Archive for the ‘Customer Service’ Category

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EHR No Substitute for Population View Provided by Registries

January 31st, 2012 by Patricia Donovan

The proliferation of EHRs is driving the format and functionality of patient registries today, according to new market research from the Healthcare Intelligence Network.

However, healthcare experts note that EHRs are no substitute for a registry.

“Registry functionality is not always the same as an EMR,” cautions Julie Schilz, manager, IPIP and PCMH for the Colorado Clinical Guidelines Collaborative. “Registry functionality is the ability to understand your patient population and their needs, whether they are being managed against evidence-based guidelines, being able to support outreach to patients who might be falling outside of the guidelines and understand per provider how their patients are being managed against evidence-based guidelines.”

The registry is used in a positive way for quality improvement, Schilz notes, not as a stick to suggest that providers and their care team are not managing effectively.

“The registry is utilized to help manage the patient population and understand how, in using the measures as a proxy, the systems that the practices put into place are having the desired impact on patient population for both health and healthcare delivery,” she concludes.

While more than two thirds of 2008 survey respondents favored freestanding database-centered registries, the trend in 2012 is toward registries as a component of an EHR, as reported by one-third of 2011 respondents, or Web-based registries, used by another 29 percent of this year’s respondents.

Registry use has remained constant at about 50 percent since HIN last surveyed the healthcare industry on this topic in 2008.

This year’s analysis also found that registries are used more than three times as often today to generate health alerts and reminders for appointments and preventive services. Only a quarter of 2008 respondents were using registries in this proactive manner. Whether as simple as an Excel® spreadsheet or a module in an EHR, healthcare organizations have warmed to the patient-tracking features and the population-eye view that registries deliver.

“To move primary care forward, you want the care team to begin preparation for visits well in advance of the patient arriving,” adds Michael Erikson, vice president of primary care services for Group Health Cooperative, an organization touted by CMS for its advanced and comprehensive primary care services. “With our EMR, which has registry-like functions within it, we know the care gaps of the patients who are coming for a visit; we see all their HEDIS measures. The team begins, one to three days before visits occur, to look for any of those care gaps, so that when a patient arrives for a visit, not only are we responding to their acute need, but we are also responding comprehensively to address any care gaps, whether that be a chronic illness, a preventive need or an acute need.”

Posted in Accountable Care Organizations, Affordable Care Act, Customer Service, Healthcare Costs, Patient-Centered Medical Home | No Comments »

Caring Communication Can Boost Patient Satisfaction Quotient

October 13th, 2011 by Patricia Donovan

“Do what you do so well that they will want to see it again and bring their friends.” Jack Welch’s words on customer satisfaction may not strictly apply to healthcare; after all, the former chairman and CEO of General Electric wouldn’t wish a hospital stay on anyone, no matter how elevated the quality of care.

However, in a value-driven environment, high marks in patient satisfaction are expected and rewarded, both by prospective patients seeking care at reputable facilities and by payors formulating reimbursement strategies.

To make the grade in patient satisfaction, healthcare organizations must clear the communication channels between providers and patients, say respondents to the 2011 Healthcare Intelligence Network survey on Improving Patient Satisfaction and the Healthcare Consumer Experience. That means everything from beefing up call management to increasing the number of touches while a patient is waiting for a doctor.

“Patient satisfaction might sound like a soft outcome, but patients get very dissatisfied when they are lying in an ED for long periods of time,” notes Toni Cesta, Lutheran Medical Center senior vice president of operational efficiency and capacity management.

“The most dissatisfying thing for patients in EDs is the time from triage until they are seen by a physician. That is the typical time in which the patient will walk out of the ED — if they have been triaged, put in a room and are waiting for a long period of time to be seen by the physician. If you can reduce that time from triage to seen by the physician in concert with ED leadership, that can help reduce the number of patients who walk out without being evaluated by a physician.”

So important is patient satisfaction that it has become a benchmark in its own right — to measure the success of healthcare initiatives from case management to accountable care organizations (ACOs). Beginning in April 2012, the National Committee for Quality Assurance (NCQA) will award extra credit to patient-centered medical homes (PCMHs) that submit CAHPS results twice a year.

Organizations preparing to join or transition to an ACO should immediately assess their patient satisfaction quotient, suggests Greg Mertz, senior project director with the Healthcare Strategy Group.

“One of the [ACO] obligations that is going to be placed on at least primary care providers is patient education, so if they haven’t spent a whole lot of time on patient compliance, or on patient satisfaction, that’s [going to be] a real learning curve issue for them…The government has said that it’s up to the physician to tell the patient that they are in an ACO. They’re going to have to convince [the patient] on no other basis than it makes good sense for your health, that you should really work with us to better manage your care.

“And since part of the evaluation of ACO shared savings is going to be based on patient input and patient satisfaction scores, [PCPs] are going to have to do it so that the patient accepts the value and is willing to give them good grades. A lot of physician behaviors are going to have to change; not that many have formal patient feedback loops at this point. It’s a different culture.”

(Excerpted from 2011 Benchmarks in Patient Satisfaction Strategies: Improving the Healthcare Consumer Experience.)

Posted in Accountable Care Organizations, Avoidable ER Use, Case Management, Customer Service, Healthcare Administration, Healthcare Quality Ratings, Patient-Centered Medical Home | No Comments »

Disney’s Building a Culture of Healthcare Excellence Program

July 18th, 2011 by Cheryl Miller

Forget fish tanks and Muzak; ever think your patients might appreciate watching a simulated space shuttle flight while waiting for their physical?

Or how about a FASTPASS® card, good for one free pass to the front of the line for a flu shot?

Or some fairy tale characters to keep the kids busy?

Disney believes it can teach hospital and healthcare executives how to meet and exceed their patients’ expectations. The mega theme park is introducing a new program, called “Building a Culture of Healthcare Excellence,” and it incorporates Disney’s 5 leading philosophies:

• Leadership excellence
• People management
• Quality service
• Brand loyalty
• Creativity/innovation

The program, created and presented by the Disney Institute, is designed to help healthcare administrators, physicians, nurses and other manager-level personnel.

The timing of the program is designed to coincide with the HCAHPS’s nationally standardized survey that allows consumers to compare hospitals based on how effectively they satisfy patient expectations. Starting this month, hospitals are required to publicly report the results of these surveys, which are published by the CMS on its Hospital Compare website.

In line with this, the Disney Institute’s program looks beyond the clinical and technical and focuses instead on the entire patient experience, including interactions with hospital staff at all levels, and amenities that can help the patient feel more comfortable, such as private rooms and on-demand dining services.

It’s an area that many healthcare executives admit they need to improve. According to the results from our recent Improving Patient Experience and Satisfaction survey, nearly 85 percent of respondents said they were not happy with their organization’s patient satisfaction scores as currently posted on the CMS Hospital Compare site. Communication and quality of care were the areas that they felt were most important to their patients and members. But more than half of them said communication was where they felt they needed the most improvement in, with access and waiting times coming in second.

So maybe we can learn a thing or two from the company that makes thousands of people happy every day.

And wishing on a star might not hurt either.

Posted in Customer Service, Healthcare Quality Ratings, Uncategorized, Wellness/Prevention | No Comments »

14 Observations on Healthcare from a Country Doctor

June 2nd, 2011 by Patricia Donovan

Last weekend I caught the tail end of NPR’s interview with David Loxtercamp, a Maine physician and author of A Measure of Days: The Journal of a Country Doctor. The interview ends with Dr. Loxtercamp’s 14 thought-provoking observations on health:

  • Health is not a commodity.

  • Risk factors are not disease.
  • Aging is not an illness.
  • To fix a problem is easy, to sit with another suffering is hard.
  • Doing all we can is not the same as doing what we should.
  • Quality is more than metrics.
  • Patients cannot see outside their pain, we cannot see in, relationship is the only bridge between.
  • Time is precious; we spend it on what we value.

  • The most common condition we treat is unhappiness.
  • And the greatest obstacle to treating a patient’s unhappiness is our own.
  • Nothing is more patient-centered than the process of change.
  • Doctors expect too much from data and not enough from conversation.
  • Community is a locus of healing, not the hospital or the clinic.
  • The foundation of medicine is friendship, conversation and hope.

The tentative title of his new book is “Conversation, Friendship and Hope.”

Posted in Affordable Care Act, Customer Service, Disease Management, Patient-Centered Medical Home, Physician Practices | 1 Comment »

What’s Keeping Physicians Busy These Days?

May 3rd, 2010 by Patricia Donovan

While hundreds of physician practices nationwide are piloting the patient-centered medical home model, still at issue is a reimbursement formula that adequately compensates physicians for the medical home’s care management components. In “What’s Keeping Us So Busy in Primary Care?,” a study published in last week’s New England Journal of Medicine, Dr. Richard Baron documents the daily duties of the five doctors in his Philadelphia practice that fall outside the scope of routine patient visits. On an average day, besides seeing 18 patients, each Greenhouse Internists physicians made 24 phone calls, wrote 17 e-mails, reviewed 20 lab reports and issued 12 prescription refills daily. While all of these tasks extend access to care, they consume a great deal of physicians‘ time outside of patient visits.

This week’s Healthcare Business Weekly Update features Dr. Baron’s recommended technology backbone to support evidence-based care delivery, taken from his presentation during our Medical Home Open House webinar series. If you missed the story, you can read it here.

Posted in Customer Service, Healthcare Trends | No Comments »

13 ways to speed patient payments

February 2nd, 2009 by Melanie Matthews

Even without EMRs, some basic QA can boost revenues and reduce bad debt, suggested Beacon Partners during HIN’s webinar last week on improving patient collections:

  • Assess your organization’s delivery from patient’s access — that initial contact with the patient — to see if you done everything you can to determine if the patient has insurance, what the policy will cover and how any balances will be satisfied.
  • Engage the patient early. This tactic has proven to be the most effective; it decreases the anxiety of the patient’s visit, it fosters recovery, it creates an advocate in the community for you and also secures the payment.
  • Educate staff on upfront collection policies, providing scripts and role-playing if necessary.
  • Install an automated verification system. Even though the technology is in its infancy, it is proving to be the single most important IT to boost revenues.
  • To anticipate and support requests for cost estimates from patients and payors, identify the five to 10 top procedures within your organization from the HIN Department and get a cost basis on procedures with and without complications.
  • Clean up your registration process to avoid delayed reimbursements. Typically, error rates during a registration process range from 30 to 50 percent.
  • The majority of bad hospital debt comes through the ER. Work with the ER management team to develop an ED discharge policy and a work flow. Ideally, have a designated discharge area where the nurse escorts the patient back to a designated area.
  • Offer financial counseling not only in the emergency room, but during pre-registration. Pre-registration can identify any patients that are self-pay and if necessary, the financial counselor can work with them to set up satisfactory payment arrangements, possibly get them some Medicaid assistance through the use of Medicaid eligibility company.
  • In a declining economy, patients forego elective procedures, which may create slack in your schedule. Compress that slack and use it to build revenue. Take advantage of down time in your schedule and get patients in when they’re hurting. If you wait a day then the pain may go away. Determine how long it takes for that patient to enter your system. Your practice management or scheduling system should be able to identify the third available appointment for that visit. So if a patient calls in today and wants to come in on Thursday, and you’re not available for Thursday, when is the next free appointment or the third one?
  • Reconciling your charts with your appointment list can increase your revenue by about 5 percent.
  • Use EMRs to increase revenue by 24 percent and avoid the seven critical problems related to the handwritten chart.
  • Educate yourselves about health savings accounts. Only 75 percent attempt to collect a co-payment at the time of visit and only 14 percent collect absolutely nothing from patients at the time of visit and they bill the insurance carrier. Providers can no longer afford to do that.
  • Train all staff on policies and procedures. Technology is only as good as the people using it and the people using it are only as good as how they use it. So if you have too many workarounds in place, you’re losing revenue somewhere. Make sure staff understands the legal ramifications of each person’s visit.

    • Posted in Consumer-Driven Healthcare, Customer Service, Healthcare Administration, Healthcare Costs | No Comments »

    How ERs Reduce Overcrowding, Long Waits

    January 5th, 2009 by Melanie Matthews

    The ER report card is in: the American College of Emergency Physicians has given the United States an overall grade of C-, largely due to poor ratings for access to emergency care. Take the survey to tell us how your organization is alleviating ER overcrowding and wait times and receive a free e-summary of the compiled results…as long as we hear from you by January 31.

    Posted in Customer Service, Healthcare Costs, Healthcare Quality Ratings, Healthcare Trends | No Comments »

    Few Five-Star Stays in Nation’s Nursing Homes

    December 22nd, 2008 by Melanie Matthews

    Last week CMS made good on its June 2008 promise to launch a star-based ranking system of America’s 15,800 nursing homes that participate in Medicare or Medicaid. The initial evaluation revealed some quality gaps — nearly a quarter of facilities received only a one-star rating. Facilities are assigned one- to five-star ratings based on three key areas — health inspection surveys, staffing information and quality of care measures. The ratings are publicly available and will be updated monthly. A nursing home may not be the only long-term care choice, and the updated Web site also includes links to information for community-based alternatives to nursing homes.

    Choosing a nursing home for a loved one is a difficult and emotional decision. A facility’s star ranking is only one aspect of the evaluation process, along with a thorough site visit and discussions with nursing home staff, residents and residents’ families. We’re betting it won’t be long before CMS invites nursing home residents to rate their experiences the way hospital patients do via the Survey of Patients’ Hospital Experiences. Read about a recent study of HCAHPS data that links patient satisfaction to quality of care.

    Posted in Consumer-Driven Healthcare, Customer Service, Healthcare Quality Ratings | No Comments »

    Gotta Keep the (Healthcare) Customer Satisfied

    October 31st, 2008 by Melanie Matthews

    Rating the cleanliness of sleeping areas and bathrooms and nighttime noise levels may seem the stuff of hotel satisfaction surveys. In fact, hospital patients across the country are asked to evaluate these areas — along with pain management, communication and discharge processes — as part of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Consumers can access patient satisfaction reviews from this national, standardized survey of hospital patient experiences at the Hospital Compare Web site.

    And if you believe that clinical excellence is the one true path to improved care delivery, think again. A new study of HCAHPS data has determined a direct link between patient satisfaction and the quality of care, suggesting that the aims of providing patient-centered care and ensuring high clinical standards can be met simultaneously.

    In a study funded by The Commonwealth Fund and the Robert Wood Johnson Foundation, researchers from Harvard School of Public Health assessed the performance of 2,429 hospitals across multiple domains of patients’ experiences—including communication, quality of nursing services and pain management—comparing HCAHPS patient survey data from July 2006 to July 2007 with data from the Hospital Quality Alliance and the American Hospital Association.

    They found that patients have moderately high levels of satisfaction with their care, and that the quality of clinical care and certain hospital characteristics, such as a higher ratio of nurses to patient-days, were associated with greater patient satisfaction.

    Key areas for improvement: nursing care, communication about medications, pain control, and provision of clear discharge instructions.

    Other key findings:

  • On average, 63 percent of patients responding to the HCAHPS survey gave their care a high overall rating (9 or 10, on a scale of 0 to 10); another 26 percent rated care as 7 or 8. Only 11 percent rated care as 6 or lower.
  • Sixty-seven percent of patients said they would definitely recommend the hospital in which they received care, and another 27 percent said they would probably recommend the hospital.
  • The ratio of nurses to patient-days was associated with patients’ satisfaction: a larger percentage of patients in hospitals placing in the top quartile of nurses-to-patient-days ratio gave their hospital a 9 or 10 rating, compared with patients in bottom-quartile hospitals (66% vs. 61%).
  • Fewer patients in for-profit hospitals gave a 9 or 10 rating than patients in either private or public nonprofit hospitals (59% vs. 65% and 65%, respectively).
  • Patients’ satisfaction with care was associated with quality of clinical care for four conditions: acute myocardial infarction, congestive heart failure, pneumonia, and prevention of surgical complications.
  • Patients’ satisfaction ranged widely across regions: 72 percent of patients in Birmingham, Ala., gave 9 or 10 ratings, compared with 50 percent of patients in East Long Island, N.Y.

    • Posted in Consumer-Driven Healthcare, Customer Service, Healthcare Costs | No Comments »

    Wait Times and “Boarding” of Psychiatric Patients in Emergency Rooms

    July 7th, 2008 by Melanie Matthews

    The world was horrified last week after watching a surveillance video of the death of a female psychiatric patient in a New York hospital’s ER waiting room. I am not going to embed the video here. If you go to YouTube.com and search on “Kings County Hospital,” you can choose from at least 48 variations of the video.

    What’s important to note is that treatment depicted in this hour-long viral video raises a host of disturbing concerns about quality of care, safety, security and confidentiality at Brooklyn’s Kings County Hospital, which last week pledged to check on waiting patients every 15 minutes and attempt to shorten the hospital’s median waiting time to around 10 hours, among other promised reforms.

    The latter goal is more than twice the average waiting time of four hours and five minutes reported in Press Ganey’s 2008 ED Pulse Report. In a survey of 1,524,726 patients treated at 1,656 EDs nationwide between January 1 and December 31, 2007, New York EDs ranked 43rd in average wait times, with an average wait time of 282 minutes. (First was South Dakota at 165 minutes; last was Utah at 385 minutes.)

    Long waits in the ED are not uncommon for people with psychiatric illnesses due to the practice of “boarding” — holding admitted patients in the ED instead of moving them to an inpatient bed. According to a survey of ED directors by the American College of Emergency Physicians, psychiatric patients (including children) admitted to the hospital from the ED can wait 24 hours or longer for an inpatient bed, principally because of a lack of psychiatric beds. Almost 80 percent of the 328 ED directors who responded to the survey said their hospital boards psychiatric patients in the ED. Thirty percent said their hospitals board psychiatric patients between eight and 24 hours, and more than one-quarter said that their hospitals board children with psychiatric illnesses for that long.

    Eighty-five percent of these doctors said that wait times for all emergency patients would improve if there were better psychiatric services available. More than 80 percent agreed that regional dedicated emergency psychiatric facilities nationwide would work better than the current system for dealing with psychiatric emergency patients.

    Posted in Customer Service, Healthcare Administration, News | No Comments »

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