Real World Health Care Blog

Tag Archives: physicians

Are Shorter Doctor’s Office Wait Times Just a Phone Call Away?

Nobody likes to wait, especially at the doctor’s office. No one knows for sure what will happen to wait times, which average from about 16 minutes to just over 24 minutes nationwide according to Vitals – as 30 million more Americans obtain health care coverage under the Affordable Care Act. But it stands to reason that wait times could increase. Couple that with the looming shortage of primary care physicians, and time spent in doctors’ waiting rooms may become an even more precious commodity.

Linda Barlow

Linda Barlow

Patients who lack, well, the patience to wait may have a solution – one that is showing great promise to eliminate doctor visit copays and is available even to those without medical insurance. The free Urgent Care app from GreatCall Inc. is designed to give people 24/7 access to health care information anytime, anywhere. Launched in January, the GreatCall app rose to the top of the Google Play and App Store medical categories by mid-May.

Urgent Care is the only app that provides users with round-the-clock access – for a price of $3.99 per call – to a live, registered nurse with LiveCare Clinic who can escalate inquiries to a board-certified doctor for health-related advice, diagnosis and even prescriptions without an appointment. It also provides a medical dictionary and medical symptom checker tool.

Urgent Care empowers patients to make choices about how and where they receive medical consultation. For example, many access the app’s Interactive Symptom Checker feature to pinpoint various symptoms of common ailments they might initially find uncomfortable to discuss in person. The app also helps identify:

  • Possible causes of symptoms
  • When to self-treat
  • When to contact a medical professional

“With the costs of medical care rising, people are looking for other options to get access to quality health care,” said Aaron Amerling, Manager of Mobile Apps at GreatCall. “Urgent Care fills a very real need by giving anyone access to medical resources, as well as the ability to quickly connect to a nurse or doctor for less than the cost of a typical Starbucks beverage.”

Amerling notes that Urgent Care is being used by a wide range of people – from those seeking a Spanish-speaking nurse or doctor to those who have health insurance and are frustrated by sitting on-hold or waiting long periods for returned calls from their health care providers.

When asked whether apps like this undermine the authority of health care providers by placing too much control in the hands of patients, Amerling said, “When people have the ability to look up ailments online, they may find a myriad of potential causes and are unable to self-diagnose safely. That’s why we made the ability to access registered nurses and board-certified physicians for expert opinions an important component of Urgent Care.”

According to Amerling, the app has been so successful that the company is looking to add even more resources for patients, including:

  • Access to health news and videos
  • Drug information forums
  • Expanded medical libraries
  • A Spanish-language version of the app

Have you ever used Urgent Care or another app to obtain medical advice? If yes, how did you feel about the quality of care you received? If not, do you think you would ever use an app like this?

Categories: Access to Care

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

VCOM Image 2

The Bioterrorism and Disaster Response Program equips students at VCOM with critical skills through field exercises and more (photo courtesy of VCOM).

When Danielle Deines crossed the finish line of the Boston Marathon on April 15, she had no idea her unique medical training as Doctor of Osteopathic Medicine would make a real difference in the life-and-death events that would soon unfold.

A 2012 graduate of the Edward Via College of Osteopathic Medicine – Virginia Campus (VCOM), Dr. Deines immediately sprang into action after the explosions violently rocked the most prestigious race in the country. Triaging people in the medical tent to ensure they received the care they needed, she helped make room for victims on a moment’s notice:

“They asked all of the runners to move to the back of the tent,” Dr. Deines said. “Once there as the volunteer physicians headed to the explosion sites, I made an effort to get to my feet and informed the nurse near me that I wanted to help. I was asked to discharge runners who were able and interested in leaving to help make room for the victims who were starting to be brought in from the street. I cleared those wishing to leave and signed off on their discharge paperwork, then helped to get them out of an entrance that had been made in the side of the tent.  We then moved the freed up cots to form triage areas. The back corner became the most severe triage area, nearest the entrance where the ambulances were arriving. 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.”

Dr. Deines’ ability to help at the time of urgent need did not come coincidentally. Her education at VCOM equipped her — and all other graduates of the Blacksburg, Virginia school — with the critical life-saving skills that are needed when attacks or other emergencies strike.

The Bioterrorism and Disaster Response Program, a two-day, mandatory training curriculum for all second-year osteopathic students at VCOM, has immersed students in real-life disaster training, field exercises and specialized courses since its inception in 2003. This comprehensive approach gives participants expertise in areas including terrorist and major disaster response, hospital planning, behavioral risk factors, psychological response to trauma, and media relations.

Students who have completed the program now serve as lifelines, having the ability to respond to catastrophes locally, nationally and internationally – from Hurricane Katrina to the Virginia Tech shootings, tsunamis and tornado damage in Virginia.

Now more than ever, a working knowledge of disaster response issues is central to providing quality patient care.

“All medical students and practicing physicians need to be able to respond to natural and manmade disasters.  With changing global weather patterns such as global warming and changing political climates, disasters are now a part of the framework,” said Dr. James Palmieri, Associate Professor and Dept. Chair at VCOM. “I always teach the students that no matter what kind of disaster takes place, both natural and manmade, it will always begin in someone’s neighborhood and the local medical community will be part of the initial response.  In light of today’s instant communication, if and when you respond, the world will see you as the local expert.  You had better know how to respond properly for both your benefit and that of your patients.”

How can VCOM’s leadership role in disaster response training be replicated by other medical training programs?  In what ways can more medical schools develop and leverage their curricula to prepare students for disaster response?

Today, more than one in five medical students in the United States are training to be osteopathic physicians, who can pursue any specialty, prescribe drugs, perform surgeries and practice medicine anywhere in the U.S. Osteopathic physicians bring the additional benefits of osteopathic manipulative techniques to diagnose and treat patients, helping patients achieve a high level of wellness by focusing on health education, injury prevention, and disease prevention.

For students who are interested in going into osteopathic medicine, visit the American Association of Colleges of Osteopathic Medicine, www.AACOM.org; and VCOM at http://www.vcom.vt.edu/.

It Takes a Community for Effective Disease Prevention and Management

To help stem the tide and high cost of persisting disparities in U.S. health care, providers are leveraging Community Health Workers (CHWs) as critical players in improving health outcomes by successfully linking “vulnerable” patient populations to better care. Living in the communities where they work, CHWs understand what is meaningful to those communities, communicate in the language of those they serve, and incorporate cultural buffers to help patients cope with stress and promote health outcomes.

As the CDC reports, growing evidence supports the involvement of CHWs as a critical link between providers and patients in the prevention and control of chronic disease:

  • They help high-risk populations, especially African-American men in urban areas, to control their hypertension.
  • They enable diabetic patients to reduce their A1C values, cholesterol triglycerides and diastolic blood pressure.
  • Their interventions improve knowledge about cancer screenings as well as screening outcomes.
  • Their interventions help patients reduce the severity of asthma.

Many Americans – especially those with low incomes, have no insurance or face other socio-economic barriers to primary care – often distrust the health care system, or lack the resources and awareness needed to take charge of their health. As a result, they wait until health issues and chronic disease escalate enough to drive them into the emergency department, where they receive short-term solutions that drive up the total cost of health care.

CHWs are changing that, community by community. Examples of CHW programs – both at home and abroad – abound. One is Penn Medicine’s IMPaCT Program.

IMPaCT (Individualized Management for Patient-Centered Targets) pairs patients in need of extra support with relatable neighbors and peers (people who have shared language, ethnic and geographic backgrounds) to assist them in navigating the medical system and identify the underlying causes of illness.

“Lower income patients tend to poorly manage chronic disease and have worse health outcomes than other patient populations,” explains Dr. Shreya Kangovi, Director of the Penn Center for Community Health Workers, which houses the IMPaCT program. “They are less likely to get preventive care and more likely to end up in the hospital. This scenario leaves health care practitioners frustrated, because they can’t move the needle on health outcomes. And it makes it difficult for the health system to meet its quality targets.”

Dr. Kangovi notes that many patients served by IMPaCT didn’t have a relationship with a primary care physician prior to joining the program.

“There is a lot of focus today on reducing hospital re-admissions,” she says. “But before we can reduce re-admissions, we need to make sure patients have a substitute for the emergency department.”

She shared the story of “Ben,” a young man with a bad case of lupus and no insurance. Ben had been visiting Penn’s Emergency Department regularly for lupus flare-ups. There, he received steroids and pain medications before being sent along his way. Thanks to IMPaCT, Ben was set up with a primary care doctor who understands his health problems, and placed Ben on a better medication regimen. Not only does Ben now feel better, he has more trust in the health care system that he sees as an ally, she says.

IMPaCT currently serves about 500 patients via two programs – one for hospitalized inpatients and one for primary care outpatients. The program’s CHWs meet with patients upon admission to the hospital to set short-term goals and identify pathways to solving their clinical and socioeconomic hurdles. They advocate for patients during their hospitalization, then work with them during discharge and beyond to get them connected to resources in their community. On the primary care side, patients work with their IMPaCT partner over six months to break long-term health goals down into smaller, achievable steps.

“Once patients leave the hospital, real-life issues intervene,” Dr. Kangovi says. “IMPaCT’s community health workers address these health and life issues on the ground, and do so much better and at a much lower cost than clinically trained personnel.”

Are CHWs making a difference where you live? How are they helping to reduce costs and improve access to health care?

Categories: Access to Care

Hospitals, Physicians Embrace Strategies To Reduce Cost of “Frequent Flyer” ER Visits

Pardee Memorial Hospital in Hendersonville, N.C., shaved nearly $405,000 from its Emergency Room (ER) expenses over a one-year period thanks to an integrated program that its founder calls a “patient-centered medical home on steroids.”

The program, Bridges to Health, helped its uninsured participants reduce their ER visits from an average of seven per year (at a typical cost of $14,004 per person) to three per year (at an average cost of $2,760 per person). Another indicator of success: 10 participants secured employment and six previously homeless members found places to live by the end of the first year.

It’s estimated that non-urgent Emergency Department (ED) visits cost the U.S. about $4.4 billion annually. At Pardee Memorial Hospital alone, 255 frequent users (“frequent flyers”) of the ED racked up more than $3 million in unpaid medical bills. Frequent flyers account for up to 40 percent of total ER visits nationwide.

Bridges to Health decreases ER expenses by providing this patient population with primary care, behavioral health services and a nurse case manager through bi-weekly health clinic visits.

“Many of these people just went to the ER because they were in pain or scared,” said Dr. Steve Crane, a family physician who started the program. “You see them going back so many times because their real issues are not supposed to be treated in the ER and are not taken care of.”

The Pardee Bridges to Health free clinic integrates medical checkups and group therapy, with doctors providing treatment and patients offering one another tips ranging from how to obtain legal assistance to saving money on food and shelter. In this way the program addresses the two main problems seen in these patients: lack of social support and access to regular primary care.

Although the results of the program are promising, Dr. Crane cautions that the patient group is small and that it only works for participants who attend the clinic meetings.

Another example of how hospitals can lower frequent flyer ER visits is in the story of Providence St. Peter Hospital (Olympia, Washington). The first step was to join a special community program called the Emergency Department Consistent Care Program and CHOICE, a unified program involving five area hospitals and a non-profit regional coalition of health care providers.

This collaborative effort resulted in ER visits among frequent flyers shrinking by about 50 percent, for a cost savings of nearly $10,000 per patient. That translated to a $2.2 million reduction in ED and inpatient expenses over two years at Providence St. Peter’s alone.

This program flags patients who visit the ED at least twice in one month or four times in six months then examines their cases for narcotic dependency, mental health issues and other factors. The program team uses that data to identify patients, then develops individual care plans and offers the assistance of primary care physicians, clinicians and specialists skilled in the patients’ particular needs.

What’s key to the success of the program? It effectively coordinates efforts with other hospitals in the area, according to its administrative coordinator, ensuring that frequent flyers get a consistent message wherever they go.

What approaches should be pursued to provide more efficient care systems while decreasing readmissions for frequent flyers? Encourage more doctors to keep their offices open longer? Leverage mental health coalitions that focus on continuity of care instead of short-term fixes?

Tell us what you think.

Categories: Cost-Savings

Making Costly – and Deadly – Medical Errors and Unnecessary Hospital Visits Something Only Grandparents Can Remember

“She died from a breakdown in the system. She died from a breakdown in communications.”

These heartbreaking words, from patient safety advocate Sorrel King about the loss of her young daughter Josie King, are words that no one should ever have to say or hear.

Her 10-year commitment to end hospital errors led to a $1 billion war on errors, funded through the Affordable Care Act.  The resulting Partnership for Patients program has already signed up more than 8,000 partners – including organizations and individual medical care providers – in a shared effort to save thousands of lives, prevent millions of injuries and take important steps toward a more dependable and affordable health care system.  According to the Centers for Medicare and Medicaid Services (CMS), the participants include:

  • Hospitals and national organizations representing physicians, nurses and other frontline health care and social services providers committed to improving their care processes and systems, and enhancing communication and coordination to reduce complication for patients.
  • Patient and consumer organizations committed to raising public awareness and developing information, tools and resources to help patients and families effectively engage with their providers and avoid preventable complications.
  • Employers and States committed to providing the incentives and support that will enable clinicians and hospitals to deliver high-quality health care to their patients, with minimal burdens.

In the April 2011 announcement launching the program, Health and Human Services Secretary Kathleen Sebelius shared two goals of the Partnership for Patients:

  1. To reduce preventable injuries in hospitals by 40 percent by the end of 2013, preventing 1.8 million injuries and saving 60,000 lives.
  2. To cut hospital readmissions by 20 percent, saving 1.6 million patient complications that force them to return to the hospital.  Achieving this goal by the end of this year would mean more than 1.6 million patients will recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.

{For a video of Ms. King explaining her work and Secretary Sebelius announcing the Partnership for Patients program, please click here.}

According to CMS, a recent study by the Office of the Inspector General (OIG) (PDF) found that 13.5% of hospitalized Medicare beneficiaries experience adverse events resulting in prolonged hospital stay, permanent harm, life-sustaining intervention, or death. Almost half of those events are considered preventable.

A recent article in the Journal of the American Medical Association showed that specific community-wide quality improvement activities are proven to reduce hospital readmissions.

Do you want to find providers and hospitals near you who have signed the pledge? It’s as easy as clicking here.

Do you want to learn more about the specifics of what actions will be taken to reduce accidents and re-admittance, and the studies conducted to determine the solutions?  Check out Altarum Institute’s blog post on the topic.

Will Consolidation Change Health Care for the Better?

The Cleveland Clinic believes it will, especially when it produces better patient outcomes and improves care across a spectrum of services.

As part of the recent wave of hospital mergers and acquisitions designed to improve quality and lower costs, Cleveland Clinic recently entered a long-term strategic alliance with Community Health Systems (CHS), a for-profit provider that operates 135 hospitals nationwide. While the two organizations will remain independent, they will “both [remain] committed to discovering novel strategies to improve care, reduce costs, enhance access to health care services and develop new approaches to care delivery.”

In discussing the alliance, CEO and President of Cleveland Clinic, Delos M. Cosgrove, MD, notes that thriving in today’s health care environment will require new ways of doing things. He calls medicine a “team sport.”

We couldn’t agree more. All effective strategies that successfully remove obstacles to quality, affordable care should be on the table in today’s health care environment. The Cleveland Clinic’s consolidation with CHS will lower expenses and improve the quality of care by:

  • Improving patient outcomes and reducing costs by creating a framework that enables physicians to share best practices while capturing, reporting and comparing data.
  • Enhancing quality and data infrastructure by assessing CHS-affiliated hospitals and applying the expertise of the Cleveland Clinic’s Heart and Vascular Institute to related programs.
  • Sharing best practices and creating synergies that encompass telemedicine initiatives, second opinion services for physicians and patients, complex care coordination and other areas in care and cost containment.

We look forward to watching the alliance between Cleveland Clinic and Community Health Systems as they continue to reframe health care.

Have you seen examples of successful collaborations that are improving access to care and/or reducing health care costs? Share them with us.