Analyst briefing revised 11 4 11 (new demo link)
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  • As you know, the major challenges faced by healthcare today are national news. With an increase of healthcare spending,hospitals are being asked to do more with less by;Becoming more efficientResponding to new reimbursement modelsStrategizing new delivery modelsAnd, limiting liability while doing so.Emmi’s business is focused on communication and patient engagement. With that focus, we have been looking at the role that communication plays in both cost of care and clinical outcomes. Today, we’ll look at these and show our data on how communication and technology can impact patient engagementBut first, let’s look at the roadblocks that clinicians face when communicating with patients
  • And its been found that patients are expected to forget up to 80% of what they just learned in a consultation visit before they even reach their car in the parking lot.
  • So we wanted to look at the role that communication plays within satisfaction, risk, operations, and clinical outcomes. From this graphic could you please point out to me which of the four you focus on most at _________ and we can dive in a bit further about that topic?
  • One market driver we have looked at is Patient Satisfaction. An enormous amount of resources are being invested here because of changes in reimbursement and healthcare’s shift from fee-for-service to pay-for-performance. HCAHPS illustrates the growing disparity between the quality of care delivered by a hospital and the patient’s perception of quality.From private hospital rooms - to valet parking - to investments in art and music, hospitals are experimenting in a number of ways to improve satisfaction. However, few of these efforts provide a measurable result. What is clear is that Communication is a key driver of satisfaction.
  • So let’s take a look at the importance of Patient Satisfaction.First, HCAHPS provides clear value for improving patient satisfaction because a percentage of DRG payments are now tied to HCAHPS performance.In addition to that, as you can see by the graph to the right, according to Press Ganey, hospital profitability is directly tied to patient satisfaction.
  • Surprisingly, patient satisfaction and loyalty are not confined to just clinical outcomes. Patient Experience is a primary factor when choosing a hospital and patients perceive quality of their hospital experience through communication with providers. According to Medical Economics, 25% of patients who switched physicians cited poor communication around treatments and alternatives as the factor for their decision. As you see from McKinsey, it is also the driver of hospital loyalty.
  • So, how do hospitals respond? Of course, the traditional response is to focus human resources on the challenge. We have seen hospitals implementing nurse rounding and “mini-rounds” where staff conducts a second set of rounds at the end of the day for no more than 2 minutes to answer questions.However, given tight budgets and a shortage of caregivers, more and more hospitals are turning to technology to supplement those caregiver conversations. A number of examinations have shown that effective use of technology resources can improve information retention and overall satisfaction.*Specific initiatives currently underway to improve patient satisfaction/experience at _______?DEMO: Based on our discussion and what you’ve just shared I think this next piece will be the most valuable to you. Please find the Emmi logo at the bottom left corner of your screen and click the link. This will be about 4-minutes and I’ll sit here on the other line until finished so we can conclude with a short dialogue. (make sure their sound is turned up)CLOSING STATEMENT: Now you have a better understanding of how we help hospitals/health systems achieve better outcomes through effective patient engagement/communication. Initial reaction/questions?Our Regional Director will actually be in _______ for meetings at _______ during the week of _________and would enjoy the opportunity to stop by and formerly introduce himself. Would it be possible to get a group together for a more focused discussion?*Remember to fall back on “I’m on the research side of things, that’s why a meeting with our Vice President would the most valuable” if they are asking a lot of questions. Goal is to pass off conversation quickly.
  • One market driver to look at is Risk Mitigation.Though the “malpractice crisis” has calmed in recent years and frequency has leveled off, claim severity is increasing. Hospitals across the country continue to feel the effects of high premiums. They also take into account the immeasurable costs of a hospital’s lost reputation.One consideration in strategizing for this is to consider the role of patient communication. According to Dr. Gerry Hickson at Vanderbilt, a patient’s likelihood to sue is directly related to dissatisfaction with their physician’s ability to establish a rapport, be accessible and deliver care consistent with expectations.
  • Ok, let’s look at how the impact of malpractice claims can effect hospitals. Not only is there the cost associated with indemnity payouts, but there is also significant cost associated with simply defending claims, which reportedly averages over $30k for “no payment claims” and increases from there.Beyond juries and settlements, there is additional cost. Claims bring with them a risk to an organization’s reputation and referral business, emotional fallout for clinical staff, and a loss in productivity and operational income.In 2009, a single claim consumed an average of 59 months – nearly 5 years. When physicians are sued, they spend an average of 22 days away from their practice. During this time, they are neither seeing patients nor generating income for themselves or any of the organizations they work with. As you can see by the graph on the right, this can mean a loss of hundreds of thousands of dollars in hospital revenue.
  • A major focus in managing malpractice risk has to be to bridge the communication gap between healthcare providers and patients. Although the principle of Informed Consent has deep roots and is intended to elevate patient autonomy, its overall effectiveness in informing patients and protecting providers is unclear. An alarming number of Americans lack a basic understanding of their health. According to the Institute of Medicine, nearly 93 million adults function at a basic or below basic literacy levels to understand their health. These patients have higher medical costs, more hospitalizations, fewer primary care visits and poorer compliance.Both the Harvard Risk Management Foundation and Stanford University have identified patient communication as a primary driver of claims. This means that the consent process does not improve decision making capacity, understanding or authorization for medical treatment.~journal of medical ethicsSo, according to JAMA, 97% of medical malpractice lawsuits do not involve medical malpractice. Instead, they are the result of miscommunication and mismanaged expectations.Healthcare organizations are then forced to look for strategies that improve communication as a way to better manage risk.
  • So, how can organizations respond? Of course, the traditional response is to focus on the providers’ conversations with patients and the task obtaining consent. But, increasingly, technology is being deployed to supplement and enhance those conversations. A number of medical institutions, including Mayo and Henry Ford, have been testing a predictive model for cardiac cath patients that assesses an individual’s specific risks for complications by drawing on data from the ???????? SWITCH American College of Cardiology’s National Cardiovascular Data Registry and tailors their consent.Others are supplementing human conversations with interactive media, prescribing patients appropriate interactive information that supports the patient with the right information, without abandoning them to search the web on their own. A number of studies have demonstrated the effectiveness of such tools. For instance, a look at cardiac cath patients demonstrated a better understanding of the procedure when verbal and written information was supplemented by computer based learning. Similar results were reported in a 2004 study appearing in the Journal of Medical Internet Research.What are some current strategies underway you are tasked with to mitigate risk within ________?DEMO: Based on our discussion and what you’ve just shared I think this next piece will be the most valuable to you. Please find the Emmi logo at the bottom left corner of your screen and click the link. This will be about 4-minutes and I’ll sit here on the other line until finished so we can conclude with a short dialogue. (make sure their sound is turned up)CLOSING STATEMENT: Now you have a better understanding of how we help hospitals/health systems achieve better outcomes through effective patient engagement/communication. Initial reaction/questions?Our Regional Director will actually be in _______ for meetings at _______ during the week of _________and would enjoy the opportunity to stop by and formerly introduce himself. Would it be possible to get a group together for a more focused discussion?*Remember to fall back on “I’m on the research side of things, that’s why a meeting with our Vice President would the most valuable” if they are asking a lot of questions. Goal is to pass off conversation quickly.
  • Operational Efficiency is a key concern for healthcare organizations as the system grapples with new approaches to delivery and reimbursement. As we noted, the escalating cost of providing quality healthcare cannot be sustained and, as a result, providers and provider organizations are being challenged to maintain or improve quality while cutting costs. A key factor in that improvement are the patients themselves and they have, in fact,play a centralrole to play. Unprepared and uninvolved patients cause a myriad of operational problems including procedure cancellations, high call volume and repetitive patient education efforts.
  • Operational Efficiency isthe extent to which an organization is able to maximize the effectiveness of available resources. So, when we have looked at it, we have focused on example areas where impact of communication effort can be measured. This has includedOperating room utilization:the number of surgical cases and procedures that can be performed on a given dayPatient throughput:the number of office visits scheduled for outpatient providers and the average length of stay for admitted patients Education time:amount of timeclinicians spend to effectively engage and inform their patients
  • Medical procedures cancelled by patients drain millions of dollars in wasted material and labor More than 28% of all surgical and procedure cancellations are the result of patient actionThe average procedure cancellation costs a hospital more than $2100 in lost staff timeCurrent steps to streamline operating room efficiency like improving accountability and scheduling, can shrink turnover times, but these efforts do not reduce the impact of patient cancellations But, engaging patients in their care prior to scheduled procedures can play a critical role in reducing cancellations and no-showsThrough the use of preoperitve phone calls the University of North Carolina Health Care ambulatory surgical center was able to decrease the daily cancellation rate by 53%, increase patient satisfaction scores and increase OR useThe data shows that more engaged and better informed patients are more compliant and less likely to miss a scheduled surgery or procedure. {Optional with extra time}:In a study recently published in the Official Journal of the Association of Perioperative Registered Nurses, patients were called 3 business days before their surgery to convey important information and address patient concerns. Whether it is through perioperative clinic visits, telephone calls or online communication, hospitals that educate and connect with patients before the day of surgery allay patient concerns and reduce cancellations Lastly, a study published by the American Academy of Otolaryngology Patient showed that comfort and satisfaction with the initial decision to undergo surgery can also predict cancellation, suggesting that efforts in shared decision making can improve patient attendance for surgical procedures
  • Patients’ poorretention of information often leads to a high number of calls to their providers’ officeIn some surgical specialties, providers average more than 25 calls per day from patient questions Each call represents a disruption in workflowMoreover, disruptions can easily multiply, as often, many attempts are needed to return a patient’s callAs you can see on the right, this can mean a quarter to a third of staff activity time Providers can make a big difference with small changes in the way they communicate with patientsUsing email or the web to educate and communicate with patients can cut call volume by as much as 18%Physicians who engage patients using electronic methods have seen productivity rise as much as 11%For a physician’s office, this translates to seeing two extra patients per dayFor an outpatient center, this means greater throughput and increased revenues*Specific initiatives currently underway to enhance operational effectiveness at _______?DEMO: Based on our discussion and what you’ve just shared I think this next piece will be the most valuable to you. Please find the Emmi logo at the bottom left corner of your screen and click the link. This will be about 4-minutes and I’ll sit here on the other line until finished so we can conclude with a short dialogue. (make sure their sound is turned up)CLOSING STATEMENT: Now you have a better understanding of how we help hospitals/health systems achieve better outcomes through effective patient engagement/communication. Initial reaction/questions?Our Regional Director will actually be in _______ for meetings at _______ during the week of _________and would enjoy the opportunity to stop by and formerly introduce himself. Would it be possible to get a group together for a more focused discussion?*Remember to fall back on “I’m on the research side of things, that’s why a meeting with our Vice President would the most valuable” if they are asking a lot of questions. Goal is to pass off conversation quickly.{Optional with extra time}:We have seen the same in surveying patients. Patients were given access to supplemental, web-based information about their specific condition or upcoming procedure. Because they could review the information online, they could repeat it, share it with their circle of care and watch it in low stress environments. Of over 65,000 patients asked, 90% (nearly 60,000 patients) reported that the resource saved them questions they would have called their physician to discuss.
  • One marketdriver we have looked at is Quality and Patient Safety. More than 70% of adverse events are caused by breakdowns in communication* among caregivers and between caregivers and patients. In addition to constraints on the time clinicians are afforded with their patients, caregiver-patient communication is further hindered by inadequate health literacy prevalent in much of the patient population. *According to Joint Commission’s Annual Report on Quality and Safety (2007)
  • The poor healthy literacy of America’s patient population has been documented in numerous studies over the past decade and continues to be a pervasive problem. Being unable to follow medical instructions can severely impact patient safety and the potential for negative outcomes is compounded by the fact that many patients are reluctant to speak up when they don’t understand what their doctor is saying or unaware that they are misunderstanding information to begin with. What seems clear is that one strategy for impacting clinical outcomes is the opportunity to help patients more effectively self manage their conditions and their health.{Optional with extra time}According to the Department of Health and Human Services, nearly 9 in 10 adults struggle with applying the basic health information and a study published in the Annals of Emergency Medicine indicates that over 75% of patients leaving the emergency room do not understand one or more critical elements of their treatment. That same study also suggests that a similar proportion of admitted patients are discharged without understanding basic aspects of their treatment as well. AHRQ found that reduced health literacy is associated with a wide range of poor outcomes including increased hospitalizations, greater use of emergency room care, lower use of mammography and influenza vaccines as well as an inability to properly take medication and interpret labels and health messages. Poor health literacy poses an even greater threat to elderly patient populations in which, according to the American Medical Association, it independently predicts all-cause mortality and cardiovascular death.
  • Conversely, informed patients who understand the health issues they’re facing are more likely to take an active role in their care. Patient engagement through effective communication can improve outcomes within the walls of the hospital by encouraging patients to properly prepare for a procedure and this active participation also allows organizations to reduce the risk of medical errors. Engaged patients are also more compliant with basic safety issues like hand washing and fall prevention and are far less likely to be readmitted. Engaging patients with effective communication is necessary throughout the entire continuum of care however, not just during an inpatient admission, especially because of the critical role that communication plays in the self-management of chronic diseases. For these conditions, self-management is the key to improving population health and reducing hospitalizations. {Optional with extra time}For example, there were nearly 2 million newly diagnosed adult diabetics last year. And yet, most lack a basic knowledge of the disease Just improving communication with diabetes patients can prompt enhanced medication adherence, better diet, and more frequent exercise and blood-glucose monitoring. Likewise, improving provider-patient communication reduces both costs and hospitalization rates. For asthma, even small improvements in provider-patient communication can make a big difference. Asthma patients who are trained in proper inhaler technique experience significantly reduced asthma severity as compared to patients who are only given the package instructions, which are often confusing.
  • Given the value that an engaged and informed patient adds to improving clinical outcomes, the question then becomes “how do we effectively educate and engage our patients?” Our research suggests there are a number of different approaches organizations are taking to improve patient-provider communication across the continuum of care:  One solution is to increase the amount of time clinicians spend with patients but as we noted earlier, for most physicians this is not a realistic approach given limited resources and bandwidth.  Another strategy is to provide physicians with additional communication training designed to improve their bedside manner and facilitate clear conversations with patients.  As we saw earlier, the transition of care that occurs around a patient’s discharge from a hospital can be a vulnerable time for patients and communication is critical to avoiding readmissions. Even with current processes like discharge instructions and follow-up phone calls, healthcare organizations are still struggling with this challenge and being forced to evaluate more efficient communication solutions.  So, more and more, organizations are leveragingtechnology to educate and engage patients across the continuum. By coordinating communication efforts , organizations can proactively and cost-effectively reach out to patients and their circle of care. *Specific initiatives you are currently working on to improve patient communication and quality outcomes?DEMO: Based on our discussion and what you’ve just shared I think this next piece will be the most valuable to you. Please find the Emmi logo at the bottom left corner of your screen and click the link. This will be about 4-minutes and I’ll sit here on the other line until finished so we can conclude with a short dialogue. (make sure their sound is turned up)CLOSING STATEMENT: Now you have a better understanding of how we help hospitals/health systems achieve better outcomes through effective patient engagement/communication. Initial reaction/questions?Our Regional Director will actually be in _______ for meetings at _______ during the week of _________and would enjoy the opportunity to stop by and formerly introduce himself. Would it be possible to get a group together for a more focused discussion?*Remember to fall back on “I’m on the research side of things, that’s why a meeting with our Vice President would the most valuable” if they are asking a lot of questions. Goal is to pass off conversation quickly.Supportive data-According to JAMA, use of technology and, specifically, interactive web-based tools to educate patients can improve chronic condition self-management. The study compared the effectiveness of different educational interventions on hypertension patients’ success in controlling their blood pressure and found that patients with access to online educational tools control their blood pressure more than twice as well as patients without those extra resources. Further, they are able to do so with fewer doctor visits.

Transcript

  • 1. Emmi Briefing:Patient Communication DrivingClinical and Financial Outcomes Fall/Winter, 2011
  • 2. WELCOME Up to 80% of information patients receive is forgotten by the time they reach the parking lot 2 University of Minnesota Annals of Emergency Medicine © 2011 Emmi Solutions, LLC
  • 3. CHALLENGES OF HEALTHCARE COMMUNICATION Average length of a patient visit is between 3 6 and 17 minutes. © 2011 Emmi Solutions, LLC
  • 4. WELCOMEBriefing Agenda Risk Mitigation Patient Quality Satisfaction and Patient and Quality 4 Patient atint Patient Patient Satisfaction Engagement Safety Safety Engagement Risk Operational Mitigation Efficiencies Operational Efficiency © 2011 Emmi Solutions, LLC
  • 5. Patient Satisfaction Communication is the key driver of patient satisfaction.All five drivers for improving Press Ganey and HCAHPS scores relate to patient-provider communication. © 2011 Emmi Solutions, LLC - Press Ganey, 2008
  • 6. PATIENT SATISFACTIONWhat is at stake?– Reimbursement CMS Value Based Purchasing Proposal – 1% impact on base operating DRG payments – 30% attributed to HCAHPS performance 6– Return Business and Referrals Improving patient satisfaction survey results by one point can lead to increased profits of $1443/patient day. Quality Management in Healthcare, 2004 © 2011 Emmi Solutions, LLC
  • 7. PATIENT SATISFACTIONNon-clinical issues drive patient loyalty– Patients perceive quality through conversations with their physicians Marketing Health Services, 2002– Communication is the number one 7 predictor of patient willingness to switch hospitals, outranking: – Patient room amenities – Billing transparency and value – Conducting scheduled meetings on time The McKinsey Quarterly, 2007 © 2011 Emmi Solutions, LLC
  • 8. PATIENT SATISFACTIONResponding to the challenge– Human Resources: Allotment of more caregiver time with patients: – Hourly Nurse Rounding HCAHPS Nursing Communication Composite is the one most highly correlated with overall hospital rating. Studer Group, 2011 – “Mini Rounds” 8– Technology: – Visualization and Video Patients who receive computer-based visualization tools retain information at a higher level and experience greater satisfaction with their procedure than those who receive standard education. Journal of Medical Internet Research, 2004; AORN, 2008 – Interactive Tools Interactive monitors boosts satisfaction with educational materials and overall satisfaction. The Beryl Institute, 2011 © 2011 Emmi Solutions, LLC
  • 9. Risk Mitigation In reality, a patient’s likelihood to sueis directly related to dissatisfaction with their physician’s ability to establish a rapport, be accessible and deliver care consistent with expectations. © 2011 Emmi Solutions, LLC -Hickson, G.B., MD “Patient Complaints and Malpractice Risk”, 2002
  • 10. RISK MITIGATIONWhat is at risk?– Financial Impact – Average indemnity payment is $274,887 New England Journal of Medicine, August 2011 – $55.6 billion a year nationally US News and World Report, 2010 – 37% of surgical patients who sue receive indemnity payments 10 CRICO RMF, 2009– Operational Impact – Litigation time for a claim was 59 months in 2009 Jury Verdict Research, 2011 – One claim equals 22 physician days away from practice The Journal of Urology. May 2006 © 2011 Emmi Solutions, LLC
  • 11. RISK MITIGATIONNon-clinical issues are driving claims– Communication is a barrier to consent – Over 90 million Americans lack basic health literacy skills Institute of Medicine, 2004 – Communication between providers, patients and families is the #3 Key Factor in surgical malpractice claims CRICO RMF, 2009 11 – The number three issue in our claims is communications between our patients and our physicians.” Jeff Driver, Stanford University Medical Center– Consent fails to achieve its goals – Decision making capacity, voluntariness, disclosure, recommendation, understanding, decision, authorization Journal of Medical Ethics, 2011 © 2011 Emmi Solutions, LLC
  • 12. RISK MITIGATIONResponding to the challenge– Human Resources: – The key to enhancing patient understanding of risks and trade-offs was to have a high-quality discussion Scientific American, 2011– Technology: – Predictive Solutions 12 Medical centers are testing new consent processes that use personalized data about the patient’s individual risk for complications in non-emergent catheterization and potential angioplasty American Medical Journal, 2010 – Web Based Tools Computer-based information program was more effective in improving patient early understanding of cardiac catheterization than standard verbal and written information alone Archives of Internal Medicine, 2009 © 2011 Emmi Solutions, LLC
  • 13. Operational Efficiencies As financial constraints become more severe, hospitals are moved to improve care while decreasing costs.Improving operational effectiveness will be essential to delivering higher-quality care and improving financial performance. © 2011 Emmi Solutions, LLC - Nursing Economics, 2009
  • 14. OPERATIONAL EFFICIENCIESDefining Operational Efficiency Education Time Operating 14 Room Utilization Patient Throughput © 2011 Emmi Solutions, LLC
  • 15. OPERATIONAL EFFICIENCIESSurgical and procedure cancellations– Procedure cancelations create financial waste – More than 28% of all surgical and procedure cancellations are the result of patient action – The average procedure cancellation costs a hospital more than $2,100 American Society of Anesthesiologists, 2006 15– Engaging patients can improve attendance rates – Preoperative phone calls can reduce patient cancellations by over 50% Association of Perioperative Registered Nurses, 2011 – Patients are less likely to cancel when they’re satisfied with the decision to undergo surgery American Academy of Otolaryngology, 2002 © 2011 Emmi Solutions, LLC
  • 16. OPERATIONAL EFFICIENCIESCommunication and patient throughput– Call volumes create workflow disruptions – Limited patient retention of information translates Time Engaged in to a high number of phone calls Teaching Activities (Percentage of Day) – Providers average more than 25 calls per day from patient questions Urologic Nursing, 2008 24% for Nurses 16– Supplemental patient communication allows providers to schedule additional office visits 34% for Clinical Specialists – Using email or the web can cut call volume by as much as 18% – Physicians who engage patients electronically Oncology Interactive Patient Education Series have seen productivity rise as much as 11% Journal of Healthcare Information Management, 2005 © 2011 Emmi Solutions, LLC
  • 17. Quality and Patient Safety An urgent issue facing health care is the mismatch between a physician’s level of communication and a patient’s level ofcomprehension, often leading to medical errors and even lawsuits. - American Medical Association © 2011 Emmi Solutions, LLC
  • 18. QUALITY AND PATIENT SAFETYHealth literacy and outcomes– Many Americans have poor health literacy – Nearly 90% adults have difficulty using everyday health information U.S. Department of Health & Human Services, 2010 – 78% of patients leave the ER without understanding critical elements of their treatment Annals of Emergency Medicine, 2008 – Similar results have been found for patients leaving hospitals Annals of Emergency Medicine, 2008 18– Limited health literacy is linked to poor outcomes – Increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poor medication compliance Agency for Healthcare Research and Quality, 2011 – About half of adults experience a medical error after hospital discharge, and 19%-23% suffer an adverse event, most commonly an adverse drug event Society of Hospital Medicine – All-cause mortality and cardiovascular death among the elderly American Medical Association, 2007 © 2011 Emmi Solutions, LLC
  • 19. QUALITY AND PATIENT SAFETYPatient engagement improves outcomes– A safer hospital experience – Patient participation prior to a procedure can reduce the risk of medical errors Journal of the American Medical Informatics Association, 2005 – Patients help patient safety efforts such as hand washing and fall prevention American Journal of Infection Control, 2004 19– Improved self-management – Providing patients with information, skills, and support to manage diabetes is a critical issue for health care providers and systems Gale Group, 2008 – Training and simple education can change patient behavior in asthma Patient Education Counsel, 2008 © 2011 Emmi Solutions, LLC
  • 20. QUALITY AND PATIENT SAFETYResponding to the challenge– “More time” – Expanded patient interactions– “Better time” – More effective communication – Medical school admission criteria – Training to avoid medical jargon, improve bedside manner 20– Enhanced discharge counseling– Interactive, multi-media education tools © 2011 Emmi Solutions, LLC