Engaging Millennial Parents to Increase Well-Child Visits

Scheduling well-child visits can be problematic for young parents. Many don’t know how often to bring in their children or understand the importance of regularly scheduled visits. Regular visits are particularly critical during the first three years of a child’s life to track growth and development, help prevent illness, and allow early intervention when necessary for optimal outcomes.

Text message reminders have become an expected touchpoint for dental appointments, vet visits, car maintenance, and various other services for today’s consumer. But some providers have been slow to engage parents via text to help keep their children on track with recommended care plans.

Millennials, who are accustomed to checking their text messages regularly throughout the day, respond positively to businesses that reach out to them via text. Young parents want the efficiency and convenience of smartphone messaging in most aspects of their lives, including appointment reminders.

See how Park Nicollet utilized PerfectServe’s Patient & Family Communication functionality to launch a text message appointment reminder program helping new parents more closely adhere to the recommended well-child visit schedule.

Constructing the Program

In 2016, Park Nicollet, part of HealthPartners, a nonprofit healthcare system based in Minnesota, launched a text-message-based reminder program to proactively support young parents in scheduling well-child visits from infancy to late childhood. The American Academy of Pediatrics (AAP) recommends six visits in the first 15 months (Health Plan Employers Data and Information Set [HEDIS] measure), which fits into the broad scope of 12 recommended well-child visits by age three.

To promote parents’ adherence to the advised schedule, our team set five goals aligned with best practices from AAP’s Bright Futures initiative:

  1. Keep children on time for well-child visits.
  2. Prevent missed visits and gaps in care.
  3. Improve the patient and parent experience.
  4. Support Bright Futures—recall and reminder system.
  5. Improve the HEDIS measure.

A program was launched using an algorithm based on birth dates to send text messages at appropriate intervals to parents of children aged two months to 36 months. Instead of waiting to reach out until after appointments were overdue, preemptive texts encouraged parents to schedule before the next well visit, offering a direct link for parents to easily schedule an appointment. The seamless and automatic process allowed Park Nicollet to reclaim precious staff time that was previously used to manage reminders.

Program Structure

Birth to Three Years

A SMS text message is sent to the child’s family or primary caregiver 30 days prior to the next well-child visit,
based on the child’s date of birth. Then, text reminders are only sent if an appointment is not scheduled in the appropriate timeframe.

Three to 10 Years

A text message is sent to the child’s family or primary caregiver two weeks prior to the next well-child visit, based on the date of the child’s last well-child visit. Then, a text reminder is only sent if an appointment is not scheduled in the appropriate timeframe.

Launching the Program

Launching the program with a small patient population (birth to three years) enabled Park Nicollet to see results quickly; early results showed that the text outreach was positive. Patient satisfaction increased among parents, who loved the ease and convenience of the program. Prior to the texting program, patients were seen an average of one month after their recommended well visit. Only three to six months after initiating the text reminder program, the one-month average gap was cut in half, meaning patients were seen closer to AAP recommendations.

Implementing the program on a smaller scale provided an opportunity to identify and address problems before expanding to the larger population. The biggest challenge involved parental consent and whether to design an opt-in or opt-out program. Park Nicollet defaulted to an opt-in program, requiring parents to provide consent to start receiving text reminders. Eventually, this obstacle overcome by training frontline staff to have parents sign consent forms, but the face-to-face process limited enrollment to the parents who were already making and keeping appointments.

Efficient enrollment and expansion required automation and updating of the electronic health record (EHR). Following the EHR integration, enrollment consent was captured in the EHR and parents didn’t need to be present in the office if they had consented to text messaging as their preferred appointment reminder.

With enterprise-wide expansion of PerfectServe’s Patient & Family Communication to all HealthPartners facilities in 2017, the automated process increased enrollment by over 35,000 and increased well-child visits by 10%. Based on the last reported 12-month period, enterprise-wide enrollment has over 79,000 active patients, which includes HealthPartners and Park Nicollet, and over 43,000 enrolled patients for Park Nicollet alone (see Table 1).

Table 1

Development and Expansion

With expansion of the program to Park Nicollet’s entire clinic care group in 2019, they began using text reminders for well visits for children up to age 10. Future initiatives with the program for Park Nicollet included incorporating additional languages (a sizable subset of HealthPartners patients is non-native-English speaking). In addition, increased enrollment of the millennial population presented opportunities to address various patient population needs—such as:

  • Reminders for flu vaccines and other immunizations.
  • Health metrics monitoring.
  • Checks for postpartum depression.

A Roadmap for Getting Started

Leveraging technology with a trusted and experienced partner enabled the team at Park Nicollet to create a program that worked for patients’ families. Following a digital roadmap, PerfectServe and Park Nicollet worked together to build reports derived from actionable, engaging, timely, and relevant data. Based on these insights, here are five recommendations for implementing a successful texting program:

  1. Partner with a solution that has proven expertise with EMR systems and experience providing reliable, secure communication to patients and their family.
  2. Engage a project champion to guide project design, implementation, effectiveness, expansion, and quality assurance.
  3. Assemble a multidisciplinary team—mobile communication technology partner, EMR vendor, physicians, quality improvement specialists, health information management (HIM), compliance and legal experts, growth strategists, and frontline managers—and solicit input from all stakeholders.
  4. Launch a scaled down program with a small population to identify and address problems before expanding to a larger patient population.
  5. Initiate the process with a mindset of patience. Avoid trying to implement the program hastily and without forethought. This endeavor demands careful preparation to ensure success.

PerfectServe’s Patient & Family Communication solution gives providers a simple and elegant way to engage directly with patients. From sharing directions to your office before an appointment to checking in with patients post-discharge, text messaging is a quick, effective, and easily automated way to stay connected with any patient population—most of all millennials.[/vc_column_text]

Learn more about how PerfectServe supports patient-provider communication by contacting one of our Clinical Communication Specialists below.

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Comprehensive Clinical Communication to Support Mother-Baby Care Delivery

Nearly four million babies are born per year in the United States.1 Obstetricians, pediatricians, nurses, case managers, discharge coordinators, and various other providers and care teams work to ensure that mothers and babies have optimal solutions for pregnancy, labor, delivery, and child healthcare.

From preconception to parenthood, PerfectServe’s comprehensive communication solutions can help your practice provide top-notch care at every touchpoint of mother and baby’s healthcare journey. Click the image below to download the infographic.

1Births and Natality, Centers for Disease Control and Prevention: cdc.gov/nchs/fastats/births.htm

To learn more about how PerfectServe can support your organization in mother-baby care delivery, contact one of our Clinical Communication Specialists.

Patient Benefits of an Advanced Automated Answering Service Solution

Patient experience is the most important factor when it comes to patient retention at any medical practice. An essential touchpoint to optimize in modern medical practices is to standardize the way your patient calls are handled. The right 24/7 answering service solution can free up valuable provider and staff resources to focus on patient care while reducing unnecessary interruptions and ensuring urgent messages reach the right provider at the right time—every time.

Removing human error and delivering an automated and reliable service for both providers and patients, advanced answering service solutions are being implemented by more and more practices to enhance both patient and provider satisfaction.

Here are just a few key patient benefits of an ideal automated answering service solution:

Less Frustration

Your patients have busy lives but your practice is busy, too. If your practice experiences call volume congestion, your patients still need to be able to reach you without being put on hold. The right answering service solution will differentiate messages based on urgency and use your on-call schedules to accurately route communication to the right provider based on escalation policies set by your practice, speeding time to treatment.

Timely Communication

Efficient practice operations help decrease the time patients spend waiting during appointments and on hold when they call your practice. Automation allows patients to reach your practice at any time, during any circumstances to get the answers and help they need. The best answering service solutions offer smart routing that ensures providers are only interrupted to address urgent requests that require responses in a timely manner.

24/7 Care Access

Although many answering services are only used for after-hours coverage, an automated answering service solution delivers around-the-clock coverage as needed. Just because you don’t see your patients on a 24-hour basis does not mean it shouldn’t be easy for them to manage their appointments and make routine requests such as medication refills whenever they think of them, which might not be during regular office hours. An automated answering service solution can support call volume overflow when the main line at your practice is busy and serve as a 24/7 backup during emergency events when your practice is closed.

Better Onsite Service

Your staff need to be able to do their jobs, but when they face constant interruptions and take on the additional task of call filtering, concentration is broken, efficiency is lost, and providers can become unable to best care for their patients. Implementing the right automated answering service solution can free up your team to focus more on what they do best—patient care.

If providing an excellent patient experience and running an efficient medical practice are priorities for you, an advanced automated answering service solution might be just what the doctor ordered.

Let’s discuss more about how the ideal automated answering service solution can benefit your patients.

 

4 Simple Steps for Reducing Third-Party Vendor Costs

In the era of nonstop mergers and acquisitions, healthcare organizations are taking on immeasurable costs in the form of third-party services. When a health system acquires a private or independent group practice, the health system inherits all the practice’s employed third-party services and systems, including:

  • Electronic Health Record (EHR)
  • Practice Management
  • Revenue Cycle Management
  • Medical Answering Service
  • Security, Maintenance, and More

When healthcare organizations merge, issues with purchased services compound as the health system takes on all existing service contracts from the practices affiliated with the previous organizations. Purchased services represent as much as 20% to 25% of an organization’s annual spend,1 so consolidating services is a valuable opportunity to save on spending.

Standardizing third-party processes and technology can be an untapped source of savings across the healthcare supply chain. To help you identify areas in need of improvement, here are four steps that can help successfully lower your organization’s purchased services costs:

Step One: Mine the data.

For many healthcare organizations, simply gaining visibility into third-party contracts and expenses can be challenging. Contracts are often managed by various people throughout healthcare organizations, or even services outside organizations, such as group purchasing organizations (GPOs).

Start gathering the actualities by creating an inventory of all third-party vendors used throughout your organization, as well as the associated stakeholders and contracts. It’s important to speak with each stakeholder and review each contract thoroughly.

Next, collect all financial data for your vendors. Check with your accounts payable department and take a look at current and past purchase orders. While purchase orders won’t tell the whole story, they are a good place to start to get an idea of total cost. Many third-party vendors have variable costs that make it difficult to get an accurate account of how much they’re really costing. Reviewing your general ledger will help you uncover variable costs.

There are a few key questions to consider when reviewing your service contracts:

  • What rate is this vendor currently charging me and how often?
  • Is there an auto-renewal in place? If so, when?
  • What are the scaling terms and are there fees associated with scaling?
  • Are there termination clauses? If so, what are they?

Place vendors into categories to get a more accurate picture of how much your organization is spending in specific areas. You may find that the individual costs of many of your third-party vendors are relatively small, but when aggregated by category, the numbers compound quickly.

Step Two: Gain Executive Buy-In

Equipped with your data, it’s time to engage your decision makers. Engaging organizational leadership early in the process is a great way to build a case to move forward. Speaking with executives can help you understand the different viewpoints and situational nuances in your organization, which helps you navigate roadblocks and build the business case to make changes.

Step Three: Evaluate Performance

Analyze vendor and service performance in three key areas:

  1. Comparing Spend
  2. Assessing Utilization
  3. Evaluating the Quality and Effectiveness

Some vendors charge hidden or variable fees, so looking at one month’s service charges can be misleading. Look at each vendor’s historical cost, trends, and variability. Then, consider local benchmarks: What prices are other vendors in your area offering for a similar service?

Another important aspect to consider is utilization. Here are a few simple questions that can help you assess your organization’s use of a particular service or vendor:

  • Who is actively using the service/vendor?
  • How is the service/vendor being used?
  • Could the service/vendor be used more efficiently?

Finally, do some digging to find out your staff’s level of satisfaction with the third-party service/vendor:

  • What level of results is the service or provider currently delivering?
  • Are your stakeholders satisfied with the performance?
  • What kinds of performance metrics can the service or vendor provide?
  • Does the service or vendor meet your organization’s performance metric needs?
  • Does the service or vendor make your staff’s job easier?

Step Four: Consider Standardization Options

Completing steps one through three will give you a firm grasp on the types of vendors you have and the services you’re paying for, how they’re being used throughout your organization, and your staff’s readiness to try new solutions.

If you consider replacing multiple similar vendors with a single standardized solution, make sure the solution you select does the following:

  • Addresses all stakeholder needs and goals.
  • Decreases (and if possible, helps to standardize) your organization’s overall spend.
  • Contributes to your organization’s strategic objectives.

When your organization undergoes a merger or acquisition, it’s more important than ever to conduct a high-level review of the spending and operating efficiency of the larger organization. At the end of your evaluation, you should be better prepared to make specific service and vendor selections based on your analysis and your organization’s strategic priorities.


1Vizient, 2020

5 Warning Signs Your Answering Service Might Be Hurting Your Practice

Medical answering services are essential to modern practices for triaging patient calls, delivering urgent messages at night, and allowing receptionists to focus on imperative tasks during business hours. An effective answering service solution can help practice managers, providers, and staff improve the overall patient experience and increase patient satisfaction.

Unfortunately, some medical answering services are susceptible to manual errors and environmental challenges. Routing mistakes and connectivity issues can negatively impact both patient and provider satisfaction.

Here are five warning signs your medical answering service might be negatively impacting your practice:

1. Poor Provider Satisfaction

Your providers’ wellbeing is essential to their satisfaction, livelihood, and ability to best care for patients—yet provider burnout is on the rise. Key contributors to burnout include receiving non-urgent calls after hours, getting unnecessary interruptions while caring for patients, and dealing with other communication challenges that interfere with providers’ daily workflows.

Contacting providers at the wrong time is a common mistake. When the answering service makes an error and contacts your provider at midnight on their Saturday off or interrupts their time with a patient for a non-urgent or routine message, it brings down the provider’s satisfaction and makes it more difficult for your practice to retain top talent.

Providers who are unable to work at their best due to unnecessary interruptions and complicated communication workflows may experience burnout and decide to leave your practice. Losing providers reduces patient satisfaction, lowers revenue, and increases your recruitment and onboarding costs.

2. Declining Patient Experience

It’s important to let patients know they are being heard and cared for, not ignored, yet missed and lost messages are another common issue with medical answering services.

If your answering service loses patient messages, fails to take thorough notes during a call, delays sending urgent messages, or sends messages to the wrong provider, your patients will begin to feel frustrated and undervalued.

3. Negative Impacts on Your Practice’s Reputation

To your patients, your answering service is a representative of your medical practice. Errors and poor patient encounters with live answering service can be harmful, and even detrimental, to your practice’s reputation in providing quality patient care.

It is imperative to ensure that your answering service—which many patients do not know is a third-party service—is delivering the quality of care and experience you want your patients to expect from you. Keeping your patients satisfied and confident in their care is the key to patient retention.

4. Fluctuation of Practice Operating Costs

Your medical answering service may be costing you much more than you originally intended. Many answering services have hidden fees and charges based on call volume and duration, causing practices to spend much more on the service than was budgeted. For a more accurate account of how much your medical answering service is really costing you, look at your month-over-month charges and take note of the fluctuations. Hidden fees can add up quickly when practices don’t pay close attention and consistently follow up on billing.

5. Inability to Support Patients During Emergencies

Healthcare can’t stop when inclement weather, natural disasters, or other emergencies happen. Keeping lines of communication open between your providers and your patients is essential, especially during times of uncertainty. Your medical answering service must be available and connected to take patient calls and route messages correctly and quickly at all times.

If your medical answering service depends on live operators, a natural disaster or similar emergency could make it impossible for agents to receive or answer your patients’ calls. You can learn more about identifying risk to prepare for unprecedented circumstances from our related blog post and our Medical Practice Disaster & Emergency Preparedness Checklist.

Not all medical answering services provide the same level of service and support.

Use the factors above to assess your current medical answering service vendor and decide if it’s time to look for another solution that can better protect your medical practice.

Consider how an automated medical answering service solution can help strengthen your practice.

The right answering service solution will provide a consistent patient experience, reliable connectivity, accurate message routing, and appropriate escalation while supporting work-life balance for your providers and eliminating variable costs.

Let’s discuss how your practice can benefit from the right answering service solution.

How much is your answering service costing you?

medical answering service warning

Sometimes, traditional medical answering services come with hidden costs that could be undercutting the success of your practice. Costs associated with human error—such as lost and delayed messages, negative patient interactions, inaccurate symptom descriptions, and more—carry significant risk for your patients and your practice.

Mistakes that were once par for the course with answering services have become largely avoidable in a modern healthcare environment. Since quality communication between patients and providers (before, during, and after business hours) is a fundamental pillar of patient care, it would be wise for any organization using a live medical answering service to ask yourself the following questions:

Are your patients being served a positive experience with your practice?

Any negative encounters with your practice (including over the phone) can begin to erode the trust and positive relationships you have built with your patients. Many patients perceive the answering service as an extension of your practice—not a separate, third-party service. That makes live call agents a contributing factor to your overall patient experience, a factor you have limited control over.

If a patient feels at any time as though their medical needs are not met with the level of urgency they feel is necessary, their trust in your practice quickly dissolves into frustration, fear, and motivation to seek care elsewhere. Whether or not a patient leaving costs you any recurring revenue, word of mouth can impact your organization’s reputation for care quality and, therefore, your ability to bring in new patients.

Is your staff empowered to use their time as efficiently as possible?
It’s tough to assign a dollar amount to the frustration of having to resolve a breakdown in patient care caused by miscommunication. It’s impossible to quantify the impact of anxiety your staff can develop when they feel unable to deliver the best patient care due to issues with the clinical communication process. But if your communication process isn’t optimized to help providers focus on delivering proper patient care, you may wind up calculating costs in terms of turnover and other negative effects of low provider satisfaction and burnout.

Are you legally or financially at risk?

Some unlucky practices have discovered a best-kept secret of certain deceptive answering services: subcontracting. In some cases, live “medical” answering services turn out to be subcontracting their work out to other answering services that don’t always have a medical focus or adhere to HIPAA compliance standards.

Few medical practice leaders would knowingly risk placing subpar answering services between their patients and their providers or practice. In fact, a practice in this situation is at risk for fines and penalties associated with breaches involving PHI and unsecure communications.

Another scenario in which a practice using a live answering service may be at risk includes one where the answering service is referencing an outdated provider shift schedule.

Consider this worst-case scenario A patient, unknowingly suffering from a stroke, calls your practice after hours to report blurred vision and confusion. The medical answering service, operating off of an inaccurate on-call schedule, fails to deliver the patient’s message to the correct on-call provider for another hour. Due to the time-sensitivity of this ailment, your practice could be at risk for a malpractice suit.

An unforeseeable and adverse incident like the one above could become a substantial loss for your practice.

Are you safeguarding your reputation?

Imagine another unfortunate scenarioA critical care surgeon with his own practice routinely performed emergent consults for a local hospital. But then, the hospital stopped calling. They felt the surgeon’s medical answering service was unable to deliver messages in a timely, efficient manner. The hospital now works with other providers instead.

Don’t let the above scenario happen to you. Your credibility and reputation in the healthcare community can be negatively affected if outside consultants and hospitals cannot reach you quickly in times of emergency. The impact of an unreliable reputation can be detrimental to your providers and your practice. It may seem easier to stick to the status quo with a live answering service, but is it worth letting avoidable lapses in communication tarnish your reputation?

Have you uncovered all hidden fees?

Most medical answering services are upfront about their fees, but practice leaders and managers seldom realize how many fee-based events they’re actually being charged for on each single after-hours call or message. Varying types of hidden fee-incurring events include:

  • Taking the call or message.
  • Relaying that message to the right clinician.
  • Relaying the clinician’s instructions back to the patient.
  • Recording and logging the conversation as a whole.
  • Recording and logging each communication.

These events can incur minute fees that can account for an unexpectedly substantial amount of overtime.

What is the real cost of your answering service?

Take a skeptical look at your answering service’s monthly invoice to understand the hard costs. Think through how your current answering service effects patient safety and satisfaction, as well as your providers’ satisfaction. Is your answering service a compliance risk? Can it harm your professional reputation? At the end of the day, these are the costs that put your practice, providers, and patients at risk.

What is the best solution to eliminate the costs and risks of your answering service?

In the age of digital communication, automated tools are commonly used to eliminate human error, simplify communication processes, and streamline accurate connections. These advantages are perhaps most valuable in a clinical environment. An ideal medical answering service solution can sync with the most up-to-date shift schedules, protect providers’ caller IDs, escalate urgent messages, and save non-urgent messages for regular business hours.


Let’s discuss how your practice can benefit from the right answering service solution.

Tips for structuring a successful device pilot

One of the most common mistakes hospital systems make when implementing a mobile device strategy is choosing the wrong devices. Problems like devices not roaming well from access point to access point, or even simple manufacturer quality issues, can sabotage a strategy’s success.

It’s easy to assume that if a device costs upward of a thousand dollars it would meet almost any need a clinician could have, but many hospitals have found out the hard — and expensive — way that a high-dollar price tag doesn’t guarantee the best device for their user groups.

The best way to avoid this risk is to pilot any device before making a big purchase.

The importance of end-user input

The most important thing to keep in mind when piloting a new device is to conduct the pilot in real-world situations. There is a greater chance of a successful pilot if the devices are put right into the hands of end users and are used throughout the day within normal workflows.

Most end-user groups in hospital settings are very mobile by the nature of their jobs. Clinicians must be in many different places throughout the facility at many different times of day. And it’s necessary to make sure their devices roam effectively throughout your facility, without falling off the network.

For example, be sure to test the user experience at somebody’s desk, in a patient room, and in common areas of the hospital such as hallways, cafeterias and conference rooms. Don’t forget about areas outside the hospital, if personal devices are going to be included in your strategy.

Also, have a variety of end-user groups — e.g., nurses, ER directors, residents — test the devices. Apply as many variations as possible to the pilot process to increase the probability of finding a deal-breaking oddity. This will help you avoid purchasing and deploying expensive devices that aren’t going to work well within your hospital’s workflows.

Consider maintenance needs along with functionality

When it comes to workflows, test the devices against IT’s own needs. Think about the IT team’s ability to maintain the agreed-upon devices and policies, as well as manage them. The devices and the device strategy need to work just as well for IT as they do for the end user.

Another critical but sometimes overlooked element of the pilot experience is to test installation of commonly used applications. The goal here is to avoid any showstopping surprises after the devices are purchased and in the hands of hundreds, maybe even thousands, of end users. There are application limitations that are common to certain operating platforms, and if these limits are not tested before a device is selected and purchased, a breakdown in workflows and strategy adoption is likely.

For example, there’s a common assumption that by purchasing an Android device, end users will be able to run any app from the Google Play Store. The reality, though, is that some of these devices are on old versions of Android — i.e., 4.9 or lower — or they are heavily modified versions of Android that don’t support the Play Store or don’t support Google Cloud Messaging.

Since Google Cloud Messaging is used for push notifications, that’s the default push notification mechanism. If devices don’t support this feature, then extra work will be required.

You want to be as informed as possible about what you’re buying and how it’s going to work in real-life scenarios within—and beyond—your hospital walls.

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Managing the surprisingly troublesome impact of real-time healthcare on clinical decision-making

We live in an age of instant gratification. From the texts we send friends and family to the orders we place on Amazon.com, we’ve come to expect immediate results: instant responses, next-day shipping, etc.

The idea of immediacy in healthcare communications is not new. In fact, in 2015, healthcare analyst Gartner outlined a vision for what it dubbed the “real-time health system”—a landscape where healthcare professionals will be constantly aware of what’s happening within their systems and with their patients.

As a person living in the digital age, you’ve probably experienced real-time awareness in other parts of your life: the repetitive dings of received text messages, the intermittent beeps of calendar alerts, the near-constant hum as your smartphone vibrates over and over to let you know your mother, children and cousins have uploaded photos to Facebook, Instagram and Snapchat. In fact, as I’m typing this piece, I’ve heard alerts for two personal text messages that I’ve yet to look at (the temptation is maddening), four work-related emails (that I did have to stop and look at), a notification that someone commented on a thread I replied to on Facebook and more.

While there’s definitely a benefit to each of us knowing what’s happening in our expanded universe in real time—and we can easily draw a direct line to the benefits that doctors, nurses and patients would experience if they could communicate instantaneously while coordinating care—the influx of information is simply overwhelming.

And when alarm fatigue sets in, important messages get missed, the communication cycle breaks down and what was once a valuable resource becomes a liability. Overwhelmed and inundated clinicians cannot optimally use their invaluable expertise to make effective clinical decisions that deliver great health outcomes.

Aggregating, analyzing and managing the distribution of clinical information

Managing the flow of data and alert fatigue is a real challenge that clinicians and the IT teams that support them need to understand. Clinicians need “just the facts, ma’am,” so to speak, and they need to know which set of facts pertain directly to them and the patients for whom they are caring. Receiving more than enough information is not always a good thing, especially when the situation calls for fast thinking and quick decisions.

Investments made in technologies implemented over the past several years have enabled healthcare as an industry to generate very large amounts of digitized clinical information. The challenge is to aggregate this patient data in real time to generate new knowledge about a patient and distribute it in a way that does not inundate the clinician recipients with unnecessary information. Physicians and nurses should receive information they need in order to act in that moment. Everything else is noise.


Learn how a care team communication solution can enable your clinical integration strategy. Get a demo.


Implementing communication-driven workflows

Once new knowledge is made available and deemed relevant to a given clinical situation, it’s important to enable workflows that drive this information to the right care team members, who can take action in that moment. Hospital-based communication workflows must encompass all modalities, adhere to strict security mandates and facilitate reliable exchanges among clinicians across boundaries (e.g., acute, pre-acute and post-acute care settings). This kind of clinical integration is the future of healthcare communications.

If clinicians are inundated with unnecessary information, messages and alerts, combined with a communication workflow that creates barriers to a) finding the right care team member to contact, b) finding the contact method that the clinician prefers and c) knowing whether the intended recipient received the message, the workflow is flawed and is inhibiting the decision-making that leads to higher standards of patient care.

Leveraging clinical expertise

The personal judgment of experienced healthcare professionals is irreplaceable in effective, real-time decision-making. Technological advances are no doubt improving healthcare, but human intuition can never be replaced by a new device or software. However, that intuition can be inhibited by technologies if they are not strategically implemented and managed. In this sense, real-time healthcare could, ironically, be eroding quality.

To truly leverage the hundreds of collective years of clinical expertise housed in the minds of your hospital’s medical staff—the expertise that yields great outcomes—you must remove the barriers to effective communication. Collecting patient data in real time is an important part of that. But analyzing and aggregating that data into digestible, valuable pieces of information that can be easily shared and collaborated on is the follow-through that is often overlooked.

The gravitation toward instant gratification isn’t going away. And it’s important to understand that the concept doesn’t apply simply to generating patient data as healthcare events are occurring, but also to the ability to extract the significant portions and begin collaborating with the broader care team to interpret the data and derive a plan to deliver high-value care.

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The Important Role Nurses Play in Care Transition and Reducing Readmissions

In its simplest form, “care transition” is defined as a hospital discharge or movement from one care setting to another. The risk that readmissions pose to patient safety requires that transitional care processes are under constant evaluation.

Nurses are the linchpin in clinical communication and coordination of patient care and thus are best equipped to coordinate a successful transition. The bedside nurse, for example, may understand a great deal more about the patient’s needs as they travel through the care continuum than other care team members. And when those needs are communicated effectively, the nurse is given the opportunity to extend to the patient high-value care beyond organizational boundaries through clinical communication.

Nurses create transitional care plans by compiling all the pertinent patient information and creating instructions to be followed. Then they share the plan in detail with all members of the new care team so that the handoff is seamless for both the patient and the new unit or facility.

The most important factor in transition of care is communication during the handoff process.

What to communicate and when

The goal of the handoff is to safely transfer the patient from one care setting to another (or to discharge the patient from the hospital completely) by exchanging the necessary information with, and by effectively transferring the responsibility of care to, either a new care team or the patient’s family.

It’s a lot to put on any nurse’s plate, but by standardizing and implementing an effective and comprehensive transition communication process, nurses can elevate patient safety, avoid adverse events that lead to costly readmissions and decrease patient anxiety during the transfer process.

It’s important to remember that the transfer process doesn’t apply only to moving a patient from an acute setting to the home or a post-acute environment. There are many different handoff scenarios within the same organization, unit and floor that need your close attention.

For example, nurses should be prepared to provide handoff communication:

  • At shift change
  • During a break
  • When patients are transferred within the hospital (e.g., from the ER to ICU, from radiology to the OR, etc.)

It’s extremely important for the purposes of continuity of care that the communication between the nurse and either the new team of clinicians or the family prepares them in such a way that they’re able to anticipate the patient’s needs and make timely decisions.

At a high level, to adequately prepare the new care team, the following should be included in the handoff communication:

  • Patient care instructions
  • Treatment description
  • Medication history
  • Services received
  • Any recent or anticipated changes

More specifically, and especially in the case of transfers to a new care team or facility, an effective care transition communication plan will include:

  • Patient’s name and age
  • Reason for admission
  • Pertinent co-morbidities
  • Code status
  • Current isolation or precautions
  • Elopement risk
  • Lab results—including any pending and/or abnormal findings
  • Relevant diagnostic studies
  • Fall risk assessment
  • Any assessment findings that are appropriate to the patient’s current health

Many times, nurses on the receiving team care for patients for whom they lack pertinent health data. For example, EKG results are often left out of the transition communication between hospitals and subacute rehabilitation facilities. In this case, if a patient has an episode of chest pain, the receiving team could conduct an EKG on their own, but without prior results to compare with, they can’t successfully rule out something dangerous, such as angina. So, they may err on the side of patient safety and send the patient back to the hospital, resulting in a readmission. However, if an EKG result is included in the transition communication, the receiving team can conduct an EKG on their own, compare the results with the EKG performed at the hospital, and determine whether there is an emergent need for a readmission or the issue is something they can safely handle in their own setting.

Pay extra close attention to medication communications

While including all pertinent test results in the handoff communication is extremely important, there’s another area that needs special attention, because it causes more admissions than any other factor: medication.

It’s estimated that 30% of hospitalized patients have at least one discrepancy on discharge medication reconciliation. Communicating medication details is an area that poses the greatest risk for error as well as the greatest opportunity to effect a positive outcome. In fact, over 66% of emergency readmissions for patients over 65 years old are due to adverse medication events.

Breaches in handoff, such as failure to include specific details of the patient’s medication history and future dosage needs, have dire consequences.

However, defective handoffs are also known to cause problems beyond adverse events. Issues such as delays in care, inappropriate treatment, and increased length of stay arise when transition communication is not strategically planned and delivered.

There are many root causes of a defective handoff, but since nurses play the most important role in the transition communication process, you must strategically develop and communicate the transitional care plan—not only by considering what information you believe should be communicated, but by extending a dialogue to the receiving team and understanding what information they feel is necessary to provide the best follow-up care possible.

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What to expect from MACRA: The early years

MACRA legislation passed in April 2015. When the initial version of the rule came down, the industry collectively braced for declining revenues, the avalanche of administrative paperwork and the increase in overhead costs that would be required to comply.

When the final rule was issued in October 2016, the tempered requirements seemed to point toward fewer projected negative payment adjustments in 2019, the target year for MACRA’s first Quality Payment Program distributions, and the tension subsided a little.

Even with the new allowances in reporting and threshold scores, the MACRA structure makes clear that there’s an abundance of work to be done, especially around efforts to promote care coordination and communication.

Year 1: 2017-2018

Now that we’re already into 2017, the first official reporting year, tensions are rising again because, even though most physicians acknowledge they are going to participate, the majority have not yet plotted their course or defined a compliance strategy.

And if you’re in the group that hasn’t figured it all out yet, the good news is you’re not alone.

According to a recent poll conducted by The Health Management Academy, almost half of the physician and practice leaders who participated are not moving very quickly toward adopting value-based payment models. In fact, only 4% claimed to be moving “very quickly” while almost 40% admitted to moving “very slowly” toward value-based care.

Somewhat surprisingly, the same is true even for large hospital systems. These organizations are perceived to be the driving force, the ones moving the fastest toward the end goal of value-based care, and yet, per a similar poll, few of the large systems are moving very quickly.

Only 8% of large hospital systems polled are moving swiftly toward implementing value-based payment models. – The Health Management Academy, 2017

The Quality Payment Program, however, is going to be the catalyst for healthcare organizations, both large and small, moving more aggressively toward these models in the next couple of years.

The MACRA structure and how you fit in

By now, you know that reimbursements are going to be variable based on performance, even if you’re still practicing in a fee-for-service structure and, like most, have not yet begun practicing in the more advanced tracks.

There are four participation categories, which fall underneath two broad tracks—the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Model (APM) track.

The four MACRA Quality Payment Program participation categories. – The Health Management Academy, 2017

The two categories in the middle of the chart are bridge areas, and won’t apply to many providers right now, but they can be considered as stepping stones from MIPS to the Advanced APM track.

The MIPS track equates to fee‑for‑service, and most physicians will, at least initially, fall into this track. They’ll balance their steps toward embracing more downside risk by continuing to practice fee-for-service medicine, and so they must prepare to report performance metrics and have payments adjusted based on those metrics in 2019.

On the other end of the spectrum is the Advanced APM track. To reach “Advanced APM Qualifying Clinician” status, physicians must engage significantly in certain downside risk-bearing payment models. In this track, participating physicians will enjoy fewer reporting requirements and more financial incentives, while still being held accountable for delivering high-value care. The only way to sustain a profitable practice in this track is to eliminate wasteful workflows that result in inefficient and unreliable communication processes among all members of the broader care team, even if they are not directly affiliated with your practice.

Year 2: 2018-2019

In the first months of 2018, physicians practicing in the MIPS track—again, that will be most of you—will be required to report metrics in three performance categories based on at least 90 consecutive days of work. This should come as more good news, because if you haven’t started measuring yet, or you’re not impressed by your initial metrics, you still have time to pivot before the data is due in early 2018.

CMS will use that data to give each physician a composite score, which will determine the payment adjustment he or she receives in 2019.

The Quality Payment Program’s initially proposed rule was accompanied by disheartening projections in terms of payment adjustments, particularly for solo physicians and small practices. While the finalized October 2016-issued rule basically guaranteed that all physicians who submit any performance data will receive at least a neutral payment adjustment, physicians are still bracing themselves for less-than-average profit margins.

As MIPS is largely a budget-neutral program, less risk equals less reward. Since fewer physicians will be subject to negative payment adjustments in 2019 (see Image 3 below), fewer dollars will be available to distribute to those who perform well.

Only 20%—versus 87%—of physicians in smaller practices are projected to experience negative payment adjustments in 2019. – The Health Management Academy, 2017

Simply put, the best way to ensure your adjustment is as high as possible is to garner a high composite score.

Effectively coordinating care with your patients’ broader care teams as accurately and efficiently as possible to reduce waste and unnecessary overhead costs is a good first step toward achieving high scores in all four MIPS performance categories.

Back to the present

One of the goals of MACRA is to drive the costs out of treatment while still providing high-value care. Physicians will be in a much better position to deliver this dichotomy, and advance to a more rewarding reporting track, when the barriers to real-time care coordination have been broken down.

Seamless care team communication and collaboration among interdisciplinary, and often disparate, providers will be a foundation on which you can lay the groundwork for improved care coordination, which leads to less waste, improved efficiencies, and ultimately better outcomes, all of which underlie value-based care and the successful reduction of healthcare costs.

Source: “Making Sense of MACRA” webinar. The Health Management Academy and PerfectServe. March 2017. 

Watch the full webinar to learn even more about MACRA and how it applies to your practice.

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