As a hospitalist, Philip Vaidyan, MD, saw patients on nearly every floor and in a variety of units. He soon found he was spending too much time moving among patients or answering pages from another area of the hospital. Then Vaidyan learned about a growing number of hospitals that reduced these frustrations by assigning hospitalists to specific units of the hospital. These hospitals, including SSM St. Mary's Health Center in St. Louis, say the move has nearly eliminated wasted travel time and given physicians more time with patients, families and staff. The hospitals also hope better access to physicians will lead to better communication, and allow treatment to begin sooner.
A bill passed by the Louisiana Senate will allow two doctors to remain on St. Bernard Parish's hospital commission while also being employed by the Franciscan Mission. The Mission is competing with Ochsner to operate a still-to-be-built hospital in the parish. However, while the doctors can serve on the St. Bernard Hospital Service District Commission, they will not be allowed to vote on any issue involving the Franciscan group. The bill now heads to Gov. Bobby Jindal.
SSM Healthcare-St. Louis recently announced another round of departures, another example of hospitals facing increasing pressure to improve care while cutting costs. In addition, quality directives from managed-care companies and the government are coming with slight, if any, increases in payment. St. Louis Post-Dispatch columnist Mary Jo Feldstein notes that one source of the economic problems facing hospitals is that as health plans raise the patients' portion of their medical bills and more families have fewer dollars to spend, some might be holding off on care. The problem is worsened as outpatient and testing services continue to grow and sends more patients out of the hospital for care, Feldstein says.
As one of the fastest growing counties in the country, Montgomery County, TX, sees nearly a thousand trauma cases annually, but a scarcity of necessary medical staff at local hospitals has left the county in critical need of even basic trauma services, according to a new report.
At least one local hospital says a lack of physicians interested in providing trauma care has left them struggling to obtain Level III certification. "Our plan, even independent of this study was to move back to being a Level III trauma center. The major thing we are facing is our ability to recruit physicians. It's a very time consuming practice, and not everyone is cut out to do it. Our timeframe for getting certified basically has to do with how soon we can find physicians who want to do this work," says Conroe Regional Medical Center CEO Jerry Nash. Conroe Regional dropped its Level III center in 2005 because it could not find physicians who were willing to be on call to the extent needed for trauma care. Nash says the hospital is attempting to regain its certification because there is such a demand for critical care in the area.
Officials at Memorial Hermann-The Woodlands say they also recognize the need for trauma services in Montgomery County and hope to obtain certification at that hospital in the spring of next year. Ann Brimberry, director of public relations for the Memorial Hermann System says, "Trauma care is not a given for any one hospital. It requires a collaborative effort between the hospital and physicians along with talented and dedicated staff, facilities, equipment, and financial resources. With overburdened Level I Trauma Centers in Houston, the need for Level III and perhaps higher level trauma centers in the suburbs is critical," she says.
The study by The Abaris Group says that costs and the ability to find willing and able surgeons will remain a challenge; however, it says the area has enough trauma patients each year to support a Level III trauma center and in five years could could most likely support a Level II facility. The researchers also determined that hospitals can profit from a Level III trauma center. It is estimated that the annual cost to run a trauma center would be $730,000.
Although medical-ethics teams are increasingly the arbiters of agonizing health decisions, there are questions about how qualified some of these professionals are to render life-and-death advice. The complex ethical issues arising from new life-prolonging medical technologies are throwing up new challenges, and hospitals face potential legal liability if patients and families feel they haven't been properly counseled or provided with all the information they need to make decisions.
There were two themes I heard repeatedly at the America's Health Insurance Plans (AHIP) conference in San Francisco last week:
Consumer-directed healthcare (CDH) is more than shifting health costs onto members; it is a way to put consumers in charge of their healthcare and provide them with the tools to make educated decisions.
Creating personal health record (PHR) portals is not enough. Consumers have not shown much interest in PHRs because the portals are used simply as a place to dump information rather than interactive tools for members to become more informed.
CDH
Sander Domaszewicz, senior consultant at Mercer Human Resources Consulting in Newport Beach, CA, said consumer-directed healthcare isn't about forcing employees to pay a greater share of their healthcare bills. A CDH plan design will fail without consumer tools like physician and hospital quality data and funding sources such as health savings accounts or health reimbursement accounts.
Domaszewicz said health plans have an opportunity to help educate their members. Though studies show that patients trust their physicians more than health plans and employers, Domaszewicz said 70% rely on family and friends for healthcare advice, half admit they haven't followed their doctors' advice, and nearly half of people reject care management program offerings.
“There is a disconnect between what is the best thing for them and their families, and what they're doing,” he said.
The challenge is engaging those people, changing their minds and behaviors, and making them part of the healthcare team. Simply creating a health plan with deductibles and health savings accounts as a way to pass healthcare costs onto employees is not the way to make an educated consumer—or a happy employee.
PHRs
Dennis Schmuland, U.S. health plans industry solutions director at Microsoft, told me health plan member portal traffic has been lower than hoped because the portals are too stagnant.
Microsoft's entry into the personal health record market last year was met with anticipation. Microsoft's personal health record, HealthVault, allows people to populate a PHR and share the information with third parties to create health, wellness, and fitness services. The technology giant added to its offerings last week with a new consumer health platform to help payers connect services like HealthVault and Windows Live, which Microsoft says will allow the user to help manage health through continuity of care documents, prescription medication lists, health histories, hospital discharge summaries, and lab test results.
Schmuland says the patient portal is an important channel, but is only one way to reach members. Health plans must provide a multi-channel approach if they expect to impact their members' health and lower costs.
“That's really where health plans need to go—to go where the consumer goes,” says Schmuland.
What can you do?
That these two topics were so prominent at AHIP should not be surprising. Both go to the heart of one of the major challenges in the health plan industry: to produce products and services that engage the member. Simply creating programs, such as a PHR or CHD will not work—consumers have shown us that.
Both have not impacted healthcare as hoped, and a reason for that is there simply isn't enough interactivity. Look at it this way: Millions of Americans don't stay up-to-date with their personal financial records like balancing checkbooks. So why would healthcare expect consumers to log in to their PHRs? You must give them a compelling reason.
The solution is to offer them valuable information that interests a member's specific needs and find out how and by what means to best reach that individual. That could mean a phone call, e-mail, instant message, interactive Web site, text messages, or any other emerging form of technology to create a multi-channel approach.
Health plans need to find ways to make valuable connections to members in order to remain competitive in this increasingly technologically-advanced marketplace. Simply transferring costs on members and uploading a PHR onto a Web site doesn't cut it.
Les Masterson is senior editor of Health Plan Insider. He can be reached at lmasterson@healthleadersmedia.com .
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