More than one in two Americans cope with a chronic disease, such as diabetes, hypertension, asthma and heart disease. And 75 million Americans have two or more of these ongoing and often incurable conditions. The costs of treating chronic diseases are enormous—more than $2 trillion annually—and chronically ill patients often struggle with fragmented care.
Beyond the countless initiatives aimed at containing costs and improving health outcomes for those with chronic diseases, what simple steps can medical practices take to improve the care experience for their complex, high-needs patients?
Laurie Morgan, senior consultant and partner at Capko & Morgan
To find out, I talked to Laurie Morgan, a senior consultant and partner at Capko & Morgan who advises medical practices on operational excellence, revenue capture and the effective use of technology.
Maureen: When it comes to improving the patient experience for those with chronic diseases, where should practices begin?
Laurie: My first recommendation would be to focus more on the human touch. These patients are often scared and overwhelmed, they’re in pain and they have to make frequent trips to the doctor.
Prioritizing a more personal touch isn’t easy, especially in practices that treat a large number of chronically ill patients. Such practices are typically very busy and their staff often doesn’t have the bandwidth to pay close attention and answer patients’ questions. Luckily, there are technology solutions now that can remove some administrative burdens and give staff more time to make patients feel welcome and address their concerns.
But even simple things, such as greeting a patient who comes in frequently by name or listening intently to a patient’s questions, go a long way.
It’s no secret that people are spending more and more of their time on social media sites, sharing everything from vacation selfies to political opinions to photos of last night’s lasagna. But what about social media rules at your own practice? Do your employees understand the consequences of inadvertently or intentionally sharing sensitive patient information? Are they familiar with patient privacy rules? Do they know whether they’re allowed to be on social media while on the clock, or which sites are off-limits at work?
Ericka Adler, Partner, Roetzel &Andress. Photo by Andrew Collings.
If your practice doesn’t have a clear and defined social media policy in place, the answer to those questions is probably a resounding no, says Ericka Adler, a healthcare attorney and partner at Chicago firm Roetzel & Andress.
According to Adler, having a social media policy that educates employees, sets expectations and outlines consequences is important for practices of all sizes.
“Every group should have a policy, or at the very least a detailed discussion,” she said. “Exposing patient information is a huge liability concern, and you can’t just assume employees understand that. “Staff operate better with rules, and a good social media policy gives them those rules.”
So what should your practice’s social media policy look like?
Americans with private health insurance have seen their total out-of-pocket healthcare costs rise steadily during recent years, according to a study published Monday in JAMA Internal Medicine.
The study, conducted by researchers at the University of Michigan, found that the nation’s overall heath spending increased 2.9% per year between 2009 and 2013. Patients’ out-of-pocket costs for hospitalizations, on the other hand, jumped 6.5% each year, totaling a 37% increase in out-of pocket hospital costs during the five-year study period.
“I think the increases are very significant given this is a period of low health-care inflation and stagnant wages,” Larry Levitt, a senior vice president at the Kaiser Family Foundation, told the Washington Post. “It’s really about finding the right balance between out-of-pocket costs that don’t discourage people from getting care they need, but also don’t encourage people to use care that is maybe wasteful. I think we are — as a society, we’re struggling to find the right balance.”
Deductibles rose 86% and coinsurance costs increased 33% from 2009 to 2013, according to the study.
The research comes as the number of Americans enrolled in high-deductible health plans continues to grow. Nearly 50% of workers are covered by a plan with a deductible of at least $1,000 for individual coverage, according to survey data from the Kaiser Family Foundation. Almost 90% of the plans offered in the Marketplace are considered high-deductible plans.
Read the JAMA Internal Medicine study (subscription required)
Read the Washington Post story
Read the Bloomberg story
Read a Health Affairs policy brief about high-deductible health plans
The number of patients with high-deductible insurance plans is rising fast, and physicians need to have the right skills and processes in place to manage such plans effectively, according to an article in Medical Economics.
Although it’s still unclear to what extent high out-of-pocket costs can cause patients to delay care, research shows that the effect is real. According to a 2015 Commonwealth Fund report cited in the article, two out of every five adults with high-deductible plans reported limiting their care in some way.
Physicians should implement a standardized way of routinely asking patients about financial hardships, and they should document those conversations in the medical record, experts advise.
Peter Lee, executive director of Covered California recommends explaining to patients that postponing care can result in much larger medical bills and far more serious health issues later on.
For example, a patient with diabetes might be reluctant to return for quarterly foot exams at more than $100 per office visit, he says. On the doctor’s part, it’s worth an attempt to explain that a little money invested upfront in office visits ideally will avoid landing in the hospital with a painful and costly foot amputation, Lee says.
Read the article.
Robin Scott doesn’t mince words when describing the challenges Virginia Cardiovascular Specialists used to face when it came to eligibility and benefits. The practice’s harried front desk staff, burdened with myriad other responsibilities, would often wait until the very end of the day to double check insurance referrals and verify eligibility for the following day’s appointments. Many times, it just didn’t get done.
“They had so much going on, and it wasn’t a high priority,” said Scott, business office manager of the 38-provider, multi-site practice. “We were only getting it done about 40 to 50% of the time, and that had a direct effect on payment. Our primary denial was insurance termination–we left so much money on the table.”
Then a year ago, just after implementing Phreesia, Scott and the practice’s leadership had an idea. Because Phreesia now automated so many of the tasks that the front desk had been performing, the practice realized it needed less staff. But VCS didn’t let those employees go. Instead, they centralized electronic E&B within the practice’s business office, charging three former front-desk staff—now called E&B coordinators—with checking for missing referrals and managing denials in advance of patients’ appointments.
Crystal Jefferson, Michele Turner and Melissa Gold, E&B coordinators at Virginia Cardiovascular Associates
It’s time once again for our weekly wrap, a collection of interesting healthcare news, analysis and insightful commentary from across the web. If you see an eye-catching news story or a juicy, stats-filled report that you think I should include in the weekly wrap, please email me at email@example.com.
- Patients’ No. 1 complaint? Customer service (Becker’s)
A study of nearly 35,000 online reviews of physicians nationwide has found that customer service is patients’ chief frustration, not physicians’ medical expertise and clinical skill.
The study, published in the current issue of the Journal of Medical Practice Management, reveals that 96 percent of patient complaints are related to customer service, while only 4 percent are about the quality of clinical care or misdiagnoses.
In summary, the study found that fewer than 1 in 20 online complaints cite diagnosis, treatments and outcomes in healthcare as unsatisfactory, whereas more than 19 of 20 unhappy patients said inadequate communications and disorganized operations drove them to post harsh reviews.
“The nearly unanimous consensus is that in terms of impact on patient satisfaction, the waiting room trumps the exam room,” Ron Harman King, co-author of the JMPM article and CEO of Vanguard Communications, a marketing and public relations firm for specialty medical practices, said in a prepared statement.
“Our study uncovered a torrent of patient allegations of doctors running behind schedule, excessive waiting time to see a provider, billing problems, indifferent staff and doctors’ bedside manners. Yet hardly anyone had a beef with the quality of healthcare received.”
Mr. King noted that the absence of dissatisfaction with physician skills per se means practices should be able to improve online reviews comparatively easily.
“Generally, it’s far simpler to fix problems at the front desk or physician scheduling than to deal with allegations of inadequate medical skills. Of course, this requires a commitment from doctors to stick to schedules, allowing for only occasional urgencies that interrupt a physician’s day,” he added. (Read more)
It’s Friday and that means it’s weekly wrap time once again, when I bring you some of the week’s most interesting healthcare news and analysis from across the web. If you see a great story that you think I should share on the blog, please email me at firstname.lastname@example.org.
- What do patients really think of your practice? (Medscape)
Patient surveys are vital barometers of physician performance and patient satisfaction with the practice. Periodically asking patients to tell you the truth about your practice via a survey may result in a painful reckoning with reality, but self-awareness can spark improvements that are hard to achieve without constructive feedback.
Many primary care physicians don’t ask patients what they think of the practice, and others who do ask often fail to get actionable feedback. Yet every doctor with a desire to excel and a goal of offering patients high-quality care and service should be doing this at least twice a year, experts maintain.
“Customer service is our lifeblood,” says Kenneth T. Hertz, principal consultant at the MGMA Health Care Consulting Group, who is based in Roanoke, Texas. “Without customers—without patients—there’s not much of a medical practice.” (Read more)
Let’s say for a moment that you’re lucky enough to have a time machine (and a particular interest in the healthcare system). You punch in the year 2021 and speed forward through time, glimpsing first-hand how healthcare has transformed itself in five years’ time. Have population health management efforts borne fruit? Are providers working in well-organized teams? And perhaps most interestingly, what does the patient experience look like?
Dr. Don Wreden, senior vice president for patient experience, Sutter Health
Dr. Don Wreden, senior vice president for patient experience at Sutter Health, a non-profit healthcare system based in Northern California, doesn’t have a time machine but as he assured me, he’s always thinking about what the healthcare system of the future might look like. Dr. Wreden was named to his role in 2015 as part of an organization-wide effort to redesign Sutter Health to be more patient-centered and responsive.
I was fortunate to speak with Dr. Wreden about promising innovations in the field of patient experience, as well as his predictions for the future.
Hi, Into Practice readers. It’s time once again for the weekly wrap, a sampling of the week’s most interesting healthcare news and insightful commentary. If you see a great story that you think I should share on the blog, please email me at email@example.com.
The Centers for Medicare and Medicaid Services launched a new risk-based primary care initiative on Monday to accelerate the shift toward value-based reimbursement with a focus on health IT and chronic care management.
As CMS officials see it, the optimal use of health IT, a focus on data and a robust learning system will help the practices make the necessary changes in care delivery to improve care of patients.
The five-year, Comprehensive Primary Care Plus, or CPC+, starts in January 2017 and will include up to 5,000 practices and 20,000 physicians in an estimated 20 regions.
It pays participating physicians under two tracks. Both give practices up-front incentive payments the physicians will either keep or repay based on their performance on quality and utilization metrics, CMS said in a news release.
Also, both tracks will “align with the Office of the National Coordinator for Health IT priority to ensure electronic health information is available when and where it matters to consumers and clinicians,” according to CMS. (Read more)
The wait is over! It’s Friday and that means it’s time for Into Practice’s weekly wrap, a sampling of the week’s most interesting, timely and insightful healthcare news. If you see a great news story or commentary that you’d like me to include in the wrap, please feel free to email me at firstname.lastname@example.org.
For Erin Moore, keeping her son’s cystic fibrosis in check requires careful monitoring to prevent the thick, sticky mucous his body produces from further damaging his lungs and digestive system. Moore keeps tabs on 6-year-old Drew’s weight, appetite, exercise and stools every day to see if they stray from his healthy baseline. When he develops a cough, she tracks that, too.
It’s been nearly a year since Drew has been hospitalized; as a baby he was admitted up to four times annually. Erin Moore credits her careful monitoring, aided by an online data tracking tool from a program at Cincinnati Children’s Hospital Medical Center called the Orchestra Project, with helping to keep him healthy.
“Now I have a picture of what health looks like for Drew,” said Moore, 35. “Tools like Orchestra that allow patients to take a more active stance in managing our health are still really undervalued.”
That may be changing,according to a study in the April issue of the journal Health Affairs that examines the movement to incorporate “patient-reported outcomes” into clinical care. (Read more)