"The Simplification of Healthcare Starts with a Single Object"

Reducing the burden on the healthcare system and empowering patients to take control of their health...

Scandadu, is the perfect example of a tool that will drive the next generation of "Patient Directed" care.

Prevention is the cure, and Education is the Vehicle. 

This palm sized device will allow consumers to monitor and track their own health to aid in the early detection of a number of conditions. This Star Trek inspired tool can provide detailed information about your heart rate and rhythm, pulse ox, blood pressure, temp and emotional state by placing it up to your forehead for only 10 seconds.  The results are then delivered to your smartphone via Bluetooth.

The device still needs to pass clinical trials and will receive FDA approval, but you can pre-order on their website http://www.scanadu.com/scout/  for $199.

Introducing the

Scanadu Scout™

A scanner packed with sensors that enables anyone to conduct sophisticated physical exams — in a snap.

Designed by Yves Béhar. Made in America.

Dare to know.

Your body’s information where it belongs: in your hands. Share it with your doctor and others to take health conversations – and discoveries – to a new level. Learn ways that different people, locations, activities, foods, beverages, and medicines affect your body. Sick or well. Discover connections. Watch trends. Spot side effects. Catch problems early. And track them. Get healthier.

What is the Scanadu Scout™?

Scanadu Scout™ is designed to be a medical grade Tricorder using your smartphone and Bluetooth LE to emulate an Emergency Room in your pocket.

Website: www.scanadu.com
Contact: info@scanadu.com

The Translation Gap: ICD-10 and HCC

5/26/2013 – Kameron Gifford, CPC

Where will ICD-10 impact your organization the most? What are you doing to protect your revenue?

The greatest hurdle in transitioning to ICD-10 will be improving clinical documentation.

Are your providers documenting with the specificity required for ICD-10? If not, where do you focus your education?

If you have not already completed a revenue risk assessment, I urge you to do so now! This will be your greatest key to success!

Start with a Revenue Risk Assessment for your Organization:

Medicare Advantage Plans/ MSO’s / IPA’s:

1.       Compile a list of your most frequently billed ICD-9 Codes per provider. (A list of 25 is sufficient).

2.       Map these codes into the corresponding ICD-10 Codes.

3.       Map ICD-10 Codes to Corresponding HCC’s to determine potential impact on revenue.

Prior, Proper, Planning…

Once you have determined the potential impact on revenue we can use this same information to create meaningful education to improve clinical documentation.

We are by nature, creatures of habit, and we must start changing the behavior of providers now to ensure adoption of new concepts.

A few examples of these include:

• Laterality – left, right, bilateral or unilateral

• Trimester of pregnancy and weeks of gestation

 • BMI calculation in Obesity

 • Which finger, and which level in a finger amputation

• The type of surgical approach for procedures

 • The severity of seizures

• The severity of retinopathy or renal disease in diabetics

Compliant coding begins with compliant documentation. Through accurate risk revenue assessments organizations can concentrate their efforts; thus encouraging greater engagement.

If your organization needs help contact ERM. We will audit up to 10 dates of services or map 10 codes at NO CHARGE.

Prosthetic tentacle

Taiwanese design student Kaylene Kau created this motorized prosthetic tentacle for a class project: "For this project we were pushed by our Professor to push the boundaries of current upper-limb prosthetic design. Through extensive research I found that the prosthetic functioned as an assistant to the dominant functioning hand. The prosthetic needed to be both flexible and adjustable in order to accommodate a variety of different grips."

PROSTHETIC ARM (via Kadrey)

Cory Doctorow at 2:37 pm Thu, May 23, 2013

http://boingboing.net/2013/05/23/prosthetic-tentacle.html

AHRQ-funded journal supplement offers lessons on primary care practice transformation

Findings provide practices with a roadmap on how to achieve transformation

LEAWOOD, Kan. – Primary care practice transformation on a large scale is the cornerstone of current health care reform efforts aimed at achieving better outcomes, better value and better experience of care. Amid emerging evidence that transformation toward the patient-centered medical home model offers a viable solution in today's health care environment, the U.S. Department of Health and Human Services' Agency for Healthcare Research and Quality funded 14 studies to learn more about the processes and determinants of successful change from practices that had already demonstrated successful transformational activities and improved outcomes. Key findings of these 14 projects, which the funders hope will inform more widespread change efforts, are published in a special supplement of Annals of Family Medicine.

The supplement, Transforming Primary Care Practice, features insights from 14 natural experiments undertaken in a wide variety of settings across the United States including independent practices, integrated delivery systems, community health centers and large government systems. The projects, which were funded by AHRQ grants awarded in 2010 totaling more than $4.1 million each year for two years, begin to identify the approaches and methods for transforming the structure, characteristics and function of primary care that are likely to be successful in a wide variety of practice types and settings.

"The lessons learned from these analyses demonstrate that true transformation toward the patient-centered medical home model is not only possible, but desirable, although not without its challenges," writes Robert J. McNellis, MPH, PA, AHRQ [insert title] and colleagues, in a commentary about the lessons learned that cut across all the projects.

In the editorial, McNellis and colleagues outline five overarching thematic findings that emerged from the projects despite the wide variety of practices studied, geographic locations, sizes, structures and motivations:

1) A strong foundation is needed for successful redesign. Existing baseline capabilities of a practice are important determinants of successful transformation. Practices must accurately assess their readiness for change and their ability to handle the change process before undertaking substantive change.

2) The process of transformation can be a long and difficult journey. The process of transforming is complex, challenging and ambitious. It takes time and is constantly evolving. Progress is a process that ebbs and flows, and practices should prepare for a taxing journey.

3) The approaches to transformation vary. The ingredients of a successful change process vary, but a few key elements seen across the projects include: integration of more team-based care, expanded access to care, use of measurement and feedback tools and the use of learning collaboratives to facilitate team communication.

4) Visionary leadership and a supportive culture ease the way for change. Having strong internal change drivers is an important facilitator of successful transformation. The two internal drivers seen to have the most influence on change were leadership and culture.

5) Contextual factors are inextricably linked to outcome. The context within which transformation occurred is critical to understanding a practice's success.

In addition to the overarching findings above, the articles raise several potential cautions, including the difficulty of measuring the financial impact of transformation on a practice. Overall, the teams found it was very difficult to understand the ultimate impact of transformation on the bottom line of the practices. Additionally, many investigators noted a difference between a true PCMH and external recognition as one, concluding that a practice could be a true PCMH without having received recognition, and a practice that has received PCMH recognition may not be a true PCMH. They warn that the journey to recognition, in contrast to true transformation, can create a culture of "box checking" rather than making the deep changes necessary to become truly patient-centered.

"Annals is excited to publish these important findings, and we hope they will inform efforts to improve health care systems' ability to support changes to improve the effectiveness and sustainability of primary care practices to better meet patient needs across the country," said Kurt Stange, MD, PhD, Annals of Family Medicine editor and corresponding author of a supplement article on the importance of reporting contextual factors. "We especially hope the grantees' innovative reporting of relevant contextual factors – information critical to understanding what happened and why in the studies – will help other practices as they attempt to transport these findings to their unique settings and circumstances."

"Few practices realize or are prepared to make the substantive changes necessary for true transformation. However, this research demonstrates that change is possible even in the face of payment systems that do not yet adequately support transformative efforts within a deeply fragemented health care system," McNellis concludes. "Research like that presented in this supplement can serve as a roadmap, if not a how-to manual on achieving transformation."

Supplement articles include:

• Lessons Learned from the Study of Primary Care Transformation
  Robert J. McNellis, MPH, PA, et al
  This editorial summarizes the interventions studied by the 14 grantees and synthesizes the major findings and lessons learned about the process of transforming.
• Support and Strategies for Change Among Small Patient-Centered Medical Home Practices
  Sarah Hudson Scholle, MPH, DrPH, et al
  Financial support, practical training, and other help are important in spreading the adoption of the PCMH model among small practices.
• Recognition as a Patient-Centered Medical Home: Fundamental or Incidental? 
  Daniel Dohan, PhD, et al
  Becoming patient centered and seeking NCQA recognition as a PCMH run along separate but parallel tracks in this case study.
• Spreading a Medical Home Redesign: Effects on Emergency Department Use and Hospital Admissions 
  Robert J. Reid, MD, PhD, et al
  It is possible to reduce emergency department use with PCMH transformation across a diverse set of clinics using a clear change strategy and sufficient resources and supports.
• Facilitators of Transforming Primary Care: A Look Under the Hood at Practice Leadership 
  Katrina E. Donahue, MD, MPH, et al
  Certain aspects of leadership help move practices forward in primary care transformation, including setting strategic direction and implementation.
• Cultivating Engaged Leadership Through a Learning Collaborative: Lessons from Primary Care Renewal in Oregon Safety Net Clinics 
  Carmit K. McMullen, PhD, et al
  A group of safety net organizations cultivates engaged leadership with scarce resources by partnering with organizational leaders in design of transformation efforts, sharing lessons and overcoming implementation hurdles.
• Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation: Findings From a Mixed Methods Evaluation 
  David L. Driscoll, PhD, MPH, MA, et al
  In this study of a tribally owned and managed primary care system, all reported measures of emergency care use showed a decreasing trend after PCMH implementation.
• Quality, Satisfaction and Financial Efficiency Associated With Elements of Primary Care Practice Transformation: Preliminary Findings 
  Julie Day, MD, et al
  A study of multiple outcomes in a redesigned model of care underscores the importance of team-based-care and continuity of care.
• Contrasting Trajectories of Change in Primary Care Clinics: Lessons From New Orleans Safety Net 
  Diane R. Rittenhouse, MD, MPH, et al
  The PCMH model can successfully address the needs of safety-net populations, particularly with the support of stable, committed leadership and deep community ties.
• Becoming a Patient-Centered Medical Home: A 9-Year Transition for a Network of Federally Qualified Health Centers 
  Neil S. Calman, MD, et al
  This study, set in a large FQHC network serving a diverse population, reports on complex system change, including its component parts and the processes by which it was facilitated.
• Assessment and Measurement of Patient-Centered Medical Home Implementation: The BCBSM Experience 
  Jeffrey A. Alexander, PhD, et al
  Approaches to PCMH measurement should be driven by the intended uses and users of the measure.
• Patient-Centered Medical Home Among Small Urban Practices Serving Low-Income and Disadvantaged Patients 
  Carolyn A. Berry, PhD, et al
  Small practices can achieve important aspects of the PCMH model of primary care, often with informal rather than formal mechanisms and strategies.
• Medical Home Transformation in Pediatric Primary Care—What Drives Change? 
  Jeanne W. McAllister, MHA, et al
  In pediatric primary care practices, medical home transformation requires continuous development, ongoing quality improvement, family partnership skills, teamwork and strong care coordination.
• A Positive Deviance Approach to Understanding Key Features to Improving Diabetes Care in the Medical Home 
  Robert A. Gabbay, MD, PhD, et al
  Key factors in primary care practices' performance improvement during medical home transformation include baseline structural capabilities and ability to buffer the stresses of change.
• Medical Home Transformation: A Gradual Process and a Continuum of Attainment 
  Leif I. Solberg, MD, et al
  Medical homes are not similar, change in outcomes is slow, and transformation occurs on a continuum.
• Context Matters: The Experience of 14 Research Teams in Systematically Reporting Contextual Factors Important for Practice Change 
  Andrada Tomoaia-Cotisel, MPH, MHA, et al
  This study offers a feasible, systematic approach for research teams to identify and convey contextual factors for understanding and transporting findings from health care research.

###

Annals of Family Medicine is a peer-reviewed, indexed research journal that provides a cross-disciplinary forum for new, evidence-based information affecting the primary care disciplines. Launched in May 2003, Annals is sponsored by seven family medical organizations, including the American Academy of Family Physicians, the American Board of Family Medicine, the Society of Teachers of Family Medicine, the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the North American Primary Care Research Group, and the College of Family Physicians of Canada. Annals is published six times each year and contains original research from the clinical, biomedical, social and health services areas, as well as contributions on methodology and theory, selected reviews, essays and editorials. Complete editorial content and interactive discussion groups for each published article, including those in the supplement, can be accessed free of charge on the journal's website, http://www.annfammed.org.

Contact: Angela Sharma
asharma@aafp.org
913-269-2269
American Academy of Family Physicians 

Medical Home Transition Long but Worth It

By David Pittman, Washington Correspondent, MedPage Today

Published: May 20, 2013

The path to becoming a patient-centered medical home is long, rough, and varies for each practice, but getting there is essential to providing high-quality, affordable healthcare to all Americans, researchers concluded.

The Agency for Healthcare Research and Quality (AHRQ) came to that conclusion in summarizing the results of 14 grants it issued in the summer of 2010 to understand the processes and determinants of transforming primary care practices.

The grants -- which totaled $4.1 million each year in a 2-year study -- allowed practices of varying size, geography, and scope to retrospectively analyze the process of becoming a patient-centered medical home (PCMH). The results were published Monday in a special supplement of the Annals of Family Medicine.

"The lessons learned demonstrate that true transformation to the PCMH model is not only possible but desirable, although not without its challenges," wrote Robert McNellis, MPH, PA, and colleagues at AHRQ's Center for Primary Care, Prevention, and Clinical Partnerships in Rockville, Md. "These lessons provide valuable insight that will likely be helpful to other practices considering or beginning this transformation."

It is difficult to know whether practices that are successful in their transformation are successful because they've become a PCMH, or whether better-performing practices are more likely to become PCMHs.

"This uncertainty has implications for how to invest resources in those practices that are not currently highly functioning, many of which are resource-starved and understaffed, and often serving as safety-net practices for large groups of uninsured or underinsured patients," the authors wrote.

Most investigators concluded a practice can be a true PCMH without having formal recognition from an accrediting body like the National Committee for Quality Assurance (NCQA).

It was tough to measure financial impact on transforming a practice, they found. "It was difficult to measure new revenue or costs of delivering new services. It was also difficult to compare pre-transformational costs with post-transformational costs," McNellis and co-authors wrote.

In one study, Sarah Hudson Scholle, DrPH, of the NCQA in Washington, and others surveyed nearly 250 small practices (fewer than five physicians) on their barriers and motivations to becoming a PCMH.

They found that time and resources were the biggest obstacles for practices to overcome, but that receiving financial rewards for becoming a PCMH would help.

A similar survey by Carolyn Berry, PhD, of the New York University School of Medicine, analyzed small practices in New York City serving mostly Medicaid or minority patient populations and concluded more flexible strategies for PCMH implementation were needed.

"We were especially struck by the relatively low use of formal mechanisms such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless," Berry and others wrote. "It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH."

In a study of 12 high-performing pediatric medical homes, Jeanne McAllister, MHA, of the Center for Medical Home Improvement in Concord, N.H., and colleagues identified four common attributes that drove change: a culture that promoted quality improvement, a family-centered care plan involving parents, and team-based and coordinated care.

"Delivering care within a family-centered medical home proved highly satisfying to physicians and coordinators," the authors wrote. "As efforts expanded, professional gratification and staff resilience appeared linked."

THR, Baylor Share ACO Growing Pains

HOSPITALS 05/23/2013| by Steve Jacob| 

Baylor Quality Alliance (BQA) President Carl Couch acknowledges his accountable care organization (ACO) is pursuing initiatives that are decreasing the health system’s revenue.

Baylor chief executive officer Joel Allison also noted at a Dallas conference earlier this month that the company’s quality efforts “are hurting the bottom line.”

“Why are we doing this?” Couch asked rhetorically. “Because we have to. It’s the only way to create value.”

Couch and Karim Kaissi, a Texas Health Resources (THR) director of business development, recounted the challenges and lessons learned at an Executive Health Network panel discussion in north Dallas Wednesday as the two large health systems develop their ACOs.

BQA was formed in August, with the Baylor Health Care System as its first client. THR and North Texas Specialty Physicians created DFW’s first ACO as one of the first crop of Pioneers in the Centers for Medicare and Medicaid program. It added commercial ACOs with Aetna and Blue Cross and Blue Shield of Texas in quick succession in January.

ACOs have spread rapidly in a little more than one year. As of February, there were 428 ACOs in 49 states.  More than half of Americans live in areas served by ACOs. Physician participation has tripled in one year. Nearly 9 out of 10 health-plan executives said they either had implemented or were planning to implement an ACO in the next 12 to 18 months, according to a recent survey.

Kaissi said the commercial ACO offers more leverage to negotiate. However, he insisted those negotiations are centered around programs rather than prices.

“We are trying to set up win-win situations for both sides,” he said. “Medicare is very restrictive. That (Pioneer) ACO allowed us to learn but there is more risk.”

Couch said today’s accountable care differs sharply from the health maintenance organizations of the 1990s.

“That was managed costs, not managed care. Also, you couldn’t measure quality back then. Now I say we have 50 percent lower mortality than seven years ago in (Baylor) facilities. We can also measure patient satisfaction now. If we can’t improve both at a lower cost, we are going to fail,” he said.

Kaissi said the ACO startups have underscored the importance of physician leadership to champion the effort. He pointed out THR recently created three geographical zones, each led by a clinical and operations executive at the same level.

An underappreciated challenge, Kaissi said, is patient accountability. THR is attempting several strategies to engage patients in their health to improve outcomes, including a patient advisory group. The system also has a 10-year agreement with Nashville-based Healthways to help physicians analyze and address patient health behavior.

Couch said winning the trust of physicians is critical to BQA’s success. He said he sees the ACO organizationally as a triangle, with the Baylor system, Baylor’s employed physicians and independent affiliated physicians as the key players.

“The independent physicians are fiercely independent, and they don’t trust hospitals. We need to win their trust by making promises that we can keep,” he said.

Couch said he believes ACO shared savings will be temporary. He said payers will “offload” risk to the providers, and then onto patients in the form of higher deductibles and benefit design.

“We can’t manage the (healthcare) system the way it is now,” he said.

Steve Jacob is editor of D Healthcare Daily and author of the book Health Care in 2020: Where Uncertain Reform, Bad Habits, Too Few Doctors and Skyrocketing Costs Are Taking Us. He can be reached at steve.jacob@dmagazine.com.

10 Healthcare Innovations That Might Change The World

Guest Column | May 23, 2013

Source:

By Justin Boyle, originally published on AlliedHealthWorld.com

Take a look at 10 up-and-comers in the ever-changing space of healthcare tech. Innovation in healthcare is non-stop, and startups like these might offer the next big breakthrough in the way we look after our bodies and psyche. Some of these forward-thinkers and inventors were inspired by their personal experience as the family of patients or medical professionals. These innovations in healthcare join numerous other procedures, devices and services that have emerged recently to help providers give better care to patients, or help patients take better care of themselves:

• 1DocWay wants to make it easier for you to see a doctor. Billing itself as "telemedicine," this New York startup intends to take some of the stress off of consumers as well as providers by making it possible to conduct psychiatric and medical business of a less serious nature by video-chat. Patients don't need to take time off work and make an extra trip for an appointment. The startup website AngelListnames the founding team as Samir and Mubeen Malik and Danish Munir, in charge of code.

• Aidin, developed by Dogpatch Labs in New York, is a software application designed to streamline patient discharge from acute care. The app uses a search tool to match patient information with the indexed details of post-acute care providers. Aidin aids social workers and case managers in providing next-step options for discharged patients.

• Axial Exchange, a Raleigh, NC, startup is led by healthcare and tech executives like Joanne Rohde, building on their collective experience at Red Hat and other high-tech firms. Software-based services target different aspects of healthcare: for example, hospitals can automatically notify primary care physicians when patients are admitted. Doctors and nurses can use Axial's Transition of Care software to send an organized batch of patient records to other providers; hospital admins can deploy a medical library or an extensive directory of contact information; and patients can stay on top of the outpatient care process.

• BitGym and its developers want to make working out at the gym more fun. The team -- Alex Gourley, Clint Stevenson, Joshua McCready and Keerthik Omanakuttan -- found support from the Rock Healthaccelerator in San Francisco, the Reuters blog reports. This firm offers video games for the iPad, iPhone and iPod Touch that interface with exercise bikes, treadmills and elliptical running machines. BitGym wants to help you become more engaged with your cardio routine, hoping to make it more enjoyable so it might "stick" as a part of your lifestyle.

• CampusMD, out of Bethesda, MD, makes telemedicine available to students at more than 1,100 colleges and universities. The program, co-advised by Kevin Kelleher, MD, and Duke University Vice President of Student Affairs Larry Moneta, is underwritten by a nationwide telehealth service called HealthNation. The service offers students 24-hour, 7-day access to physicians who can diagnose and recommend treatment for minor ailments.

• Care Thread is a Providence, RI, company founded by CEO Scott Guelich, CTO Andrew Shearer and COO Nick Adams, who contribute years of experience in both high-tech and healthcare industry positions. With a goal of moving intra- and inter-facility communication away from pagers and whiteboards and toward today's multimedia devices, Care Thread's mobile messaging service focuses on connecting and organizing the multiple streams of patient information necessary for effective care.
• EveryMove takes the "rewards program" concept that credit cards have been using for decades and applies it to the world of exercise: rewards for doing what's right for your body. Co-founders Russell Benaroya and Marcelo Calbucci -- a healthcare entrepreneur and an experienced technologist, respectively -- aim to connect exercisers with entities such as insurance companies, employers and brands that offer rewards.

• Omada Health is a San Francisco startup specializing in programs to help prevent and treat type 2 diabetes through healthier habits and more wellness-conscious behavior. The firm's founders are startup veterans Sean Duffy, Adrian James and Andrew DiMichele. Omada makes use of personalized coaching, digital tracking, and support from family and friends to guide individuals with prediabetes or type 2 diabetes to build healthier lifestyle choices.

• Slow Control, a French company started by inventor and biomedical engineer Jacques Lepine, takes a slightly unorthodox approach to boosting human health. Lepine's invention, a digital fork, measures the speed at which a user eats and shows personalized results online. Slow Control hopes to fight disease and prevent metabolic harm by encouraging people to take their time eating, rather than shoveling food into their mouths.

• SmartWard is designed to reduce human error when transferring a patient from one healthcare department to another by reducing paperwork and enhancing staff communications. The app's features were devised by Michelle Teo, a doctor based in Nottingham, England, and built by a global team of designers and developers to work across platforms, on computers or mobile devices. The firm was founded at Startup Weekend London, a Silicon Valley Comes to the UK 2012 event.

Healthcare sees a continuous influx of new technologies aimed at enhancing our well-being and helping care facilities and other institutions run more smoothly. These 10 are just a few of the emerging developments on the horizon -- stay on the lookout for other healthcare innovations. The current standards for healthcare technologies had to start somewhere, and a quiet little startup flying under the radar might become the next industry standard.

About the Author

Justin Boyle is an experienced tutor and media technologist who works in video design for an ecology non-profit. He lives in Austin, Texas, and finds a lot of things interesting, especially food, finance, education, software, art and travel.

Medicare increasingly tough on doctors

Medicare increasingly tough on doctors


One physician says it's going to be impossible for her to remain in Medicare because of the new paperwork, regulations and costs associated with the program.

As doctors are faced with the expansion of Medicare, pay cuts, and red tape associated with the federal healthcare overhaul, some are thinking twice about remaining in the program.

Dr. Alieta Eck, the immediate past president of the Association of American Physicians and Surgeons (AAPS), says she enjoys taking care of her elderly patients, many who are forced to enroll in Medicare. Because of that, she has continued to cooperate with Medicare. But with new mandates added continually, she tells OneNewsNow she will soon be forced to make a tough decision.

Eck

"All that's required of me is becoming so burdensome that I will either see my patients, or fill out all the forms required," she laments. "But I probably can't do both."

Eck reports that Medicare has introduced another mandate called The Physician Quality Reporting System, or PQRS. By 2014, doctors must record patient illnesses or injuries using new digits and numbers. Current electronic medical records will be updated, which is costly for individual physicians, so Eck fears that only doctors who are part of hospitals or groups will be able to survive the changes.

"It's not clear at all why the government has a vested interest in such technology, but perhaps it's related to the fact that they want me to put my electronic medical records online," the physician poses. "That means the whole record, and that's a red line that I will not cross."

The New Jersey-based doctor concludes that patient records are for doctors to offer better care for their patients -- not for a federal bureaucracy to review and store.

-

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

By Bob Glissmann / World-Herald staff writer

May 24, 2013

Medicare is withholding more than $1 million from metro Omaha and Lincoln hospitals because too many of their patients returned to the hospitals within a month of being sent home.

Medicare officials, as part of an effort to curb rising costs, are taking aim at avoidable hospital readmissions, which they consider to be one of the biggest problems facing the country's health care system. Twenty percent of elderly patients are back in the hospital within 30 days of leaving, the federal Centers for Medicare & Medicaid Services say.

The penalties are one reason some hospitals are paying nurses to make follow-up home visits and set up doctor's appointments for patients — tasks that used to be left to patients' relatives or the patients themselves.

If someone is readmitted to the hospital so soon after being treated, it “means they have some problem that wasn't addressed or they developed a new problem at home,” said Susan Mende, senior program officer for the Robert Wood Johnson Foundation. Such readmissions, she said, “are really a quality and cost problem that very negatively impacts people's lives and wastes very precious health care resources.”

Tips for avoiding a return to the hospital

Ask questions about unclear instructions.

Repeat instructions back to your doctors and nurses in your own words.

Have a family member or caregiver in the room when getting instructions and at follow-up appointments.

Know danger signs and what to do if your symptoms get worse.

Ask your doctors for information on your health conditions so you can learn how to continue staying healthy.

Visit your primary care doctor or specialist within two weeks of leaving the hospital.

Get a discharge plan and bring it to all follow-up appointments. It should include:

» A schedule of appointments

» A list of health conditions and allergies

» The names of doctors, hospitals and pharmacies and their phone numbers

» A list of new equipment that's needed (cane, wheelchair, grab bar)

» A medication list that you take to your appointments. It should include:

a) All medications, including vitamins and over-the-counter medicines

b) A schedule of when to take each medicine, how much and for how long

c) Possible side effects

d) Whether any new medicines are replacing old ones

Source: Robert Wood Johnson Foundation.

Readmissions for Medicare patients alone cost $26 billion a year, according to a foundation report, and more than $17 billion of that pays for return trips that don't need to happen if patients get the right care in the first place. The health insurance program for people age 65 and older is financed by U.S. taxpayers.

The total reduction in U.S. hospitals' Medicare reimbursements topped $280 million. Hospitals could lose up to 1 percent of their Medicare payments for fiscal year 2013, up to 2 percent for 2014 and up to 3 percent for 2015.

The government says its efforts to address the problem are paying off already: The country's hospitals had about 70,000 fewer readmissions in 2012, and the national readmission rate is estimated to have dropped to 17.8 percent in October after averaging 19 percent for the previous five years.

Local hospital officials say they have been working hard to reduce the number of readmissions and say their numbers are improving.

Earlier this week, Maria Hackenberg, a home health nurse for Methodist Hospital, visited Dan Simpson in his home in Valley to make sure his blood was clotting properly after hip-replacement surgery.

Such patients are prescribed blood thinners after surgery to make sure they don't develop clots that could send them back to the hospital or even threaten their lives.

Simpson's blood was fine. The 50-year-old crane operator for Valmont reported that he also was following the directions he had been given at the hospital: “You can't cross your legs, you have to keep them apart and you can't bend past 90 (degrees).”

It will take awhile for hospitals' improvements to show up in the U.S. government database. The recent penalties were assessed for the qualifying readmissions that occurred between the beginning of July 2008 and the end of June 2011.

The government is penalizing hospitals with high rates of readmitting three groups of patients: those with heart failure, heart attacks and pneumonia. (That list is scheduled to expand in fiscal year 2015 to include patients admitted for treatment of a sudden worsening of chronic obstructive pulmonary disease symptoms and those admitted for elective total hip or total knee surgeries.)

In metro Omaha and Lincoln, the first round of penalties ranged from .01 percent of a hospital's Medicare payments to 1 percent, which translated to losses of more than $1,600 to around $350,000, depending on the hospital.

Three years ago, Methodist Health System convened a readmission task force to look at the care provided in the hospital, through home health providers and in the Methodist Physicians Clinics. Today, care coordinators make sure patients have doctor's appointments scheduled within three to five days of dismissal, said Ruth Freed, Methodist Health System's director of clinical alignment.

Nurses also call congestive heart failure patients and pneumonia patients within 24 hours of dismissal to see if they are taking their medications and to find out how things are going at home. In addition, they make sure the patients know which symptoms, such as weight gain for heart failure patients, are serious enough to require a call to their doctor.

Advanced practice nurses also accompany home health nurses on visits to the homes of some of the very ill, Freed said. They look for safety concerns, review the person's medications to make sure none would conflict with newly prescribed drugs and, if the person is a heart patient, check to see if there are lots of foods containing salt in the house.

Dr. Anton Piskac, vice president for performance improvement for Methodist Health System, said Methodist Hospital and Methodist Women's Hospital had 570 admissions for pneumonia in the years covered in the Medicare report. Within 30 days of their dismissal, 128 of those patients returned to one of the hospitals. If 17 fewer patients had returned during the 30-day window, Piskac said, the hospitals could have avoided the nearly $270,000 reduction in its Medicare reimbursement.

“It's not a small amount,” Piskac said. “Believe me, we notice that.”

Some of the responsibility for avoiding readmissions lies with patients or their families, said Mende, with the Robert Wood Johnson Foundation.

“When you are going to be discharged, have a written discharge plan,” Mende said. “Ask questions, and ask those questions again and again. Make sure you understand.”

The printed discharge report, she said, should list the person's medications, the reason the person was admitted, the type of surgery he or she had, any scheduled follow-up appointments and other details.

“We only can really control so much,” said Angela Ward, quality and ancillary services executive for Alegent Creighton Health. “What the patients choose to do when they leave is hard for us to control.”

Yet the hospitals try anyway, both to avoid penalties and improve the quality of care. Care managers and social workers on the nursing units in Alegent Creighton hospitals work with patients before they leave, and a pharmacist meets with patients to go over their medications. After the patients go home, one of 32 care coordinators from Alegent Creighton clinics checks up on them.

Ward said readmission rates in the system's hospitals have been “trending down very nicely over the last several years.”

Some of the readmission-reduction programs get federal help in the form of grants, but others don't. Methodist's Piskac said it's hard to determine how much the programs are costing, as they supplement efforts that already were in place. Whatever the cost, he said, it's the right thing to do.

It's not as if the government effort was the first to target readmissions. Hackenberg, the Methodist home health nurse, said she has visited joint-replacement patients in their homes for years.

The patients at highest risk for readmissions are those with chronic medical conditions, especially if the person is on multiple medications or has no safety net or family support at home, said Dr. Stephen Smith, the Nebraska Medical Center's chief medical officer. As part of a program the med center has with the Visiting Nurse Association, a health coach visits people after they are discharged to make sure they stay healthy.

Sydney Smith, a certified nursing assistant who works as a VNA coach, met this week with Dan Ostergard at his central Omaha home to review his medications. Ostergard, 56, was diagnosed with Type 2 diabetes after being admitted to the med center in early May with pneumonia.

Smith had Ostergard write in a small book the name of each medication, the dosage, the reason for taking it and whether it was new to him or not. He then could take the book to his doctor's appointments.

Ostergard knew what each drug did and why he was taking it. His job is to help organize estate and moving sales, so he's good with details.

Smith asked Ostergard to set a personal goal, medical-related or not. He said he hoped to adhere to a more healthy lifestyle and reduce stress. “I've been notorious for burning the candle at both ends for quite a number of years,” he said, “and see where it's gotten me.”

In Lincoln, representatives from hospitals, skilled-care centers and home health providers meet quarterly to talk about how they can improve care providers' handoffs of patients, said Pat Hoidal, director of performance improvement at St. Elizabeth Regional Medical Center. Under federal rules, she said, “We will have to function as one long continuum. We will have to build strong relationships with each other.

“We tolerated the readmissions in the past. Clearly it's not the right way to be delivering services.”

Contact the writer:

402-444-1109, bob.glissmann@owh.com

twitter.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

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.