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How to Win Docs and Influence Patients

Pretty much everyone agrees that we need to improve the quality of healthcare delivered to patients. We’ve all heard the frightening statistics
from the Institute of Medicine about medical error rates – that as many
as 98,000 patients die each year as a result of them – and we also know
that the US spends about 33% more than most industrialized country on healthcare, without substantial improvements in outcomes.

However, a large number of quality improvement initiatives rely on
additional rules, regulations, and penalties to inspire change (for
example, decreasing Medicare payments to hospitals with higher
readmission rates, and decreasing provider compensation based on quality indicators).
Not only am I skeptical about this stick vs. carrot strategy, but I
think it will further demoralize providers, pit key stakeholders
against one another, and cause people to spend their energy figuring
out how to game the system than do the right thing for patients.

There is a carrot approach that could theoretically result in a $757
billion savings/year that has not been fully explored – and I suggest
that we take a look at it before we “release the hounds” on hospitals
and providers in an attempt to improve healthcare quality.

I attended the Senate Finance Committee’s hearing on budget options
for health care reform on February 25th. One of the potential areas of
substantial cost savings identified by the Congressional Budget Office
(CBO) is non evidence-based variations in practice patterns. In fact,
at the recent Medicare Policy Summit, CBO staff identified this problem
as one of the top three causes of rising healthcare costs. Just take a look at this map of variations of healthcare spending
to get a feel for the local practice cultures that influence treatment
choices and prices for those treatments. There seems to be no
organizing principle at all.

Senator Baucus (Chairman of the Senate Finance Committee) appeared
genuinely distressed about this situation and was unclear about the
best way to incentivize (or penalize) doctors to make their care
decisions more uniformly evidence-based. In my opinion, a “top down”
approach will likely be received with mistrust and disgruntlement on
the part of physicians. What the Senator needs to know is that there is
a bottom up approach already in place that could provide a real win-win
here.

Some 340 thousand physicians have access to a fully peer-reviewed, regularly updated decision-support tool (called “UpToDate“)
online and on their PDAs. This virtual treatment guide has 3900
contributing authors and editors, and 120 million page views per year.
The goal of the tool is to make specific recommendations for patient
care based on the best available evidence. The content is monetized
100% through subscriptions – meaning there is no industry influence in
the guidelines adopted. Science is carefully analyzed by the very top
leaders in their respective fields, and care consensuses are reached –
and updated as frequently as new evidence requires it.

Not only has this tool developed “cult status” among physicians – but some confess to being addicted to it,
unwilling to practice medicine without it at their side for reference
purposes. The brand is universally recognized for its quality and
clinical excellence and is subscribed to by 88% of academic medical
centers.

In addition, a recent study published in the International Journal of Medical Informatics found
that there was a “dose response” relationship between use of the
decision support tool and quality indicators, meaning that the more
pages of the database that were accessed by physicians at participating
hospitals, the better the patient outcomes (lower complication rates
and better safety compliance), and shorter the lengths of stay.

So, we already have an online, evidence-based treatment support
guide that many physicians know and respect. If improved quality
measures are our goal, why not incentivize hospitals and providers to
use UpToDate more regularly? A public-private partnership like this (where the government subsidizes subscriptions for hospitals, channels comparative clinical effectiveness research findings to UpToDate staff, and perhaps offers Medicare bonuses to hospitals and providers for UpToDate
page views) could single handedly ensure that all clinicians are
operating out of the same playbook (one that was created by a team of
unbiased scientists in reviewing all available research). I believe
that this might be the easiest, most palatable way to target the
problem of inconsistent practice styles on a national level. And as
Senator Baucus has noted – the potential savings associated with having
all providers on the same practice “page” is on the order of $757
billion. And that’s real money.

I highly recommend a bottom up approach, not top down. That’s how you win docs and influence patients.

Val Jones, M.D., is the President and CEO of Better Health, LLC. Most
recently she was the Senior Medical Director of Revolution Health, a
consumer health portal with over 120 million page views per month in
its network. Prior to her work with Revolution Health, Dr. Jones served
as the founding editor of Clinical Nutrition & Obesity, a
peer-reviewed e-section of the online Medscape medical journal. She currently blogs at Get Better Health, where this post first appeared.

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cigna dental providersGary LampmanDr StevenACountAntTeresa Sharkey Recent comment authors
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cigna dental providers
Guest

I will right away snatch your rss as I can not find your e-mail subscription link or newsletter service. Do you have any? Kindly let me recognise in order that I could subscribe. Thanks.

Gary Lampman
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Gary Lampman

Oh, No special treament for the Rush Limbaugh who has put a Free advertising plug in for the Industry. Tort Reform is not the issue as only 1 to 5 %percent of lawsuites proceed with any rewards. These are the most serious Cases of Medical Error that end in a lifetime of infirmity, Disability and Death. Tort Cases are the ONLY means of accountability! Otherwise, the patient would bare the insurmountable costs of Medical Error. The problem is,neither the doctors or the institutions want to be Held accountable for anything that may happens. If it be Medical Error or Hospital… Read more »

Gary Lampman
Guest
Gary Lampman

Its Amazing that Doctors are more concerned about Corporate Compliance boards than doing right by patients?How Fasinating to realize that the patients are not the Focus of their Concern but rather Corporate Boards and Health Insurance. How niave it is for the patient to believe that doctors are in it to save lives.They don’t have the common sense to understand that Health Care Professions are part of a Business profoilo.Private corporations will sacrifice people to survive and so does Health Care. We have taken Health Care from a comprehensive measured Care. To itiemized list of products and services that fails… Read more »

Dr Steven
Guest

Timely article, Provide good care and services. Implementation of EMR reduces the errors and helps in giving the quality care.
medical coding training</

ACountAnt
Guest
ACountAnt

Healthcare Information and Management Systems Society is in “Dire Straights” CEO, H. Stephen Lieber recently announced to staff: “I am not planning to layoff anyone, but we are in Dire Starights. We need to apply for government grants that are offered as part of the $20 billion HIT plan”. Employees questioned how Healthcare Information and Management Systems Society can be in “dire straights” if Healthcare Information and Management Systems Society had a $1 million surplus the year before, when staff were asked for ideas on “how to spend a $1 million”. Lieber plans to continue with the FY09 Healthcare Information… Read more »

MD as HELL
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MD as HELL

We should neither encourage nor fund “thousands of unemployed single Moms”. It takes two parents to raise a child, not a village. The people in this country need to love and cherish freedom from governmenmt oppression and tyranny above all other civic and social things. Evidence in medicine is great. But somethimes a doctor has a hunch that either pays off or doesn’t. If is were easy to be a doctor, a caveman could do it with a computer, protocols and algorithms. So why don’t they? When all the evidence is in and the results are bad, the computer doesn’t… Read more »

Teresa Sharkey
Guest
Teresa Sharkey

HD, One empathizes. I agree that anyone with the slightest of basic healthcare knowledge can pick up a CPT code book and order tests; however they cannot analyze those tests and provide a treatment plan. About the little girl, I do believe people young and old should be allowed to die with dignity and respect. With that I have but a few questions for you: Have you ever held a little dyeing girl? Have you ever had a family member plagued with a chronic illness? Have you ever felt, tasted the pain, the agony the anger, the hurt those families… Read more »

HD
Guest
HD

You make some very good points, but you are missing the main thrust of Nationalized Healthcare. This is what the experts who are designing policy know: 1) Medicine is actually very simple and easy – doctors just use the “8-12 years of post-college education excuse” as a way to corner the market on a lucrative career. The field should be open to anyone who feels doctorish. 2) All doctors can easily be replaced by PA’s and NP’s or techs who just pull up an ICD-10 code and look to the 3rd party payer to see what treatment/medication is authorized. That’s… Read more »

Teresa Sharkey
Guest
Teresa Sharkey

A kiosk? What you have to be joking! First and foremost no computer will ever take the place of direct patient care. (Lord knows we have enough med mal when they see a live DR.) I have worked in several ER’s in various states and I know all too well the “frequent flyers” that “abuse” the system. I do think that evidence based practice is a KEY component of healthcare reform coupled with managed care (case management and medical management) I can tell you from an ER nurse’s prospective that you know the Dr.’s that are going to test a… Read more »

Melissa
Guest

Select Collect: A novel and cost-effective approach for patient collection. The client designs their own collection process by selecting the activities that they would like to be performed on their accounts. Interestingly, these are most of the same techniques that may have been used on their accounts in the past by a conventional collection agency. However, in this program, the client retains 100% of the money collected and is only billed for the activities selected.

HD
Guest
HD

A Top Down Approach is the Answer rbar is right: A sick person should be able to enter their symptoms into a waiting room kiosk, while at the same time, their vital statistics are taken by the machine. A simple Evidence Based formula could be used to treat the patient with printed messages, such as: 1) “You have a cold. Go home and have some soup.” 2) “You have a sinus infection. Take your printed prescription for the cheap, outdated, antibiotic to the Pharmacy window.” 3) “You have had a severe head injury and cerebrospinal fluid is leaking out your… Read more »

HD
Guest
HD

Can quality in healthcare and equality of outcome co-exist? Will electronic records or a “medical home” make a difference? Who cares? Either way it means billions of dollars to the businesses that win these government contracts. That’s a win for the economy! That’s a win for America!
The discredited study promulgated by Dr. Jones can still be used to prop up the argument for centralized control of medicine. Studies show that no matter how wildly inaccurate the study, if the results are quoted in the media often enough they become TRUE!

HD
Guest
HD

An honest discussion of American Medicine is not complete without mentioning some responsibility on the patient’s side of the equation. A simple solution, and one that has a great deal of appeal to third party payers and cost containment experts in Medicare, is to deny medical care to those who display unhealthy behaviors such as smoking, drinking, eating fast food, maintaining an abnormal Body Mass Index, failing to excercise, or those who have a genetic predisposition towards certain disorders. Insurers and hospitals are also interested in denying care for those who are injured while engaging in risky activities such as… Read more »

MD as HELL
Guest
MD as HELL

Right Ms. Burton, That’s why the same dialysis patients come in volume overloaded. That’s why the same asthmatics come in out of their medicine. That’s why the same diabetics come in not taking their insulin. That’s why the came chronic pain patients come in seeking narcotics. That is why the same heart patients and COPD patients continue to smoke. And I am an ED doc and my patients know they can call me and I also run a doc-in the-box separate from teh ED. I know many of these patients. ED medicine in a small town is not anonymous. There… Read more »

BarBara Burton
Guest
BarBara Burton

Patient ignorance culturally ingrained???? Did you for one minute think that maybe, just maybe, the physician, the nurse, or the discharge planner didn’t do their job in explaining to the patient what they need to do at home? Do you have them repeat to you the instructions you gave them? Do you tell the patient that they or a family member are free to call you if there are any questions? Emergency room docs are the very worse at this because they think if a patient comes back he/she will probably be seen by another doc-in-a-box! I hope that President… Read more »