Guest post by Abhinav Shashank, CEO and c0-founder, Innovaccer.
Abhinav Shashank
Former US President Abraham Lincoln once said, “Give me six hours to chop down a tree and I’ll spend four hours sharpening the ax.” After having a look at the efficiency of the US healthcare system, one cannot help but notice the irony. A country spending $10,345 per person on healthcare shouldn’t be on the last spot of OECD rankings for life expectancy at birth!
A report from Commonwealth Fund points how massive is US healthcare budget. Various US governments have left no stone unturned in becoming the highest spender on healthcare, but have equally managed to see most of its money going down the drain!
Here are some highlights from the report:
The US is third when it comes to public spending on health care. The figure is $4,197 per capita, but it covers only 34 percent of its residents. On the other hand, the UK spends only $2,802 per capita and covers 100 percent of the population.
With $1,074, the US has the second highest private spending on healthcare.
In 2013, US allotted 17.1 percent of its GDP to healthcare, which was highest by any OECD country. In terms of money, this was almost 50 percent more than the country on the second spot.
In the year 2013, the number of practicing physicians in the US was 2.6 per 1000 persons, which is less than the OECD median (3.2).
The infant mortality rate in the US was also higher than other OECD nations.
Sixty-eight percent of the population above 65 in the US is suffering from two or more chronic conditions, which is again the highest among OECD nations.
The major cause of these problems is the lack of knowledge about the population trends. The strategies in place will vibrantly work with the law only if they are designed according to the needs of the people.
What is Population Health Management?
Population health management (PHM) might have been mentioned in ACA (2010), but the meaning of it is lost on many. I feel, the definition of population health, given by Richard J. Gilfillan, president and CEO of Trinity Health, is the most suitable one.
“Population health refers to addressing the health status of a defined population. A population can be defined in many different ways, including demographics, clinical diagnoses, geographic location, etc. Population health management is a clinical discipline that develops, implements and continually refines operational activities that improve the measures of health status for defined populations.”
The true realization of population health management (PHM) is to design a care delivery model that provides quality coordinated care in an efficient manner. Efforts in the right direction are being made, but the tools required for it are much more advanced and most providers lack the resources to own them.
Countless Possibilities
If population health management is in place, technology can be leveraged to find out proactive solutions to acute episodes. Based on past episodes and outcomes, better decision could be made.
The concept of health coaches and care managers can actually be implemented. When a patient is being discharged, care managers can confirm the compliance of the health care plans. They can mitigate the possibility of readmission by keeping up with the needs and appointments of patients. Patients could be reminded about their medications. The linked health coaches could be intimated to further reduce the possibility of readmission.
Guest post by Sivan Agranat, M.D., VP, Medical R&D, medCPU.
Sivan Agranat
The successful implementation of new IT solutions can depend as much on user acceptance as on the technical aspects of implementation. Gaining that user acceptance is largely a matter of ensuring stakeholders are part of the conversation during pre-implementation, followed by fully accounting for and meeting end-user needs during roll-out and beyond. Nobody, especially busy doctors and nurses, appreciates having new technology dropped on them; nor should they. Their input throughout the process is critical not only to their acceptance, but also to solution optimization.
The following is a suggested course of action for gaining stakeholder buy-in and sustained satisfaction that can make new technologies a welcomed addition to clinical care settings.
The technology selection process
Provider organizations invariably have some clinicians who appreciate the benefits of health IT more so than others, and who serve as internal IT champions. When their opinions are respected by their peers, they can be invaluable allies in new implementation projects, which is why it’s imperative to loop them in as clinical representatives at the beginning of the vendor selection process. Their combination of clinical expertise and affinity for IT can be indispensable in validating vendor claims, ensuring the most promising solutions rise to the top. Additionally, having been involved from project start can help enable them to be better positioned to promote the solution internally and offer meaningful support to their peers as they gain user proficiency.
One important element that’s too often overlooked is: When gathering input from clinical representatives during vendor selection, pay close attention to ensure solution capabilities align with existing workflows. Making later adjustments to ensure the right information is delivered to the right person at the right time can be costly and time-consuming.
Before making a final decision on vendor selection, hold an all-stakeholder preview meeting. This can help head off resistance while gaining needed input. Include all targeted end users, not just nurses and doctors, but members of the nursing and clinical support teams as well. If the implementation is a major initiative, consider having meetings with primary stakeholders and include an introduction by the Chief Medical Officer, who can best explain the project’s importance.
In all stakeholder preview meetings, begin by describing how and why the project transpired and what it is designed to accomplish. Next demonstrate the solution and engage people and ask for their feedback. Most importantly, take all feedback to heart, and address stated concerns as clearly as possible. This attention and courtesy can help ward off skepticism at time of rollout, and help ensure acceptance. Also, you may learn from the end user feedback that will help foster enhanced final adjustments before the actual rollout.
Guest post by Valerie Gleaton, managing editor, Health eCareers.
Valerie Gleaton
Salaries for healthcare IT professionals are on the rise, but they aren’t growing as fast as some other healthcare positions. That may be impacting satisfaction levels, according to a recent survey. Healthcare job site Health eCareers polled nearly 20,000 U.S. healthcare workers and found that the average annual salary for healthcare IT professionals increased 2.2 percent from 2015 to 2016. However, some of the other positions included in the survey saw more sizeable gains. For instance, those working in academics, research, administration, operations and allied health saw compensation increases in excess of 10 percent.
With more available jobs than professionals to fill them, hospitals, healthcare clinics and other providers are increasingly willing to loosen their purse strings and pay higher wages to both current employees and new hires. These factors have created a perfect storm of opportunity for healthcare workers, and 87 percent report that their pay is the same or has increased compared to a year ago. Survey respondents pointed to merit raises or employer changes as the primary reasons for their increase. There were exceptions, however. Nurses and healthcare executives saw a 3 percent and 13 percent drop, respectively.
$91k is Average for Healthcare IT
Healthcare information technology professionals are enjoying robust job prospects, as healthcare organizations come under the gun to improve efficiencies, cut costs and find better ways share patient information. The study revealed that America’s healthcare IT workers earn an average of $91,251 a year, the fifth-highest paid healthcare profession, topped only by physicians/surgeons, healthcare executives, physician assistants and nurse practitioners.
Pay Fluctuates by Location, Experience and Position
Location seems to influence pay, with salaries varying widely from state to state. For instance, healthcare IT professionals in California earn an average of $95,224 per year, while their counterparts in Texas make nearly 6 percent less, averaging $89,758 a year.
Another large and unsurprising determinant of pay is experience. New healthcare IT professionals — those with five or fewer years of experience — earn an average of $74,815 per year, while those with more than 10 years of experience report an average annual salary of $104,343. Those that fall in the middle with 6–10 years of experience pull in an average of $98,082.
Health eCareers also found big pay discrepancies by types of healthcare IT disciplines. Health information technology executives are far and away the best paid, with a median annual income of $127,500. IT technology managers also do well, with median earnings of $111,500 per year. Further down the pay scale are healthcare informatics employees at $74,500, and toward the bottom are health information technicians, who report median salaries of just $50,500.
Guest post by Lea Chatham, editor-in-chief, Getting Paid, a Kareo Resource.
Lea Chatham
Patient engagement has been the hot topic of this past year or two. Everyone agrees that engaging patients more in their healthcare can help reduce costs and improve overall health. A study conducted by HIMSS in 2015 showed that the majority of physicians believe patient engagement is beneficial and should be a part of their job. However, the study also concluded that over 40 percent of physicians worry that there is little reimbursement for engagement activities.
Patient are looking for more ways to connect with providers from online scheduling to text reminder to email follow ups and social media. And while many see these as conveniences, the reality is that they do also improve health and have the potential to reduce costs. Studies have shown that simple follow up communications via text and email can help ensure patients show up for appointments and can reduce hospital re-admissions, which has a big impact on healthcare costs.
Unfortunately, physicians are already stretched thin trying to care for patients, run their practices, adhere to complex programs like meaningful use and PQRS, and navigate changes like ICD-10. Who has the time to do more? And many providers worry that “engagement” means more work with less reimbursement. But it doesn’t have to be that way.
In fact there are many opportunities to automate engagement and provide the tools patients want without adding any time or effort to a provider’s plate. Today, there are solutions that once set up enable easy online scheduling, text and email reminders, follow up patient surveys, and even re-care programs.
This infographic highlights some of the feelings of both patients and providers feel about patient engagement and shows how practices can utilize engagement strategies that benefits both and do have a financial return.
The huge growth of the home care industry in recent years has led to a Catch 22 situation. On the one hand, people are living for longer than ever before and the number of home health aides is growing at a rate far higher than the average for all industries. On the other, the increase in life expectancy means that the number of elderly people requiring home care has never been higher, and even the increase in home care workers isn’t enough to cope with demand. Also, the tightening of licensing regulations will shrink the pool of available caregivers.
In this infographic from Be Independent Home Care, we can see that the home care industry is at a crossroads and faces into a potentially troublesome future. By 2024, the number of home health aides is projected to have grown by 38 percent from a decade previously. By 2020, the global homecare industry is expected to produce revenues of $300 billion, compared to $180 billion in 2014. All the while, the senior citizen population in the U.S. has doubled from just four years ago, with one in five Americans now of senior age.
Where does the home care industry go from here? Quite simply, it needs to keep adding to the number of qualified caregivers – just at an even faster rate than at present. That won’t be easy considering that the current rate is well above the overall average, but unless that rate is maintained, demand will exceed supply and then there really will be a home care crisis. Here, perhaps, is the epitome of being a victim of one’s success.
Guest post by Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Donald Voltz, MD
As Halloween approaches, the usual spate of horror movies will intrigue audiences across the US, replete with slashers named Jason or Freddie running amuck in the corridors of all too easily accessible hospitals. They grab a hospital gown and the zombies fit right in. While this is just a movie you can turn off, the real horror of patient data theft can follow you.
(I know how terrible this type of crime can be. I myself have been the victim of a data theft by hackers who stole my deceased father’s medical files, running up more than $300,000 in false charges. I am still disputing on-going bills that have been accruing for the last 15 years).
Unfortunately, this horror movie scenario is similar to how data thefts often occur at medical facilities. In 2015, the healthcare industry was one of the top three hardest hit industries with serious data breaches and major attacks, along with government and manufacturers. Packed with a wealth of exploitable information such as credit card data, email addresses, Social Security numbers, employment information and medical history records, much of which will remain valid for years, if not decades and fetch a high price on the black market.
Who Are The Hackers?
It is commonly believed attacks are from outside intruders looking to steal valuable patient data and 45 percent of the hacks are external. However, “phantom” hackers are also often your colleagues, employees and business associates who are unwittingly careless in the use of passwords or lured by phishing schemes that open the door for data thieves. Not only is data stolen, but privacy violations are insidious.
The problem is not only high-tech, but also low-tech, requiring that providers across the continuum simply become smarter about data protection and privacy issues. Medical facilities are finding they must teach doctors and nurses not to click on suspicious links.
To thwart accidental and purposeful hackers, organizations should implement physical security procedures to secure network hardware and storage media through measures like maintaining a visitor log and installing security cameras. Also limiting physical access to server rooms and restricting the ability to remove devices from secure areas. Yes, humans are the weakest link.
Growing Nightmare
Medical data theft is a growing national nightmare. IDC’s Health Insights group predicts that one in three healthcare recipients will be the victim of a medical data breach in 2016. Other surveys found that in the last two years, 89 percent of healthcare organizations reported at least one data breach, with 79 percent reporting two or more breaches. The most commonly compromised data are medical records, followed by billing and insurance records. The average cost of a healthcare data breach is about $2.2 million.
At health insurer Anthem, Inc., foreign hackers stole up to 80 million records using social engineering to dig their way into the company’s network using the credentials of five tech workers. The hackers stole names, Social Security numbers and other sensitive information, but were thwarted when an Anthem computer system administrator discovered outsiders were using his own security credentials to log into the company system and to hack databases.
Investigators believe the hackers somehow compromised the tech worker’s security through a phishing scheme that tricked the employee into unknowingly revealing a password or downloading malicious software. Using this login information, they were able to access the company’s database and steal files.
Healthcare Hacks Spread Hospital Mayhem in Diabolical Ways
Not only is current patient data security an issue, but thieves can also drain the electronic economic blood from hospitals’ jugular vein—its IT systems. Hospitals increasingly rely on cloud delivery of big enterprise data from start-ups like iCare that can predict epidemics, cure disease, and avoid preventable deaths. They also add Personal Health Record apps to the system from fitness apps like FitBit and Jawbone.
Banner Health, operating 29 hospitals in Arizona, had to notify millions of individuals that their data was exposed. The breach began when hackers gained access to payment card processing systems at some of its food and beverage outlets. That apparently also opened the door to the attackers accessing a variety of healthcare-related information.
Because Banner Health says its breach began with an attack on payment systems, it differentiates from other recent hacker breaches. While payment system attacks have plagued the retail sector, they are almost unheard of by healthcare entities.
Guest post by Cheri Bankston, RN, MSN, director of clinical advisory services, Curaspan.
Cheri Bankston
When determining a discharge plan, hospitals must provide a list of home health agencies (HHAs) or skilled nursing facilities (SNFs) that are available to care for the patient; this comes as part of the Conditions of Participation (CoPs) for Discharge Planning. In the case of a HHA, the provider must be able to serve the patient in the area where the patient resides, or in the case of a SNF, the area requested by the patient.
Acute care providers have been struggling on how to set up a high quality provider network to support patient choice as we move from volume to value. Provider networks aim to gather more information to assist beneficiaries with selecting a high-quality post-acute provider. CMS has not outlined any specific criterion that deems a provider “high quality,” but the end goal is to provide the patient more information on quality performance and resource use at the time they are making a decision. Through the Center for Medicaid and Medicare Services’ (CMS) Star Rating program, discharge planners or case managers working for hospitals are able to highlight those provider networks that will best fit the needs of the patient. The networks are able to counsel patients about their available choices, while more importantly upholding the patient’s right to choose.
Under the Affordable Care Act’s value-based purchasing initiative, hospitals are at financial risk for the outcomes of care its patients receive from post-acute care providers, leading hospitals to work towards establishing high-quality provider networks. For many, upholding the standard of Medicare policy – patient freedom of choice – is challenged by potential financial incentives and penalties for the bottom line – the quality of care provided to the patient after discharge impacts the reimbursement levels for hospitals and ACOs. Although provider networks may appear to narrow patient choice, they actually create a set of higher quality post-acute providers that improve patient outcomes without impeding access to care.
Payers have been using “provider networks” for years, but being applied to hospitals is a brand new concept. An ACO’s success depends on using a provider network that has a demonstrated history of high quality of care outcomes. For example, SNFs that have a high rate of patients going to emergency rooms and not being admitted must be evaluated to determine the variance from other providers with the same level of care and fewer emergency room visits. Quality outcomes and patient satisfaction are going to drive the definition of provider networks.
Ironically the prevailing attitude among clinicians remains; “healthcare does not consider itself a process or system industry” therefore, it is not one which would significantly benefit from leveraging technology to improve its processes. As a data science community within the healthcare industry, we must all push the envelope to demonstrate that Healthcare has a lot to gain by becoming more efficient and effective via process improvement technologies as it clearly has done by embracing clinical improvement technologies.
Dale Schroyer, a certified data scientist, and ProModel’s leading healthcare simulation expert overheard these comments while attending an immersion workshop on RCA, or root cause analysis, at the NPSF Patient Safety Congress earlier this year.
This program looked at what hospitals do when an adverse event occurs. According to the workshop instructors, Dr. James P. Bagian and Mr. Joseph M. DeRosier, “Usually, such events occur because of system faults or failures, not necessarily human error. The challenge is determining what the faults in the system are, how they can be fixed and instituting actions to fix them and measure those fixes.”
Schroyer found it a fascinating topic because of the similarities to what is done in the aerospace industry in which he started his career. One of the instructors was also from the aerospace industry. Both instructors teach at the University of Michigan which is also Schroyer’s alma mater.
From listening and interacting with conference attendees, most of whom were nurses and doctors, Schroyer observed that healthcare does not consider itself a process industry. However, the mere fact that doctors and nurses were having the conversation is a considerable step in the right direction.
Many in attendance wanted to know what techniques would best serve them in convincing their coworkers back home that the system approach is a good and necessary one for the healthcare industry that can benefit patients, hospitals, nurses and physicians. Using a predictive/prescriptive analytic tool such as discrete event simulation (DES) is one possible approach.
Schroyer spoke with the instructors, as well as other attendees, about simulation as a tool to improve patient flow and other hospital system shortfalls. They mentioned that the barriers to simulation are many such as a long, cumbersome learning curve.
