The number of U.S. physicians and other medical professionals prescribing electronically is expected to more than double in 2009 due to higher Medicare payments tied to the technology's use. However, only one in four physicians and other prescribers who are office based are e-prescribing, up from 74,000 in 2008. And through the end of August, only 110 million of the more than 3.7 billion prescriptions dispensed annually by U.S. retail pharmacies were sent electronically, according to data released by Surescripts.
This report by CSC Healthcare Group highlights 10 barriers that hospitals must overcome to achieve meaningful use of EHRs, such as integrating decision support into CPOE, managing new types of electronic information, and sharing data with patients and other clinicians electronically. "Achieving meaningful use represents a huge clinical and operational change project on a compressed timeline,' write the report's authors, adding that they "believe that hospitals that learn from the experience of others and succeed on the top ten challenges defined in this white paper will be well on the way to achieving meaningful use."
Meryl Montgomery, MSN, RN, ANCC Magnet Recognition Program® director at the Medical Center of Central Georgia, discusses how the economy is affecting bedside caregivers and how managers can improve staff morale.
For the first time in history, there are four distinct generations in the American workplace. Although no one learning style or preference is common to all members of a specific generation, there are some general characteristics that serve as guidelines for teaching strategies.
Be careful, however, not to stereotype learners. These characteristics and strategies are general suggestions to be adapted to the needs of individual learners.
Research findings indicate that each generation has particular attitudes, expectations, values, work ethics, communication styles, and motivators (Hammill 2005). Let's look at each generation, its characteristics, and teaching strategies that might be most helpful for its members.
The Veterans
Also known as Traditionalists, Veterans were born between 1922 and 1945 and personally dealt with two of the most significant events of the 20th Century: the Great Depression and World War II (Avillion 2008, Filipczak et al. 1999, and Hammill.)
The Veteran's view of family is that of a "traditional" nuclear family, consisting of two parents and their children within one household. They look upon education as a privilege (Avillion, Hammill) and view authority figures with respect. They are not likely to question them or express concerns directly, so you may not find they have concerns until you read their evaluations, so ask for feedback throughout the program. They prefer formal, businesslike learning environments (Avillion).
Teaching strategies for Veterans include:
Make sure learners are able to use equipment needed for the learning activity, especially for distance activities (such as computers, simulation tools, etc.) but don't assume they don't know how to use new technology.
Provide organized handouts that summarize the key points of the learning activity.
Explain how new skills relate to job performance
Encourage discussion.
Don't put Veterans "on-the-spot" by asking them to demonstrate unfamiliar techniques in front of others. Allow practice time in private.
Baby Boomers
Baby Boomers, the product of the post WWII baby boom, were born between 1946 and 1964. Baby Boomers saw the beginnings of changes in the family structure, from the traditional viewpoint of the Veterans to increased number of divorces and single-parent families (Avillion; Filipczak et al.; Hammill).
Boomers were usually doted on by their parents and grew up believing that they were entitled to the best the world has to offer. They believe that they are entitled to education, including higher education, and that they have a responsibility to change the world for the better (Avillion; Filipczak et al.)
Boomers have a passionate work ethic and desire for financial success. They value both teamwork and personal gratification in the workplace. Boomers are dedicated learners and initiated the self-help craze (Avillion; Hammill).
Boomers may come across as know-it-alls and do not respond well to authority figures. They respond best to educators who treat them as equals and share examples of their own experiences with learners. They value team work and personal gratification in the workplace and during learning activities (Avillion).
Baby Boomers are best motivated to learn if new knowledge and skills are designed to help them excel on the job and gain recognition (Avillion; Filipczak et al.; Hammill).
Consider these tips when planning education for Baby Boomers:
Incorporate team building activities, discussion, and icebreakers as part of learning activities.
Avoid extensive role-playing activities. Boomers do not usually like them.
Allow time for private practice of new skills since Boomers, like Veterans, don't like to display lack of knowledge in public.
Make information easily accessible. Remember that Boomers are the first generation to access the Internet and are fascinated with its use.
Generation X
Members of Generation X were born between 1965 and 1980. Referred to as the latch-key generation, Xers are accustomed to having both parents work outside the home and letting themselves in after school with their own keys (Avillion; Hammill).
Xers view education as a means to success. They are cautious about money, having seen their parents downsized, perhaps more than once. Accustomed to change in family and work status, this generation is comfortable with change. They like a balance between work and leisure, value flexibility, dislike close supervision, and prefer self-directed learning. Xers are born distance learners (Avillion; Filipczak et al.; Hammill).
Because they witnessed the downsizing of their parents, and perhaps grandparents, members of Generation X are not loyal to an organization. They do not automatically respect authority figures; you need to earn their respect. Instead, they are loyal to themselves and their own individual career paths (Avillion; Filipczak et al.; Hammill).
There are some distinct differences between how Boomers and Xers view work and education. Boomers invented the 60 hour work week while Xers insist on a balance between work and leisure. Boomers value the team concept at work and in learning, while Xers are perfectly content to pursue distance learning at a time and place convenient for them (Avillion; Filipczak et al.; Hammill).
Here are some tips for designing teaching/learning strategies for Xers:
Make learning activities fun. Xers value fun as part of work and learning.
Incorporate role-playing when possible. Xers enjoy role-playing scenarios and are not really worried about making mistakes in front of others as they learn.
Allow time for discussion. If the learning activity is conducted at a distance set up time for group meetings or online chats. Make use of e-mail as a means to answer questions and share information.
Earn Xers' respect by demonstrating expertise, and sharing your experiences with them. Be enthusiastic.
Xers like visual stimulation. They don't generally read as much as Baby Boomers and prefer visual illustrations over printed materials.
Generation Y
Members of Generation Y were born between 1981 and 2002 and are also referred to as members of the Echo-Boom Generation or Generation Net Avillion; Filipczak et al.; Hammill).
Generation Y's have grown up with technology and are completely comfortable with its frequent advances and changes. They equate education with the ability to find good jobs (Avillion).
They view downsizing as normal and have even less loyalty to organizations than Xers. They focus on what they do, not where they work (Avillion; Filipczak et al.; Hammill).
Here are some education tips for Y's:
Incorporate opportunities to interact with colleagues and educators.
Incorporate fun as well as structure in education. Provide information about objectives, goals, and schedules.
Establish a mentor program.
Provide written resources and ways to access journals, books, and other materials. Unlike, Xers, Y's enjoy and value the time that they spend reading.
Provide convenient distance learning opportunities, but make sure that you offer opportunities to collaborate and have discussions with each other and with educators.
Because you will be dealing with members of all four generations, plan varied activities that incorporate a variety of teaching/learning strategies. Be flexible and enthusiastic. All learners value educators who are sincerely interested in facilitating continuing education and the professional growth and development of their learners.
References
Avillion, A. E. (2008). A Practical Guide to Staff Development: Evidence-Based Tools and Techniques for Effective Education. Marblehead, MA: HCPro, Inc.
Hammill, G. (2005). "Mixing and managing four generations of employees." FDU Magazine Online. Retrieved September 1, 2009 from www.fdu.edu/newspubs/magazine/05ws/generations.htm.
Filipczak, B., Raines, C., & Zemke, R. (1999). "Generation gaps in the classroom." Training 36(11): 48-54.
This article was adapted from one that originally appeared in the October 2009 issue of The Staff Educator, an HCPro publication.
Lawmakers should be careful about imposing an excise tax on health insurers whose so-called Cadillac plans cost more than $8,750 for an individual, or $23,000 per year for a family.
The proposal under consideration by the Senate Finance Committee makes a big mistake in treating the value of those plans as if they are the same—regardless of the groups that those plans cover.
That's the message from Robert Dobson of Milliman, Inc., a large actuarial and consulting firm specializing in health plan and cost analysis.
That's because the actual value of the services a plan provides depends not so much on its price tag, but on the age, gender, profession, health status, and location of the covered population.
For example, Dobson writes in a recent paper, "No Room to Stand," the cost of an employer-sponsored plan for a typical family of four in Miami is $20,282 in 2009. But caring for a similar family in Phoenix costs only $15,000. That's because Miami has the most expensive costs for providing healthcare while Phoenix has the least expensive costs.
This shows "how much more susceptible certain areas of the country are to hitting a fixed-dollar excise tax threshold, such as $21,000," (the amount in the original Finance Committee bill, which has since been raised.)
"Given that medical costs have trended upward at a rate of between 7% and 10% over the last five years, one is left to wonder if the average Miami family will find its benefits exceeding the tax triggering ceiling by the time the tax provision is imposed in 2013," Dobson wrote.
"The main take-away message is that you can't put in a flat dollar amount," Dobson says. What's smarter and fairer is to figure out an actuarial value that would have to be risk adjusted."
Plans covering a group of employees who are predominantly younger, say a group of 30-year-old males, cost about $155 a month, or less than $2,000 per year. But for a plan covering employees who are largely 60-year-old females, the per member per month cost is $717, or $8,604, which comes close to exceeding the ceiling currently under discussion.
And there also is the question of occupational risk. Certain professions have higher utilization of the medical system than others, for example, firefighters or coal-miners. "Does this reform risk penalizing those in higher-risk professions?" Dobson asks.
Dobson says that current hikes in these thresholds, which were intended to be responsive to some concerns about fairness, don't go far enough to resolve the problems.
Dobson asks if the reform proposals under discussion "install both a ceiling and a floor without leaving room to even stand up? . . . It is certainly not out of the question for situations to arise where the ceiling for a given employer group could be lower than one or more of the prescribed floors."
Though health providers nervously prepare for an influenza pandemic that threatens their hospitals, office practices and clinics, more than half of Americans surveyed don't think the virus will have a significant impact on public health.
That's the conclusion of a Harris Interactive telephone survey commissioned between Sept. 10 and 13 by the Deloitte Center for Health Solutions. Of the 2,500 people who received phone calls, 40% agreed to respond.
"The reality is we're never going to get to near epidemic reaction until something really, really hits us hard," says Paul Keckley, PhD, executive director, Deloitte Center for Health Solutions.
Still, Keckley adds, public health officials should be congratulated for being so successful in spreading the word. The survey shows that while 52% don't think H1N1 will have a serious impact, 44% believe it will. "The fact that nearly half the population is aware (H1N1 could be a serious health issue) is a good thing."
Keckley says he was surprised at one finding from the survey, which is that many of those who responded said they did not see the urgency of getting vaccinated and are not associating the virus "as something that could pose a major threat."
That may be, he acknowledged, because precautionary public health messages about washing hands, coughing into one's sleeve, getting vaccinated and not going to work or school while sick have been coming since spring and throughout the summer.
"Maybe people have been anesthetized to the potential threat of this virus," Keckley notes.
Among other significant survey findings:
Respondents in the Northeast (58%) and the West (56%) are more likely to think H1N1 will not have a major impact on the U.S. But 49% of respondents in the South say they believe it is a major threat.
Those who are underinsured are less likely to say they will get vaccinated against H1N1 virus than the uninsured.
While 53% say they plan to get vaccinated, 41% of respondents do not plan to get vaccinated.
79% know the symptoms and where they would go to get vaccinated.
Those who have no health coverage and those who identified themselves as African Americans are more likely than insured or underinsured and those of other racial groups to believe the virus will have a major impact.
Those who are between the ages of 55 and 64 and those 65 and older are also more likely to plan to get vaccinated.
49% said they have a plan where they work or go to school to handle the H1N1 virus. But only 34% of the uninsured say they have such a plan.
Keckley says public health officials have done a good job getting the word around about the potential impact of an H1N1 pandemic, but he says that the days of getting the message out through mainstream media outlets may be over.
That's particularly important for the H1N1 threat, which disproportionately affects younger people than older people, because increasingly, young people don't read a daily newspaper or make a regular habit of watching televised news shows.
Instead, he says, they're more responsive to social media "narrowcasting –tweeting and blogging" messages.
"Huge numbers of people don't come in contact with a news source each day. That's huge."
The Senate may be in a temporary healthcare reform holding pattern for a day or two as the Congressional Budget Office continues to "score," or estimate, the related costs spent or saved in the Finance Committee bill approved Friday. However, blocks away on Pennsylvania Avenue, President Obama on Monday was rallying the "troops"—in this case physicians from every state in this union—for reform in the White House Rose Garden.
The friendly crowd represented groups such as the American Medical Association, the National Medical Association, the Academy of Family Physicians, the American College of Physicians, the American College of Pediatrics, and American College of Cardiology. They also represented workers in hospitals, clinics, and private practices. A number of the physicians were members of a group called Doctors for America, a grassroots organization backing healthcare reform efforts.
"These men and women here would not be supporting health insurance reform if they really believed that it would lead to government bureaucrats making decisions that are best left to doctors," Obama told the audience. "They wouldn't be here today if they believed that reform in any way would damage the very critical and sacred doctor patient relationship."
"Every one of you here today took an oath when you entered the medical profession. It was not an oath that you would spend a lot of time on the phone with insurance companies," Obama joked.
He did talk about prohibiting insurers from denying coverage because of preexisting conditions, placing limits on out-of-pocket expenses, removing caps on lifetime coverage, implementing electronic records, fixing the Sustainable Growth Rate formula by which doctors are reimbursed under Medicare, providing loan forgiveness for primary care physicians who choose to practice in rural and underserved areas, and implementing an insurance exchange. What was not mentioned directly: a public insurance option.
On a related note, Peter Orszag, director of the White House Office of Management and Budget, said in his blog Monday that the "need for health insurance reform just became clearer with the release from the non partisan Institute of Medicine (IOM) of an estimate that the health care system contains over $800 billion in excess costs."
Citing the report, he said that "excess costs” come from a variety of sources such as high administrative costs for insurers, physicians, and hospitals ($200 billion); unnecessary services, such as using more expensive brand name drugs or overusing tests and treatments ($200 billion); errors and avoidable complications ($75 billion); and fraud ($75 billion).
To reduce the costs, he noted that the IOM study identified "different levers to push change" such as: uniform administrative requirements for paperwork; reform of payment incentives oriented toward results and quality; increased reliance on evidence based quality practices; and use of electronic clinical records that can be shared.
"As one goes down the list, almost all these changes have been endorsed by the administration and most are included in the reform bills making their way through Congress, including the legislation currently being considered by the Finance Committee," he said.
A Senate Finance Committee vote on healthcare reform will be pushed back to later this week, and perhaps into next week, as they await an estimate on how much the overhaul would cost. The Senate Finance Committee wrapped up work Oct. 2 on a reform bill, but committee Chairman Max Baucus (D-MT) promised his members that before voting they would have a "reasonable" amount of time to review the bill's price tag, as assessed by the nonpartisan Congressional Budget Office. That report will arrive later than expected.
As Democrats prepare to take up healthcare legislation on the floor of the Senate and the House, they are facing tough choices about two competing priorities: They want people to pay affordable prices for health insurance policies, but they want those policies to offer comprehensive health benefits, reports the New York Times. That tension between keeping costs low and improving coverage is just one of many challenges facing Congress and the Obama administration as they head toward the final stages of the effort to pass healthcare legislation, according to the Times.
For two decades, a Pennsylvania agency has published death and complication rates from more than 50 types of treatments and surgery at hospitals. The state has found that publishing results can prompt hospitals to improve, and that good medical treatment is often less expensive than bad care. The Senate Finance Committee's sweeping health bill would make available $75 million annually for the U.S. Department of Health and Human Services to develop methods of improving quality, including potentially publishing outcomes.
