Going into Drydock

Posted on February 7, 2012 by Janet Sameh

I am going to take a bit of a sabbatical from this blog. I am spending more time working with companies in the patient/provider communication space, and find my inspiration is aligning more around that subject. My husband and I contribute to a blog, “Leave a Message…”, where we share our thoughts about tips, trends, best (and worst) practices on how patients and healthcare providers interact, whether it is via phone, social media, the internet, patient portals, signal flags (just kidding) or any other communication medium.

Healthcare is rapidly changing with tricky seas ahead. Some day, I may decide once again, to put this old boat back in the water But til then I wish my readers smooth sailing and give a honk and a waive when you pass by.

Janet

Convenience Causes the Lines to Blur

Posted on November 27, 2011 by Janet Sameh

No matter what your profession, during social events talk turns to topics that are related to what you do. Lawyers are often engaged in conversation regarding legal topics, clergy often get cornered on religious topics, and nurses and physicians are often shanghaied into a conversation that has to do with someone’s health history. Since my family knows that I am a recent Healthcare management MBA, the topic I often encounter is the business of healthcare, or why does it cost so much. One such conversation occurred after Thanksgiving dinner, between my uncle, a retired businessman who survived a major health issue, my aunt who is a physician who works for the VA, and my brother who is a government employee. The discussion had many interesting points, (VA clinics vs. Medicare vs. Private Coverage, what people pay in vs. benefits received), but what struck me as the “aha” moment was when we started comparing notes on where we all got our flu shots. Gone are the days when you waited to make an appointment to get the vaccination from your doctor. Nowadays, you are just as likely to get them from a pharmacist or NP at a drugstore, as you are from your GP or internist. Cost is not a big driving factor, if one is covered by Medicare or private insurance (as we all were), the out of pocket cost is about the same. The driver of our choices of where to go, seemed to be convenience.

The Thanksgiving conversation seemed to mirror the findings of a Rand report that was released earlier in the week. A press release for the study noted a 10 fold increase in retail clinic usage between 2007 and 2009. (If the numbers ran to 2011 I’m sure there would be a greater increase). The RAND team used data from a commercially-insured population of 13.3 million lives. Of that number, close to a third (3.8 million enrollees) made at least one clinic visit between 2007 and 2009.

According to the press release, “The strongest predictor of retail clinic use was proximity. Other key predictors are gender (females were more likely to visit clinics than males), age (retail clinic patients tended to be between the ages of 18 and 44; those over 65 were excluded from the study), higher income (those from zip codes with median incomes of more than $59,000 were more likely to use retail clinics than lower income groups), and good health (those with a chronic health complaint were less likely to use retail clinics).”

“It appears that those with a higher income place more value on their time, and will use clinics for convenience if they have a simple health issue such as a sore throat or earache,” said Dr. Ateev Mehrotra, the study’s senior author and an investigator at RAND and the University of Pittsburgh.”

The trend for healthcare provisioning in alternate venues will only increase as more businesses realize the synergy of being in the clinical space. If the Rand report is correct, it shows those who value time will opt for convenience (retail clinics close to home), leaving sicker/poorer patients to use the higher priced options (clinics and E/R’s). While Wal-Mart back peddled on a rumored RFI to create a low cost integrated primary platform, (see here) make no mistake, it is looking at ways to increase its reach in the healthcare. According to a recent report in FierceMobile Wal-Mart (like Walgreens and others) is exploring many options, including mHealth applications. As these new players, with their deep pockets and consumer expertise, enter the clinical space, traditional players will need to adapt to keep profitable market share. Like the dinosaurs, size will not matter. Those who survive will understand the cultural shifts that have to start now, so that their organizations will be ready when this trend reaches critical mass. Don’t ignore the lesson of the independent drugstores. They used to be plentiful. But when was the last time you saw one of them?

Social Media for Internal Communication

Posted on October 27, 2011 by Janet Sameh

One of the great things about living in the Chicago area is that I am able to attend events that I might not normally attend if they were in other cities. Such was last week’s Modern Healthcare/Studer Group’s “Best Places to Work conference. One of the sessions was a topic near and dear to my heart, social media, but this time the spin was a bit different. Instead of focusing on external communications (patients/community), it focused on using the platform to communicate with employees. The moderator was Kriss Dunn who runs two websites hrcapitalist.com and fistfuloftalent.com, and the panelists were Vicki Noel, VP of HR/Organizational Development at Southern Ohio Medical Center and Rulon Stacey, CEO of Poudre Valley Health System.

(Disclosure before I continue: I did not record the session; I am relying on memory and notes. My apologies in advance if I misrepresent any of the information shared).

Each of the presenters had different experiences to share. Ms. Noel spoke about SOMC’s experiences with setting up an internal Facebook group. The original intent was to use an internal site to master the medium for external use. However once SOMC was involved, they found that it was a powerful platform to engage their staff. While using the site is optional 1300 of the 2300 employees engage with the site on an ongoing basis (one of the examples cited was a request for input on a script sale which generated 800 responses in a 24 hour period). Dr. Stacey spoke about how his blog http://visionary.pvhs.org/ is one of the many vehicles he uses to connect with the employees of PVHS. It allows him to share and showcase great employee stories to both his organization and to the outside world.

Many organizations are afraid that letting employees access to social media during working hours will open a Pandora’s Box of issues including inappropriate use of the media, loss of productivity, and other issues that can put the organization at risk. However, it has been shown that many of those issues can be addressed with appropriate HR and Social Media training and policies. (Side note: In this day and age, if you do not have a social media policy in place you should create one STAT! What is said and done online outside the workplace can be as or more troublesome than what is done inside the workplace). If you are not comfortable with public forums, products exist like Yammer that allow for closed network communication.

Ignoring social media platforms (Blogs, Facebook, LinkedIn, Twitter) cuts off a vibrant communication to communicate with your employees in a framework they use. Many organizations are using the tools to recruit, communicate and engage their staff. Moving forward, the question is should not be if but how to best use social media tools for internal communication in your organization.

Hospitals as Hotels?

Posted on October 9, 2011 by Janet Sameh

While I was not able to attend last month’s e-patient conference in Philadelphia, I was able to watch some of the sessions online. One of talks that garnered the most feedback was a talk by Harris Rosen, the head of Rosen Hotel group, based in Orlando, Florida. Most of his talk click here revolved around his philosophy regarding employer self-funded healthcare (including his insistence that his employees stay nicotine free). However, the part of the talk that really spoke to me was his observations regarding hospitals and patient experience (around 41:30 in the talk). Rosen is toying with the idea of opening a hospital modeled after a hotel. Check-in would be like a hotel, patients can wear their own PJ’s, rooms would have Murphy beds for family staying over, pets would be allowed, and there would be 24 hour room service. Rosen feels that he can provide a luxury stay at a cost effective price because his company has a large infrastructure in place including finance and purchasing.

While some of his ideas would be hard to implement, (pets in a hospital?), some do have merit. I applaud his vision of treating patients as guests (and employees as family), rather than the objects they are now. Patients seek healthcare when they are most vulnerable, yet we tolerate a dehumanizing healthcare system. Yes, there are reasons private destination hospitals tend to lead the way in patient comfort. They have to give families confidence to entrust their love one’s care to them instead of a local (and often less costly) institution. But there is no reason that public and non-profit hospitals can’t create a culture of kindness and humanity, even within their limited resources. Just ask any worker in any hospital. They can and will give you great ideas on how to improve their patients’ experience.

We know the winds are changing. One of the metrics that Medicare will be using in their Value Based Purchasing reimbursement (planned start – October 2012), is how satisfied patients are with their experience of care at a hospital. It will take time, dedication, leadership, patience (lots of patience) and ongoing commitment to change our current healthcare culture to meet this new emphasis of patient experience. While I do not advocate institutions remodel to look like the local Hampton Inn or Embassy Suites, they could take some examples from hotels on how to improve the customer experience in their product offering (free WiFi for example). Hospitals have a year before patient experience starts truly effecting their bottom line. They better start now.

Another example of educated patients improving their outcome…

Posted on September 14, 2011 by Janet Sameh

Regular readers of my blog, knows that improved outcomes via patient adherence is an ongoing interest of mine. Earlier this month, the New York Times had a blogpost about a program at UCSF where nurse educators worked with heart failure patients to reduce readmissions.

How the program worked was very simple. A coordinator spends at least one hour explaining the patient’s condition to the patient and his or her family, and preparing them to manage the patient’s condition outside the hospital setting. The coordinator asks questions about the patient’s diet and gives healthy alternatives. They teach caregivers how look for troubling symptoms, and about the medications the patient is on. Patients and caregivers develop an ongoing relationship with the program with emails, phone calls and home visits. There is even coaching on how to interact with other health care providers.

While the program is not cheap, it has a great ROI. It began with a $575,000 grant and UCSF continues to fund it. However, since the program began three years ago, the hospital’s heart failure readmission rate has dropped by 30 percent and the hospital estimates the program has saved Medicare at least $1 million a year.

It’s another example of educated patients (and caregivers) improving the quality of their lives, and reducing the burden on our healthcare system. It’s a no brainer, and yet these programs are few and far between. We need to figure out ways to fund and support more of these programs. It’s in everyone’s best interest.

You have to give them carrots and sticks….

Posted on August 26, 2011 by Janet Sameh

Hospitals are dammed if they do, dammed if they don’t. The federal government is pushing them to reduce 30 day readmissions to lessen the Medicare spend. However, when hospitals comply, they get bit. An example taken from a recent post to the Bloomberg News website.

The Mount Sinai (NY) experience may be instructive. From September 2010 to May 2011, the hospital’s Medicare revenue rose only 2 percent over the previous year — in part because the number of inpatient cases fell. Why was that? One important reason was that the number of patients readmitted to the hospital within 30 days of discharge was 5 percent less than what it had been the previous year.

The post continues;

Reimbursement from Medicare is still primarily based on how many services hospitals perform rather than on how well they care for patients, so hospitals are often financially penalized for improving value and quality. The Mount Sinai program to reduce readmissions, for example, is costly for the hospital both because of the extra expense of running it and because fewer readmissions means less revenue. Ken Davis, the president and chief executive officer of Mount Sinai, says the hospital won’t be able to afford continuing the successful program if the financial incentives remain so skewed against it.

Granted the author, Peter Orszag has a political agenda with his views, having been a President Obama’s former director of the Office of Management and Budget. However, the only reason Mt Sinai is even looking at reducing 30 day admissions is because they are no getting paid for it. However if at the end of the day, the math doesn’t work, look for it and other hospitals to question their readmission reduction programs.

The Intersection of Cost, Quality, and Patient Satisfaction

Posted on July 24, 2011 by Janet Sameh

Now that we are in the dog days of summer, I have some time to catch up on some of my backlog. There were two items today that caught my attention.

John Goodman (the policy analyst, not the actor), has been writing in his blog about the relationship between the underlying cost of care, wait times, amenities and quality. In an April 27 blog post he observes that when costs are transparent, and consumers have skin in the game, providers will compete on price and quality to garner business. In a follow up post dated June 29th , he writes about the inverse, what happens when third-party payors obscure the true cost of care. Goodman notes that when patients do not make choices based on price, they will make choices based on time, quality or amenities. And since quality information is the hardest to gather, patients will make use the markers that are easier to see, time to access, and amenities. Goodman observes in markets where there is a undersupply of services, hospitals wanting to cater to patient satisfaction might not be as quick to improve quality if it means grumbling patients have to wait longer for services. And in markets that have oversupply, many facilities go the less expensive route and compete on amenities, rather than instituting the more expensive changes that bring up quality levels. Goodman says it best “Some of the literature on hospital economics suggests that quality improvement is quite expensive, and that dollar-for-dollar amenity improvements will increase hospital revenues by more than quality improvement. This is coupled with surveys that find patients more sensitive to amenity changes than to quality changes. (Of course, this latter finding may only reflect the fact that hospitals aren’t really trying to communicate quality information.)”

A perfect intersection of what Goodman is talking about is a new service called InQuickER. It is a website that allows patients to schedule their ER visits with participating hospitals. My first reaction was “Are you kidding?”, but after I counted to 10, I started to smile.

The concept is brilliant. Emergent cases are notified to go to the nearest ER. Non-emergent cases are slotted in predictable times. Patients love that they are not sitting around the ED waiting room. Staff likes it because it allows load balancing of non-critical cases. Participating hospitals like it as they are able to offer a low-cost perk, and differentiator. There is a fee to use it, which looks like $4.99 for an urgent care center appointment, $9.99 for an ED appointment.

However I have to ask, if the patient is paying the true cost instead of the co-pay, would they be going to the ED for non-critical care in the first place? Or would they go to a physician’s office (or retail clinic) instead?

A True Google+ Experience

Posted on June 30, 2011 by Janet Sameh

So yesterday while I and my #socpharm friends were talking about Google+, my daughter, Melissa Sameh, was already on it and using it. I asked her to share her experience. Her thoughts are below:

A benefit of having young, smart, technology-focused friends means that I get invited to all the cool parties when they’re announced, such as Google+. I’ve had accounts on several social media sites, both successful and unsuccessful — hi5, myspace, twitter — and I like to think I’ve gotten a handle on what helps a site like this succeed and what won’t. The core secret to success is the same as in any other business — give people what they want, and/or do it better than everyone else. Of course, that’s easier said than done — when twitter took off, Google thought people wanted something like that in conjunction with their email, so they launched Buzz.

However, Google really seems to be on the right track this time around. My first impression of Google+ is that its design and structure is similar to facebook, but easier to use. When I first heard about this service before my invite arrived, the introductory screenshots did not impress me. Circles? Another friend update stream? Don’t we have enough of these already? But really, the user experience is so much more smooth and intuitive than you can tell by pictures and video of people dragging and dropping contacts into groups.

When you first begin creating a profile on Google+, whatever information you’ve previously released in your Google profile is auto-loaded. As in Facebook, there are notifications and integrated chat, but no ads or endless invitations to play farmcityville cafewars. I also personally find the Google+ integrated chat more useful because it uses google chat rather than creating a whole new system to check.

There are also circles, which function more or less like friends lists do in Facebook. However, instead of being a peripheral feature, they are a central focus. People are not your connections unless you place them in a circle. Each connection can also be in more than one circle. The starter groups include Friends, Family, and Acquaintances, but you can add more for whichever custom categories you might want. The actual process of adding people to circles is easy as well — it’s all based in dragging and dropping contacts from an automatically imported list containing your gmail contacts into whichever circle you wish to add them to, either one by one or in groups.

The ease and widespread use of circles basically eliminates the need for separate business and personal profiles. You can set your chat status so that it is only visible to people in certain circles. Every time you make a post, you are able to filter it easily to specific circles as well, which leads to added functionality for things like planning a get-together (Nearby Friends circle only) or a moving announcement (all circles), for instance. Work-related updates could be shown only to your Co-Workers circle or Industry Professionals.

If I had to choose one killer feature of Google+, however, it would not be the circles; it would be hanging out, their name for group videochatt. Even today, equivalent videoconferencing systems usually require expensive equipment and still end up lagging, but this free online system works surprisingly well. I personally tested it for up to six people chatting at once, and at five and fewer participants I had no problems with lag. It is a full-featured system involving video thumbnails of everyone in the conversation forming the bottom row of chat with a larger section of the screen focused on whoever is talking. The “focus” shifts based on speech, or it can be forced by clicking on one of the thumbnails. Also, even if you’re the one speaking, it does not focus on your face, instead showing you someone else. Despite sounding awkward, within under a minute of use the switching focus feels very natural.

Hangouts is another feature that can be filtered by circles, though there are also options for recruiting people from your extended circle — analogous to friends of friends — and from the general public. Remember all those heartwarming facetime commercials from the iPhone 4? This has potential for all of that, and more.

Though it lacks the hangouts feature, the mobile site is nearly as full-featured as the regular site. There is already an app available on the android marketplace, but as an iPhone user, I only tested the mobile web version of Google+. Unlike most mobile webapps, it’s a much more full-featured and smooth user experience than I expected. The stream is accessible in the same capacity, as are live-updating notifications; you can update your circles, though without the same drag and drop functionality; you can view, but not upload, photos. As photo uploading is one of the features of the android app, however, I expect that the forthcoming iPhone app will contain this capability as well. A neat feature in the mobile site is the ability to show updates from people physically near you, which would be useful during conferences and the like. It’s also easier than I expected to enable and disable location information per post — the setting is not hidden behind a menu or in a settings page.

Google+ comes off as what it’s meant to be: the site that aims to displace Facebook. Not every feature in it is groundbreaking, but the showy whiz-bang features are honestly excellent and unique, and the rest of the features seem to be in more accessible condition than they are on other social networking sites.

So it seems that Google may have finally gotten social right. If Meli and her friends are any indication, Facebook should start looking over their shoulder.

Hospital Compare

Posted on June 27, 2011 by Janet Sameh

So instead of doing my reading for my project management class (only 5 more weeks of school), I was on HootSuite seeing what was going on in my Twitter world. On my business account @janetlsameh I follow 275+ folks from all over the world. In a 30 minute period I can see tweets that range from complaints about local barrista’s to comments on macroeconomics trends. Most of the commentators I follow touch healthcare, so the majority of what I see falls within that realm.

Two unrelated tweets caught my eye today. The first was from Atul Gawande linking to an blog post from the Atlantic. The article talked about Todd Park. For those who do not know about Todd, he is the chief technology officer of HHS, and has the idea to harness the power of HHS data to spur innovations that improve the nation’s health and welfare. One of the new tools that uses the HHS data, is Hospital Compare, a website that contains detailed quality and patient satisfaction information from hospitals across the country. The second tweet was from Mark Harmel, linking to a blog post from e-Patient Dave (Dave deBronkart) where Dave shares his experience of using Hospital Compare to choose which hospital to take his wife to when she had a foot problem. Dave talks about how instead of automatically going to their default hospital an hour away, the deBronkarts decided to use Health Compare to choose a much closer hospital. And it worked out fine.

e-Patient Dave’s experience shows that Todd Park’s vision is starting to work. Granted Dave is a noted patient advocate and a VERY educated consumer of healthcare, but as more applications like Health Compare start to become accessible to consumers, it will begin to impact choices that patients make. e-Patient Dave’s case would not be a lot of revenue for the default hospital, but it impacted the relationship the deBronkarts had with it. Instead of always going to one hospital, the deBronkarts, now have options.

Thanks to Todd Park, the data is out there. Hospital and health systems who don’t understand the impact that having the HHS data in an online patient friendly platform need to get up to speed quick. Consumers are used to going to sites like Yelp or travel sites to see feedback on hotels, restaurants and the like. Once they learn there is a place they can compare quality data and patient satisfaction scores for their local hospitals, they will use that to make healthcare decisions as well.

Patching the Boat

Fixing the USS Healthcare