Doctor/Patient Communications
Can email improve patient outcomes?
Can email communications with healthcare providers improve overall health? Results from a new Kaiser Permanente study say so (at least for some patients). And using email can improve efficiency and reduce phone and in-person contacts too.
The study is among the first to examine how the ability to send secure emails to doctors affects patient behavior, preferences, and perceptions about their own healthcare.
According to the survey, which was published in The American Journal of Managed Care at the end of 2015, a third of patients with chronic conditions who exchanged secure emails with their doctors said these communications improved their overall health.
“As more patients gain access to online portal tools associated with electronic health records, emails between patients and providers may shift the way that healthcare is delivered and also impact efficiency, quality, and health outcomes,” says Mary E. Reed, DrPH, Staff Scientist with the Kaiser Permanente Division of Research in Oakland, CA, and the study’s lead author.
The researchers surveyed 1,041 Kaiser Permanente patients in Northern California who had chronic conditions. Survey participants included patients who had used Kaiser Permanente’s online patient portal, called My Health Manager, to send secure email messages, as well as patients who had not sent any messages. Surveys were completed in 2011 by mail, online, or by phone.
Kaiser Permanente members can use the portal to schedule appointments, refill prescriptions, and send secure email messages to their healthcare providers. Patient-initiated emails are usually answered within 24 hours. In 2014, members sent more than 20 million secure emails to providers through the portal.
Highlights of the survey findings include:
- Virtually all patients with chronic conditions said that exchanging email with their healthcare provider either improved (32 percent) or did not change their overall health (67 percent); less than 1 percent said emailing made their health worse.
- More than half of respondents (56 percent) had sent their provider an email within the previous year, and 46 percent used email as the first method of contact for one or more medical concerns.
- Among patients who had emailed their healthcare provider, 42 percent reported it reduced phone contacts, and 36 percent said it reduced in-person visits.
More information on this survey and its results can be found at www.dor.kaiser.org.
Source: Kaiser Permanente
Mobile Computing
If your style is limited edition and fully loaded, and you see technology as art, HP’s got your number when it comes to premium notebook PC design.
The HP Spectre features a full HD 13.3-inch diagonal edge-to-edge display with Bang & Olufsen sound, Intel Core i processors, and a CNC-machined aluminum chassis as thin as a AAA battery – just 0.4 inches. Weighing in at just under 2.5 pounds, it sports a carbon-fiber bottom and a hidden piston hinge, and it wears high-gloss copper accents. Inside you’ll find a lightning-fast PCIe solid-state drive with storage up to 512 GB and up to 8 GB of RAM. An innovative split-battery design houses the power plant into two thinner pieces that deliver the same wattage as a single battery for up to 9.5 hours of run time.
Value-Based Care
CMS launches five-year primary care initiative
On April 11, the Centers for Medicare & Medicaid Services (CMS) announced its largest-ever initiative aimed at helping practices move away from one-size-fits-all, fee-for-service healthcare.
The Comprehensive Primary Care Plus (CPC+) model will be implemented in up to 20 regions and can accommodate up to 5,000 practices, which would encompass more than 20,000 doctors and clinicians and the 25 million people they serve. Under the CPC+ model, Medicare will partner with commercial and state health insurance plans to support primary care practices in delivering advanced primary care with the following five key components:
- Access and continuity;
- Care management;
- Comprehensiveness and coordination;
- Patient and caregiver engagement; and
- Planned care and population health.
Primary care practices will participate in one of two tracks. Both tracks will require practices to perform the functions and meet the criteria listed above, but practices in Track 2 will also provide more comprehensive services for patients with complex medical and behavioral health needs.
In Track 1, CMS will pay practices a monthly care management fee in addition to the fee-for-service payments under the Medicare Physician Fee Schedule for activities. In Track 2, practices will also receive a monthly care management fee and, instead of full Medicare fee-for-service payments for evaluation and management services, they will receive a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments for those services. This hybrid payment design should allow greater flexibility in how practices deliver care outside traditional face-to-face encounters.
Both tracks will receive up-front incentive payments that they will either keep or repay based on their performance on quality and utilization metrics. The payments under this model are meant to encourage doctors to focus on health outcomes rather than the volume of visits or tests.
For more information about the CPC+ model, including a fact sheet, go to http://innovation.cms.gov/initiatives/Comprehensive-Primary-Care-Plus.
Payment Models
AMGA responds to proposed MACRA rule
The American Medical Group Association (AMGA) was quick to respond to the Department of Health and Human Services’ April 27, 2016, announcement about implementing legislation that modernizes how Medicare pays physicians for quality. The Notice of Proposed Rulemaking is a first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
Congress has streamlined various programs into a single framework to help clinicians transition from payments based on volume to payments based on value. The proposed rule would implement these changes through the unified framework called the Quality Payment Program, which includes two paths: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs).
“We understand the rulemaking process is part of an ongoing conversation with CMS,” said Donald W. Fisher, Ph.D., CAE, President and Chief Executive Officer, AMGA. “Based on a very preliminary look, CMS appears to have recognized the need for flexibility as providers move toward a risk-based payment system. However, we remain concerned that qualifying as an APM remains challenging at best, even for AMGA members, many of whom are very experienced with risk-based payment models.”
Besides the MIPS and Advanced APM models, the proposed rule also allows clinicians to switch between MIPs and the Advanced APM track. MIPS applies to Medicare Part B clinicians, including physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists. All Medicare Part B clinicians will report through MIPS beginning January 2017.
AMGA expressed concern about the quick timeline, given that CMS would begin measuring performance for doctors and other clinicians through MIPS in 2017.
AMGA provided the following additional comments:
- Provider performance will be assessed at the group level, which recognizes the type of integrated care that AMGA members provide.
- The rule proposes a MIPS performance category called “Advancing Care Information” that would replace the Meaningful Use program. This appears to be customizable and acknowledges the flaws with the current “one-size-fits-all” EHR measurement and reporting program.
- The rule also details the criteria for Advanced APM participation. AMGA expressed it is disappointed, however, that Track 1 accountable care organizations (ACOs) are excluded from Advanced APMs, given that AMGA member medical groups have invested significant financial, clinical, operational, and leadership resources to support the goals of the Medicare Shared Savings Program, including Track 1 ACOs.
AMGA has launched a MACRA and Risk Initiative to help members better understand the program and better prepare themselves for risk-based payment models. Offerings include educational materials and webinars.
Monitoring Tech
System based on Microsoft Xbox Kinect eliminates falls
Mission Health, North Carolina’s sixth-largest health system and the only not-for-profit, independent community hospital system in the western part of the state, eliminated falls in its neurosciences unit in Asheville and avoided more than $100,000 in one-to-one sitter costs during a three-month pilot program of the Cerner Patient Observer. This EHR-agnostic “smart room” tool features instant visual and audio alert monitoring for multiple patient rooms simultaneously.
With six cameras and a 94-day pilot, Mission Health was able to monitor 8,615 patient hours. This is equivalent to $103,380 in one-to-one sitter costs that were avoided by successful use of the patient observation solution. With plans to expand to 72 cameras across the enterprise, this would equate to 401,189 patient monitoring hours per year, equivalent to $4.8 million in avoided sitter costs.
