Health Literacy Needs a Place in Physicians' Practices

I was invited to sit in on a presentation by Mark Dumoff, an expert on patient communication and health literacy, to the chief medical officers of a large private insurer a few weeks ago.

It struck all of us, as we struggle to adapt to legislation that attempts to set our healthcare system on the right track with new taxes, mandates, and regulation, that fundamentals are falling to the wayside. Failing to master basics like doctor-patient communications is hugely expensive in terms of quality of life, time and money.

The statistics Dumoff outlined are a wakeup call:
• 90 million adults have low health literacy levels
• Cost to the U.S. economy : $106 billion to $238 billion/year
• $1.6 trillion to $3.6 trillion burden to future generations in today’s dollars
• White, native-born Americans are the majority group

This happens because one out of three patients can’t understand instructions for self-care, after-care, and transitions in care from one setting to another. Another one out of three struggles with them. As a result, patient transitions and coordinated care are adversely affected, which researchers say caused $25 billion to $45 billion in wasteful spending in 2011, mostly due to avoidable complications and hospital readmissions.

The cycle is as familiar as the solution seems to be elusive:
1. Patient seeks medical help
2. Patient is asked to complete complex, confusing forms
3. Doctor explains patient’s condition and treatment plan using medical jargon
4. Doctor writes multiple prescriptions and referrals for tests
5. Doctor does not confirm patient’s understanding
6. Patient goes home with complicated, generic instructions
7. No one follows up with patient
8. Patient takes medications incorrectly and does not follow up
9. The cycle begins again - patient seeks medical help

Those with chronic conditions such as diabetes, hypertension, and asthma are at the highest risk of disease progression and co-morbidity while patients in transition from acute to sub-acute care for conditions such as CHF, COPD, pneumonia, and AMI are at the highest risk of unnecessary hospital readmission.

As of Monday, Medicare will start fining hospitals for having too many patients readmitted within 30 days of discharge due to complications. About two-thirds of the hospitals serving Medicare patients, or about 2,200 facilities, will be hit with penalties averaging $125,000 each this coming year according to government estimates. The likely response will be to focus on discharge instructions and to initiate quality and patient experience measurements for their admitting physicians as a barometer of risk.

In an emerging era of shared risk and performance-based remuneration, getting fundamentals such as effective patient communication right is especially important to survival and success in medical practice.

It takes some work to change embedded habits and practice culture, but, once done, the rewards keep paying dividends far into the future.

These simple changes to the treatment cycle can make meaningful improvements in outcome:
1. Patient seeks medical help
2. Scheduler sends simple forms and offers help in filling them out
3. Staff collects forms and asks patient if they need help in completing them
4. Doctor explains patient’s condition and treatment plan using simple terms
5. Doctor writes multiple prescriptions and referrals for tests and doctor or staff explain what they are for, what to do, and what to expect
6. Doctor or staff or both confirm patient’s understanding
7. Patient goes home with clear, simple instructions
8. Staff follows up with patient to ensure compliance, answer questions, and ensure patient returns for follow-up visits
9. Patient’s condition is being well managed
In the end, everyone gains:

Practice/Physician Impact:
• Enhances patient engagement in self-care
• Promotes positive behavioral change
• Improves adherence and outcomes
• Upgrades quality, compliance, measurement, and reporting
• Increases patient, physician, and staff satisfaction
• Reduces risk and may lower malpractice rates
• Maximizes payment incentives
• Enhances quality of care/reduces length of stay, readmissions, and medical expenses
• Proactively manages risk
• Increases new patient referrals

Patient Impact:
• Better healthcare decisions/more effective self-care
• Healthier outcomes
• Fewer visits
• Less out-of-pocket expense
• More meaningful doctor-patient relationship

Mastering fundamentals may not be as sexy or stimulating as mastering a new technique or technology, but they win the day. Ask any athletic trainer or coach. Their success is built on executing fundamentals flawlessly.

Find out more about James Doulgeris and our other Practice Notes bloggers.

View the original article here

Personal Health Record Usage and Medical Practices

Patients say they want transparency and instant access to their healthcare information, yet most remain on the sidelines when it comes to using these tools. Maybe that's no surprise when many physicians are still getting up to speed on EHRs. That may change — and soon. Stage 2 of the federal EHR meaningful use incentive programs requires that eligible providers make more healthcare information available electronically to more patients starting in 2014 — personal health records (PHRs) can help physicians reach that goal.

Still, meaningful use is not the primary motivator for PHR adoption, say medical practices using the technology successfully. Instead, it is driven by patient expectations, adept integration of information systems, and demands for value from physicians, patients, and payers.

So far, the PHR installations that seem to gain the quickest acceptance from patients share three elements: user-friendly technology, tie-in to a medical practice's website, and the encouragement of physician advocates.

Here's more information on what's driving the adoption of PHRs, what value they bring to practices and patients, and key tips for implementing them and encouraging patients to use them.

Patient expectations

Although recent surveys indicate disinterest in PHRs among patients — about 10 percent of Americans used them in 2011, according to Deloitte Center for Health Solutions — Brock Morris, chief information officer at Redmond, Wash.-based Pediatric Associates, hears a different story from parents of the practice's patients. That's probably no surprise, he says. Many of the parents bringing their children to the 85-physician multisite practice also work for the city's top private employer, Microsoft Corporation. "The parents of our patients tend to be a technically-minded demographic," Morris says. "We get asked all the time: 'What new services and solutions can you provide us?'"

PHRs, he adds, are a natural extension of his patients' parents' everyday experiences. "The parents are used to having information at their fingertips and being able to control it. They are frustrated when they want their child's immunizations or a growth chart and are told they have to wait a few days. In almost every other environment today, people get information quickly and can manage it themselves."

As younger, more tech-savvy patients become more active users of medical practices, the drive toward PHR adoption will increase. Indeed, Morris notes that younger generations of patients, including the parents he hears from at Pediatric Associates, gravitate to websites, text messaging, and other forms of communication.

Improved capabilities

Pediatric Associates is one of several practices around the nation involved in pilot testing interfaces between Microsoft's Web-based HealthVault PHR and their EHRs — Greenway's EHR in the case of Pediatric Associates. The approach aims to tie PHRs to EHRs via websites and, potentially, tie both to the medical devices patients use at home.

Morris says the beta version his practice is trying out allows parents to pull continuity-of-care documents (CCDs) about their child's care from the EHR and into HealthVault. Parents also can hook up their child's glucose monitor — and soon, other home health devices — to electronically enter data into the PHR to share with the child's medical team.

The pilot projects hope to overcome a barrier hobbling the prospects of free-standing, or "untethered," PHRs — lack of tight integration with a patient's clinical records and his provider's website.

Any individual can use HealthVault on the Web or via apps to create untethered accounts. But because HealthVault also supports common exchange formats, like CCDs, it essentially becomes a tethered system capable of electronically connecting with home health devices and a configured EHR. 

View the original article here

Personal Health Record Usage and Medical Practices

Patients say they want transparency and instant access to their healthcare information, yet most remain on the sidelines when it comes to using these tools. Maybe that's no surprise when many physicians are still getting up to speed on EHRs. That may change — and soon. Stage 2 of the federal EHR meaningful use incentive programs requires that eligible providers make more healthcare information available electronically to more patients starting in 2014 — personal health records (PHRs) can help physicians reach that goal.

Still, meaningful use is not the primary motivator for PHR adoption, say medical practices using the technology successfully. Instead, it is driven by patient expectations, adept integration of information systems, and demands for value from physicians, patients, and payers.

So far, the PHR installations that seem to gain the quickest acceptance from patients share three elements: user-friendly technology, tie-in to a medical practice's website, and the encouragement of physician advocates.

Here's more information on what's driving the adoption of PHRs, what value they bring to practices and patients, and key tips for implementing them and encouraging patients to use them.

Patient expectations

Although recent surveys indicate disinterest in PHRs among patients — about 10 percent of Americans used them in 2011, according to Deloitte Center for Health Solutions — Brock Morris, chief information officer at Redmond, Wash.-based Pediatric Associates, hears a different story from parents of the practice's patients. That's probably no surprise, he says. Many of the parents bringing their children to the 85-physician multisite practice also work for the city's top private employer, Microsoft Corporation. "The parents of our patients tend to be a technically-minded demographic," Morris says. "We get asked all the time: 'What new services and solutions can you provide us?'"

PHRs, he adds, are a natural extension of his patients' parents' everyday experiences. "The parents are used to having information at their fingertips and being able to control it. They are frustrated when they want their child's immunizations or a growth chart and are told they have to wait a few days. In almost every other environment today, people get information quickly and can manage it themselves."

As younger, more tech-savvy patients become more active users of medical practices, the drive toward PHR adoption will increase. Indeed, Morris notes that younger generations of patients, including the parents he hears from at Pediatric Associates, gravitate to websites, text messaging, and other forms of communication.

Improved capabilities

Pediatric Associates is one of several practices around the nation involved in pilot testing interfaces between Microsoft's Web-based HealthVault PHR and their EHRs — Greenway's EHR in the case of Pediatric Associates. The approach aims to tie PHRs to EHRs via websites and, potentially, tie both to the medical devices patients use at home.

Morris says the beta version his practice is trying out allows parents to pull continuity-of-care documents (CCDs) about their child's care from the EHR and into HealthVault. Parents also can hook up their child's glucose monitor — and soon, other home health devices — to electronically enter data into the PHR to share with the child's medical team.

The pilot projects hope to overcome a barrier hobbling the prospects of free-standing, or "untethered," PHRs — lack of tight integration with a patient's clinical records and his provider's website.

Any individual can use HealthVault on the Web or via apps to create untethered accounts. But because HealthVault also supports common exchange formats, like CCDs, it essentially becomes a tethered system capable of electronically connecting with home health devices and a configured EHR. 

View the original article here

Health Literacy Needs a Place in Physicians' Practices

I was invited to sit in on a presentation by Mark Dumoff, an expert on patient communication and health literacy, to the chief medical officers of a large private insurer a few weeks ago.

It struck all of us, as we struggle to adapt to legislation that attempts to set our healthcare system on the right track with new taxes, mandates, and regulation, that fundamentals are falling to the wayside. Failing to master basics like doctor-patient communications is hugely expensive in terms of quality of life, time and money.

The statistics Dumoff outlined are a wakeup call:
• 90 million adults have low health literacy levels
• Cost to the U.S. economy : $106 billion to $238 billion/year
• $1.6 trillion to $3.6 trillion burden to future generations in today’s dollars
• White, native-born Americans are the majority group

This happens because one out of three patients can’t understand instructions for self-care, after-care, and transitions in care from one setting to another. Another one out of three struggles with them. As a result, patient transitions and coordinated care are adversely affected, which researchers say caused $25 billion to $45 billion in wasteful spending in 2011, mostly due to avoidable complications and hospital readmissions.

The cycle is as familiar as the solution seems to be elusive:
1. Patient seeks medical help
2. Patient is asked to complete complex, confusing forms
3. Doctor explains patient’s condition and treatment plan using medical jargon
4. Doctor writes multiple prescriptions and referrals for tests
5. Doctor does not confirm patient’s understanding
6. Patient goes home with complicated, generic instructions
7. No one follows up with patient
8. Patient takes medications incorrectly and does not follow up
9. The cycle begins again - patient seeks medical help

Those with chronic conditions such as diabetes, hypertension, and asthma are at the highest risk of disease progression and co-morbidity while patients in transition from acute to sub-acute care for conditions such as CHF, COPD, pneumonia, and AMI are at the highest risk of unnecessary hospital readmission.

As of Monday, Medicare will start fining hospitals for having too many patients readmitted within 30 days of discharge due to complications. About two-thirds of the hospitals serving Medicare patients, or about 2,200 facilities, will be hit with penalties averaging $125,000 each this coming year according to government estimates. The likely response will be to focus on discharge instructions and to initiate quality and patient experience measurements for their admitting physicians as a barometer of risk.

In an emerging era of shared risk and performance-based remuneration, getting fundamentals such as effective patient communication right is especially important to survival and success in medical practice.

It takes some work to change embedded habits and practice culture, but, once done, the rewards keep paying dividends far into the future.

These simple changes to the treatment cycle can make meaningful improvements in outcome:
1. Patient seeks medical help
2. Scheduler sends simple forms and offers help in filling them out
3. Staff collects forms and asks patient if they need help in completing them
4. Doctor explains patient’s condition and treatment plan using simple terms
5. Doctor writes multiple prescriptions and referrals for tests and doctor or staff explain what they are for, what to do, and what to expect
6. Doctor or staff or both confirm patient’s understanding
7. Patient goes home with clear, simple instructions
8. Staff follows up with patient to ensure compliance, answer questions, and ensure patient returns for follow-up visits
9. Patient’s condition is being well managed
In the end, everyone gains:

Practice/Physician Impact:
• Enhances patient engagement in self-care
• Promotes positive behavioral change
• Improves adherence and outcomes
• Upgrades quality, compliance, measurement, and reporting
• Increases patient, physician, and staff satisfaction
• Reduces risk and may lower malpractice rates
• Maximizes payment incentives
• Enhances quality of care/reduces length of stay, readmissions, and medical expenses
• Proactively manages risk
• Increases new patient referrals

Patient Impact:
• Better healthcare decisions/more effective self-care
• Healthier outcomes
• Fewer visits
• Less out-of-pocket expense
• More meaningful doctor-patient relationship

Mastering fundamentals may not be as sexy or stimulating as mastering a new technique or technology, but they win the day. Ask any athletic trainer or coach. Their success is built on executing fundamentals flawlessly.

Find out more about James Doulgeris and our other Practice Notes bloggers.

View the original article here

Romney and Ryan camps clarify health law positions

On Sunday, GOP presidential nominee Mitt Romney, appearing on NBC’s Meet the Press, said he would keep the popular provision in President Barack Obama’s health law that “makes sure those with pre-existing conditions can get coverage.”

And on ABC’s This Week with George Stephanopoulus, Paul Ryan appeared to back a lesser-known part of the law called “maintenance of effort” that prohibits states from making it harder for people to get covered by Medicaid, the state-federal health program for the poor, until 2014.

Both statements seemed to signal dramatic shifts in position for the Republican presidential ticket. But campaign officials later insisted the men hadn’t said anything they hadn’t said before.

On pre-existing conditions,  campaign officials said later Sunday that Romney supports coverage for people with pre-existing conditions, but only for those who have had continuous coverage — a position Romney has had for months. That helps people who change jobs, but leaves out those with a gap in coverage. The Commonwealth Fund found that about 89 million Americans between 2004 and 2007  had at least a one-month gap of coverage.

A Romney official said that such people would be taken care of by state high-risk insurance pools.

In contrast, the federal health law starting in 2014 blocks insurers from denying coverage for pre-existing conditions for everyone. The provision is already in effect for children.

Since 1996, a federal law has protected people from being denied coverage for pre-existing conditions if they continually have coverage. The downside of that law is there is no limit on what insurers can charge. Under the federal health law, in 2014, insurers won’t be able to charge higher rates based on a person’s health status.

On the “maintenance of effort” provision, which was first included in the federal stimulus package in 2009, then continued by the 2010 health law,  campaign officials clarified that despite Ryan’s comment, he is still in favor of killing the requirement because it inhibits state flexibility with Medicaid.

Ryan favors giving states block grants so they have broader power over the program. Stephanopoulus noted that the Urban Institute has estimated that between 14 million and 27 million fewer people will be covered under Medicaid block grants.

“I won’t get into the details, but with maintenance of effort requirements, which is what we’ve done in the past, they still have to serve this population,” Ryan said in the television interview.

Joe Antos, an economist with the conservative American Enterprise Institute, said he thinks Ryan meant to say that even if Medicaid became a block grant, states would have to continue serving those eligible for the program.

To receive guaranteed federal funding, states today must cover certain “mandatory” populations. These include children under age 6 with family income below 133 percent of the federal poverty line; children ages 6 to 18 with income below the poverty line; pregnant women with income below 133 percent of the poverty line; and most seniors and persons with disabilities who receive cash assistance through the Supplemental Security Income  program.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

View the original article here

What the platforms tell us about parties' stance on health IT

It’s a joke without a punch line: Both Republican and Democratic national party platforms make sparse mention of health IT.

To be certain, there’s plenty of focus on the broader healthcare issues. The GOP platform, in fact, dedicates its first two sections to ‘Saving Medicare for future generations’ and ‘Strengthening Medicaid in the states’, while the Democrats also address the issue early on with a section about healthcare as part of ‘The middle class bargain’ and another on ‘Social Security and Medicaid.’

As for any particulars of health IT, well, that’s another matter. Quite literally, each party offers up a single sentence on its intentions for health IT.

From page 33 of the 2012 Republican Platform PDF:
We support technology enhancements for health records and data systems while affirming patient privacy and ownership of health information.

Now, should that strike you as oddly vague, just wait.

“If anyone was disappointed in the scant attention given to health IT in the Republican Party Platform, then the Democratic Party Platform should give them pause,” said Brian Ahier, health IT evangelist at Mid-Columbia Medical Center, author of the Healthcare, Technology, and Government 2.0 blog, and city councilor in The Dalles, Ore. “Health IT is barely mentioned at all, and only in the context of broader technology initiatives.”

Indeed, in the 2012 Democratic National Party Platform health IT is on page 41 of the PDF:
We will ensure that America has a 21st century digital infrastructure – robust wired and wireless broadband capability, a smarter electrical grid, and upgraded information technology infrastructure in key sectors such as health care and education.

Reactions to the perhaps pithy stances of both parties stance have been mixed.

“I regret that the platforms are largely silent on HIT,” former four-term Vermont Governor Jim Douglas wrote in an email exchange with Government Health IT. Douglas is now a member of the Bipartisan Policy Center’s Governor’s Council and executive-in-residence at Middlebury College. “Perhaps it’s not a sexy topic, but it’s essential to our efforts to improve the quality of care and contain costs.”

So, why such vague references to health IT? Shouldn’t the national party platforms include a greater vision of and intent for the technologies forging the underpinnings of next-gen healthcare in America? Or is what the parties outlined enough for the majority of American voters?

“At this point in time I think maybe it is enough,” said Iowa State Representative Linda Upmeyer (R), a career nurse practitioner who has proposed health IT legislation since being elected 10 years ago. “I hope what it means is that this is really in an early state, but there’s a commitment to move health IT forward, that they’re listening and trying to continually improve so that the government doesn’t get this wrong.”

While some will argue that the November elections might test the bipartisan nature of health IT, at least for now Ahier, Douglas and Upmeyer view the party platforms as evidence that bipartisanship remains intact.

“It would seem that both parties agree that when health IT is used effectively it can help address the challenges confronting our healthcare system,” Ahier said. Douglas added that “the current administration continues to move the ball down the field through grants to the states, incentives to providers and implementation of the meaningful use standards,” he said. “I’m confident that the bipartisan support will continue because both parties understand the value of HIT.”

Which leads back to the beginning, where both parties support health IT, but are short on detail about exactly how – which may be because neither party can say for sure precisely what committing to health IT will really mean for the future.

“It’s always important to have something that keeps policymakers pushing health IT to the forefront, but we policymakers, be it inside the beltway or inside the golden dome in Iowa, don’t have the solutions or all the answers. So we can commit to investing in health IT and rely on the people really doing it to help determine what the next steps are,” Upmeyer, the Iowa rep said. “I don’t really want congressmen or senators or legislators deciding for them.”

Neither does Steven Waldren, MD, director of the Center for Health IT at the American Academy of Family Physicians.

“I’d much rather health IT not be a political football and remain behind the scenes a little because there’s no political urgency such that either side is going to try to politicize it and move forward. Instead, they recognize it’s an important issue,” Waldren said. “The two platforms have different philosophies but at least it’s not being debated at the level of lies, made up truths, or spinning things out of context.”

Although, there might be a solid punch line or two to emerge from that manner of rhetoric.

For more of our politics coverage, visit Political Malpractice: Healthcare in the 2012 Election.

View the original article here