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Understanding Burnout

Doctor charting

In your work, have you come across people with symptoms and signs of burnout? They just don't seem to be themselves, are cynical and negative toward others, seem totally exhausted, and they seem to feel like they do nothing good. They are stressed out.

A recent study of 2,000 physicians found that over 45 percent of physicians nationally have at least one symptom of burnout. The incidence has been increasing the past two decades. People usually get happier as they age. But health care professionals seem to be going the other way, and physicians have the highest incidence of burnout compared to other highly educated professionals. Physicians often start healthier than other professionals but they tend to take less care of themselves and deteriorate faster. Harried training schedules early in their careers may limit exercise, normal sleep patterns and good eating habits, and may contribute to excessive alcohol use. Life change units like isolation, divorce, moving, work overload, excessive interruptions, job changes, births of children, and changes in living and working conditions increase their stress scores. In recent decades, increasing time devoted to billing and documentation requirements displacing patient care time, increasing demands of payers and customers while compensation changes intensify, and less time for conversations and socialization with professional colleagues has reduced joy in work.

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2016 Quality Conference Focuses on Patient and Family Engagement

CMS Gallery Walk

Each year the Centers for Medicare & Medicaid Services (CMS) holds a quality conference in Baltimore, Maryland, to explore how key stakeholders – specifically patients, advocates and health care leaders – can develop and spread solutions to health system challenges. As a first time attendee, my expectation was influenced by my experiences at other large conferences. I was expecting thousands of people, some good presentations and a lot of information to absorb, and my expectations were met. In addition, this conference maintained a consistent focus on the patient, their family and how we, inside the health care system, can collaborate with them to improve their health and their lives.

CMS describes how the health care system could include the patient and family perspective in their quality strategy:

  • If an individual feels their beliefs, desires, and culture are considered in their care, they are more likely to follow that plan of care.
  • If an individual is able to communicate effectively with their providers and have a role in making health care decisions, they will receive better care and can more effectively manage their health. This can lead to a reduction in expensive health care services, such as emergency department utilization.

Effort was clearly made to involve the patient and encourage family engagement as evidenced by the number of activities provided throughout the conference. For instance, patients from various advocacy groups were asked to hand out the quality awards from CMS to the Quality Improvement Networks-Quality Improvement Organizations (QIN-QIOs). Others were invited to listening sessions scheduled with CMS. Patients were filmed while talking about their personal health care journeys and these videos were shown in the gallery throughout the three-day conference. In addition, their photos and personal stories were displayed in an informal gallery for viewing by passersby.

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What’s Next for Transparency in Health Care?

Stethescope

Regardless of whether you celebrated or grieved the results of our recent presidential election, the reality is a new administration will soon be upon us. And as with any change, there is fear, there are rumors and there is uncertainty.

On a website that details the President-Elect's views on health policy reform, Transparency—an issue near and dear to our HealthInsight hearts—appears to be a priority:

"Require price transparency from all health care providers, especially doctors and health care organizations like clinics and hospitals. Individuals should be able to shop to find the best prices for procedures, exams or any other medical-related procedure."

This policy principle is consistent with a business-like approach to health care, an industry that has historically lacked some of the fundamental elements of successful, competitive business markets, such as a consumer orientation and access to comparative performance information.

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Checking the Pulse of Health Care Reform

Stethoscope and money

The recent national election has clouded the outlook for the health care industry that accounts for one-sixth of the U.S. economy. The fate of the Affordable Care Act (ACA or "Obamacare") hangs in the balance, and the stakes are enormous-not only for the more than 20 million Americans who gained insurance through the ACA, but for the health professionals who provide services for them, the insurers that cover those lives and the elected officials who have pledged to "repeal and replace" the law.

Beneath this high-profile political drama, though, beats the quiet, steady pulse of a reform movement that seeks to improve health care for all Americans.

For the past 12 years, I've been privileged to work with people who have devoted their careers to improving the quality of health care for those with Medicare and Medicaid benefits, and by extension, for all citizens. Much of our work with community partners—providers, health plans, public health agencies, consumers and others—has been guided by an activist federal program that has devoted significant resources to the reform of health care delivery, and more recently to payment reform.

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A Tale of Two Patients

TEST LINK FIRST

In the last two weeks, my mother and my husband had surgery. I'm happy to say that both had relatively positive experiences and outcomes. However, what was striking to me was the difference in the course of their stays.

Some background: I've been a nurse and have lived in Las Vegas for a long time. I know and work with lots of people in Nevada who:

  • Are senior executives in health care organizations
  • Are senior executives in insurance companies
  • Are skilled health care providers

Mom was having a hernia repair, a common and relatively uncomplicated procedure. And, as with most procedures, it requires coordination and communication among different disciplines and hospital departments. Despite my background and experience, I found myself:

  • Unable to get my mother answers to her questions (e.g., "Why am I getting antibiotics?")
  • Unable to get her providers the information they needed about her past medical history in a timely manner (e.g., "What were the results of the outpatient CT scan ordered by another physician?")
  • Unable to coordinate her care among providers

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Dreaming of What Can Be

Woman looking up

Each year at this time, I begin humming a tune in my head by song writer Bob Franke: "Thanksgiving Eve." The simple and inspiring lyrics begin with:

It's so easy to dream of the days gone by
So hard to think of the times to come

Nostalgia for "days gone by" is part of the human condition. It helps us appreciate and commemorate the past and, hopefully, to learn and to grow. The trick is to not become stuck in this place. As my horoscope recently reminded me, fear of the unknown is part of a journey, but it shouldn't become a parking lot. This is true of our work in the health care environment. Things are changing-fast-and we can be part of crafting the journey if we can use our uncertainty to propel us forward and dream of what can be.

The song's chorus continues:

What can you do with your days
But work and hope
Let your dreams bind your work to your play

What a glorious notion: that the work you do helps fulfill your dreams. At HealthInsight we have hope for a health care system that delivers on its intrinsic promise of care. Care for those in need, who are frightened and troubled, who worry if they can continue to work and be who they have always been as they face illness and treatment in a complicated system. I see the dedication in those I work with who advocate every day for a system that puts the patient first, that delivers the safest and best quality care at a fair cost, and that contributes to individual and community well-being.

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Fall Chili and Physical Activity

Couple walking in forest

Recently, my family and I attended a chili cook-off in our neighborhood. Although we did not win the cook-off, I'm still confident our beef-cubed chili, with just the right amount of spices, is a winner. Nevertheless, between the aromatic spells of chili, fall, pumpkins and cider, I enjoyed talking to and getting to know folks in my neighbor's backyard, many of whom I had never met.

While visiting with our neighbors, I had a conversation with a man who is a researcher at the University of Utah. He told me about a clinical trial he is working on where he is tracking the effects increased physical activity on aging. If I understood my neighbor, his main hypothesis is that increasing physical activity at any age or in any circumstance has positive health outcomes and can contribute to living longer. He mentioned various studies which are showing a link between lower hospital readmission rates and physical activity.

After my conversation, and after having indulged in several varieties of chili, I left the evening thinking of my personal need to increase physical activity and the simplicity of this health care intervention. I wondered what other information was available correlating with my neighbor's hypothesis.

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Total Cost of Care: A vital step toward payment reform

stethoscope and money

Constant change is the "new normal" in health care, and for me, some of the most exciting changes involve redesigning the way we pay for care. Recent federal legislation and Medicare program directives have aligned the monetary stars in favor of fundamental change in provider reimbursement, emphasizing health outcomes and value over volume of services.

Public and private payers, purchasers, providers and consumers all recognize that payment reform is essential to achieve better care at lower cost. First, though, we need more comprehensive quality and cost information to make the business case for change, enhance delivery systems and measure outcomes. At the core, we need reliable, transparent data about costs and their drivers.

That's why the Network for Regional Healthcare Improvement (NRHI) was so excited to receive funding from the Robert Wood Johnson Foundation (RWJF) for a multiregional pilot initiative focused on producing, sharing and using data on the Total Cost of Care (TCoC). This initiative, launched in November 2013, has developed a standardized approach to measuring and reporting the total cost of care and resource use across regions, and has created and tested a process for benchmarking multi-payer commercial health care costs.

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New Initiative Supporting Transition to Alternative Payment Kicks Off At HealthInsight

Doctor with clipboard

I am really excited to announce that HealthInsight was recently awarded a special innovation project as an add-on to our Quality Innovation Network - Quality Improvement Organization contract from the Centers for Medicare & Medicaid Services (CMS). The project is titled Catalyzing Complex Systems Change by Optimizing Patient Flow with the ECHO Model™. Our goal is to make it simpler for primary care practices to undergo the change needed to be successful in emerging payment models that focus on quality markers and smart spending. The project focuses on optimizing patients process (or flows), with an initial focus on annual wellness visits and follow-up sessions on chronic care management, or community referrals and end-of-life. The project will include 50 practices across Nevada, New Mexico, Oregon and Utah.

We are inviting a diverse group of primary care practices to learn together using the Extension for community Healthcare Outcomes (ECHO) model, which brings providers together using video conferencing and allows participants to learn from experts in other fields. Presenters will provide short lectures on key topics, and then participants will spend much of the ECHO session sharing the changes they made to their patient flows, including what went well and what barriers they experienced. The outcomes will initially be seen through increased claims for the target services with downstream positive impacts on health and spending. For example, claims for the Annual Wellness and Welcome to Medicare Visits should increase by at least 20 percent, along with tasks that might occur at those visits, or be triggered by them, like advanced directive use, immunizations, behavioral health screenings, cancer screenings, referral for diabetes education, etc. We also hope the patient experience is improved and the practices learn skills needed for success in the new Quality Payment Program (formerly known as MACRA) and a variety of alternative payment models. If the pilot is successful, we hope CMS will extend funding, beyond the initial two years, so we can add in other patient flows such as care across the continuum, acute and urgent care, and complex patient care.

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Try a Little Mindfulness

Brain

I like to think I have an analytical mind. I've built a career in accounting and finance, with side interests in technology and programming, and I've worked with health-related organizations for a number of years. Given that context, what I'm about to share may come as a surprise.

Daily meditation has had a greater impact on my wellbeing than any pharmaceutical drug or diagnostic test. It has also been a valuable resource in my professional life. Best of all, it costs nothing but my own time and dedication.

In our quest for the "quick fix," we may overlook the power of mindfulness. As often as we talk about engaging patients in their own care, we may not recognize the potential for healing within ourselves.

Migraines and epilepsy have run in my family. I was young when my migraines began, and I was given opioids to treat them from age 12 on. Sometimes I had to visit the emergency room for higher doses of morphine to find pain relief. My epilepsy required me to undergo semiannual electroencephalograms (EEGs) to maintain my driver's license, and to take medications that had negative effects on my personality. Yet all of this seemed normal and sustainable until I found a better solution.

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