Tag: Patient Trends

EHR Use a Top Patient Preference in the Doctor’s Office

Although EHR use offers a wide array of benefits, including increased care coordination and lower healthcare costs, a recent survey shows that perhaps these digital systems are not being utilized to their fullest potential.

The Connected Care and the Patient Experience survey, commissioned by Surescripts and conducted by Kelton Global, shows that a majority of patients are not seeing advancements in electronic healthcare delivery. According to the survey, nearly 55 percent of respondents find their patient histories are missing or incomplete.

Furthermore, approximately half of patients state their physicians do not know which prescriptions they are taking, 61 percent state their physicians to not know which allergies they have, and approximately 40 percent state that their doctor’s office does not have their personal or insurance information on file.

The survey also shows that 29 percent of patients are often charged with sharing their medical information, test results, and other information from physician to physician. Furthermore, 40 percent report great difficulty accessing their own health records.

The survey shows that patients take notice, and are frustrated by, the hurdles they face in accessing health records. Half of respondents state that renewing their driver’s license would require less paperwork than a doctor’s office visit. Additionally, over half of respondents state that visiting the doctor’s office is equally frustrating as buying a new car.

Patients reportedly take notice of the prevalence of paperwork inside of the physician’s office, as well. Over half of respondents report signing paperwork and having their health insurance card or ID scanned during each visit, and nearly 30 percent are charged with filling out personal or medical information on paper each visit.

The study shows that this increased paperwork takes valuable time away from the patient visit. On average, respondents reported spending five minutes filling out paperwork, and six minutes verbally sharing patient information. This review of patient information consumes approximately 11 minutes of the average 15-minute appointment. Because of this, 49 percent of respondents arrive early to doctor’s appointments and 28 percent have appointments scheduled with extra time built in to account for paperwork.

Respondents also report preferring and having more confidence in a physician who uses technology to enhance his or her healthcare delivery. Nearly 40 percent of respondents state that they would be more likely to recommend a physician who utilized EHRs, and 36 percent state that EHR use would make them less likely to switch to a new physician. Furthermore, when faced with two doctors of equal skill, over half of respondents would select the one who allowed them to fill out information online prior to an appointment, receive test results online, store medical records electronically, and schedule appointments online.

Patients also tend to have more confidence in physicians who utilize EHRs and other technology, the survey shows. For example, nearly half of respondents report an increased likelihood to communicate with their physician more openly if they were able to text message or email their physician with concerns. Additionally, patients reportedly feel more at ease at practices that utilize technology for administrative tasks. Forty percent of respondents report that physicians who use computers or tablets or more innovative, 33 percent feel they are more competent, and nearly 70 percent feel they are more organized and efficient.

Surescripts officials state that these gaps in electronic healthcare are a major detriment to the industry. In order to achieve goals of increased quality of care, patient experience, and lowered cost of care, EHRs and other electronic health tools need to be utilized to their potential.

“Dangerous voids in health information sharing can easily be solved through the use of digital communications and technology,” says Chief Executive Officer of Surescripts Tom Skelton in a press release. “This survey proves patients take notice and are ready for a change. As an industry, we need to come together to connect the nation’s healthcare system — to enhance the patient experience while improving quality and lowering the cost of care.”

On Yelp, Doctors Get Reviewed Like Restaurants — And It Rankles

Dental patients really don’t like Western Dental. Not its Anaheim, Calif., clinic: “I hate this place!!!” one reviewer wrote on the rating site Yelp. Or one of its locations in Phoenix: “Learn from my terrible experience and stay far, far away.”

In fact, the chain of low-cost dental clinics, which has more Yelp reviews than any other health provider, has been repeatedly, often brutally, panned in some 3,000 online critiques — 379 include the word “horrible.” Its average rating: 1.8 out of 5 stars.

Patients on Yelp aren’t fans of the ubiquitous lab testing company Quest Diagnostics, either. The word “rude” appeared in 13 percent of its 2,500 reviews (average 2.7 stars). “It’s like the seventh level of hell,” one reviewer wrote of a Quest lab in Greenbrae, Calif.

Indeed, doctors and health professionals everywhere could learn a valuable lesson from the archives of Yelp: Your officious personality or brusque office staff can sink your reputation even if your professional skills are just fine.

“Rudest office staff ever. Also incompetent. I will settle for rude & competent or polite & incompetent. But both rude & incompetent is unacceptable,” wrote one Yelp reviewer of a New York internist.

ProPublica and Yelp recently agreed to a partnership that will allow information from ProPublica’s interactive health databases to begin appearing on Yelp’s health provider pages. In addition to reading about consumers’ experiences with hospitals, nursing homes and doctors, Yelp users will see objective data about how the providers’ practice patterns compare to their peers.

As part of the relationship, ProPublica gets an unprecedented peek inside Yelp’s trove of 1.3 million health reviews. To search and sort, we used RevEx, a tool built for us by the Department of Computer Science and Engineering at the NYU Polytechnic School of Engineering.

Though Yelp has become synonymous with restaurant and store reviews, an analysis of its health profiles shows some interesting trends. On the whole people are happy — there are far more 5-star ratings than 1 star. But when they weren’t, they let it be known. Providers with the most reviews generally had poorer ratings.

Of the top 10 most-reviewed health providers, only Elements Massage, a national chain, and LaserAway, a tattoo and laser hair removal company with locations in California and Arizona, had an average rating of at least 4 stars.

Western Dental did not return phone calls and emails seeking comment.

Dennis Moynihan, a spokesman for Madison, N.J.-based Quest Diagnostics, said the company has more than 2,200 patient service centers around the country and had 51 million customer encounters last year. He said all feedback is valued.

“While one negative customer experience is one too many, we don’t believe the numbers presented are representative of the service that a vast majority of our customers receive every day,” he said.

For years, doctors have lamented the proliferation of online rating websites, saying patients simply aren’t equipped to review their quality and expertise. Some have gone so far as to threaten — or even sue — consumers who posted negative feedback.

But such reviews have only grown in popularity as consumers increasingly challenge the notion that doctor knows best about everything. Though Yelp’s health reviews date back to 2004, more than half of them were written in the past two years. They get millions of page views every month on Yelp’s site alone.

In many ways, consumers on Yelp rate health providers in the same way they do restaurants: on how they feel they’ve been treated. Instead of calling out a doctor over botched care or a possible misdiagnosis (these certainly do happen), patients are far more likely to object to long wait times, the difficulty of securing an appointment, billing errors, a doctor’s chilly bedside manner or the unprofessionalism of the office staff.

Health providers as a whole earned an average of 4 stars.

But sort by profession and the greater dissatisfaction with doctors stands out.

Doctors earned a lower proportion of 5-star reviews than other health professionals, pushing their average review to the lowest of any large health profession, at 3.6. Acupuncturists, chiropractors and massage therapists did far better, with average ratings of 4.5 to 4.6.

Other providers, like dentists and physical therapists, are “actively seeking out customers to review them, whereas doctors have a lot of antipathy toward reviews and as a result have been trying to suppress reviews for many years,” said Eric Goldman, a professor at Santa Clara University School of Law and co-director of its High Tech Law Institute. He has written extensively about physician review websites and physician arguments against them, but did not review the Yelp data.

Doctor visits also tend to be more complex than visits to the dentist or chiropractor. A typical dental visit is for a specific service — a teeth cleaning, a cavity filled or a root canal. In general, expectations are clear, and ways to gauge success are easier than with a doctor visit.

Healthgrades, a site which focuses solely on health providers, also sees slightly lower ratings for doctors than for dentists and other health providers, though the differences are smaller than those on Yelp.

Unlike Yelp, Healthgrades, which says it has 6 million survey scores, has not allowed consumers to post comments. But Evan Marks, Healthgrades’ chief strategy officer, said the health rating systems are in their infancy. Soon, he said, patients could see different questions based on the type of doctor they see to provide far more useful feedback to those searching the site.

None of this has yet gained favor with physicians. The American Medical Association encourages patients to talk to their doctors if they have concerns, not post views anonymously. And those looking for doctors should be similarly skeptical, the group says in a statement. “Choosing a physician is more complicated than choosing a good restaurant, and patients owe it to themselves to use the best available resources when making this important decision.”

The AMA has called on all those who profile physicians to give the doctors “the right to review and certify adequacy of the information prior to the profile being distributed, including being placed on the Internet.”

In 2012, the group partnered with a company called Reputation.com to offer discounts to doctors for a service that monitors their online presence and tries to combat negative reviews.

Western Dental’s average rating of 1.8 stars on Yelp is well below the average of 4 for all dentists nationwide. About 1,250 of its 3,000 reviews used the words “wait” or “waiting” and about 15 percent of them, the word “worst.”

When patients leave angry comments, the chain’s “social media response team” often replies, inviting patients to call or email and citing a federal patient privacy law known as HIPAA for not responding in more detail. “Thank you for reaching out and providing the opportunity to improve our services. We hope to speak with you soon,” the notes say.

At least one patient gave a Yelp follow-up review of the social media response team’s performance: “I responded to the info in their response twice and got no reply at all … they are just attempting to minimize the PR damage caused by undertrained and rude, lazy staff.”

Periodically doctors, dentists and other providers threaten or even file lawsuits against people who post negative reviews on Yelp or against Yelp itself. Their track record is poor: Courts have ruled in favor of the company and various consumers.

In June, New Jersey resident Christina Lipsky complained in a 1-star review on Yelp that Brighter Dental Care had recommended $6,000 worth of work that a another dentist subsequently determined was unnecessary.

Within days, she received a letter from a lawyer who said he was retained by Brighter Dental “to pursue legal action against you and all others acting in concert with you.” The letter was signed by Scott J. Singer, an attorney whose office is in the same building as a Brighter Dental clinic. A man named Scott Singer was also listed in 2012 as the non-clinical chief executive officer of Brighter Dental. Singer did not return a call or email seeking comment.

After Lipsky took her story to local media, Singer sent her a letter saying Brighter Dental was dropping its legal pursuit. In an email to ProPublica, Lipsky said “People put a lot of trust into their health care providers, and if my review could help others make an informed decision regarding their treatment, then it was worth it.”

EHR Records Find Almost 20 Percent of Patients with Hypertension

Expanding blood pressure screenings to non-primary care settings can help identify more patients with hypertension, and could contribute to better hypertension control and management.

That is the finding of a Kaiser Permanente study of more than one million patients’ electronic health records published in the Journal of Clinical Hypertension.

The researchers analyzed the records of 1,076,000 Kaiser Permanente Southern California patients seen over a two-year period in primary care settings and non-primary care settings, including optometry, orthopedics and urology. The study reported the prevalence of hypertension and compared the characteristics of those patients identified with hypertension in a non-primary care setting to those identified in primary care settings.

Of the patients studied, 112,000 were found to have high blood pressure by the end of the two-year study period. Of these, 83 percent were diagnosed in a primary care setting and 17 percent in a non-primary care setting. The main non-primary care specialties to first identify a high blood pressure reading were ophthalmology/optometry with 25 percent, neurology with 19 percent, and dermatology with 13 percent. All staff members conducting blood pressure screenings in these clinical settings were certified in blood pressure measurement to ensure consistency in screenings.

According to the researchers, the number of false positives were comparable between both settings, suggesting that blood pressure readings in non-primary care settings were as accurate as those taken in primary care settings. Patients who were screened in non-primary care settings and found to have high blood-pressure readings were sent back for follow-up visits with their primary care provider.

“Patients who do not see their primary care providers on a regular basis may have hypertension that goes unrecognized,” said study lead author Joel Handler, M.D. “For this reason, expanding hypertension screening to non-primary care settings may be an opportunity to improve early hypertension recognition and control.”

The study indicated that patients identified with hypertension during non-primary care visits were more likely to be older, male and non-Hispanic white. In addition, these patients were also more likely to smoke and to have chronic kidney disease. Researchers also found that patients with an initial high blood pressure identified during non-primary care were less likely to be obese compared to those with an initial high blood pressure identified during a primary care visit.

Docs Not Even Close to Meeting Digital Needs of Patients

The majority of patients would like to have digital services from their physicians such as online appointment scheduling, bill paying, and access to lab results, yet only about one primary care physician in three offers such customer service.

That is the finding of a new survey from TechnologyAdvice, a Nashville-based company that provides independent review and analysis of enterprise technology products.

“Primary care physicians are reporting some of the highest rates of EHR adoption to comply with government regulations and to receive incentives from Meaningful Use, but a significantly lower number of patients claim to have access to these patient portal services,” said TechnologyAdvice Managing Editor Cameron Graham, who authored the survey. “The issue here may not be implementation of digital services, but instead a lack of patient awareness. If physicians are offering these in-demand digital services, a more proactive approach to promoting them is needed and could create an advantage in attracting and retaining patients.”

Sixty percent of patients surveyed said digital services like online appointment scheduling and online bill pay are either “important” or “somewhat important” when choosing a physician. However, when asked what services their current physician provides, less than one-third of patients indicated they have access to either online bill pay, online appointment scheduling, or the ability to view test results and diagnoses online, which are the top three services that patients report wanting the most.

In addition, 68.6 percent of respondents said it was either “somewhat important” or “very important” that a physician follow up with them, yet only 30 percent of respondents reported receiving a follow-up that wasn’t related to bill pay.

Patient age also appears to influence what services are expected from physicians. Notably, every digital service listed on the survey was in greater demand among younger respondents. For example, 41.2 percent of patients between the ages of 25-34 said they would like their physician to offer online appointment scheduling, while just 13.5 percent of respondents over 65 said the same. The results also showed that 48.4 percent of the youngest respondents (18-24 year olds) would like to use a smartphone app to schedule online appointments.

Healthcare hiring boom will bypass hospitals

The healthcare sector of the U.S. economy will be hiring at a faster pace in 2015 as a healthier economy and shrinking uninsured population fuel an uptick in demand for routine and discretionary services. The era of hiring restraint—fueled by the recession and the steady rise in high-deductible plans—appears to be ending.

The hiring binge will be uneven, though. The outlook for growth in hospital employment—healthcare’s largest employer—is modest at best. Many hospitals will be reducing head counts. Others are holding the line on adding new employees since the federal government plans to keep a tight rein on reimbursement while private insurers are pushing more participation in risk-based contracts. Hospital margins shrank over the past year as rising labor costs ate into a slower-growing top line.

Hiring at outpatient facilities and ambulatory surgical centers, on the other hand, is expected to continue its rapid growth as technological changes and financial pressures push the locus of care from inpatient to outpatient settings. Home healthcare’s need for personal aides will continue to mushroom.

And beneath it all, healthcare human resource departments will continue to face a major skills gap, especially when it comes to filling nursing positions. That problem will worsen as hundreds of thousands of aging baby-boomer nurses retire. New delivery models, which are expanding the need for people steeped in population health management, patient outreach and care coordination, exacerbate the problem.

Hiring across healthcare grew at less than 2% a year since the 2009 recession because of a long, anemic recovery. But the pace picked up as 2014 drew to a close. The sector’s monthly hiring more than doubled over the course of the year, finishing with 14.9 million jobs, up 2.1% from the end of 2013.

The year-end pace of hiring will likely continue this year, said Ani Turner, deputy director of the Center for Sustainable Health Spending at the Altarum Institute. “I don’t see any reason why it’s going to drop off,” she said, citing the Patient Protection and Affordable Care Act creating more households with health insurance and a falling unemployment rate giving people more income to spend on healthcare.

But healthcare’s largest sector—hospitals—is the outlier. Facing continued financial pressure from public and private payers, hospitals are intensifying their efforts to reduce their largest expense: labor. “I think we’re going to see pockets of layoffs,” said Jennifer Stewart, managing director of research and insights at the Advisory Board Co.

It’s already happening at Denver-based Catholic Health Initiatives, which in December announced it would eliminate about 1% of its 90,500-person workforce. The 92-hospital system said the move was in response to its poor financial performance. “The CHI workforce reduction was limited to about 1,000 positions,” the system said in a statement.

It’s a microcosm of the sectorwide trend. The Bureau of Labor Statistics projects hospital employment will grow by 815,000, or 17%, over the next decade. But overall healthcare employment will grow significantly faster—29.4%—with the much smaller home health and skilled-nursing facility sectors each adding almost as many jobs as hospitals. Hospital employment will fall to 25.5% of the sector’s jobs in 2022 compared with 28.2% in 2012.

That leaves hospital recruiters with a new problem—a growing shortage of experienced registered nurses to replace older nurses and to fill slots in care coordination, a fast-growing specialty. The nation will need a million new registered nurses by 2022, according to personnel placement firm NAS Recruitment Innovation.

Carolinas HealthCare, based in Charlotte, N.C., increased by 15% the number of advanced-practice nurses and other practitioners last year as the system worked to expand its primary-care capacity. The number of advanced practitioners Carolinas employs has doubled in the past five years to 741.

“We’re focused on meeting our patients where they want to receive assistance,” said Debra Plousha Moore, chief human resources officer for the 22-hospital system.

While it has no overall projection for hiring this year, Carolinas did eliminate 100 executive- and management-level jobs as part of an effort to reduce operating expenses by $110 million annually. “There is clearly increased pressure for hospitals to improve their bottom lines,” said John Klare, a managing director and healthcare practice leader for Navigant Healthcare.

Post-acute-care companies, which continue to expand, will pick up the slack in healthcare hiring. It will be concentrated in the home health field, which grew 4.3% last year to 1.3 million jobs. “You’re seeing a trend across the states, especially for the Medicaid populations to … move patients out of skilled-nursing facilities and get them into a home,” said Toby Wann, founder of Nashville-based equity research firm Obsidian Research Group.

FirstLight HomeCare, a Cincinnati-based provider with more than 120 franchises across the country, added 500 caregiver jobs last year and expects to add a similar number this year. “Our outlook for hiring is very bullish, both at new offices and at existing offices,” said CEO Jeff Bevis. “Demand has certainly increased the latter part of 2014 going into 2015 compared to where we were this time last year.”

Skilled-nursing and residential-care facilities—which saw anemic growth of only 1% last year, bringing total employment in the sector to 3.3 million jobs—face a mixed employment picture in 2015. While home care is often touted as being more cost-effective, it increases the demand for nurses and nurses’ aides.

“Home care is less efficient than skilled nursing because you have a one-on-one care model,” said Fred Benjamin, chief operating officer at Medicalodges, a Coffeyville, Kan.-based long-term-care provider. “Therefore, you need more people.”

But given the overall shift toward home care—the American Health Care Association, which represents long-term care and post-acute providers, projects 27 million people will be receiving long-term care, including home health services, in 2022, up from 6 million currently—the hiring pace at nursing homes may slow.

“We don’t foresee any reductions in our workforce in 2015,” said Gerald Coggin, senior vice president for National Health Corp., a Tennessee-based operator of 73 skilled-nursing facilities in 10 states. “By the end of the year, once we get all of our new building projects completed, we could add approximately 250 to 400 new employees.”

To Obsidian Research’s Wann, that translates to very different recruitment pressures on the home health and nursing-care segments of post-acute care. “You probably will see a little pressure to raise wages on the home-health side,” he said. “Conversely, on the skilled-nursing side, I don’t see much upward pressure in terms of wage rates in the skilled-nursing facilities.”

The hunt for qualified physicians interested in primary care will continue to dominate the physician employment landscape in 2015. The Bureau of Labor Statistics projects total physician employment will grow only 18% to 814,700 positions in 2022, significantly below healthcare as a whole. But filling those extra slots will be exacerbated by the baby boomer retirement wave among doctors, just as it will be with nurses.

Phillip Miller, vice president of the Irving, Texas-based physician-recruitment firm Merritt Hawkins, notes 66% of oncologists are 55 or older, as are 60% of psychiatrists, 54% of cardiologists and 52% of orthopedic surgeons. “Now that the stock market has rebounded, we do anticipate an unprecedented wave of retirements that the industry is not prepared for,” he said. “It’s like a tsunami lurking off shore.”

Yet specialist recruiting isn’t the major problem faced by Dr. Matthew Gibb, chief medical officer at the Carle Foundation, an integrated health system with a 393-bed hospital in Urbana, Ill. “We’re seeing the biggest difficulties in our primary-care recruiting,” he said. “There’s a lot more competition for primary-care physicians both nationally and regionally.”

His solution? Signing bonuses, educational loan repayments and a $10,000 to $20,000 boost in the current starting salary of $190,000.

“We’ve placed a high emphasis on coordinated care, team-based care and population health,” which is attracting candidates, he said. “The employed model doesn’t seem to bother our recruits.”

You can show patients test results, but will they understand them?

With the increasing adoption of electronic health records, more patients are able to view their lab results electronically outside of clinical consultations, but a study suggests that access doesn’t mean patients understand what they’re seeing.

A team at the University of Michigan schools of Public Health and Medicine discovered that people with low literacy skills and low numerical comprehension were less than half as likely to identify if a lab result was inside or outside the standard range. They were also less capable of determining, based on the test values, whether or not they should contact their doctor, researchers said.

“We can spend all the money we want making sure that patients have access to their test results, but it won’t matter if they don’t know what to do with them,” Brian Zikmund-Fisher, associate professor of health behavior and health education at the university’s School of Public Health, said in a release. “The problem is, many people can’t imagine that giving someone an accurate number isn’t enough, even if it is in complex format.”

Through an Internet-administered survey, the research team asked more than 1,800 adults between the ages of 40 and 70, of whom nearly half were diabetics, to respond as if they had Type 2 diabetes. They were shown lab test results for hemoglobin A1c—a common measure for checking blood sugar—along with other blood tests, in addition to being measured on their ability to apply simple mathematical concepts and health literacy skills.

Of those who were assessed as having higher numerical comprehension and literacy skills, 77% could identify levels that fell outside of the standard or acceptable range. But of those with lower numerical comprehension and literacy skills, just 38% could do so. Those with higher scores on the numerical comprehension and literacy tests also were more sensitive to the test results insofar as knowing when they should consult with their doctor.

One motivation behind providing patients with access to their own data is to help them manage their own healthcare, but more research is necessary to decide how best to display this information, according to Zikmund-Fisher.

“Improving how we show people their health data may be a simple but powerful way to improve health outcomes,” he said.

The study, reported this month online in the Journal of Medical Internet Research, was supported by a grant from the University of Michigan Risk Science Center.