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Tag Archives: physicians

Speaking Up: Let Patients Have a Say

One of the main tenets of patient-centered care is giving patients more control over their health and health decisions made on their behalf. Patients have a clear and important role in their own care through a concept called “patienthood” — the self-management behavior that ensures we either give to ourselves or get from others the care we need to manage our health risks and medical problems.

Linda Barlow

Linda Barlow

On the surface, patienthood seems like a simple concept: our body, our health, our decisions. What might be right for the patient next door may not be right for us. At one end of the spectrum, patienthood may involve strategies like eating right and exercising to avoid problems related to obesity. At the other end of the spectrum, it may involve saying “no” to certain suggested treatments, as I did when I opted not to have chemotherapy after my breast cancer operation.

According to a report from Kaiser Health News, in many hospitals and clinics around the country, health care professionals simply tell patients what treatments they should have, or at least give them strong recommendations. But at UC San Francisco, a formal process called “shared decision making” allows patients to work with doctors to make choices –regarding their care. The approach has become a model for other programs around the country.

The report mentions a stumbling block to this approach: many patients aren’t accustomed to speaking up. Even the most engaged or educated patients may defer to their doctors because they are scared, they don’t want to be seen as difficult or they think the doctor knows best.

Doctors who recognize this stumbling block may want to take a cue from one family doctor profiled in the Washington Post who, when faced with a medical conundrum involving an elderly patient, pushed aside talk of possible treatments and asked the patient a simple question: “What are your goals for care, and how can I help you?”

This particular patient wasn’t looking for a cure. He simply wanted to live out his remaining days at home without worrying about falling. So the doctor put together a hospice and physical therapy plan that let him do just that.

Patients speaking up. Doctors asking the right questions…and listening to the answers. Patients and doctors deciding together on a course of care or treatment. The concept of patient-centered care cannot be fully realized until everyone involved has a say.

Have you ever played a role in deciding on your own course of treatment? Or do you typically hesitate to speak up to your health care providers? Let us know in the comments section.

Virtual Health Care: Your Questions Answered by a Telehealth Pioneer

If you follow the latest developments in health care, you may have noticed: telehealth has taken off. Our country is focused on making health care more accessible for Americans, and naturally, telehealth has emerged as a key innovation that can help to make this a reality. It’s an effective way to deliver evidence-based medicine – and it’s something that we as physicians can embrace right now.

Dr. Peter Antall

Dr. Peter Antall

As President and Medical Director of the world’s first telehealth practice, Online Care Group, I’m often asked a handful of common questions about telehealth. Here, I share the most common questions and my answers with Real World Health Care’s readers.

What is telehealth?

To me, telehealth is simple. Telehealth is a live video visit between a doctor and a patient from home or work. This differs from traditional telemedicine, which mainly connected hospital facilities to each other and relied on big, expensive hardware in clinical locations.

With telehealth, the patient can have a video visit with a doctor using every day consumer technologies that are becoming ubiquitous: a smartphone, tablet, or computer. There are other forms of telehealth on the market that use only phone or secure email; however, these visits do not allow for the same level of clinical patient evaluation. I have met with medical boards and associations across the country and found that live video is greatly preferred because it represents the closest interaction comparable to an in-person visit.

Do patients really want to talk to a doctor virtually?

For starters, let me just ask you when was the last time you shopped, banked, booked travel, made a dinner reservation, filed your taxes, or communicated with friends and family online. Chances are – if you’re like many Americans – you’ve done more than one of these things today, probably on your phone or tablet.

While the health care industry has done a great job of supplying information to patients online and has even started to offer patients the opportunity to book appointments online, information and scheduling stop short of what patients want and expect from health care: quality interactions with clinicians. To date, health care ‘transactions’ have only occurred at the intersection of a physical location and the supply of available clinicians. The industry can do better.

Over the last several years, a number of studies have shown that patients are rapidly warming to the concept of interacting with doctors online. Estimates suggest that half to three-quarters of Americans are interested in online consults, and I’d expect this number to grow as more patients have access to telehealth services and as more doctors offer such services to patients.

If you think about the patient experience today, it’s not surprising that most folks respond so positively to the value of telehealth. Consider the national average wait time to see a doctor of 18.5 days, not to mention the excessive wait time in certain urban and rural areas. And once you’re in the doctor’s office, that wait can be long, too, which you know if you’ve ever spent two or three hours in an urgent care clinic or emergency room waiting to be seen. Retail clinics are an option, but these are generally not staffed by a doctor and are often not available outside of normal business hours.

On the other hand, a patient can see a doctor in just a few minutes from their phone or tablet. For example, our wait times at the Online Care Group currently average less than 2.5 minutes, and there’s no appointment or travel required. So it’s not surprising that 97% of patients rate the service “very good” or “excellent”.

How do you examine a patient during a telehealth visit?

Examining a patient through video is different from in-person, though the fundamental rules of medicine still apply. The most important elements of any consultation – online or in-person – is taking a thorough history, asking plenty of questions, and doing a visual examination. Having a video connection with a patient is really important in helping to understand the patient’s overall demeanor and level of discomfort and stress, just as in the exam room. This gives me great insight into the patient’s physical and mental well-being. In terms of a physical exam, I’ve developed protocols to help our doctors guide patients through self-exams in order to provide empirical feedback that’s useful in making certain diagnoses.

One of our main tenets is that doctors must use their own clinical discretion when treating patients online. Our physicians diagnose and treat only when enough data can be ascertained in the video consultation to do so. If not, our physicians triage the patient and refer out for in-person care. That may mean seeing their doctor in-person, going to the emergency room, or ordering tests at a local health center.

What about security issues?

As with brick-and-mortar medicine, it is extremely important to protect patient health information. The information regarding a patient’s health should remain private between the physician and the patient and be stored securely, in compliance with the Health Insurance Portability and Accountability Act (HIPAA). American Well provides a secure space for patients to safely and confidentially consult with a doctor online. This is imperative for an effective and safe telehealth practice.

What does telehealth have to offer me as a doctor?

Telehealth is not only convenient for patients; it offers doctors flexibility at work, reliable pay, and access to new patients. And not only individual and group practices, but even large medical practices and hospitals, are starting to use telehealth to attract and retain patients and to expand their reach.

By incorporating telehealth, hospitals under accountable care organization (ACO) contracts, or otherwise caring for patients under capitation, reap the financial benefits of having healthier patients. Private offices can offer open access and after-hours care or designate that a subset of visits, like medication follow-up, be managed through telehealth. Practices can also bring in other specialties virtually into their office, like certified diabetes educators, dieticians, or behavioral health specialists.

Can I make money with telehealth?

There is high demand from patients for urgent-care-like telehealth services. Today, physicians across the country – including those in our national telehealth practice – make a very good living practicing medicine online, providing care anywhere from 10-40 hours per week.

Another option is for doctors to offer telehealth to their existing patients. In many states, doctors are already being reimbursed for services delivered to their own patients by including GT modifiers in their billing (this modifier is used to indicate telehealth services via interactive audio and video telecommunication systems). Currently 20 states mandate private payer reimbursement for telehealth services and 45 states reimburse for some telehealth services. As our doctors move from fee-for-service to capitated payment models under the Affordable Care Act, they are absorbing the risk (“rewarded for performance,” as some might say). Telehealth is one way to improve efficacy and efficiency of patient care. Telehealth lets doctors increase the number of touch points for patients, which potentially can improve outcomes as well.

Is telehealth the future of healthcare?

Telehealth isn’t really a new form of healthcare; it is the same healthcare that Americans are using every day, delivered in a faster, less expensive, more convenient way. Although not everything can be treated via telehealth, it’s a great option for many types of acute care, chronic care, behavioral health, and wellness services. Patients, doctors, hospital systems, employers, insurers, regulators, and legislators are all rapidly changing the way they view health care in order to incorporate telehealth. In the coming months, the proof that telehealth is here to stay will become even more evident. It’s time to embrace the now of health care.

Have you ever used telehealth? Would you? Share your thoughts and experiences in the comments section.

If you have any questions or to learn more about where and how I practice telehealth, email me at peter.antall@americanwell.com.

Dr. Antall is the Medical Director of Online Care Group, a physician-owned primary care group that offers its clinical services online using American Well’s technology. American Well’s web and mobile telehealth platform connects patients and clinicians for live, clinically meaningful visits through video, supplemented by secure text chat and phone. For more information, visit AmericanWell.com

Categories: Access to Care

Our Top 4 Most ‘Liked’ Health Care Stories

This week is Real World Health Care’s one-year anniversary. Over the past year, we showcased solutions that are proven to lower costs, increase access, and provide more patient-centered care. In celebration of this milestone, we are sharing the favorite posts as measured by Facebook ‘likes’ from our readers, who have visited the blog over 10,000 times.

 

#4 – Keeping Boston Strong: How Disaster Training at Osteopathic Medical School Helped Save Lives

In May, former RWHC editor Paul DeMiglio told the story of Dr. Danielle Deines’ emergency response to the Boston Marathon bombing. Dr. Deines’ education at the Edward Via College of Osteopathic Medicine – Virginia Campus (VCOM) required her to participate in a two-day, mandatory training curriculum on Bioterrorism and Disaster Response Program, which immersed her in real-life disaster training, field exercises and specialized courses.

(Photo courtesy of VCOM)

(Photo courtesy of VCOM)

The day of the bombing, after crossing the finish line, Dr. Deines found herself triaging runners in medical tents to make room for the victims. “The back corner became the most severe triage area, nearest the entrance where the ambulances were arriving,” she said. “I saw victims with traumatic amputations of the lower extremities, legs that had partially severed or had shrapnel embedded, and clothing and shoes literally blown off of victims’ bodies.”

Read the post: http://www.realworldhealthcare.org/2013/05/keeping-boston-strong-how-disaster-training-at-osteopathic-medical-school-helped-save-lives/

 

#3 – Making Life Easier for Patients and Loved Ones: Meet MyHealthTeams

In April, Eric Peacock, Co-founder and CEO of MyHealthTeams, contributed a guest blog about the need for social networks for communities of people living with chronic conditions. These networks allow patients to “share recommendations of local providers, openly discuss daily triumphs and issues, share tips and advice, and gain access to local services,” he wrote.

“Sharing with people who are in your shoes offers a sense of community that can’t be found elsewhere – these are people who know the language of your condition; they understand the daily frustrations and the small triumphs that can mean so much,” he added.

Read the post: http://www.realworldhealthcare.org/2013/04/making-life-easier-for-patients-and-loved-ones-meet-myhealthteams/

 

#2 – When the Health Care Blogger Becomes the Cancer Patient

In August, even as she was still undergoing daily radiation treatments, contributor Linda Barlow shared her personal story of being diagnosed with cancer and the slew of medical bills she faced even though she had insurance.

Linda Barlow

Linda Barlow

“While these out of pocket costs are certainly hard to swallow – I can think of a hundred other things I’d rather spend my money on – for my family, they are doable,” she wrote. “We won’t have to skip a mortgage payment or a utility bill. We won’t have to dip into a child’s college tuition fund. We certainly won’t have to worry about having enough money for food. But I know – from my work on this blog and with its main sponsor, the HealthWell Foundation – that many families living with cancer aren’t so lucky.”

Read the post: http://www.realworldhealthcare.org/2013/08/when-the-health-care-blogger-becomes-the-cancer-patient/

 

#1 – What If You Want Politicians to Get Moving But You Can’t Move?

Neil Cavuto

Neil Cavuto

Last week, Neil Cavuto, Senior Vice President and Anchor, Fox News and Fox Business, contributed a moving guest post about his triumphs over multiple sclerosis (MS) for MS Awareness Week. His deeply personal blog inspired resounding praise in the comments section and 1,300 Facebook ‘likes’.

“If I can pass along any advice at all, it is…to simply never accept a prognosis as is,” he wrote. “Fight it. Challenge it. ‘Will’ yourself over it. Many doctors say it’s a naïve approach to the disease, but attitude counts a lot for me with MS, as it did for me two decades ago when I was battling advanced Hodgkin’s Disease. Then, as now, it was about one day at a time, and staying optimistic and positive all the time.”

Read the post: http://www.realworldhealthcare.org/2014/03/ms-awareness-week/

 

If you would like to suggest a topic, contribute a guest post, or learn more about short-term co-sponsorship opportunities, please contact us at dsheon@WHITECOATstrategies.com. As a blog currently sponsored solely by the HealthWell Foundation, an independent non-profit providing nationwide financial assistance to insured Americans with high out-of-pocket medication expenses, co-sponsorship helps us keep Real World Health Care alive and well as a resource for journalists, health care professionals, policymakers, and patients. Plus, co-sponsorship will increase your organization’s visibility among thought leaders in the health care sphere.

Do you have a favorite Real World Health Care post? Is there something you’d like to see more of? Post to the comments section or tweet at us at @RWHCblog.

It’s Not Over Yet: Addressing Part Two of the Door-to-Balloon Time Initiative’s Success

ReillyJohn

John P. Reilly, M.D., FSCAI

From the very first sign of a heart attack, the clock starts ticking in the race to save a patient’s heart muscle and even his or her life.

Thanks to technology and finely tuned systems of heart attack care that are now available in communities throughout the United States, we are getting faster all the time.

But sometimes we still lose the race.

During a heart attack, the heart is deprived of oxygen. The longer the heart goes with too little oxygen, the more muscle is lost, often irreversibly. This is what doctors mean when we say, “Time is muscle.” How quickly a patient receives treatment once heart attack symptoms appear often determines if he or she will make a full recovery, suffer heart muscle damage, or die.

Door to Balloon Signaled Success, or Did It?

This is why, a decade ago, healthcare professionals across the country set out to reduce the time it takes to treat heart attack patients once they arrive at the hospital. Since stopping a heart attack often involves balloon angioplasty to reopen the blocked artery, the effort was called the Door-to-Balloon (D2B) Initiative. This effort has prevented or limited heart damage for countless patients.

The D2B initiative involved making the healthcare system more efficient, more responsive and more effective, starting from the moment a heart attack patient comes to the attention of an emergency medical responder (EMR) answering a 9-1-1 call or presenting in the emergency department.  When D2B began, it often took more than two hours from the time a heart attack patient arrived at the hospital until he or she received life-saving treatment to reopen a blocked artery.

Now, 90 percent of patients who enter hospital doors receive treatment in less than 90 minutes and many are treated within 60, 30, even 15 minutes. [1]

D2B is one of healthcare’s greatest success stories. But, according to a new study [2], reducing D2B times has not been enough to significantly reduce mortality rates among heart attack patients.

What Happens Before the Hospital Door?

There are two sides to the time equation. Unfortunately, the part of the equation that has not improved enough is how long it takes patients to get to the hospital once heart attack symptoms start. Most patients wait two or more hours after heart attack symptoms appear to seek medical help. [3] Many patients are taking too long to call 9-1-1, placing themselves at risk of suffering irreversible heart damage or death.

We must do for Symptom-to-Door (S2D) Time what we have done so successfully for D2B. Revamping a system of care outside the hospital, however, is much different and perhaps more difficult than revamping a system of care within the hospital.

There have been myriad heart attack awareness programs, including online public education programs like SecondsCount.org, for which I am an editor, aimed at helping people understand the risks of heart attack, how to recognize the symptoms and why responding promptly is essential.

We have made progress. An increasing number of people know that chest pain, shortness of breath, nausea, fatigue, dizziness, and pain in the jaw, back or arm are often the first signs of heart attack. While I see more people who identified their symptoms early on, there are also many who remain unaware, are in denial or are just confused. Every day, I see patients who thought their symptoms “weren’t that bad” or explain them away as indigestion or a virus. I also see the toll that lost time takes in hearts damaged and lives lost.

Only 60 percent of patients contact emergency medical responders when experiencing symptoms. About 40 percent arrive at our hospitals on their own. [4] That’s dangerous, whether the patient is driving him- or herself. Or, even if a friend or relative is driving, it still represents a lost opportunity for treatment to begin in the ambulance, or to alert the doctors in the emergency room that a heart attack patient is on the way in.

Let’s Save More Hearts and Lives

To get started, here are a few thoughts on how we might reduce S2D:

  • We need a concerted national effort to reduce S2D time that establishes consistent messages rather than myriad programs offering incomplete or inconsistent information.
  • We must improve regional and statewide systems of care to coordinate heart attack care to ensure everyone gets the most expeditious care.
  • We need to better inform the people who are most at risk for heart attack or other heart issues about what symptoms to look for and what to do if they develop.
  • And, of course, we must continue our educational efforts, helping everyone to understand that if they are concerned they may be having a heart attack, then they should call 9-1-1 without delay and without concern about looking foolish if their symptoms turn out to be something other than a heart attack.  The alternative – sitting at home while having a heart attack, with heart muscle dying as the minutes tick by – would be far worse.

We’ve had remarkable success in reducing D2B times. But it’s not enough. To save hearts and lives, we must take on the other side of the heart attack challenge.

We’ve done it once. We can do it again.

1. Bates ER, Jacobs AK. Time to Treatment in Patients with STEMI. N Engl J Med 2013;369:889-892.
2. Menees DS, Peterson ED, Wang Y, et al. Door-to-balloon time and mortality among patients undergoing primary PCI. N Engl J Med 2013;369:901-9.
3.  Life After a Heart Attack. National Heart, Lung, and Blood Institute.
4.  http://nypress.com/forty-percent-do-not-call-911-survival-rates-show-every-minute-matters/, http://www.nejm.org/doi/full/10.1056/NEJMp1308772

Give Patients the Gift of Hope and Health by Supporting HealthWell for #GivingTuesday

We are proud to announce that the HealthWell Foundation – an independent 501(c)(3) charity that provides financial assistance to insured patients living with chronic and life-altering illnesses – is joining the #GivingTuesday campaign, which launches today. 100 percent of your donation to HealthWell goes directly to grants and services that will benefit patients in need across the country. This week we are sharing some powerful real-world examples of how your gift to HealthWell will help transform lives.

Lynn Harcharik

Lynn, who received financial assistance from HealthWell for cancer treatments.

As one of our country’s most trusted independent charities, we believe that no patient, including those living with cancer, should go without health care because they can’t afford it. By donating to HealthWell for #GivingTuesday, you’ll join us in making that commitment a reality that will change lives for the better, one patient at a time – just like Lynn.

It was ovarian cancer spreading to the colon. My husband called many places, no cancer society would help! One society asked what type of cancer it was, and replied: there are no funds for ovarian cancer – we cannot help. Another organization had already used their funds. It was very discouraging, but my oncologist’s secretary told us about the HealthWell Foundation. After calling and talking to your group, the answer was YES, you would help. (Thanks!) In October of 2008, reversal surgery was done with the ileostomy. And yes, the cancer came back, or maybe was not completely gone from before, but-more chemo! Thank you for being there in my time of need. My prayers are with your group and your work. Thanks!

– Lynn (Streator, IL)

We want to make a difference for even more patients like Lynn so they can access critical medical treatments and get better. But that can only happen with your support.

That’s why, for this year’s #GivingTuesday, we’re urging Real World Health Care (RWHC) Blog readers to donate to the HealthWell Foundation’s Emergency Cancer Relief Fund (ECRF). Your generous holiday gift will help ensure that patients living with cancer are not forced to choose between paying the rent or buying food and affording life-saving care.

So what, specifically, will your tax-deductible #GivingTuesday donation do? Giving to ECRF will bring us closer to meeting our $100,000 goal by the end of the year so the fund can open in January. We are almost halfway there with more than $46,000 raised so far. Every dollar counts, and with just a little more help, we will hit our goal so that more cancer patients can start 2014 off right.

To help more families and patients afford the urgent medical treatments they desperately need, we need you to support #GivingTuesday starting today. Please contribute as generously as you possibly can.

Thank you for giving the gift of health this holiday season.

Categories: Cost-Savings

MD and DO Medical Schools Consider Major Changes to Education Model

Experts from allopathic medical colleges (those that graduate MDs) and from osteopathic medical colleges (those that graduate DOs) have been actively exploring ways to lower the cost of medical and graduate school without sacrificing the quality of the education.

Paul DeMiglio

Paul DeMiglio

Groundbreaking recommendations were issued Monday that seek to improve osteopathic medical education in the U.S. and help fuel a new generation of primary care physicians who will be equipped to meet the demands of today’s changing health care landscape. One out of four students headed to medical school this fall are attending osteopathic medical school.

Released by the Blue Ribbon Commission (BRC) – a medical panel comprised of some of the nation’s leading experts in osteopathic medical education – the report (“A New Pathway in Medical Education”) coincides with publication of a related story in Health AffairsBRC aims to find a solution to the primary care physician shortage by transforming the osteopathic medical education model, reducing inefficiencies and addressing high costs as well as rising student debt.

Osteopathic physicians, or DOs, emphasize “helping each person achieve a high level of wellness by focusing on health promotion and disease prevention” through hands-on diagnosis and treatment, according to the American Association of Colleges of Osteopathic Medicine (AACOM). Licensed to practice in all 50 states, DOs work in various environments across specialties.

MD education experts also recognize an urgency for changing medical education. Transforming the way students are trained to practice medicine is key to improving access to quality care for patients, according to an October 30th Perspective article (“Are We in a Medical Education Bubble Market?”) that appeared in the New England Journal of Medicine (NEJM). The article underscores why lowering the cost of health care and reducing the cost of medical education go hand in hand.

“If we want to keep health care costs down and still have access to well-qualified physicians, we need to keep the cost of creating those physicians down by changing the way that physicians are trained,” the authors are quoted as saying in a news release from Penn Medicine. “From college through licensure and credentialing, our annual physician-production costs are high, and they are made higher by the long time we devote to training.” 

Cleveland Clinic, Ohio University Heritage College of Osteopathic Medicine Lead by Example
The Cleveland Clinic’s South Pointe Hospital is partnering with the Ohio University Heritage College of Osteopathic Medicine (OUHCOM) to implement the BRC findings through a new pathway that has five components:

  • Focus on community needs served by primary care physicians.
    Emphasize primary prevention and improvement of public health to raise the quality and efficiency of care.
  • Advance based on knowledge, not years of study.
    Build a curriculum that centers on biomedical, behavioral and clinical science foundations so that the graduates’ readiness for practice can be better assessed through outcomes specific to medical education.
  • Boost clinical experience.
    Offer clinical experience from the first year instead of doing so later on. Increase responsibility throughout the training, and streamline training between undergraduate and graduate school to avoid redundancies and inefficiencies.
  • Require a range of experiences.
    These should include hospital, ambulance, and community health systems to provide the best learning experience.
  • Require modern health system literacy.
    Focus on health care delivery science including principles of high quality, high value, and outcomes-based health care environments.

Dr. Robert S. Juhasz, DO, president of South Pointe Hospital, says that Cleveland Clinic and OUHCOM will work to develop a curriculum that emphasizes early clinical contact to ensure “we are providing the right care, in the right setting for the right person at the right time.”

The partnership, Dr. Juhasz says, “will transform primary care education,” and go far to help shift the focus of medical education “toward competency-based rather than time-based education. We want learners to be engaged, practice-ready primary care physicians and be equipped to care for the communities they serve.”

South Pointe, which has trained DOs for 40 years, is renovating its facilities to now accommodate OUHCOM. Starting in July, 2015 it will train 32 osteopathic medical student residents per class.

The implications of BRC’s recommended changes, according to Dr. Juhasz, “will enhance our primary care base for delivery of care in a patient-centered model, increasing access and quality and reducing costs,” while also cultivating a learning environment that will “encourage more students to enter DO and find hope and joy in serving patients so that they will want to work in the area they train.”

Lead author of the NEJM article — David A. Asch, MD, MBA, Professor of Medicine and Director of the Center for Health Care Innovation at Penn Medicine — says that medical colleges can play a critical role in helping to avoid a burst in the “medical education bubble.” One solution is for schools to lower the cost of tuition and reduce high debt-to-income ratios that could discourage medical students from pursuing careers in fields where more physicians are needed, including primary care.

“Doctors do well financially,” he says, “but the cost of becoming a doctor is rising faster than the benefits of being a doctor, and that is catching up to primary care more quickly than orthopedics, and that ratio is close to overtaking the veterinarians.”

Now tell us what you think. What ways do you think medical school could be overhauled? What incentives can be provided to attract more students to study medicine and become doctors, particularly in primary care, to help reduce the rising provider shortage?

Experts Say More Med Students Good News for U.S. Health Care

Fresh data released just last week demonstrates that new student enrollment at medical schools is on the rise nationwide.

Paul DeMiglio

Paul DeMiglio

The Association of American Medical Colleges (AAMC) announced Thursday that the total number of those who applied to and were accepted into medical school grew by 6.1 percent this year to a record 48,014. This figure beats out
— by 1,049 students — the previous all-time high set in 1996. The AAMC, which represents U.S. hospitals, health systems, Department of Veterans Affairs medical centers, academic societies and 141 accredited U.S. and 17 accredited Canadian medical schools, also found that:

  • The number of first-time applicants climbed to 35,727 (5.5 percent increase).
  • The number of students enrolled in their first year of medical school went past 20,000 for the first time. 

“At a time when the nation faces a shortage of more than 90,000 doctors by the end of the decade and millions are gaining access to health insurance, we are very glad that more students than ever want to become physicians. However, unless Congress lifts the 16-year-old cap on federal support for residency training, we will still face a shortfall of physicians across dozens of specialties,” AAMC President and CEO Darrell G. Kirch, M.D. said in a statement. “Students are doing their part by applying to medical school in record numbers. Medical schools are doing their part by expanding enrollment. Now Congress needs to do its part and act without delay to expand residency training to ensure that everyone who needs a doctor has access to one.”

Record-breaking enrollment is also being seen at colleges of osteopathic medicine, where 20% of medical students are enrolled. Although they make up a smaller number of students, their growth rates increased even faster. In an announcement released Wednesday by the American Association of Colleges of Osteopathic Medicine (AACOM), experts say this trend will help offset the looming primary care crisis that will result from a growing shortfall in the number of doctors.

Enrollment at colleges of osteopathic medicine has almost doubled over the past decade, with the number of students who applied this year hitting 16,454. Other key findings, according to AACOM, show that:

  • Osteopathic medical colleges saw an 11.1 percent increase in first-year student enrollment for 2013, bringing total enrollment to 22,054.
  • 4,726 new osteopathic physicians graduated this past spring, representing an increase of more than 50% over the number of such graduates 10 years ago.

“Because large numbers of new osteopathic physicians become primary care physicians, often in rural and underserved areas, I’m hopeful that the osteopathic medical profession can help the nation avoid a primary care crisis and help alleviate growing physician shortages,” Stephen C. Shannon, DO, MPH, President and CEO of AACOM, said in a statement. “Interest in osteopathic medical education is at an all-time high.”

Primary care physicians are expected to be hit harder than any other specialty, with a projected shortage of about 50,000 by 2025. 

So what exactly is osteopathic medicine and osteopathic physicians (DOs)? According to AACOM, which represents the nation’s 30 colleges of osteopathic medicine at 40 locations in 28 states, DOs offer a comprehensive, holistic approach to medical care.

One in five medical students are now enrolled in osteopathic medical schools, and this percentage will grow even more as new campuses open and colleges continue to expand to keep pace with more students.

Now it’s your turn. What are potential advantages and disadvantages of more medical school graduates – to cost, care and access? Will the rise in new enrollment be enough to offset expected physician shortages? Tell us what you think.

The President and His Stent: How the Patient-Physician Relationship Represents What Works Best in U.S. Health Care

BassTed_jpg

Dr. Ted A. Bass

The decision by former President George W. Bush and his doctors to treat a blockage in one of his heart arteries with angioplasty and stenting has become the newest chapter in the intense debate over appropriateness in stenting.

Bush’s physical examination revealed irregularities that led to tests that revealed a blockage in his coronary artery, which Bush and his doctors decided to treat with a stent, according to his statement. That he was not having a heart attack and apparently had not felt any symptoms, such as chest pain, brought objections from those who would place sharp limits on the use of stents.

Only President Bush’s physicians and family know what alternative therapy choices were presented to Bush, but we do know medical advances allowed him to choose from several therapeutic courses. Bush, in consultation with his doctors, chose the one that was right for him and the quality of life he wished to maintain.

High quality medical care is patient-centered. We strongly value the right of patients, with their doctors, to make informed choices in line with their health and quality of life goals. This right is threatened by critics who would “reform” the health care system by ignoring the complex nature of medicine, cardiovascular disease and the individual needs of each patient.

For those who are quick to dismiss the benefit of stents, I would encourage them to speak to our patients. As a practicing interventional cardiologist, I see first-hand the benefits of interventional cardiology procedures. I see it when a patient’s life is saved during a heart attack, in infants born with a serious heart defect whose hearts beat strong because of advances of interventional care and in seniors who enjoy productive lives again after a minimally invasive heart procedure. In patients with stable coronary artery disease, stenting reduces chest pain from poor circulation of the heart arteries, decreases the need for repeat procedures, and improves the overall circulation of the heart.

And this is what the President Bush case demonstrates:  Health care decisions must be made between the patient and his or her doctor. As outsiders in the Bush case, we do not presume to make that decision for him – nor should others. While it is important to review patient cases to continually improve, learn from and advance the science of medicine, we must not judge the appropriateness of a medical decision on the basis of limited information. To do so is to rush to a judgment that is short sighted, uninformed and, ultimately, emphasizes attention-seeking soundbites over patient care.

In our quest to reduce costs and ensure that appropriate and optimal treatment is provided to each patient and is in step with the guidelines, let us not forget the doctor-patient relationship at the heart of all we do as physicians. It is a fundamental trust that must not be jeopardized.

Now tell us what you think. Do you agree that stents are beneficial to patients? Why or why not? What does the case of President Bush illustrate in terms of the doctor-patient relationship?

(Medical) Home is Where the Care and Cost-Savings Are

The word “home” has many connotations: the building in which you live, the place you come from, and even the end point of a game. Now, there is a new type of home: The Patient-Centered Medical Home (PCMH).

Linda Barlow

Linda Barlow

PCMH is a model of primary care that is patient-centered, comprehensive, team-based, coordinated, accessible and focused on quality and safety. It has become a widely accepted – and cost-effective – model for how primary care should be organized and delivered, encouraging providers to give patients the right care in the right place, at the right time and in the manner that best suits their needs.

“The magnitude of savings depends on a range of factors, including program design, enrollment, payer, target population, and implementation phase,” explains Michelle Shaljian, MPA, Chief Strategy Officer of the Patient-Centered Primary Care Collaborative (PCPCC). “Most often, the medical home’s effect on lowering costs is attributed to reducing expensive, unnecessary hospital and emergency department utilization.”

When the Affordable Care Act (ACA) was signed into law in 2010, medical homes got a boost because of numerous provisions that increased primary care payments, expanded insurance coverage and invested in medical home pilots, among other programs.

The model has been adopted by more than 90 health plans, dozens of employers, 43 state Medicaid programs, numerous federal agencies, hundreds of safety net clinics and thousands of small and large clinical practices nationwide since then. Among the results:

  • In Michigan, Blue Cross Blue Shield – the nation’s largest PCMH designation program — saved an estimated $155 million in preventative claim costs over the first three years of implementation.
  • CareFirst Blue Cross Blue Shield in Maryland reported nearly $40 million savings in 2011 and a 4.2 percent average reduction in expected patient’s overall health care costs among 60 percent of practices participating for six or more months.
  • In New York, the Priority Community Healthcare Center Medicaid Program in Chemung County saved about $150,000 or 11 percent in the first nine months of implementation, reduced hospital spending by 27 percent and reduced ER spending by 35 percent.
  • In Pennsylvania, Pinnacle Health achieved a zero percent hospital readmission rate for PCMH patients versus a 10-20 percent readmission rate for non-PCMH patients.

The PCPCC is the leading national coalition dedicated to advancing PCMH. According to PCPCC, the medical home is an approach to the delivery of primary care that is:

  • Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preference, and that patients have the education and support they need to make decisions and participate in their own care.
  • Comprehensive: A team of care providers is accountable for a patient’s physical and mental health needs, including prevention and wellness, acute care, and chronic care.
  • Coordinated: Care is organized across all elements of the broader health care system, including specialty care, hospitals, home health care, community services and supports.
  • Accessible: Patients access services with shorter wait times, “after hours” care, 24/7 electronic or telephone access, and strong communication through health IT innovations.
  • Committed to quality and safety: Clinicians and staff enhance quality improvement through the use of health IT and other tools to ensure that patients and families make informed decisions about their health.

According to Melinda Abrams, Vice President of Patient-Centered Primary Care Program at the Commonwealth Fund, to have the greatest impact, a medical home must be located at the center of a “medical neighborhood” inhabited by hospitals, specialty physicians, physical therapists, social workers, long-term care facilities, mental health professionals and other service providers. She notes that it is the role of the primary care provider to coordinate care and make sure that patients don’t slip through the cracks, or receive tests or procedures they’ve already had – a particular concern for patients who see multiple doctors.

The National Committee for Quality Assurance (NCQA) – a non-profit, independent group dedicated to improving health care quality – accredits and certifies a wide range of health care organizations and is the leading national group that recognizes PCMH with the most widely adopted model. Currently, there are almost 5,000 NCQA Recognized PCMHs across the country.

Other organizations with PCMH recognition programs include Accreditation Association for Ambulatory Health Care, Inc. (AAAHC), the Joint Commission, and URACVideos from the American Association of Family Physicians (AAFP) feature family physicians who discuss practice redesign aimed at lowering costs, maximizing staff expertise and improving patient care.

“Practices seeking to initiate a patient-centered medical home will find that an assessment process is very helpful to understand where they are,” said Shaljian. “Some practices have electronic health records, a very strong history of team-based care, and strong connections with specialists, hospitals, and other stakeholders in the community, while others do not. Some are deeply affected by an internal culture of quality improvement, which makes a huge difference in how successful some medical homes are.”

Want to learn more about PCMH? Visit the U.S. Department of Health & Human Services’ Agency for Healthcare Research and Quality content-rich Resource Center.

How can health care continue to move the nation to PCMH? And how can the model tackle its number-one challenge: the current fee-for-service payment system?

Striking the Right Balance for Better Patient Outcomes

A recent article in Health Affairs reports that ChenMed – which serves low-to-moderate income elderly patients primarily through the Medicare Advantage program – is achieving better health outcomes for Medicare-eligible seniors, including those living with five or more major and chronic health conditions.  Dozens of Chen and JenCare Neighborhood Medical Centers are helping tens of thousands of seniors live better, longer: 

chris_chen

Dr. Christopher Chen, ChenMed CEO

  • Total hospital days per 1,000 patients at ChenMed in 2011 were 1,058 for the Miami area in comparison with 1,712 total US hospital days per 1,000 patients in the same year (Centers for Medicare and Medicaid Services Office of the Actuary).
  • Just one year prior, according to Dartmouth Atlas of Health Care, the Miami Hospital Referral Region was above the 90th percentile in inpatient hospital days.

Why is ChenMed so successful?

Dr. Christopher Chen, CEO of the organization, says its patient care model integrates cutting-edge medical expertise in a way that empowers physicians to ensure patients receive personalized attention and optimal care.

“People always ask, ‘What is your secret?’ There really is no secret,” he says. “It comes down to having the right incentives, the right physician and staff culture, and the right philosophy of care. My goal at the end of the day is to be cost-effective through improvement of outcomes by changing the philosophy of care. We care about results.”

The group practice’s popularity also attests to its effective one-stop-shop approach to patient-centered care through multi-specialty services. Smaller physician panel sizes of 350-450 patients spur intensive health coaching and preventive care, and prescriptions are given to patients during their visits at all Chenand JenCare Neighborhood Medical Centers.

This aspect of ChenMed’s model makes the biggest difference in boosting medication adherence, followed by strong one-on-one doctor-patient relationships that help to change habits for the better. Receiving meds within 3-5 minutes of ordering drugs not only means patients don’t have to wait for the treatment they need, but that they receive their medications while having face-to-face interactions with their primary care doctors.

“In our model we aren’t looking for high-income patients,” Dr. Chen says. “People ask, ‘Are you saying that patients like you because you give more attention to them and provide more access to doctors than those who pay for concierge service?’ I would say yes.”

ChenMed continuously employs top specialists from a variety of fields to conveniently provide fully integrated medical services to patients.  It effectively combines services like acupuncture into its portfolio of care, and improves outcomes and patient experience with customized end-to-end technologies enhancing its daily operations. For example, all the medical assistants and staff are equipped with iPads and can offer physician support tailored to each patient. This fuels collaboration, enabling doctors to work side by side with patients and providing a significant convenience to all parties as a result.

Primary care physicians at Chen and JenCare Neighborhood Medical Centers also meet three times a week, engaging in thoughtful ongoing discussions that generate numerous enhancements to care and delivery for better outcomes.

“We discuss whether a hospitalization could be improved through better outpatient care. We ask, ‘What can we do to improve patient outcomes while the patient is in the hospital?’ We innovate to improve outcomes and can achieve great things for patients because of our small panel sizes. These meetings have saved many lives and continue to do so,” explains Dr. Chen.

When interviewing prospective doctors to work at ChenMed, they are asked whether they like spending time with patients and whether they love the complexity of medicine. If they say no to either of those questions, then this group is probably not the best place for them, Dr. Chen says, underscoring that:

“We want you to practice medicine the way you thought you would when you graduated from medical school. It’s not about how many patients you see, how many procedures you do, or how much you bill. You should want to be a doctor to make people feel better.” 

ChenMed, through its Primary Management Resources subsidiary, also provides behind-the-scenes consulting services to enhance medical practice operations nationwide.  Physicians interested in end-to-end solutions that streamline operations while enhancing patient health outcomes and the patient experience should contact ChenMed at (305) 628-6117 or go to ChenMed.com.