New Brookings Report on Person-Centered Care

A working group including former Senator Tom Daschle and former HHS Secretary Michael Leavitt was convened by the Brookings Institute and has published a new white paper on person-centeredness in health care reform. The report argues that person-centered health care is the best way to improve care and health while also bending the curve of health care cost growth. The report is focused on truly system-wide reform, including specific discussions on improvements to Medicare and Medicaid, and recommendations for the private sector to achieve more person-centered care. The report also recommends changes to the health care delivery system, including improved cost and quality transparency, and increased anti-trust enforcement.  The authors suggest that private employers can do more to support multi-payer financing reforms, including contributing consistent data to more comprehensive and effective ways to measure quality and continuing to innovate in reforms in benefit design to promote higher-value care.

Study: Patient Satisfaction May Not Be A Good Indicator Of Surgical Quality

A new study in the current issue of JAMA Surgery finds little relationship between a hospital’s patient satisfaction scores and most quality ratings. The study, led by researchers at the Johns Hopkins University medical and public health schools, looked at patient satisfaction and surgical quality measures at 31 urban hospitals in 10 states. Patient satisfaction was determined by the results of standard Medicare surveys given to patients after they left the hospital. Quality was judged by how consistently surgeons and nurses followed recommended standards of care, such as giving antibiotics at the right time and taking precautionary steps to avert blood clots. The researchers also looked at how hospital employees evaluated safety attitudes at their hospital.

Previous studies of the relationship between patient views and the quality of care also have found that they are not necessarily correlated, but Medicare views them as useful. The patient assessments account for 30 percent of bonuses and penalties given to hospitals in the first year of Medicare’s “value-based purchasing” program, which was created by the Affordable Care Act.

Some of the surgical measures are also included in the calculations that make up the other 70 percent of the bonuses and penalties this year. Hospitals can gain or lose 1 percent of their regular Medicare payments under the quality program. All those individual scores are available to the public on Medicare’s Hospital Compare.

The researchers found that there was some relationship between how patients rated their experiences and whether hospital workers considered themselves part of a team approach to caring for patients and felt their work environment was not excessively stressful. There was no relationship between patient scores and hospital workers’ overall assessment of the hospital’s safety culture, which also included job satisfaction, working conditions and perception of management.

RWJF Funds Group To Develop Patient-Reported Outcomes

The Robert Wood Johnson Foundation announced a $1.9 million grant to PatientsLikeMe to fund efforts to build a platform to help researchers include patient-reported health outcomes measures in their work, the group announced this morning. The platform will be free and adaptable to clinical studies to enable researchers "to rapidly develop health outcome measures that better reflect patients’ experiences with a disease and how it is affecting their health and quality of life.” By providing open access to this information and focusing on what is meaningful to patients, this initiative has the potential to accelerate discovery, advance medicine, and improve health for all health care stakeholders.

Use of Patient Navigators Increasing

The Wall Street Journal reports that a growing number of professionals are helping individuals and families find their way through an increasingly complicated and costly health-care system. These specialists—known as patient navigators, health advocates and medical consultants—research treatments, grapple with bureaucrats, and process and appeal medical claims, among other tasks.

One such organization, Patient Navigator, based in Vienna, VA, was founded in 2009 and has expanded to 200 professionals. Fees typically run between $60 and $250 an hour. Various nonprofits offer similar advice for free, as do a growing number of hospitals, clinics, health insurers and employers.

Services vary. Some, including Healthcare Navigation of Shelton, Conn., primarily evaluate insurance options and resolve insurance and billing disputes. The nonprofit Patient Advocate Foundation in Hampton, VA handles appeals of claims denials and negotiates access to medications and medical services for those with chronic or life-threatening illnesses. Others aim to facilitate medical decision-making; for example, locating clinical trials, securing expedited medical appointments and helping those without a diagnosis find appropriate specialists. Some navigators serve a niche clientele, such as Medicare recipients or cancer patients. While some navigators have degrees in social work, nursing, or medicine, no specific training is required.

Many of these organizations are members of the National Association of Healthcare Advocacy Consultants (NAHAC). Members of NAHAC are bound by a code of ethics that, among other things, bars them from making treatment recommendations.

Under the health-care law, federal and state-sponsored health-insurance exchanges must hire navigators to help individuals and businesses evaluate and enroll in health plans.

Many Americans See Specialists For Primary Care

Two in five adults in the U.S. are getting general health care from specialist doctors, according to a new study showing that figure held steady for nearly a decade.  Researchers found that in 1999 and 2007, approximately 59% of visits in the U.S. for primary care were to family physicians. The other 41% were to specialists, such as internists and obstetricians-gynecologists.

There is evidence that in health care systems where primary care doctors are the first point of contact, patients see better outcomes, according to the study's lead author.  A study from 2011, for example, found that seniors living in areas with more primary care doctors were less likely to be hospitalized with a preventable disease and had lower death rates.

On top of quality concerns, another issue is cost. A 2010 study found that primary care doctors earn about $60 per hour, which is much less than the $92 per hour and $85 per hour rates for surgeons and ob-gyns, respectively.

The researchers write in the Archives of Internal Medicine that there can be a few reasons people turn to specialists over family doctors for primary care. One may be a belief that specialists are better at treating specific conditions. Another reason may be that a shortage of family doctors in the U.S. drives people to specialists.

The 2010 health care reform legislation, the Affordable Care Act, contains provisions directed at alleviating that shortage, including incentives for doctors to choose to specialize in primary care.

Alliance of Community Health Plans Report on Readmissions

As hospitals wrestle with ways to bring down readmission rates, a new Alliance of Community Health Plans report looks at five key steps that improve patients’ odds of being able to go home and stay there. Though the program is still in the early stages, some data suggest that ACHP members with care transition programs are bringing down readmission rates and reducing costs. Still, only a few AHCP plans found “concrete” cost savings from their programs so far.

 

The report discusses five practices that plans identified as key facilitators of their programs’ success, helping to break down silos of care, promote coordination among providers and engage patients to facilitate effective transitions from hospital to home:

• Using data to tailor care transition programs to patients’ needs
• Anticipating patients’ needs and involving them early in the transition process
• Engaging providers to become program partners
• Leveraging technology to improve care transitions
• Incorporating care transitions into broader quality initiatives

Doctors take issue with new language of medicine

In a recent commentary in The New York Times, Dr. Danielle Ofri, an associate professor of medicine at New York University School of Medicine, looks at how physicians view increasingly ubiquitous terms such as health care provider, hospitalist and health care consumer.

She notes the recent essay on this topic by Dr. Pamela Hartzband and Dr. Jerome Groopman in The New England Journal of Medicine.

According to Dr. Ofri... "maybe it’s splitting hairs to want to be called a doctor, rather than a provider. Yes, maybe there is a hint of paternalism in preferring “patient” over “consumer” or “customer.” And yes, there are probably grander problems in medicine that require urgent attention. But words do influence us. In a world that is increasingly depersonalized, it is ever more critical to maintain protected spheres of human interaction."

What do you think?