Entries in Other (16)


Four Questions for CoxHealth: Post-Webinar Interview

Recently, DNV GL Healthcare and CoxHealth participated in a Healthcare Web Summit webinar discussion on Unconventional Paths to Reducing Patient Readmissions. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed the CoxHealth team on four key takeaways from the webinar: 

1. Your study looked at readmission rates for congestive heart failure patients, how did you identify physicians with higher than average readmission rates? 

CoxHealth: We are currently identifying CHF patients who have readmitted for a second time and enrolling them in the Advanced Practice Paramedic Program.  Our data showed that if a person readmits once, they are more likely to readmit a second, third, etc time.  We felt our best use of resources was to stop the multiple readmitters. 

2. From a case management perspective, what were lessons learned from skilled nursing facilities? 

CoxHealth: We brought a few different skilled nursing facilities together and diet was determined to be the single largest item that helped keep readmission rates low.  Our APPs have a great focus on diet with the patient and the patient’s family when they enroll. 

3. Describe your Advanced Practice Paramedics program and key successes with this program in managing emergency department high utilizers. 

CoxHealth: We identify a high utilizer as anyone who visits the ED 5 or more times in a 12 month period.  One of our keys of success, that we learned because we didn’t start this way, is to have an APP in the ED to visit with the patients real-time and enroll them.  We started with a social worker doing this and we weren’t having the acceptance we were hoping for.  When we had the paramedic, who would then be coming into their home, visit about the program, our acceptance rate increased drastically.  

Another key to our success is our goal is to graduate patients from the program in approximately 90 days.  We continue to track the ED utilization after the enrollment period to ensure we don’t need to touch base again with the patient, but our goal is to work with them on what interventions can be implemented so they don’t have to visit the ED as often.  If our APPs didn’t graduate patients, we wouldn’t be able to enroll new patients and continue to grow our success. 

Our final keys to success is to not overly prescribe to the APP what they should be doing for the patient.  We have individualized care plans and encourage the APPs to think outside the box when providing care. 

4. Who pays for the APP program? 

CoxHealth: CoxHealth pays for the program.  We are proving the program’s worth through cost avoidance of low reimbursement patients in the ED as well as decreasing readmissions cost.  We are currently in discussions with two large payers to begin reimbursement for APP visits.


Five Questions for Kelly Proctor, Physical Environment Sector Lead, DNV GL Healthcare: Post-Webinar Interview

By Claire Thayer, June 28, 2018

Recently, Kelly Proctor, Physical Environment Sector Lead, DNV GL Healthcare, participated in a Healthcare Web Summit webinar discussion on Workplace Violence, Security Vulnerability Analysis, and Ensuring Sound Security Management. If you missed this informative webinar presentation, watch the On-Demand version here. After the webinar, we interviewed Patrick on five key takeaways from the webinar:

 1. What is ISO 9001?

Kelly Proctor: ISO 9001 is a Quality Management System that ensures risk based thinking and continual improvement.

2. Why introduce ISO 9001 to hospitals and tie this to the accreditation process?

Kelly Proctor: ISO 9001 when implemented properly will ensure that the hospital considers all risks both internally and externally while building an effective Quality Management System. The Quality management system will be the infrastructure for all the other standards and requirements for the organization as well as serve as the quality improvement program forcing the hospital to consider risks, both internally and externally. A strong ISO 9001 program will improve processes and sustainability.

3. Your webinar focused on Security Management and specifically NFPA 99 2012 Chapter 13.  Can you define this for our audience?

Kelly Proctor: All CMS reimbursed hospitals are required to follow the National Fire Protection Agency (NFPA) 99 2012 Edition and NFPA 101 2012 Edition standards. CMS allows hospitals to exclude Chapters 7, 8, 12 and 13 of the NFPA 99 2012 standards however DNV-GL does not allow its client hospitals to exclude chapters 12 (Emergency Management) and Chapter 13 (Security Management). Chapter 13, has a focus on the security of the hospital and requires the hospital to identify its security risks, areas to be secured, abduction risks and security measures, Work Place Violence and more.

4. In your discussion on the value of conducting a thorough Security Vulnerability Analysis (SVA), you've indicated that this should be considered as living document.  Can you tell us more?

Kelly Proctor: The SVA should be considered a living document because as your security risks change so should your SAV. NFPA 99 requires an annual review of the SVA however if there are changes in the hospital risks the SVA should be adjusted to reflect these changes.

5. What are the 7 building blocks for developing an effective workplace violence prevention program?

Kelly Proctor: These 7 building blocks can be found in the NIAHO standards Revision 18 under the interpretive guidelines. They are as follows:

• Establishment of a Threat Assessment Team

• Hazard Assessments

• Workplace Hazard Control and Prevention

• Training and Education

• Incident Reporting, Investigation, Follow-up and Evaluation

• Recordkeeping


Disobey, Please

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By Kim Bellard, March 29, 2017


The M.I.T. Media Lab is taking nominations for its Disobedience Award, which was first announced last year.  As the award's site proudly quotes Joi Ito, the Director of the Lab and who came up with the idea: "You don't change the world by doing what you are told."

I love it. 


The site, and the award's proponents, make clear that they are not talking about disobedience for the sake of disobedience.  It's not about breaking laws.  They're promoting "responsible disobedience," rule-breaking that is for the sake of the greater good.  The site specifies: This award will go to a person or group engaged in what we believe is an extraordinary example of disobedience for the benefit of society."   


In Mr. Ito's original announcement, he elaborated: The disobedience that we would like to call out is the kind that seeks to change society in a positive way, and is consistent with a key set of principles. The principles include non-violence, creativity, courage, and taking responsibility for one's actions." 


The creators of the award are probably not thinking much about health care -- despite disavowing it is about civil disobedience, many examples they've given revolve around people resisting what they think are improper government actions -- but they should be. 

If there's a field where lots of stupid, or even bad, things happen to people , through design, indifference, or inaction, health care has to be it.

The list of disobedient acts in health care that would serve society is longer than my imagination can produce, but here are some examples:

·         The nurse who says, no, I'm not going to wake up our patients in the middle of the night for readings no one is going to look at.

·         The doctor (or nurse) who knows a doctor that they believe is incompetent and decides, I'm going to speak up about it.  I'll make sure patients know.

·         The billing expert who decides, no, I'm not going to keep up the charge master, with this set of charges that aren't based on actual costs and which almost never actually get used (except by those unfortunate people without insurance).  Instead, we'll have a set of real prices, and, if we give anyone any discounts, they will be based on ability to pay, not on type of insurance.

·         The EHR developer who realizes that, it's silly that this institution's EHR can't communicate with that institution's EHR, even though they use the same platform and/or use the same data fields.  .

·         The insurance executive who vows, I'm tired of selling products that are full of jargon, loopholes, and legalese, so that no one understands them or knows what is or isn't covered.  We're going to sell a product that can be clearly described on one page using simple language.

·         The practice administrator who understands that patients' time is valuable too, and orders that the practice will limit overbooking and will not charge patients if they have to wait longer than 15 minutes. 

·         The medical specialty that commits to being for patients, not its physician members, by developing measures, specific to patient outcomes, in order to validate ongoing competence.


Going back to the award's principles of non-violence, creativity, courage, and taking responsibility for one's actions -- well, the above would all seem to fit.  They're all achievable.  It only takes someone to stand up and decide to do them.

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


Under the Influence

By Kim Bellard, March 18, 2016

new analysis by ProPublica found that doctors who receive money from drug companies do, in fact, tend to prescribe more brand name drugs, and that the more money they got, the more brand name prescribing they did.

ProPublica looked at prescribing patterns from five specialties -- cardiovascular, family medicine, internal medicine, ophthalmology, and psychiatry -- with the restriction that individual physicians had to have had at least 1,000 Part D prescriptions in the study period (2014).  Overall, about three-fourths of physicians took some money from a drug company, although there was wide variation by specialty and geography -- e.g., nearly 9 of 10 cardiologists took payments, just as around 90% of physicians took such payments in Nevada, Kentucky, Alabama, and South Carolina. 

Conversely, in Minnesota and Vermont the percentage was closer to 25%.

The amount of the payments appeared to have an impact.  Internists who received no payments had brand-name prescribing rates of about 20%, while those getting more than $5,000 had rates of around 30%.

The defenses from physician organizations and the drug industry make for fun reading.  Dr. Richard Baron, the president and chief executive of the America Board of Internal Medicine, protested that doctors almost have to go out of their way to avoid taking these kinds of payments.

The president of the American College of Cardiology suggested the patterns were re-enforcing; the more they learn about a drug, the more they tend to use it, and the more they use it, the more drug companies pay them to be speakers and consultants.

Seriously, these are their defenses?

We've been learning a lot more about how pervasive industry payments -- not just pharmaceutical companies but also medical device and other health care suppliers -- are since the advent of the Open Payments initiative.  We're talking about over $6.5b in payments in 2014, made to over 600,000 physicians and 1100 hospitals.  I wrote about this last summer, and the new ProPublica analysis certainly should rattle any remaining doubts anyone might have had about the potential impact of such payments. 

True to form, last fall the AMA called for a ban on DTC advertising.   That's right, they don't seem disturbed about the $6.5b physicians are getting, but they think that the ads that we see are bad.  There's a certain logic to that; it has long been suspected that these ads help drive consumer demand.

Austin Frakt, of The New York Timesrecently challenged this conventional wisdom.  For one thing, he notes that while drug ads do cause an increase in sales for the advertised drug, they also increase sales of other drugs in the same class, using Prozac as an example.  Seeing drug ads may help "normalize" the condition being treated, making getting treatment for it more acceptable, and may also help encourage patients to continue with existing prescriptions.  

Mr. Frakt points out that it is not only the drug companies who benefit from drug advertising, but also physicians.  Every $28 in drug advertising results in an additional doctor visit; someone has to do the prescribing, after all.  And, of course, the DTC spending is dwarfed by the direct-to-physician "promotions" -- Mr. Frakt estimates drug companies spend seven times more on these than on DTC advertising. 

So we're back to the ProPublica analysis. 

It simply is not plausible to maintain that these efforts are not influencing physicians' decisions, and that they may not always be in the best interests of patients.  As Bloomberg put it last summer: the payments "seek to convince doctors that second choice is OK."
Well, I don't know about you, but that is not OK with me. 

This post is an abridged version of the posting in Kim Bellard’s blogsite. Click here to read the full posting


Healthcare Startups Capitalizing on the Sharing Economy and More

By Clive Riddle, April 1, 2015

These five healthcare lists – courtesy of healthsprocket - should be of great interest today –addressing the sharing economy; King v Burwell; upcoming M&A transactions; headlines you might have missed; and hot innovation initiatives:

Healthcare Startups Capitalizing on the Sharing Economy and More

  1. Uberlance - provide on-demand ambulance services with your SUV
  2. Airpital - rent out your spare rooms for hospital services
  3. PatientGrades - site for doctors to rate their patients
  4. TeleCrowd - crowdsourcing telemedicine - vote on patient's diagnosis & treatment
  5. AirRx - Start a Mail Order Pharmacy with your unused prescriptions

Five Possible Outcomes for SCOTUS King v Burwell Decision

  1. To avoid split tie decision, Scalia and Ginsberg thumb wrestle to settle matter
  2. Court disallows federal funding in states using, with farmer exemption allowing combined corn/healthplan subsidy
  3. Court strikes down Obamacare - Congress passes emergency band-aid bill providing monthly lottery tickets and band-aids to uninsured
  4. Court rules federal subsidies may continue, but not via - strict interpretation requires actual physical marketplace with pop-up tents
  5. Court keeps Obamacare intact - Congress authorizes funding of time travel - terminator cyborg to go back to 2010 and prevent passage of ACA

Four Upcoming Blockbuster Healthcare M&A Transactions to Watch For

  1. UnitedHealthcare acquires states of Florida and Arizona to increase Medicare marketshare
  2. J&J acquires actual cloud covering east coast for cloud-based pharma initiatives - relocates cloud to reduce future employee snow days
  3. Company formerly known as WellPoint acquires copyright to Star Spangled Banner as part of re-branding company as "National Anthem"
  4. HCA acquires Carnival Cruise Lines to create new medical tourism fleet

Important Healthcare Headlines You Might Have Missed

  1. German government delays renown U.S. Clinic's expansion to Hamburg and Frankfurt - puts Mayo on hold
  2. In nod to digital age, doctor offices now feature e-versions of past magazines in patient lobbies using refurbished Apple Newton tablets
  3. Red Cross licenses use of name to Blue Cross Blue Shield plans wishing to re-brand insurance products in Republican states
  4. Concerns mount with new obesity management procedure converting unused part of brain to second stomach
  5. GAO investigation uncovers missing "M" in Centers for Medicare & Medicaid Services acronym

Hot Healthcare Innovation Initiatives

  1. Implantable chip sends you text message letting you know when your knee hurts
  2. McDonalds / CMS partnership pairing choice of Value Meal with each Value-Based payment
  3. Exercise treadmills installed in fast food line queues
  4. StubHub-like app to auction your doctor appointment time
  5. Starbucks Pharmacies dispensing your daily prescription with your latte

The lists provided in Healthsprocket’s annual April 1st edition of the SprocketRocket newsletter. If you’d like to check out similar lists from previous April 1st editions, click here