Personal Contact Reduces Readmission Rates
New research suggests that adding a personal touch to the doctor-patient relationship after discharge from the hospital may help to lower readmission rates of patients. This information comes courtesy of a trial program put together by three non-profit hospitals located in the Bronx, NY. Montefiore Medical Center, Bronx Lebanon Hospital Center and St. Barnabas hospital all reported significant drops in readmission rates after installing a few new but basic follow up procedures to their post-discharge practices.
Methods of Personal Contact Post-Discharge
The new personal contact methods laid out in this study were quite straightforward. Prior to discharge, patients selected for increased personal contact attended an information session aimed at educating them on proper behavior upon leaving the hospital. Additionally, care transition managers set up a follow up appointment for these patients, scheduled to occur within 14 days of their discharge. Finally, patients received up to four follow-up phone calls within the next 60 days. During these phone calls, care transition managers checked in on the health of patients and made sure that they had attended their follow-up appointment.Testing the Success of Personal Contact
In order to develop a framework for testing the success of personal contact post-discharge for lowering readmission rates, these three hospitals first used a predictive modeling system to identify a group of patients considered likely to be readmitted. This group of patients was then divided into two groups. The first was a group of 500 who received additional personal contact following discharge. The second was a group of 190 individuals who received the standard treatment following discharge. After 60 days, 26.3 percent of patients who received standard care had been readmitted to the hospital. However, only 17.6 percent of patients who had received a more thorough level of personal contact had been readmitted. The hospitals involved in this study concluded that if their new personal contact initiatives were extended to all patients at high risk of readmission, they could reach approximately 9,300 patients within the local hospital system. They estimate that this change in policy could save the local hospitals $5.5 million annually.End of Life Care Improvements
End of Life Care Improvements
According to a new report, Medicare patients are experiencing improvements in the end of life care that they receive. Specifically, beneficiaries who were chronically ill and in their last six months of life spent fewer days in the hospital in 2010 than they would have in 2007. Additionally, these beneficiaries spent more time in hospice care in 2010 than a similar cohort did in 2007. This news comes courtesy of the Dartmouth Atlas Project. Researchers looked at over 1 million claims which were attributed to Medicare patients who died in the year 2010. When comparing these numbers to totals compiled in 2007, the researchers found that in just three years the number of hospital days logged by each patient dropped 9.5 percent. Additionally, the number of deaths that occurred among this cohort while at the hospital dropped by 11 percent. These lower hospital stay numbers were mirrored by a parallel rise in hospice care usage. Compared to 2007 numbers, hospice care usage in 2010 was up 13.3 percent. The number of days spent in hospice care also increased by 15 percent. Researchers attribute the changes in end of life care behavior to a greater focus on the wishes of dying individuals. They believe that increased hospice care might align more closely with the preferences of these Medicare beneficiaries, and that these numbers reflect medical professionals’ increased attention to patients’ wishes. Although these new numbers generally bode well for the medical community, and may free up valuable hospital resources, not all of the researchers’ findings were positive. Medicare beneficiaries were equally likely to spend time in an intensive care unit in 2010 as in 2007. Additionally, the researchers found that Medicare beneficiaries in 2010 were more likely to see 10 or more doctors during the last six months of their lives than they had been in 2010.EMR and Mental Health
A recent study released in The International Journal of Medical Informatics suggests that the inclusion of a psychiatric patient’s psychiatric records within their electronic medical record can result in a decreased likelihood of their re-admittance to a hospital following discharge. Within the scope of the study, the researchers concluded that psychiatric patients were 40 percent less likely to be readmitted to a hospital within a month of discharge when their mental health records were included in their EMR.
Carried out by Johns Hopkins University, this study involved the top 18 hospitals in the United States as they were defined in a 2007 U.S. News & World Report list. Of these top 18 hospitals, less than half of them included inpatient psychiatric records within inpatient EMRs. But even within the hospitals that included these records in EMRs, many did not make this mental health information available to non-psychiatric doctors. Overall, of the 18 hospitals surveyed, only 22 percent included mental health records in patient’s EMRs and made these record easily accessible to non-psychiatric doctors.
Standard Psychiatric Care
Traditionally, a patient’s psychiatric records have remained separate from the rest of their medical records. This practice has been in place in order to show respect for a patient’s privacy in matters of mental health. However, the preliminary findings of this study suggest that including the mental health history of a patient within their EMR aids doctors in successfully administering treatment. Since the prevailing goal of all medical disciplines is to successfully treat a patient so that they may enjoy good health, studies of this kind make a strong case for a higher degree of transparency within the medical field. Proper communication between cooperating entities is a fundamental part of any business. This is exceptionally true within the field of medicine, where the clientele’s quality of life is at stake. Tools like electronic medical records and readily-available psychiatric information will help your business function more smoothly, but these practices are capable of even greater feats. They can help your patients’ quality of life. After all, that’s what you’re in the business for.EMR Software and Malpractice
For any physician, the potential of having to address a malpractice claim represents a major area of concern. It is thus in the best interest of medical professionals everywhere to mitigate this risk wherever and whenever possible.
Reduce Medical Malpractice
A recent study in Massachusetts by Harvard Medical School has found a positive relationship between the use of electronic medical record software by physicians and a decrease in medical malpractice claims. In the study, 275 physicians were tracked and surveyed between the years 2005 and 2007. During that time period, 33 experienced malpractice claims. Of the total 52 claims that were filed, 49 took place before EMR implementation and only two were filed after implementation. Within the scope of this study, researchers estimated that the likelihood of experiencing a malpractice claim was reduced by 84 percent following electronic record implementation. Although this research is limited by a relatively small sample size, it is nonetheless helpful when evaluating the effects of EMR on medical malpractice claim volume. The implication of this research is that contrary to the inference by some that EMR will increase the occurrence of malpractice claims, it can actually lower their number. In addition to the ability of electronic medical records to streamline your medical practice from a functionality standpoint, they must also be considered within the context of lowering your exposure to malpractice risk. Not only is EMR implementation a formidable organizational tool, but it is also a way to bolster your practice’s security and valuable reputation.FDA Approves First Pre-Surgical Breast Cancer-Fighting Drug
The US Food and Drug Administration (FDA) approved a biotech drug from Roche, offering an earlier approach to treat breast cancer before surgery. Perjeta, approved by the European Union in 2012, is now available to patients in the US.
A New First Step
Typically the first step to fight most forms of cancer is surgery to remove tumors. Perjeta can be prescribed as part of a cancer treatment program prior to surgery to help prevent cancer from spreading and decrease tumor size. Perjeta is an inhibitor of HER-2, a protein overproduced in about 20 percent of breast cancer patients with tumors. This overproduction of the HER-2 protein rapidly increases tumor growth.
Perjeta is intended for “patients with HER2-positive, locally advanced, inflammatory or early stage breast cancer (tumor greater than 2 cm in diameter or with positive lymph nodes) who are at high risk of having their cancer return or spread (metastasize) or of dying from the disease,” according to an FDA press release. The drug is approved under the FDA’s accelerated approval program, making it available to patients while clinical trials to confirm the results and determine the long term effects will be ongoing. Results are anticipated by 2016.
The 417-women study showed patient’s cancer reaching undetectable levels increases 18 percent when using the new drug in conjunction with chemotherapy and Herceptin (trastuzumab), compared to the results of using chemotherapy and Herceptin alone.
Not Quite the Solution
Surgery is still required as part of the treatment program with the new drug. However, in some cases, the patient only needs a lumpectomy instead of a mastectomy. While Perjeta doesn’t eliminate surgery altogether, it can provide a dramatic improvement in the invasiveness of the surgery required. This new drug lays claim to first in the industry, helping to improve the treatment breast cancer.
Anesthesia Documentation Lagging
A survey taken by the Academic Health Sciences Centre of Canada and published in the U.S. National Library of Medicine found wide-ranging inconsistencies between recorded anesthetic data. To conduct the survey, the research team provided questionnaires to four different adult McGill University hospitals. Anesthesiologists were asked to rank operational variables on a scale of 1 to 5. There were 23 preoperative variables and another 33 intraoperative variables to rank according to importance.
Roughly 90% of the surveys sent by the Academic Health Sciences Centre research team were completed and returned. The research team only studied the results turned in by the McGill hospitals’ staff anesthesiologists.
Most Important Anesthetic Variables
In preoperative documentation, anesthesiologists reported two critical pieces of medical data to record. Anesthesiologists cited the patient’s allergy status as one of these two primary pieces of information. The other critical preoperative data to be recorded was the examination of the patient’s airway.
In intraoperative documentation, anesthesiologists cited the patient’s vital signs as the single most important variable to be recorded.
Recorded Anesthetic Data
After receiving the completed surveys regarding the most important anesthetic variables, the Academic Health Sciences Centre research team found that the only variable to be recorded on every patient’s medical records during anesthesia was the anesthesiologist’s name.
The patient’s allergy status was the most recorded preoperative variable, appearing on roughly 84% of medical charts. Intraoperative documentation showed a wide range of recorded data. Some anesthesiologists recorded items such as start times of the anesthesia, while other anesthesiologists recorded nothing more than the patient’s estimated blood loss.
Why is Anesthetic Documentation Important?
In terms of medical accuracy, there is a large need to improve anesthetic documentation. Inconsistencies during anesthetic documentation inhibit the medical community’s ability, as a whole, to distribute, analyze, and improve upon anesthetic data correlating with surgical performance. With more consistent anesthetic records, patients may benefit from a better communication of anesthesia-related medical information.
In terms of medical billing and coding, it is increasingly critical to maintain thorough, accurate, and consistent medical records across all areas of practice for the following reasons:
- Precise clinical anesthetic documentation describes the correct combination of diagnostic and/or treatment code for the medical biller and coder to implement.
- When medical billers and coders are able to depict the most accurate version of the surgical procedure, the medical practice is able to maximize reimbursement and minimize the need for resubmission of insurance claims.
- By maximizing the medical practice’s reimbursements and minimize the need to resubmit insurance claims, patients are happier. The practice functions in a more efficient manner. In turn, the medical practice is able to maximize revenue and profits while earning an effective reputation for easily managing health insurance claims.
Oregon Reduces Number of Frequent ER Patients
America faces a physician shortage that is only set to intensify when the Affordable Care Act takes full effect in January of 2014. A number of ongoing efforts are being made to streamline the care process for patients without compromising their level of care. In July of 2012, hospitals in Oregon began a program aimed at limiting the number of “frequent flier” visits to their ERs. Although the new initiative will take place over the course of five years, it shows early signs of success.
Oregon’s New ER Program
Approximately 80 percent of all healthcare expenditures in the United States are used to service only 20 percent of the population. Visits to the emergency room can be notoriously expensive. Officials in Oregon have taken these two factors into consideration and designed a new program aimed at lowering ER visits, especially by “frequent flyers.” Frequent flyers are defined by the program as patients who visit the ER ten times or more each year. Some of the patients who fall into this group annually visit the ER at a rate of once a week.
Oregon’s program is federally funded; as of 2012, the state began receiving almost $2 billion in federal funds to be spread out over the course of five years. The goal of the program is to reduce the medical inflation rate in Oregon by two percent over the course of this period. Promising early numbers suggest that this goal is reasonable to expect. In the first year, emergency room attendance rates by documented frequent flyers have dropped in many Oregon hospitals – in the case of at least one hospital, at a rate of 48 percent.
The Methods of the New Program
The main technique used in this new program is to isolate patient issues which do not directly demand a visit to the emergency room. Many patients end up in the emergency room with complaints that do not necessitate immediate care, and this number is especially high among frequent flyers. Additionally, frequent flyers may end up in the emergency room due to complications from relatively benign health issues.
Patients in Oregon are being walked through the care process by Coordinated Care Organizations, or CCOs. Employees in these organizations help patients navigate the medical system and encourage frequent flyers to make regular appointments with a primary care doctor instead of visiting the emergency room whenever a perceived problem arises. Additionally, these CCOs may provide basic shelter and hygiene support for individuals who run into emergency-level health issues on a regular basis as a result of their lifestyle. On a case-by-case and hospital-by-hospital basis, the numbers coming out of Oregon may help to set the precedent for more nuanced ER practices and less cluttered ERs moving forward.
New Action Set Reduces Hospital Readmissions
A new set of protocols has been found to be effective in reducing the number of patient readmissions following their initial discharge.
The Re-engineered Discharge Toolkit
Researchers at the Boston University Medical Center have established the Re-engineered Discharge Toolkit, or “RED.” The researchers amended and expanded on a list of proactive steps aimed at limiting patient readmissions.
While researching and writing the steps included in RED, enhanced emphasis was placed on cross-cultural differences. The researchers examined the ways in which healthcare is viewed differently depending on the cultural background of patients. Much of the re-engineering aspect of their work came in the form of increased focus on communication prior to patient discharge. Specifically, they focused on the issues that can arise in the event of a language barrier.
Following discharge, a patient must take greater responsibility for their own care. In order to do this, they must be well-versed on the appropriate care-related behavior that is expected from them by the healthcare professionals who are approving their discharge.
The RED steps outline the procedures for making sure patients understand proper behavior following discharge, including how and where to obtain necessary medications, as well as how and when to take them. Furthermore, a variety of follow-up measures subsequent to patient discharge are aimed at avoiding relapses due to forgetfulness or negligence on the part of patients.
The Proven Results of RED
When put into application, the new RED steps were deemed to be successful in lowering readmission rates. According to the researchers, RED resulted in a 30 percent reduction in hospitalization utilization within 30 days of patient discharge. The researchers also saw a 34-percent reduction in per-patient costs during that time period as well.
These results serve as a positive reminder of what increased efficiency measures within the healthcare system can do for both patient health and healthcare provider productivity.
Hospital Readmission Rates are Down
Hospital Readmission Rates are Down
New data from the Centers for Medicare & Medicare Services shows that there has been improvement in hospital readmission rates over the last several years. While hospital readmission rates have been steady over the last five years, these new numbers show a small but significant readmission downturn in recent times.
Readmission Numbers
When analyzing this new data, CMS applied a broad focus. Specifically, CMS looked at 30 day readmission rates for Medicare patients without focusing on a specific cause for readmission. In the year of 2012, CMS concluded that Medicare patient readmission rates had fallen from a steady 19 percent over the last five years to 18.4 percent in 2012. This translates to approximately 70,000 less readmissions in 2012 than in previous years. Additionally, when looking specifically at the last quarter of 2012, 30 day readmission rates were down to 17.8 percent, which may suggest a trend of further positive movement.
Reasons for Less Readmission
When releasing these numbers, CMS did not attempt to explain the specific reasons behind a positive trend in readmission rates. Still, there are some theories as to what has caused readmission rates to dip. Jonathan Blum, who is the director of the Center for Medicare believes that reforms in payment and delivery have aided the drop in readmissions.
Additionally, readmission rates may have dropped as a result of a new program aimed at lowering them. This program went into effect on October 1, 2012 as part of the Affordable Care Act. Under this new program, hospitals must lower their readmission rates in critical areas or else face financial penalties. These financial penalties are set to increase each year through 2015, and must no doubt serve as motivation for hospitals to improve their readmission numbers. This new data from the CMS seems to suggest that the penalty program is beginning to have an effect on readmission rates.