideas they collected and rank these ideas based on key business goals, like cost, speed of implementation, strategic alignment to goals, or improvement of customer service. The platform enables the collection of key performance indicators to measure the ideas that are being put forth," Cummins says, "and, when completed, there is a better understanding of how solutions align with goals."

Innovation Excellence and Kevin Riley, founder of Kevin Riley & Associates, is one of the first to use the new platform for a yearlong project called modelH, the Health Model Co-Creation Forum. The modelH project will engage a team of 500 members from the healthcare community to co-create new business models for the industry.

"We are trying to accomplish no small feat: to co-create a better healthcare system with some of the best thinkers from disparate healthcare disciplines. We needed so much more than an idea system. We needed an engine to help us create, collaborate, and validate. I have looked at many innovation platforms, including the market leaders. In my experience, the Batterii platform is the only one that can serve our need. I am wholly impressed."

LeAnna J. Carey, Chief Digital Officer of Innovation Excellence, says that, "The modelH project is a groundbreaking project; we have pulled together an innovation dream team and Batterii is an unique platform that intersects social, collaboration, and co-creation with scalability."

Batterii will be featuring the new platform April 22nd to 24th at the Food Technology & Innovation Forum in Chicago. In addition, don't miss Batterii's booth at FEI, the Front End of Innovation conference in Boston May 6-8, 2013. Batterii founder Chad Reynolds will speak on the value of the creative process in innovation on May 6^th.

About Batterii
Batterii offers an enterprise SaaS platform that empowers businesses and teams to accelerate collaboration and build inspired solutions. Batterii facilitates the creative process to engage employees, partners and customers and yield better products, ideas and breakthrough innovations. With Inspiration, Insights and Ideas at its core, the Batterii platform allows businesses to access the full creative potential in a small team or a global work force.

‘Hybrid innovation’: Clayton Christensen Institute introduces new disruption concept

By Emi Kolawole, Published: May 23, 2013 at 4:23 pmE-mail the writer

There’s a new term in the innovation lexicon.

Clayton Christensen, the Harvard Business School professor credited with coining the term “disruptive innovation,” authored a white paper with colleagues Heather Staker and Michael Horn titled “Is K–12 blended learning disruptive? An introduction of the theory of hybrids.” In it, the authors introduce “hybrid innovation”, which is described in a release as “a fundamentally new concept [in] the world of disruptive innovation.” The paper was announced by the Clayton Christensen Institute for Disruptive Innovation (formerly the Innosight Institute) on Thursday.

The disruption landscape is no stranger to new concepts. In a piece for Harvard Business Review in April, Paul Nunes of the Accenture Institute for High Performance and Larry Downes, a fellow at the institute, introduced “big bang disruption,” or the game-changing innovations that change industries overnight.

In an executive summary, the team defines a hybrid as “a combination of the new, disruptive technology with the old technology” that “represents a sustaining innovation relative to the old technology.” The authors go on to write in the full paper that:

“Whenever a disruptive technology emerges, the leading ﬁrms in the ﬁeld usually do not completely ignore it as they march forward with better products with higher proﬁts for their best customers. Instead, they try to adopt the disruptive technology, but they do so through a sustaining strategy—they create a hybrid. The hybrid solution marries the old technology with the new in an attempt to create a “best of both worlds” alternative that the incumbent ﬁrms can market as a better product to their existing customers.

Okay, and that means what exactly?

Well, think of hybrid cars. They use gasoline (old) and electricity (new…well, sort of), they aren’t significantly easier to use or necessarily cheaper than their gas-only counterparts and go after pretty much the same pool of customers. More recently, think of the disruption of the photography industry. A landscape of photo paper and printing stations, turned into one of digital cameras and desktop software. Then came the disruption: smartphones with Hipstamatic, and not long after Instagram. Then there’s banking, which incorporates mobile banking alongside the brick-and-mortar banks. Mobile wallets, the authors note, stand to fundamentally disrupt the need for traditional banking services.

The team identifies four ways of identifying hybrid innovations. These types of innovations are “less ‘foolproof’” than disruptive innovations, meaning they fail to be significantly less expensive or easier to use than the older models. Hybrid innovations offer old tech and new tech simultaneously. They try to do the same job as the old tech. And hybrids try to appeal to customers already consuming the old tech.

The authors use K-12 education as a sort of canvas, showing how different education models use new technologies along with brick-and-mortar classrooms, resulting in hybrid innovation. In a piece for Forbes, Horn writes:

“Almost every student has access to a government-funded school of some sort. As a result, we can predict that most students will, in the future, still attend schools, but they will be hybrids—blended learning schools that combine brick-and-mortar buildings with online learning.”

Ultimately, continues Horn, schools will transition into community centers as academics are moved to the Web. This will make the development and maintenance of quality facilities an even greater priority.

And, with that, I think we’ve used our “innovation” word quota for the day.

Deaconess Gateway Heart Hospital Recognized for Patient Experience

Deaconess Gateway Heart Hospital Recognized for Patient Experience

A Tri-State hospital receives national recognition. The Heart Hospital at Deaconess Gateway is named among the top five percent in the nation for outstanding patient experience. An independent organization known as "Health Grades" handed out the recognition.

Brent Miller was a patient in the Heart Hospital last year. He says it was his first time staying in a hospital overnight, and the staff made him feel very at ease.

"Just the nurses and doctors were all so willing to share information," said Miller, "and just make my stay as comfortable as it could be."

More than 3,800 hospitals in the country were analyzed in the survey.

Patient and Family Insights on Patient Experience Shared by The Beryl Institute

New White Paper Highlights Importance of Including Patient Voices in Healthcare Improvement Efforts

Dallas, Texas (PRWEB) May 22, 2013

The Beryl Institute releases its latest white paper,Voices of Patients and Families: Partners in Improving Patient Experience, in an effort to highlight the importance of including patient input and listening to and acting on patient feedback when planning and evaluating patient experience efforts.

The paper shares insights on patient experience gained in speaking with 18 courageous patients and family members from healthcare practitioners to patient advocates. More than 450 pages of interview transcripts were collected for the paper, which includes a broad selection of quotes, statements and stories from contributors based on the following questions:

How do you define the patient/family experience?
Why do you believe a focus on patient experience is (and should be) central to healthcare today?
What are the most important efforts healthcare organizations can take on to address patient experience?
What do you see as the role/responsibility of patients/families in supporting/informing patient experience efforts?
What do you see as the greatest roadblocks to effectively addressing patient experience and what would you say are/would be some of the greatest supports of success?
What advice do you have for healthcare leaders working to address the patient experience in their organization?

Nearly all of the contributors have dealt with chronic or severe illnesses and offer perspectives that arise from intense and long exposure to healthcare systems around the world. Their comments stem from both personal experience and what they have observed while engaging in the causes they address.

“The contributors’ perceptions of the healthcare system provide an opportunity for readers to gain new insights on how to deliver the experience that patients expect,” said Jason Wolf, President, The Beryl Institute. “They remind us that the patient experience is both universal and unique, and that there has to be active engagement across the care continuum to be sure all voices are heard.”

The paper is a companion to earlier publications in the Voices series including Voices of the C-Suite, Voices of Practice and Voices of the Future. A common theme across all the Voices papers is the acknowledgement that a crucial element of any healthcare worker’s role is the ability to listen, to hear and to act on the voices of all involved in the patient experience.

To download the white paper, visit http://www.theberylinstitute.org/?page=PUBS .

28 Statistics on Hospitals' Patient Experience Strategies

Written by Molly Gamble

Most healthcare organizations use committees to oversee and direct patient experience initiatives, but there is also a growing trend where hospitals delegate this responsibility to a dedicated leader, according to a new survey from Catalyst Healthcare Research and the Beryl Institute.

The survey is based on responses from more than 1,000 hospitals or hospital systems representing 672 unique organizations. Chief experience officers accounted for 25 percent of the respondent base, along with chief quality officers, chief nursing officers, CEOs, COOs and clinical staff members.

Here are some main takeaways from the survey.

Respondents ranked the following as one of their top three priorities for the next three years:

1. Patient experience and satisfaction: 70 percent
2. Quality and patient safety: 63 percent
3. Cost management and/or reduction: 37 percent
4. Electronic health records, meaningful use and health information technology: 35 percent
5. Employee engagement and satisfaction: 22 percent
6. Accountable care organization development and/or implementation: 18 percent
7. Physician recruitment/retention: 17 percent
8. Construction and/or capital improvements: 11 percent

Who in the organization has primary responsibility and direct accountability for addressing the patient experience?

1. Committee: 26 percent
2. Chief experience officer or patient experience director: 22 percent
3. Chief nursing officer: 14 percent
4. CEO or senior administrator: 8 percent
5. Chief quality officer: 8 percent
6. COO: 3 percent
7. Physician, nurse or clinical staff: 3 percent
8. CMO: 1 percent
9. Chief marketing officer: 1 percent
10. No one in particular: 1 percent
11. Other: 12 percent

Those with primary responsibility for the patient experience spend an average of 63 percent of their time supporting those efforts, and most (36 percent) have a staff of one to two people to aid in those efforts, whereas 28 percent do not have a staff and 24 percent have a staff of five or more people.

The top five key components for organizations' patient experience initiatives are:

1. Sharing patient satisfaction and experience scores: 52 percent
2. Regular or hourly rounding by clinical team members: 50 percent
3. Leadership rounding by members of senior management: 49 percent
4. Staffing training programs for customer service or other behaviors: 49 percent
5. Special initiatives to improve specific Hospital Consumer Assessment of Healthcare Providers and System domains: 38 percent

States pressured to match their false claims acts to federal law

5/24/2013

By Adam Kerlin

NEW YORK (Reuters) - Ten states are at risk of losing a 10 percent federal bonus from settlements of Medicaid fraud lawsuits if they don't make an August deadline to pass state false claims laws that meet new federal standards.

When Congress passed the Deficit Reduction Act of 2005, it included a strong incentive for states to adopt laws similar to the federal False Claims Act, which punishes those who defraud government programs. The law includes a "qui tam" provision that lets whistle-blowers who tip off officials to fraud share in any recovery.

Under the act, any state that adopted a similar law designed specifically to combat Medicaid fraud would be entitled to an additional 10 percent of resulting Medicaid fraud settlements.

In a typical Medicaid fraud suit, an employee of a medical supply company, say, tips off the Justice Department that the employee's company may be overcharging Medicaid. If the tip leads to a recovery of money by the government, the tipster gets a share of the bounty.

In fiscal 2012, the government reported recovering $4.2 billion from companies found through false claims investigations to have committed Medicaid fraud. Most of those probes were sparked by whistle-blowers.

When the Deficit Reduction Act with its incentive became law in 2005, at least a dozen states became eligible for the bonus. But they lost that status when Congress passed the Fraud Enforcement and Recovery Act of 2009 and, in 2010, the Affordable Care Act and the Dodd-Frank Act - three laws that expanded whistle-blower protections and increased penalties for violators.

The Department of Health and Human Services determined that these adjustments made previously compliant state laws too weak to qualify for the 10 percent bonus.

As a result, 12 states - New York, Georgia, Hawaii, Illinois, Indiana, Massachusetts, Minnesota, Nevada, Rhode Island, Tennessee, Texas and Virginia - became ineligible for the incentive. In 2011 the Health and Human Services' inspector general gave those states a two-year grace period, during which they could continue to qualify for the incentive without the enhancements until August 31 of this year.

MERITLESS LAWSUITS

So far, only two of the 12 states that had laws that were compliant prior to the amendments, Hawaii and Illinois, have updated their false claims laws to meet the new federal standards. The other 10 states will forfeit the bonus at the end of August unless they pass such legislation.

There are 21 states that have not passed any state-level false claims law, making their road to federal compliance and the Deficit Reduction Act bonus even tougher.

Most of the rest of the states have false claims statutes which came into effect after 2005 and were never approved as qualifying for the 10 percent bonus.

The enactment of the Fraud Enforcement and Recovery Act, the Affordable Care Act and the Dodd-Frank Act coming over just a two-year period derailed many state efforts, as legislatures tried to amend their false claims statutes multiple times to comply with the federal changes, said Patrick Burns, communications director for the Taxpayers Against Fraud Education Fund, a non-profit group.

What's more, not all state lawmakers have embraced the new requirements. Some opponents have questioned the cost-effectiveness of statutes that are proposed, which require significant government resources to investigate the Medicaid claims and oblige the government to share recoveries with whistle-blowers, said Ellyn Sternfield, an attorney with Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, who specializes in healthcare fraud enforcement.

States have also been lobbied by drug and medical companies, which have argued that the whistle-blower provisions encourage meritless lawsuits and create a hostile business environment.

"The incentive is there financially, but it's still a hard pill for some legislatures to swallow," Sternfield said. "The state can recover two million in a case, but half goes to lawyers and whistle-blowers. And the federal government gets a portion of the recovery, too."

PENNSYLVANIA ATTEMPTS

Texas, often touted by false claims experts as having an effective state-level statute, is still working to get its law amended to meet the new federal standards.

Burns, of the Taxpayers Against Fraud group, said the delay is due largely to opposition to expanded protection granted to whistle-blowers under the new federal requirements. But he said he expects Texas will update its law.

If the money Texas collected in bonus payments over the last seven years is representative, the state would stand to make tens of millions of dollars less in Medicaid recoveries over the next few years if it doesn't pass a law that qualifies it for the Deficit Reduction Act incentive, according to a study by the Taxpayers Against Fraud Education Fund.

After subtracting for whistle-blower shares and attorneys' fees, Texas recovered more than $821 million over the last seven years, according to the study, which used data from the Texas attorney general's office to track Medicaid fraud recoveries.

Pennsylvania is one of the 21 states that has no version of a false claims act. Legislation to enact one has been introduced multiple times over the last decade, but a coalition of Pennsylvania business groups urged the legislature to kill the legislation each time.

Opponents say the bill would duplicate the federal statute and hurt the state's efforts to recruit and retain physicians.

Earlier this year, Pennsylvania State Representative Brandon Neuman drafted another false claims bill. He said he hopes the Deficit Reduction Act's 10 percent incentive will help propel the new version through the Pennsylvania legislature. But opposition looms.

"All of the state proposals we've seen go far beyond what the federal Deficit Reduction Act requires, which is always a fear for us," said Sam Denisco, vice president of government affairs for the Pennsylvania Chamber of Business and Industry.

Omaha, Lincoln hospitals not assessed penalties
In Omaha: Midwest Surgical Hospital,
Nebraska Orthopaedic Hospital, Nebraska Spine Hospital.
In Lincoln: Bryan Medical Center,
Lincoln Surgical Hospital and Nebraska Heart Hospital.
Sources: The hospitals, Kaiser Health News