Tag: Practice Management

Doctors turn to free eConsult platforms to reduce diagnostic errors, study finds



Dive Brief:

  • As providers step up efforts to reduce medical errors and misdiagnoses, more physicians are availing virtual consultation tools to get second opinions, a study in npj Digital Medicine shows.
  • Researchers looked at physician use of WebMD’s free online Medscape Consult between November 2015 and October 2017. During that time, 310,563 physicians accessed the platform — 37,706 of them “active users” who generated a total of 117,346 posts (7,834 original contacts and 109,512 responses).
  • The No. 1 specialty area identified by eConsult users as their primary practice area was internal medicine, at 26.9%. Pediatrics, cardiology, obstetrics and gynecology and dermatology rounded out the top five most frequent specialties. The median time to first response was 90 minutes.


Dive Insight:

The researchers stress that Medscape Consult is not the only online doctor-to-doctor engagement platform. Other crowdsourced platforms include Sermo, Human Diagnosis Project and QuantiaMD. There are also apps like HealthTap and CrowdMed that allow consumers to consult doctors or other health professionals about symptoms and diagnoses.

“Artificial intelligence has been advocated as the definitive pathway for reducing misdiagnosis. But our findings suggest the potential for collective human intelligence, which is algorithm-free and performed rapidly on a voluntary basis, to emerge as a competitive or complementary strategy,” the authors write. “While there are certainly more refinements and study of this platform required, we have demonstrated an extraordinary reach and potential for a multispecialty, crowdsourced, global virtual consultation platform at scale for physicians in search of diagnostic input.”

The global study, conducted by Scripps Research Institute and WebMD, shows the growing popularity of eConsults with physicians everywhere. While younger doctors made up the bulk of initial queries, the majority of responses (more than 60%) were from physicians aged 61 and older, suggesting “older physicians feel comfortable with and support this type of virtual engagement,” the authors write.

A study in JAMA earlier this year found eConsult can significantly improve access to specialists and reduce specialty work for primary care physicians. But it warned also of new workload challenges for eConsult users, such as increased administrative burden, added clinical responsibility and restructured specialty care delivery.

For eConsult to thrive, stakeholders need to realign expectations and improve communications between primary care doctors and specialists, a 2017 New England Journal of Medicine case study at NYC Health + Hospitals concluded. eConsults can also lead to changes in workflow, such as more scheduling shifting from primary care to specialist, which could trigger changes in dedicated staff, according to the study.

Patient-matching tools viable but nowhere near perfect, Pew says



Dive Brief:

  • No solution currently exists that could achieve perfect or near perfect match rates across EHR systems for all patients, according to a report released Tuesday by the Pew Charitable Trusts. However, actions can be taken to better link records, to the benefit of patients and providers.
  • In the short term, Pew recommends clarifying government funding restrictions for unique identifiers, agreeing on standardized demographics, assessing privacy ramifications, continuing to research (and adopt) referential matching using third-party data and verifying phone numbers and other identifying information provided by patients.
  • To develop a stronger patient matching chassis, long-term opportunities include creating a single countrywide oversight organization, launching pilot projects for patients to use their own smartphones to help match records and determining the infrastructure and standards necessary to use biometrics and other more secure and effective patient-matching strategies.


Dive Insight:

Effective patient matching is among the necessary elements to move toward the elusive goal of interoperability. On that front, industry is eagerly awaiting proposed new rules laying out how HHS will curb providers from hoarding data via information blocking.

The 21st Century Cures Act requires the Government Accountability Office to take steps to reduce matching errors and HHS and the Office of the National Coordinator for Health Information Technology to support the nationwide exchange of health information.

EHRs can promote efficiency, but in the absence of standardization doctors are confronted with the question of whether they are worth the pain. Administration burden associated with EHRs are a leading cause of physician burnout and dissatisfaction, and problems with system implementation and operability can manifest in problems with patient care.

And for EHR systems to be effective, they need to be able to communicate effectively both intra and intersystem — a goal that depends on several factors such as desire of said institutions to share data and correctly link record to patient, according to Pew.

The report attempts to identify solutions to the latter dilemma, as patient-matching rates vary widely across the United States. Such inconsistencies can lead to safety problems and needless costs in repeat tests and delays in care.

Currently, matching is typically done through the use of algorithms, unique identifiers, manual review or a combination of those methods. Among the factors contributing to inadequate match rates are standardization variance, typos, unentered information, information changes and identity fraud.

Pew examined four main approaches for improvement. The first is in the realm of unique identifiers that identify a person and link to his or her records, such as biometrics. Biometrics (body measurements specific to a person, such as fingerprint or eye scan) are en vogue in European airports, for example, as a way to quickly and easily confirm someone’s identity. However, such measurements can be stolen and, once compromised, can’t be changed, for obvious reasons.

A second suggestion allow patients to ensure their records are matched correctly through a portal such as a smartphone app. However, patients would need to be motivated to participate for this strategy to have legs.

Pew also recommended standardizing demographic indicators across systems to promote interoperability and pinpointed referential matching, or using non-health related data from credit bureaus and other organizations, as a helpful scheme when other basic information such as address changes.

Pew researchers convened a series of panels, focus groups and interviews, including healthcare executives, yielded some interesting insight on how the C-suite views patient matching. Interorganization patient matching was found to offer the biggest opportunity for progress in their eyes.

Consistently, executives had a goal of 99% success rate in matching but no consistent method to measure progress to that goal, although many indicated they had already invested in software or employees to track matching.

More than half of Americans share doctor experiences online, survey shows



Dive Brief:

  • Americans are increasingly going online to find doctors and rate their healthcare experiences. In a new Binary Foundation survey, 51% of respondents said they share their personal medical experiences via social media, online ratings and review sites — 65% more than did so a year ago.
  • Among millennials, 70% reported sharing doctor and hospital experiences online. The share was slightly lower for young millennials age 18 to 24 at 68%, but a whopping 94% jump from the previous year.
  • Meanwhile, 70% of Americans say their choice of doctor was influenced by online ratings and reviews, and 41% admitted checking out a doctor online even when another provider referred them.


Dive Insight:

Hospitals and doctors may not be thrilled about the growing reliance on online reviews, but with more consumers using them to select and rate their care, they need to take them seriously. With CMS focused on patient engagement and patient experience, how a provider handles patient feedback can impact their quality performance ratings.

Providers should suppress the urge to get angry over negative reviews and instead look at the review from the patient’s perspective, David Williams, chief strategy officer at LEVO Health, previously told Healthcare Dive. “The quicker the response, the more likely people will … feel heard,” he said.

In the latest survey, 95% of respondents called online ratings and reviews “somewhat” to “very” reliable. And of those, 100% of 18-24 year olds and 97% of 24-34 year olds said online comments and rankings are reliable, according to the second annual Healthcare Consumer Insight & Digital Engagement survey.

When asked about their expectations for patient care, 48% of all respondents said a friendly and caring attitude is the most important quality they look for in a doctor. Other key factors are the ability to answer patients’ questions (47%) and thoroughness of the examination (45%).

Americans also value their time and, with more virtual and retail care options available, don’t have to put up with limited hours and packed waiting rooms. More than four in 10 consumers (43%) said wait time is the most frustrating part of seeing the doctor. By contrast, 10% each mentioned cost and payment and waiting for exam results, while 9% chafed at scheduling appointments.

The foundation also highlighted providers’ need to understand and respond to what’s being said about their services online.

“The survey results underscore the significance of online ratings and reviews as online reputation management for physicians becomes ever-more important in today’s healthcare environment,” Aaron Clifford, senior vice president of marketing at Binary Foundation, said in a statement. “As patients are becoming more vocal about their healthcare experiences, healthcare organizations need to play a more active role in compiling, reviewing and responding to patient feedback, if they want to compete in today’s marketplace.”

Facebook is the platform of choice for sharing healthcare experiences among 25-54 year olds. Google replaced Twitter as the preferred platform among young millennials in this year’s survey.

Nearly a quarter of providers not using speech recognition technology



Dive Brief:

  • Despite having been around for years, just 62% of healthcare providers use speech recognition technology, a new Reaction Data report finds. Another 14% have plans to use it, but nearly a quarter say speech recognition is not on their radar.
  • The market intelligence firm surveyed providers to see where speech recognition is headed, which vendors are most popular and how the technology is being integrated into EHRs.
  • Among those not who do not use such tools, 19% blame budgetary constraints, while 16% said their physicians prefer to input by hand in the EHR. Other reasons for not adopting speech recognition include accuracy concerns (16%), fear that physicians won’t use it (12%) and difficulty of integrating with an organization’s EHR.


Dive Insight:

Demand for voice recognition is expected to grow as doctors face increasing regulations and reporting burdens. Big minds, including at Google and Nuance are working on this, and EHR vendors will want to be at the forefront when the next best solution comes along.

Physicians say they spend too much time putting information into EHRs, and that can lead to poor job satisfaction and burnout. Google, which has shown particular interest in finding AI uses in healthcare, has been working with Stanford Medical on voice recognition and job postings from the Internet giant point to continuing interest in the area.

The report found that when it comes to vendors, Nuance rules the roost with 86% of the market. The next largest purveyor is M*Modal at 12%, followed by IBM, with just 2% of market share.

Nuance also seems to be gaining the most traction and is making strides with speech-enabled EHRs, according to the report. M*Modal is a solid second contender, with IBM, Dolbey and nVoq and other smaller competitors nabbing occasional customers.

When asked which speech-enabled EHRs providers are using, 40% said Epic. The next three most popular vendors are Cerner (13%), Allscripts (9%) and Meditech (8%). Epic seems to integrate well with both Nuance and M*Modal, while Allscripts integrates better with M*Modal and Cerner does better with Nuance.

Generally, though, respondents who use voice tools are happy with the EHR integration. A full 75% reported integration is seamless, while 13% were neutral and 12% said integration was poor. Overall, Nuance has a pretty good track record, with a majority of uses reporting a seamless experience on each of the top EHRs: Cerner (86%), Epic (75%), Meditech (64%) and Allscripts (55%). While fewer have it, M*Modal got strong reviews from Epic and Allscripts users, with 100% saying integration is seamless.

That satisfaction is important when it comes to building out adoption. While 61% of speech recognition users said they are “likely to recommend” their product to someone else, 23% were neutral and 16% said they would not recommend it.

“Not perfected yet – sketchy speech recognition,” one respondent wrote. “You adjust around the limitations of the system but the system does not!”

Oklahoma hospital turns to go GoFundMe to stay afloat


Dive Brief:

  • Pauls Valley Hospital Authority owes millions to an Austin, Texas-based management firm that operated the rural Oklahoma hospital until this past July. A temporary restraining order has been lifted and the hospital now needs to pay its lingering debts to NewLight Healthcare. The firm alleges it’s owed more than $2.8 million, according to a lawsuit filed in federal court in the Western District of Oklahoma.
  • The problem is that the hospital can’t afford to pay its debt and maintain payroll. The hospital’s newest CEO Frank Avignone has turned to the community, asking them to open their wallets to keep the facility open.
  • If the hospital closes, patients will have to travel at least 30 minutes to another acute-care facility, Avignone said on the GoFundMe page. By Wednesday morning, the donations totaled slightly more than $3,000, barely a dent in the $2 million goal.


Dive Insight:

Pauls Valley is not alone in its struggle to stay off life support.

At least 88 rural hospitals have closed since 2010, according to the North Carolina Rural Health Research program.

That figure has fallen in recent years to 13 in 2016 and 8 in 2017. So far in 2018, there have been 5 hospital closures, according to the data tallied by university’s Sheps Center.

Other factors are putting pressure on rural hospitals as well. Those in states that have not expanded Medicaid, like Oklahoma, face margin pressure that is more acute than peers in other expansion states, according to a report from Health Affairs.

Rural hospitals tend to have a payer mix that heavily relies on Medicaid and Medicare. These facilities, like many hospitals, have to contend with declining admissions as they try to turn a profit without a large base of commercially insured patients.

Nonprofit hospitals experienced more credit downgrades in 2017 than the year prior, according to a report from Moody’s. The rating agency also downgraded its review of the sector from stable to negative.

But Avignone said mismanagement by the previous operators has played a role in the decline of Pauls Valley. Avignone told Healthcare Dive the firm “managed the hospital into the train wreck it’s in.”

A lawsuit filed in Aug. 26 details a falling out between the hospital owner and the previous operator and the battle over assets.

The owner, Pauls Valley Hospital Authority, alleges the previous group, NewLight HealthCare, “utterly failed in their performance to the point of the Hospital’s near financial failure and now seek to strip the Hospital of its near-cash assets on their way out the door.”

The judge lifted a temporary restraining order on Sept. 12, essentially granting NewLight access to the cash it says it is owed.

NewLight alleges in a counterclaim that it had agreed to forgo its monthly management fees from the authority temporarily. NewLight said it agreed to put off collecting what it was owed to allow the authority to “shore up its finances.”

This meant NewLight was “foregoing payment” of its fees, reimbursement of expenses, and was now covering the salary, travel, expenses, and benefits of the hospital CEO.

The authority then went back to NewLight twice to secure a loan to address cash flow problems, the counterclaim alleges.

The defendants claim that they have not been paid by the authority since January 2016.

Prior to NewLight taking over operations, the hospital had filed for Chapter 9 Bankruptcy in 2013.

Avignone said he’s hopeful the hospital can remain open. But he said he’s concerned for other municipal-owned hospitals run by lay officials who know very little about the industry and make deals with third-parties.

ACOs using medical home physicians save money, yield higher quality, report finds



Dive Insight:

With 10% of the U.S. population in ACOs and almost 1,000 available around the country, these findings are widely applicable for healthcare players in both the public and private sectors as they work out new payment models amid the turbulent rise of value-based care.

This report, co-created by the PCPCC and the Robert Graham Center, coalesces two promising approaches in the space, as PCMHs and ACOs (although created separately) both exist in the same ecosystem focused on outcomes-driven care.

PCMH is a care delivery model where a patient’s care is coordinated through their PCP, and the system aims to produce coordinated, team-based holistic treatment. They have become more widespread over the past decade, with nearly 500 public and private sector PCMH initiatives being tracked across the U.S., according to the report.

Introduced in 2006, ACOs are similar but more broad. They hold groups of providers across different care settings accountable for both the cost and the quality of a cohort of patients. The providers therefore share the risks and rewards of patients’ health, prioritizing value.

“ACOs and patient-centered medical homes are cut out of the same cloth,” said Robert Mechanic, executive director of the Institute for Accountable Care in a panel convened by PCPCC on Wednesday.

He also pointed out that, although both PCMH and ACO performance have varied in U.S. studies, a wealth of evidence supports the role of robust primary care delivery in bolstering population health, reiterating the importance of continued studies such as this report.

The study also stressed that the characteristics that lead to the success of ACOs were also pivotal to the success of advanced primary care models such as the PCMH.

The study, which is the first of its kind to examine the interaction between these two models, also identified six domains that contributed to successful ACOs, with success defined as ACOs with shared savings, improved quality or adroit use of healthcare services. The six categories were leadership and culture, prior experience, health IT, care management strategies, organization and environmental factors and incentive and payer alignment.

Regarding leadership and culture, one important factor referenced throughout the literature was physicians acting as “clinical champions,” acting in leadership roles and lobbying on their patient’s behalf. Diverse, collaborative governance structures were also noted as important to foster coordinated communication across the ACO, along with establishing a culture of shared commitment and accountability.

“Providing care is a service, not a building,” said Ann Hwang, director of the Center for Consumer Engagement in Health Innovation. The focus should always be on the patient as a whole being, not a set of symptoms, she said.

From a provider perspective, two things are inserted into this equation, according to Farzad Mostashari, chief executive officer of Aledade: total cost of care accountability and voluntary alignment of practices. Successful ACOs must be a coalition of the willing, as the “whole dynamic of the network is incredibly powerful.”

Another subject brought up in Wednesday’s panel was the mounting role of technology in health. Along with using technology to coordinate care, identify high-risk patients and track patient care beyond the ACO, the report highlighted the critical role of health IT in performance data feedback for quality improvement.

William Kassler, deputy chief health officer and lead population health officer at IBM Watson Health, said he sees such technology as an “enabling tool” for providers, stressing that “data is key for quality improvement.”

When asked to identify obstacles to ACO and value-based progress, the panel was quick to provide a flurry of answers, including sluggish public policy, increasing consolidation threatening competition (a notable quote was from Mostashari , “if you’re big, you don’t have to be good”) and binary or reductive analytic results.

According to Anthem vice president of provider alignment solutions Mai Pham, larger structural issues such as a fee-for-service cornerstone of American healthcare are the elephant in the room. Anthem, she said, plans to pivot to a place where it is “ready to leave some providers behind” if they fail to modernize their business models.

A 2017 evaluation of the Medicare MSSP program showed that one-third of ACOs in the program achieved savings, although they outperformed their FFS counterparts on most quality measures. These new findings, taken in tandem with past research, suggest that a foundation of advanced primary care is crucial to successful care delivery reform focused on lowering costs and keeping people healthy and out of the hospital.