Filtering by Tag: hospitals

Does Your Healthcare Tech Product Fuel the "Alarm Fatigue Syndrome"?

Alarm clock.jpg

Data is good. More data is better. At least that’s what some people think. Although there is some truth to that position, at some point, too much information leads to overload. There is a difference between the volume and the value of data, and more data doesn’t automatically lead to better patient or operational outcomes.   

In an interview published in the April 30, 2018 issue of Modern Healthcare, Allscripts CEO Paul Black discussed data that is not properly managed, harmonized and de-duplicated. His comments referred to assimilating Big Data feeds that incorporate information from several sources, but his remarks apply to all of healthcare data. “It’s like reading the New York Times, Wall Street Journal, and C-Span all at once,” he said.  Without an interpretive framework, data is just noise.

Anyone who has spent any time in either an inpatient or Emergency Department setting has heard numerous alarms happily chirping in the background and being ignored by virtually everyone. Many electronic gizmos that are part of patient care these days sport alarms to alert caregivers when some kind of threshold is exceeded. And these thresholds are exceeded regularly. By many devices. And they are regularly ignored. If everything becomes urgent, nothing is urgent.

When medication management software for physicians first hit the market, there were so many low threshold alerts about dosing and potential interactions that many physicians learned to click right through them and essentially ignore most of them, defeating the alerts’ purposes. In some cases, they missed truly important warnings resulting in patient harm.

Patients may think it’s wonderful that their primary care physician can access the steady stream of heartrate and other biometric data from their fitness monitors, but no physician has the time to sort through tons of undifferentiated data. Even getting a condensed daily feed of summary data can be overwhelming unless there is an analytical overlay to alert the clinician when action is required. The best apps provide clear alert systems (e.g., color-coding patients as green, yellow or red) so someone from the physician’s staff can immediately identify the patients that require immediate attention.

Recommendations: 

  • If you are vendor offering a product that greatly increases data flow to physicians or hospitals, be sure to solicit input from relevant clinicians concerning the types of information that are truly helpful. 

  • You must include an analytical framework that provides immediately identifiable intervention thresholds. 

  • Incorporate the ability to conveniently modify alert thresholds so clinicians can customize notifications to match their preferences.

  • Develop mechanisms that guide clinicians toward suitable interventions so they can easily step in. Remember that beyond being valid, data must also be actionable.

  • As you are presenting your product, make sure you communicate that you understand the difference between volume of data and value of data that has been curated.

Expert Panel Weighs In On Value-Based Reimbursement

Earlier this month, I had the privilege of moderating a panel on Value-Based Reimbursement (VBR) at the Georgia HIMSS annual conference. Panelists were:

  • Mary G. Gregg, MD, FACS, MHA – Enterprise Director, CareSource

  • Raymond Snead, Jr., D.Sc., FHFMA, FACHE – long-time CFO/CEO who recently served as Interim CEO at Grant Memorial Hospital, Petersburg, WV

  • Barry S. Herrin, FAHIMA, FHIMSS, FACHE, Esq. – Founder, Herrin Health Law, PC

GA HIMSS Oct 2018 Panel Cropped.jpg

Here are some of the highlights from our lively interchange:

  • There has been little true progress toward containing healthcare expenditures despite decades of trying various approaches including HMOs, PPOs, DRGs, ACOs, CON, and other efforts.

  • For the most part, VBR amounts to transferring risk to providers and does little to truly improve care.

  • Each party in the healthcare equation has a different definition of “value.” Patients want the most care for the least amount of money. Payers and employers want to pay providers as little as possible. Providers want to be adequately compensated for the care they deliver.

  • By and large, VBR does not allow for variability in patient differences, including the extent to which they follow good health practices and adhere to suggested care guidelines. Chronic illnesses represent a huge part of health status and medical costs. Patients can do more to improve their health and, thereby, help moderate costs through better lifestyle choices and compliance with care guidelines.

  • Technology can help identify and address health and, therefore, tamp down coats. However, some organizations merely throw new technology or an app at a problem without adequately defining it or developing a comprehensive plan to address root cause issues.

  • Hospitals must get physician involvement from the very beginning whenever proposing a change in medical practice or adopting new technology. Walking three-quarters of the way through a process and then inviting physicians into the discussion guarantees failure.

  • The days of considering data security as an afterthought are over. Ironclad practices must be baked in from Day One.

  • We need better analytics for identifying and tracking the 20% of patients who require the greatest level of care.

  • Patient mental health issues contribute greatly to total costs but are not being effectively addressed.

  • Cost coverage is being relegated to a smaller and smaller percentage of patients with insurance policies that fully cover the cost of care. As the number of plans covering costs dwindles, in order to stay in business, hospitals continue to shift more and more costs to those with more adequate plans. This effectively makes hospitals taxing agencies.

  • With increasing pressures from all sides, physicians are burning out faster than ever before.

  • Innovation is not being rewarded within the current delivery and payment system.

  • Amazon and others outside the traditional healthcare arena may be the source of truly disruptive innovation.

You can see the conversation went well beyond just VBR since all these issues covered interlock. The overall consensus was that the enormous complexities of the healthcare system make it impossible for a single approach like VBR to “tame the cost beast.”

Cherry-Picking and Cost-Shifting Are the Name of the Game

The following letter was published in the August 27, 2018 issue of Modern Healthcare magazine.

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The statistics in the Aug. 13 Data Points regarding where emergency services providers choose to locate (“Stand-alone EDs flock to affluent ZIP codes,” Data Points, p. 31) point to a trend that some fail to grasp. I agree that in most retail situations – cars, flat screen TVs, etc. – competition encourages increased quality and tamps down prices. Your data reveals that potentially profitable service lines gravitate toward more affluent areas. This is especially true for facilities like free-standing surgery centers, and it amounts to cherry-picking. I don’t see people rushing to set up trauma centers in downtown Atlanta or Chicago to siphon off the uninsured car wreck, overdose and gunshot cases.

Everyone knows about the cost shifting to commercial payers because of less-than-cost payments from Medicaid, the uninsured and, in many cases, Medicare. But there is another type of cost shifting that takes place within the hospital. Since many of the vital services they offer cause a financial drain, they make up the difference from other areas that do yield net income. If they lose too many profitable patients, their ability to prop up the necessary but financially draining service areas declines.

One bright spot in your statistics is that two-thirds of the freestanding EDs are hospital-affiliated, meaning they are presumably helping the profitability of the hospitals that operate them.

Glenn E. Pearson, FACHE

Principal

Pearson Health Tech Insights, LLC

Marietta, Ga.