Oct 1, 2008 | Instruments & Equipment, Laboratory Pathology
As the nation’s healthcare system pursues the goal of a universal electronic medical record (EMR) and a paperless, all-electronic environment, one barrier to adoption may be the large number of physicians nearing retirement. That’s the opinion of a neurosurgeon in his recent testimony before a congressional committee.
Physicians within five years of retirement may not get a return on their investment, Philip Tally, M.D., a neurosurgeon in Bradenton, Florida, told a hearing on “Cost and Confidentiality: The Unforeseen Challenges of Electronic Health Records in Small Specialty Practices,” on July 31 before the House Committee on Small Business.
Just 4% of physicians have an extensive, fully functional EMR and only 13% have a basic system, Tally told the committee, citing an article, “Electronic Health Records in Ambulatory Care-A National Survey of Physicians,” in the July 3, 2008, issue of the New England Journal of Medicine. The committee hearing was on the unforeseen challenges faced by small specialty medical practices when installing an EMR system.
“If you’re not thinking about practicing more than five years, don’t bother because the transition and the cost and the time to make it proficient for you in a small practice is probably not worth it-with one exception and that would only be if you intend to sell your practice someday,” Tally told Modern Healthcare magazine. When selling a practice, the physician who buys the practice is likely to want the EMR, he added.
The American Medical Association’s Physician Characteristics and Distribution in the U.S., 2008 edition, shows how physician demographics are weighted toward approaching retirement. There are 921,900 physicians in this country, of which 343,200 (37.2%) are over age 54. Approximately 166,000 physicians are aged 55 to 64 and 177,200 are aged 65 and older.
Interestingly, Tally was speaking from experience. His three-physician practice of neurosurgeons installed an EMR in 1992, making the group just the fifth in the nation and the first neurosurgery group to do so. At the time, the practice spent $50,000 for the EMR and about $5,000 annually to maintain the system. Tally, who chairs the Florida Medical Association’s IT committee, the congressional hearing that his group spent about 1,000 hours to configure the system after it was installed. His medical office staff found the process challenging, as the staff turnover rate climbed to 30%. Tally did observe that the EMR system, once implemented, significantly increased productivity.
Accurately measuring the return on investment (ROI) that accrues to a physician group from implementing an EMR is complicated by many factors. These include: 1) savings from eliminating the need to maintain and store paper charts; 2) savings in time for physicians to see patients under the new EMR system versus the time it took under the old system; and, 3) savings from electronic data entry of laboratory tests results in the EMR. Perhaps most difficult to measure is physician and patient satisfaction with the new EMR system versus the old.
Tally has an overlooked perspective on why physician age is likely to be an impediment to EMR adoption. He points out that more than one in three physicians in this country are within a decade or less from retirement-and are thus likely to find the transition to an electronic medical records system to be both uneconomical and unwelcome. It may turn out that more financial incentives from federal and state government sources, along with private payer incentives, will be required to encourage smaller physician groups to implement an EMR system. Clinical laboratories will need to take these factors into consideration as they develop effective strategies for supporting to move to a fully-digital patient health record by their office-based physician clients.
Physicians in America (In round numbers)
Younger than age 35 141,500
35 to 44 213,300
45 to 54 223,900
55 to 64 166,000
65 and older 177,200
Total 921,900
Source: American Medical Association’s Physician Characteristics and Distribution in the U.S., 2008 edition
Related Information:
Dr. Tally’s prepared remarks for the House Small Business Committee:
Committee Examines Costs and Challenges of Electronic Health Records to Small Medical Practices
Sep 29, 2008 | Laboratory News, Laboratory Pathology
As many as one-third of the nation’s uninsured qualify for public health programs and the answer to getting them insured may be as simple as educating these individuals about which health insurance programs are available to them! That should be big news for hospitals, health systems, and clinical laboratories that spend millions of dollars annually on uncompensated care for uninsured individuals each year.
About 34% of uninsured individuals qualify for public health programs but are not aware they are eligible, according to commentary from Phil Lebherz, Founder and Executive Director of the Foundation for Health Coverage Education in Modern Healthcare. These people are mostly the working poor, the elderly, and single parents of young children. But that’s not all! Another 32% of uninsured individuals-because they make enough money-could afford to purchase their own health coverage, but they are not informed enough to know the importance of health insurance. 14% of uninsured individuals are between jobs and may not know about the availability of COBRA or other programs.
Recognizing this opportunity to help uninsured obtain health coverage, some forward-thinking hospitals have teamed with non-profit organizations to utilize the Internet to explain viable options for health care to such individuals. The Foundation for Health Coverage Education was one of the first to reach out to hospitals to get them to help promote health insurance education online. Their site, coverageforall.org, gives consumers the opportunity to answer a 5-question quiz to figure out which health insurance options are available to them based on their state of residency. The data from the quiz can be re-used to start the enrollment process should the individual completing it want to enroll in a health insurance program.
For every 1% increase in the unemployment rate, another 1.1 million individuals become uninsured. The work of the Foundation for Health Coverage Education demonstrates that simple programs to educate uninsured patients have the potential to generate major benefits, and reduce the number of Americans who lack health insurance.
Finally, 34% (approximately 15 million) of the nation’s 45 million uninsured individuals qualify for the federal Medicaid program. Why are state and federal efforts to educate and enroll such people in these social safety net health programs failing to reach so many individuals? Could it be that, because of budget squeezes and spending fears, that our elected officials and program bureaucrats have huge financial and political disincentives to be more successful at identifying the insured and bringing them into such health programs as Medicaid? That certainly is a dimension to solving the nation’s uninsured problem that gets little attention by the intellectual class and the national media.
Related Articles:
Educating the uninsured
Sep 24, 2008 | Laboratory Management and Operations, Laboratory Pathology
With the theme of a “Lean Laboratory Supporting Lean Healthcare,” attendees at Lab Quality Confab this morning in Atlanta, Georgia, heard the remarkable story of Stockholm, Sweden-based St. Göran Hospital’s Lean journey to improved clinical outcomes and better customer service for its patients. This 250-bed hospital serves 21,000 inpatients and 200,000 outpatients annually.
This story had added intrigue because it is healthcare delivered to the public in Sweden’s single-payer health system, provided by a privately-owned hospital! St. Göran Hospital is owned by Capio, a for-profit company that provides hospital, radiology, laboratory, and other healthcare services in eight European countries. Thus, it demonstrates how private sector Lean-based innovation and execution is advancing patient care in Sweden. In fact, St. Göran Hospital was sold to Capio by the Swedish health system at the beginning of this decade specifically to be a demonstration site to show other healthcare providers in Sweden how private sector initiative could produce innovation that improves the quality of care while lowering the cost of care.
In his presentation at Lab Quality Confab this morning, Tom M. Pettersson, Ph.D., Head of Development, for Capio Diagnostics/Unilabs at St. Görans Hospital, shared how Lean methods are being used to boost performance in each of the clinical departments, which then do inter-disciplinary Lean improvement projects as integrated teams. Step one, earlier this decade, was to make over the laboratory with an exhaustive application of Lean methods and principles. During this phase, process-ordered production was instituted throughout the laboratory, along with targeted automation solutions. At the same time, staffing was reorganized and laboratory staff satisfaction became a regularly measured attribute. The result was a significant contribution to clinical care through shortened turnaround times, improved quality, and significant reductions in errors.
But what captured the audience’s attention was Pettersson’s fascinating explanation of how, at the next phase, laboratory services played a role in improving work processes in the primary care and inpatient care continuums. Again, Lean methods and techniques were used to realign processes to respond to the voice of the customer while improving outcomes. Pettersson spoke at length about how this was accomplished in the Emergency Department (ED), in a project originally launched in 2005.
Lean techniques were used to address five targeted problems in the ED:
1. We do too few things in parallel-this increases waiting time and reduces value.
2. The best competences examine too few patients and that too late.
3. Lack of coordination and routines.
4. Working hours of doctors not synchronized with patient flows.
5. There is much distractions and waste (Muda) in doctors’ work
These problems are common to emergency departments in hospitals in this country. What distinguishes the ED at St. Goran’s Hospital from most of their American hospital peers is how the use of Lean methods has improved the performance of its emergency department. Pettersson explained how the following six Lean approaches were utilized to change work flow through the ED, with impressive gains in patient throughput, outcomes, and reduced costs:
1. Link activities-to recognize problems early.
2. Activities in parallel-to gain time.
3. Pull-next step in chain is prepared to receive the patient.
4. Visualize-everyone sees what must be done.
5. Takting (takt time) the flow-improve the working environment.
6. Standardize-that we can see problems to solve (waste to eliminate).
What captured the audience’s attention was the range of solutions that were inspired by use of these Lean methods. For example, like most hospitals, C discharged the vast majority of its patients daily during the late morning and early afternoon-a batch mindset that has been changed. Now the hospital has a continuous flow of patients into and out of wards across the day and the evening. This has helped the emergency department move patients more effectively from presentation to treatment and either discharge or admit.
This is just one example of how Lean-inspired thinking lead to an unorthodox, but highly-effective solution to a problem common in most hospitals across the globe. That’s been the theme in presentations this morning, which included the laboratory profession’s first public look at the “smart room” developed at University of Pittsburgh (UPMC) . There will be more to come on events unfolding at this week’s Lab Quality Confab.
Regards,
Robert Michel
Dark Daily Editor
Sep 19, 2008 | Laboratory News, Laboratory Pathology
When it comes to satisfaction ratings, physicians in Houston have turned the tables on payers! In a groundbreaking survey, the Harris County (Texas) Medical Society allowed physicians to rate health insurance companies. Results were made available late last year and were widely publicized across newspapers and healthcare magazines. It seems only fair that physicians, who increasingly find themselves rated by health insurance companies, should get the opportunity to turn the tables and rate the health insurance companies for the benefit of their patients.
“All insurers were rated very low by doctors in most areas, and the response was quite uniform,” said Kimberly Monday, M.D, a neurologist and Vice-Chairwoman of the Harris County Medical Society’s board of medical legislation. “The survey shows insurance companies are failing patients, doctors and employers who pay for healthcare services by creating ways and resistance to hold onto their money.”
487 physicians in Houston responded to the survey, which evaluated Aetna, Cigna, Humana, The Texas Blues, Unicare, and UnitedHealthcare. Here are some interesting statistics from the survey:
- More than 65% of the doctors reported they have experienced difficulty getting their patients’ medical services approved.
- 69% have problems with prompt payment, and 64% say they are paid less than their contracted rate.
- 58% say their patients do not understand benefits, copayments, deductibles and limitations of their coverage.
- 65% say their patients rarely understand preventative services and care-coordination services available to them.
The Harris county group is not the first medical society to conduct a survey on health insurers – the Colorado Medical Society has conducted several similar surveys. The difference is that Harris County chose to make their results public and transparent. In the age of transparent healthcare services, this will probably become a trend. This means that health insurance companies may need to pay as much attention to physician satisfaction as they do to employer and beneficiary satisfaction.
For laboratory administrators and pathologists, the attention garnered by the Harris County Medical Society physicians’ rating of payer services demonstrates how transparency is opening up new channels of information for the public. Many patients are smart enough to know that if their health insurance company treats doctors poorly, that can affect both the patients’ access to care and the quality of care they receive. That is why public disclosure of physician satisfaction with different health plans can trigger improvement in how payers work with providers.
Related Articles:
Health insurance companies are failing patients, businesses & physicians, say physicians
Turning the tables: insurers win low marks in doc-satisfaction survey (Modern Healthcare subscription required)
Sep 17, 2008 | Laboratory Management and Operations, Laboratory Pathology
In the United States and many countries around the world, primary goals for healthcare reform commonly center on better patient safety, improved health outcomes, and higher quality services. As clinicians in these countries actively work to achieve these goals, the clinical laboratories that serve them must respond to these efforts with appropriate lab tests and services.
Last week, Dark Daily Editor Robert Michel traveled to New Jersey to participate in a lab management meeting specifically organized to look at healthcare globalization and identify how this globalization trend is influencing clinical laboratory services. It was the annual meeting of the Customer Advisory Board (CAB) for the Pre-Analytical Services division of Becton, Dickinson and Company (BD) (NYSE:BDX) of Franklin Lakes, New Jersey. To foster productive discussion about globalization in healthcare and laboratory testing, BD arranged for presentations via teleconference from laboratory experts in India, South Africa, Belgium, and Mexico. Here are noteworthy points from each presentation:
INDIA: Healthcare services in this country are provided through government programs and the private sector. Annual spending on health is about US$37 billion. Government health services are delivered at the state level and India has 22 states. Experts identify the need for 896,000 more hospital beds in this nation and the private sector is responding to meet this goal. Because of the lack of healthcare resources in rural areas, telemedicine services are being pushed because it extends the reach of physicians and greatly increases their productivity. In the laboratory sector, there may be as many as 40,000 independent labs. Consolidation and acquisitions have created at least five major laboratory companies. There is a shortage of laboratory technologists. Phlebotomy is performed by medical technologists, each of who must have a four-year degree. Laboratory accreditation often involves an ISO standard and ISO 15189 is gaining favor.
SOUTH AFRICA: This government provides a minimum health insurance program to individuals who fall below a certain level of income. Above that income, private health insurance is the major source of healthcare. One challenge for the country is that it has at least 13 different races which are genetically unique. As genetic medicine advances, personalized services appropriate to these patients must be developed. HIV is a major factor in South Africa. Up to 90% of government health spending goes to HIV positive patients who undergo treatment for other health conditions. There is a shortage of pathologists in the public hospital sector of South Africa. Phlebotomy is done by trained nurses who attended college. Because it can take two or three days to move a specimen from some areas of the country, there is strong interest in point of care testing. (POCT). ISO 17025 is often used by private sector hospitals and laboratories for accreditation.
BELGIUM: As a developed nation with aging demographics, healthcare in this country faces many of the same challenges as the United States. Hospitals have their own laboratories and independent lab companies serve physician offices. There has been some consolidation of the independent lab sector. There is a shortage of both pathologists and technical laboratory staff in Belgium. Laboratories must be accredited with a quality management system (QMS) and ISO 17025 has been used. However, up to 20% of the nation’s laboratories are using ISO 15189 for their accreditation. Lean and Six Sigma is gaining wide acceptance and integrates well with accreditation under ISO standards.
Phlebotomy must be done only by physicians, nurses, and medical technologists.
MEXICO: Healthcare in this country reflects the extremes of wealth and poverty among the population. The government’s social security system provides minimum health benefits to everyone with a job. However, self pay and private health insurance play significant roles in the Mexican healthcare system. A national health priority is extending health services to remote areas of the country. There are still deaths from diseases such as cholera simply because individuals in these areas have no access to healthcare. Phlebotomy is done by nurses and medical technologists. Physicians do not draw blood in their offices, but refer patients to the collection sites operated by independent laboratories. Laboratory accreditation is mandatory in Mexico and ISO 9000 has been used. ISO 15189 is an option to meet accreditation requirements and growing numbers of laboratories are using ISO 15189.
Not surprisingly, everyone participating at the BD meeting on healthcare globalization was fascinated by the similarities and differences in healthcare and laboratory services in each of these four international presentations. Observation number one: Across these four countries, it was obvious that standards of care are tightening. Accreditation of laboratories is one example. In this regard, the quiet inroads being made by ISO 15189 in all four countries caught the attention of the American lab managers participating at this meeting. They recognized that other countries are moving rather rapidly to bring their laboratory services up to the level seen in developed countries.
Observation number two is that the adage “all healthcare is local” remains true. That was illustrated by the different national objectives. In India, use of telemedicine to support rural needs is different than in Mexico, where there are major efforts to create healthcare infrastructure in regions totally lacking any health services whatsoever. Similarly, In South Africa, meeting the health needs of so many HIV positive patients is the primary objective, whereas Belgium’s healthcare system is preparing to serve the many aging, but reasonably well-off individuals soon to reach their retirement years.
Further, it was pointed out that the demand for reliable and cheap point of care (POC) diagnostic tests by countries such as India, South Africa, and Mexico as a way to support rural care, would make these attractive and sizable markets for the IVD industry. Thus, more innovation in POC testing innovation is likely to occur first in those countries, rather than in the United States or Europe.
Your Dark Daily Editor,
Robert Michel
