By ASHISH JHA, MD

A few months ago, the Centers for Medicare and Medicaid Services (CMS) put out its latest year of data on the Hospital Readmissions Reduction Program (HRRP). As a quick refresher – HRRP is the program within the Affordable Care Act (ACA) that penalizes hospitals for higher than expected readmission rates. We are now three years into the program and I thought a quick summary of where we are might be in order.

I was initially quite unenthusiastic about the HRRP (primarily feeling like we had bigger fish to fry), but over time, have come to appreciate that as a utilization measure, it has value. Anecdotally, HRRP has gotten some hospitals to think more creatively, focusing greater attention on the discharge process and ensuring that as patients transition out of the hospital, key elements of their care are managed effectively. These institutions are thinking more carefully about what happens to their patients after they leave the hospital. That is undoubtedly a good thing. Of course, there are countervailing anecdotes as well – about pressure to avoid admitting a patient who comes to the ER within 30 days of being discharged, or admitting them to “observation” status, which does not count as a readmission. All in all, a few years into the program, the evidence seems to be that the program is working – readmissions in the Medicare fee-for-service program are down about 1.1 percentage points nationally. To the extent that the drop comes from better care, we should be pleased.Continue reading…

By Tom Giulianni, MD

There is no doubt that the topic of patient engagement has taken center stage in healthcare. It was the hot topic at HIMSS 2015 where a major national study was unveiled, Three Perspectives of Patient Engagement. And that was just one of the many sessions, events, and booths focused on patient engagement at the event.

Thanks to Meaningful Use, a lot of the focus on patient engagement has been around patient portals. It makes sense since practices have to meet specific thresholds in both MU2 and MU3 for portal use. They certainly play a key role in providing patients with access to medical records, test results, and even tools like online scheduling and billpay. The benefits have not gone unnoticed by providers. Over 80% of doctors believe a patient portal helps with patient satisfaction and 71% believe it helps with patient/physicians communication. The benefits haven’t gone unnoticed by patients either. Two-thirds of patients say they would be more loyal to physicians who provides a portal through an EHR.

Despite the undeniable value of portals, they are just one component of true patient engagement. This was clear in the presentation about the new national study released at HIMSS. According to the presentation, the biggest problem in creating patient engagement isn’t providing access to health information. The problem is shifting the attitudes and expectations of both clinicians and patients.

Resolving this problem requires a major culture change in healthcare. Despite the fact that patients and providers say they want improved access, communication, and outcomes and that patient engagement may hold the key, change is slow.

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By NORTIN HADLER, MD

On Saturday, Dr. Hadler delivered the commencement address at the University of Michigan Medical School.  THCB is pleased to feature his remarks. 

Thank you, Class of 2015, for the privilege of sharing this special occasion with you, your families and the community that has come together to celebrate with you. This is a rare day of pure self-indulgence. Our professional life allows little room for self-indulgence and seldom applauds when one of us makes the room. For those of you who are drawn to a career anchored at the bedside, the trade-off is the quiet, internalized quest to become the best physician you can be. I have pursued this goal nearly all my life – literally, I have been working in hospitals since I was 12. If I had it to do over, I would pursue the same goal.

This goal demands expertise. Expertise requires intellect and discipline. I have a superabundance of both and so do you. Expertise is necessary but not sufficient.  More than expertise, one must understand myriad contexts in which illness plays out.

Medicine is not a science. Medicine is a philosophy informed by science.

I was a medical student when this dawned on me. Like you, I entered clinical rotations brimming with the pathophysiology of all those diseases that are poised to smite a mighty blow. Was I missing the forest for the biochemistry? Many of our patients are elderly patient and plagued by more than one serious disease. As we set to the task of confronting each in turn, it occurred to me that I might not care as much about what kills me as I care about when, and what the journey was like? Today, we have a good handle on that “when”. I can make a strong argument that if you manage to stay well to 85, you’re off warranty.

Notions of “fatal diseases” and of “saving a life” demand a temporal component.  Realize that in America, you can’t die without a diagnosis. In the mid-1980s, I started to sign the death certificates of frail elderly patients with “It was her time.” I would get a call from Raleigh; Doctor Hadler you can’t do that. I’d respond, “Which of the several diseases vying for the honor do you want me to list?” Whenever you hear of the epidemic of cancer or heart disease or stroke, ask the “When” question.

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By JOE SELBY, MD

For more than a decade, the United States has faced an escalating opioid abuse crisis. The number of deaths associated with abuse of these prescription painkillers more than tripled between 1999 and 2012 and now outstrips the number associated with any other drug, according to the US Centers for Disease Control and Prevention. The problem is estimated to approach $56 billion in costs to society.

Often, opioid abuse or overuse is associated with patients seeking effective relief from the common and often devastating problem of chronic pain, which has been reported as affecting up to one in three US adults. People in pain often request opioid medications, not understanding that these drugs don’t effectively treat certain types of pain, don’t work well for many people, and can lead to a range of additional health problems.

Researchers, policy makers, clinicians, and their professional organizations are working hard to stem the opioid abuse epidemic, seeking ways to reduce overprescribing of these drugs by expanding the use of alternative and supporting therapies, as well as identifying more effective treatments for addiction.Continue reading…