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Providing Practice Transformation in Nevada and Utah

Doctor and Nurse Charting

The future of independent practices remains uncertain, except for one truth—change. Across the nation, some practices have been bought by integrated systems and many others have signed up with Accountable Care Organizations (ACO), all of which offer a wide array of services. HealthInsight continues to educate providers in our community about their options, as alternative payment models through the Centers for Medicare & Medicaid Services (CMS) emerge. We are committed that they make the best decisions for their practices and their patients.

As opportunities arise, HealthInsight will facilitate introductions with ACOs and/or Practice Transformation Networks. ACOs may utilize some of HealthInsight's experienced staff to supply onsite technical assistance as practices prepare to start Medicare Shared Savings Programs in 2017. (See recent blog by Sharon Donnelly)

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Doctors are Lazy

Doctor with Patient

I just read an article in Medical Economics by William M. Gilkison, MD, an older physician, entitled, "Opinion: Doctors are lazy". He pointed out that patients complain to him that physicians have very little contact with them during exams: they come in for five minutes and leave. Some physicians even tell patients that they can only discuss one problem at each visit. Certainly, if the physician was the patient, he or she would not tolerate being treated in this manner. What if he or she had diabetes with a comorbidity such as high blood pressure, high cholesterol, heart disease or depression?

Practicing good medicine dictates that all medical problems should be addressed at the visit and it will take more than five minutes. Years ago I might have agreed with the author, but now I'm not so sure. Over time, as more and more physicians became employed by hospitals, insurance companies and large groups, they began to feel pressured to see more and more patients. Then, as they all began using electronic health records (EHRs), they found that they needed to collect more data for others – insurances and government (including the Physician Quality Reporting System - PQRS, meaningful use, and prescriptions by computer only). It seemed that every time they turned around, there seemed to be more time-consuming tasks that they were expected to do.

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Beyond End of Life: Random Thoughts on Coping with Personal Loss

Wildflowers

Caring for ourselves and others after a loss can be challenging. At HealthInsight, our work is focused in several arenas aimed at making sure our health and wellness doesn't fall by the wayside, even in times of loss and grief. HealthInsight, through various projects, is working on improving end of life care; depression and behavioral health screenings, and annual wellness visits in older adults; improving the lives of those with diabetes and other chronic illnesses through self-management classes; and improving care in nursing homes and home health agencies to make sure patients are getting the best care possible right up until the very end.

In previous blogs, I have written about my family's journey through end of life issues and my thoughts on how the health care system and providers can positively impact a family's journey. Death and loss hit all of us at various stages of life and in the end we all deal with these challenges in a different manner. The one commonality is, most likely, the impact the loss can have on our physical and mental health.

One year ago today as I write this blog, I received the call, at 8 p.m., we all dread and fear when a family member or loved one is near death. Mom had died in her sleep after a 7-year battle with Alzheimer's. The flood of emotions for me was significant from grief, denial and fear, all the way to relief that mom is no longer suffering and can now be in peace.

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HealthInsight Begins Exciting New Work with ESRD Networks

Doctor with Machine

HealthInsight is continually working to improve the health and health care of the residents in our area and now we are expanding and moving into new areas of work, with the goal of improving the lives of even more people.

In December, HealthInsight was awarded two new end-stage renal disease (ESRD) contracts from the Centers for Medicare & Medicaid Services (CMS) and work has already begun on improving the care and resources for patients with ESRD. HealthInsight will be working in ESRD Network 16 and 18, serving residents in Alaska, Southern California, Idaho, Montana, Oregon and Washington. CMS awarded $110 million in combined ESRD funding to six Quality Innovation Network Quality Improvement Organizations (QIN-QIOs) and one independent entity for five-year contracts.

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I Choose Joy

Woman in B-W

Two decades ago when Professor Martin Seligman and others decided to focus on exploring well-being instead of human despair the field of positive psychology was born. What makes people flourish? Which factors contribute to a fulfilling life? As more research is conducted in this emerging discipline, light is shone on multiple facets of our day-to-day lives.

JOY: three letters describing a feeling of happiness and well-being. A word I associated with photos of giggling babies or that person standing on a lone mountain top. Recently though, the word has come up several times in different contexts and has really made me think.

Marie Kondo, goddess of organization and decluttering and the subject of a recent national radio segment, says that when you are deciding whether or not to keep something you should think "does touching this spark joy?" Keep only those things that speak to your heart. A different way of looking at the numerous white binders of neatly divided meeting minutes in my office indeed...

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Flight of the Bumblebee – A Soundtrack for Innovation

Flower

Consider the bumblebee – industrious worker, agricultural catalyst, cooperative colonist. When winter's chill is chased away by spring's warm breezes, bumblebees will help ensure we have beautiful flowers and healthy fruit to enjoy this summer. Effecting a valued outcome through deliberate activity, the bumblebee is an apt metaphor for an activity which is highly valued in innovation circles - cross pollination.

For many years, the concept of cross pollination has been considered a mechanism for stimulating creative solutions to challenging problems by working across functional silos to reframe successful approaches in inventive ways. In theory, combining individuals from different disciplines will create fertile ground for innovation and promote visionary thinking. But is this true?

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Medicare Shared Savings Program: What To Do Before You Start

Doctors and Nurses

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed last April ended the Sustainable Growth Rate (SGR) formula for determining Medicare payments to health care providers, creating a new pathway to value base payments. Future fee schedule adjustments will be driven by participation in either (1) a Merit-Based Incentive Payment System (MIPS) that combines existing quality reporting and incentive programs or (2) qualified Alternative Payment Models (APMs) that require providers take on a yet to be defined "more than nominal" financial risk. Given the complexity of MIPS and long-term potential higher earnings under APMs, many physicians are interested in preparing for participation in APMs and see the current Medicare Shared Saving Program (MSSP) as a logical stepping stone.

As more physicians in the U.S. move into Accountable Care Organizations (ACOs) and the MSSP their peers are watching their successes and struggles, trying to discern what drives the difference in the 28 percent that are reaping shared savings and the great majority that are not. MSSP requires ACOs to hit savings targets benchmarked from their existing spending patterns, as well as score well on 33 quality measures. What is needed to prepare to successfully engage under these new payments models? A useful reference is the Brookings white paper on "Adopting Accountable Care: An Implementation Guide for Physician Practices". This toolkit identifies four capacities critical for success: (1) identify and managing high-risk patients; (2) develop high-value referral networks; (3) receive notifications of acute events such as emergency room (ER) visits or hospitalizations; and (4) engage patients in self-management and shared decision-making.

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Will, Ideas and Execution: A recipe for change

Change letters

Earlier this month I had the pleasure of attending the Centers for Medicare & Medicaid Services (CMS) Quality Conference in Baltimore, Maryland. This annual conference held in the inner harbor and heart of Baltimore, is where quality professionals and CMS contractors from all over the country gather every year for three days to learn from experts in the field and to join together as colleagues, all pursuing the same vision; improved health of our population, improved delivery of care and smarter spending of health care dollars. On the final day of the conference attendees had the great pleasure of hearing from one of the most widely recognized individuals of health care improvement, Dr. Donald Berwick. Dr. Berwick shared stories of how change and improvement in the health care system have impacted everyday people in our local communities and shared his personal experience working as the administrator of CMS in 2012 and how CMS' commitment to value-based care is a pivotal, unprecedented and necessary shift in the evolution of the Medicare program.

Dr. Berwick framed his presentation on the need for change using three simple words: will, ideas and execution. One must first have the will or desire to change. One must also have an idea or thought about the change. And finally, one must act or do something to create that change. Dr. Berwick spoke of this basic principle and how all change ever takes is these three elements, and that all great improvements start and end with this key principle.

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“What is Important to You?” Take Time at the Holidays for Important Conversations about End of Life Wishes

Holding hands

Holidays are a time of family and togetherness with some of the people closest to us. We send greetings and try our best to catch up with people that we love. We honor traditions, we engage in meaningful reflection, we love to share meals and we share gifts. This season, I am committed that my family adds an important conversation to our holiday activities, a conversation about our wishes for end-of-life care.

In last week's blog, Fern mentioned several resources to help in end-of-life care planning and making your wishes known, but how do we begin?

I'd like to share a resource that can make these conversations easier to start.

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Hearing the Patient’s Voice

Mother with daughter

My dear friend Carol is very ill. She's been in the hospital in the intensive care until (ICU) for over two weeks, and though there are small signs of improvement in some areas, there are also setbacks in others. What is most frustrating for me is the inability to communicate with her. Although she is sometimes aware loved ones are with her, she's unable to participate in her care—unable to speak, write or let us know what she's thinking.

As is the case with many who end up in the ICU, she didn't have an advance directive, living will, Physician Orders for Life Sustaining Treatment (POLST) form, medical power of attorney, do not resuscitate or other instrument that contains the voice of the patient.

As I concern myself about what Carol would want, I also think about what I would and wouldn't want under similar circumstances. I know I wouldn't want my husband and sister to have to "guess" my wishes.

  • I would want them to have a starting place
  • I would want them to know there is a plan I have thought about that provides a guideline for their decisions
  • I would want to help make their choices as easy as possible

It's confusing though—does a person need to have all of the documents mentioned above? What's the difference between them? How are they used?

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