In Summer of 2019, eHealth Initiative and UnitedHealthcare’s National Strategic Partnerships Division convened a collaborative meeting of leaders from payer organizations and other stakeholder groups to address the use of ICD-10-CM codes for capturing social determinants of health (SDOH) data. This meeting marked a significant milestone in the shift to value-based care. Despite the competitive nature of healthcare, the private sector is working together to address factors pertinent to patient care and well-being in a sustainable, scalable manner. The group discussed the need for better education of provider and billing coders on the value of collecting and using SDOH data and identified strategies to accomplish this task:

• Develop a consistent and unified approach to communicate and assist providers and coders in utilizing existing ICD-10-CM codes for SDOH.
• Formulate a strategy and unified approach for providers and coders to assist with adoption and utilization of the proposed SDOH codes once approved.

Attendees agreed that the best strategy to communicate and promote the adoption of ICD-10-CM codes for SDOH to various stakeholder audiences was to:

• Develop this document as well as two-page communication tools for various audiences, including providers and coders. The coder tool, Transforming health care: Why including SDOH codes on claims is critical and provider tool, Using SDOH coding to transform health outcomes are available for use.
• Promote the use of the communication tools at various payer organizations through a high-level communication plan that outlines dissemination to stakeholder groups.

For a brief overview on the topic, check out our eHI Explains ICD-10-CM Coding for SDOH. Links to the provider and coder documents are forthcoming.

Missed Appointments, Missed Opportunities: Tackling The Patient No-Show Problem

I was asked last week at a healthcare industry roundtable about the single-biggest problem I’m trying to solve in my organization. My answer was surprisingly mundane, but relatable to anyone who has worked in a medical office: helping to address the ever-patient vexing problem of predicting and addressing patient no-shows.

Much has been made about the economic effects of patient “no-shows” on the health care system. One study found that no-shows cost the U.S. health care system more than $150 billion a year and individual physicians an average of $200 per unused time slot. After all, whether or not patients show up, healthcare organizations and medical practices still have to pay their staffs and cover expenses like rent and the cost of equipment.

But above and beyond the economic implications, no-shows have a direct impact on individuals’ health. When patients miss appointments, continuity of care is interrupted. Medication efficacy can’t be monitored regularly. Preventive services and screenings can’t be delivered in a timely manner. Acute illnesses are more likely to go untreated and become chronic conditions with complications. In short, missing an appointment can be severely detrimental to one’s health.

The full Forbes article can be viewed at this link.  

Looking Through a Different Lens: Patient Satisfaction With Telemedicine in Delivering Pediatric Fracture Care

Telemedicine may transform health care by overcoming geographical and travel-associated barriers to patient care. This study assesses patient satisfaction with telemedicine for fracture care.

Two groups of patients were compared from suburban/ rural Pennsylvania. One group reported to a regional medical center for real-time video consultation with a pediatric orthopaedic surgeon facilitated by a physician’s assistant. The other group underwent conventional outpatient clinic visits at a tertiary care hospital. The distance between the tertiary care hospital and the regional medical center was 69 miles. New or follow-up fracture patients not living in the vicinity of either medical center were included. A satisfaction survey and questionnaire were administered to both groups at the end of their visit.

One hundred sixty-seven patients returned the questionnaires (66 conventional and 101 telemedicine). Telemedicine visits decreased indirect and direct costs (P = 0.032). Travel costs and travel times were lower (P , 0.001) in the telemedicine group. Patient satisfaction was similar. Only 8 of 101 patients in the telemedicine cohort preferred their next visit to be a conventional follow-up.

Utilization of video consultation and trained physician assistants to provide pediatric orthopaedic care across suburban/rural areas can increase pediatric orthopaedic surgeon access and decrease travel costs while maintaining patient satisfaction.

The full article can be downloaded below.  

Spinning the lens on physician power: narratives of humanism and healing

Divisive, disabling and dangerous power has featured heavily in health professions literature, social media and medical education. Negative accounts of the wielding of power have discoloured the lens through which the public sees medicine and distorted the view of a profession long associated with healing, humanism and heart. What has been buried in the midst of this discourse are positive accounts of power where the yielding of power is encouraging, empathetic and empowering. This article offers three personal vignettes illustrating the ability of power to positively affect lives in the practice of medicine, for patients and doctors alike. More of these stories are needed to uplift and rebalance the conversation on physician power and how it can be used for good. It is necessary to provide a narrative framework of what it looks like to be a healer and a humanistic doctor to satisfy the general public through a commitment to cultivate multidimensional future healthcare providers.

The full article can be downloaded below.  

AI needs patients’ voices in order to revolutionize health care

Patients’ stories — what doctors call patient histories — are the bedrock of medicine. “Listen to your patient; they are telling you the diagnosis,” an aphorism attributed to Dr. William Osler, the founder of modern medicine, still holds true today. The disappearance of patients’ stories from electronic health records could be one reason that artificial intelligence and machine learning have so far failed to deliver their promised revolution of health care.

The medical industry’s fascination with artificial intelligence is understandable. Advancements in medicine have dramatically improved patient outcomes, and there is every reason to believe that machine learning, deep learning, artificial intelligence, and the like will do the same. But before we jump on the AI bandwagon, I offer this caution: consider the source of the data it is dependent on.

The full STAT article can be viewed at this link.  

Impact of Integrated Care on Patient-Related Outcomes Among Older People – A Systematic Review

This systematic review has explored multiple patient-related outcomes of integrated care targeting older people. The findings suggest that integrated care may have a positive impact on hospital admission rates in older age. Integrated care may also positively influence the length of hospital stay and possibly also patient satisfaction and readmission. In contrast, integrated care did not have an impact on mortality. However due to lack of robust findings, the effectiveness of integrated care on patient-related outcomes in later life remain largely unknown. Whilst this review has tried to identify patient-related outcomes important in integrated care provided to older adults, further theory-based research is needed to assess the effect on these outcomes in integrated care settings.

The full article can be downloaded below.  

Physician burnout and medical breakthroughs: a patient’s story

I entered my doctor’s exam room worried about my health. I exited worried about his.

A lack of pressure when he placed the stethoscope over my heart. His ghost-eyed look when I spoke. His nearly inaudible voice. All of this registered as the most severe depletion of spirit — or what is sometimes and inadequately referred to as burnout — I’d seen in one of my doctors. And I’ve seen a lot of doctors over the years.

The full STAT article can be viewed at this link.  

Strong medicine is needed to solve America’s rural health crisis

The health care situation in rural America has gotten worse since my childhood. Rural Americans face serious health disparities because of the shortage of physicians and the resulting lack of access to care. According to the Centers for Disease Control and Prevention, rural residents are generally sicker and poorer than urban residents, and are more likely to die from heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke than their urban counterparts. Residents of rural areas who have cancer are diagnosed at later stages of the disease, have less access to clinical trials, worse outcomes, and spend 66% more time traveling to see cancer care providers.

The full STAT article can be viewed at this link.  

Prevalence, severity, and nature of preventable patient harm across medical care settings: systematic review and meta-analysis

Our findings affirm that preventable patient harm is a serious problem across medical care settings. Priority areas are the mitigation of major sources of preventable patient harm (such as drug incidents) and greater focus on advanced medical specialties. It is equally imperative to build evidence across specialties such as primary care and psychiatry, vulnerable patient groups, and developing countries. Improving the assessment and reporting standards of preventability in future studies is critical for reducing patient harm in medical care settings.

The full article can be downloaded below.  

Why An Aging Population Means Healthcare Customer Experience Must Adapt

America is getting older, and the healthcare system is buckling under the pressure. The double whammy of people generally living longer and the massive Baby Boomer generation creating the “largest-ever population of older adults in America” has necessitated a level of experience innovation in the healthcare industry that simply has no precedent.  

Thankfully, there are a lot of brilliant minds working on a solution to this problem, identifying and addressing the needs of health consumers, medical providers and insurers all at once in order to create a smoother system for all.

In the final article of a three-part series, I interviewed three leaders in the healthcare industry for whom addressing the experience of the aging population is a top priority. 

The full Forbes article can be viewed at this link.