analyst briefing revised 11 4 11 (new demo link)
TRANSCRIPT
Emmi Briefing:
Patient Communication Driving Clinical and Financial Outcomes
Fall/Winter, 2011
© 2011 Emmi Solutions, LLC
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WELCOME
Up to 80% of information patients receive is forgotten by the time they reach the parking lot
University of MinnesotaAnnals of Emergency Medicine
© 2011 Emmi Solutions, LLC
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CHALLENGES OF HEALTHCARE COMMUNICATION
Average length of a patient visit is between 6 and 17 minutes.
© 2011 Emmi Solutions, LLC
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Briefing Agenda
WELCOME
atint Engagement
Patient Satisfaction
Risk Mitigation
Quality and
Patient Safety
Operational Efficiencies
Patient Engagement
Risk Mitigation
Quality and Patient Safety
Operational Efficiency
Patient Satisfaction
© 2011 Emmi Solutions, LLC
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.
- Press Ganey, 2008
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What is at stake?
– Reimbursement
CMS Value Based Purchasing Proposal– 1% impact on base operating DRG
payments– 30% attributed to HCAHPS
performance
– 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
PATIENT SATISFACTION
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Non-clinical issues drive patient loyalty
– Patients perceive quality through
conversations with their physiciansMarketing Health Services, 2002
– Communication is the number one
predictor of patient willingness to switch
hospitals, outranking:– Patient room amenities– Billing transparency and value– Conducting scheduled meetings on
timeThe McKinsey Quarterly, 2007
PATIENT SATISFACTION
© 2011 Emmi Solutions, LLC
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Responding 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”
– 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
PATIENT SATISFACTION
© 2011 Emmi Solutions, LLC
Risk Mitigation
In reality, 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.
-Hickson, G.B., MD “Patient Complaints and Malpractice Risk”, 2002
© 2011 Emmi Solutions, LLC
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What is at risk?
– Financial Impact– Average indemnity payment is $274,887
New England Journal of Medicine, August 2011
– $55.6 billion a year nationallyUS News and World Report, 2010
– 37% of surgical patients who sue receive indemnity payments
CRICO RMF, 2009
– Operational Impact– Litigation time for a claim was 59
months in 2009Jury Verdict Research, 2011
– One claim equals 22 physician days away from practice
The Journal of Urology. May 2006
RISK MITIGATION
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Non-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
– 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
RISK MITIGATION
© 2011 Emmi Solutions, LLC
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Responding 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
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
RISK MITIGATION
© 2011 Emmi Solutions, LLC
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.
- Nursing Economics, 2009
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OPERATIONAL EFFICIENCIES
Patient Throughput
Operating Room Utilization
Education
Time
Defining Operational Efficiency
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Surgical 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 $2,100American Society of Anesthesiologists, 2006
– 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 surgeryAmerican Academy of Otolaryngology, 2002
OPERATIONAL EFFICIENCIES
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Communication and patient throughput
– Call volumes create workflow disruptions– Limited patient retention of information translates
to a high number of phone calls – Providers average more than 25 calls per day
from patient questions Urologic Nursing, 2008
– Supplemental patient communication allows
providers to schedule additional office visits– Using email or the web can cut call volume by as
much as 18% – Physicians who engage patients electronically
have seen productivity rise as much as 11%Journal of Healthcare Information Management, 2005
OPERATIONAL EFFICIENCIES
Time Engaged in
Teaching Activities (Percentage of Day)
24% for Nurses
34% for Clinical Specialists
Oncology Interactive
Patient Education Series
© 2011 Emmi Solutions, LLC
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 of
comprehension, often leading to medical errors and even lawsuits.
- American Medical Association
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Health literacy and outcomes
– Many Americans have poor health literacy
– Nearly 90% adults have difficulty using everyday health informationU.S. Department of Health & Human Services, 2010
– 78% of patients leave the ER without understanding critical elements of their treatmentAnnals of Emergency Medicine, 2008
– Similar results have been found for patients leaving hospitalsAnnals of Emergency Medicine, 2008
– 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 eventSociety of Hospital Medicine
– All-cause mortality and cardiovascular death among the elderlyAmerican Medical Association, 2007
QUALITY AND PATIENT SAFETY
© 2011 Emmi Solutions, LLC
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Patient engagement improves outcomes
– A safer hospital experience
– Patient participation prior to a procedure
can reduce the risk of medical errorsJournal of the American Medical Informatics Association, 2005
– Patients help patient safety efforts such as
hand washing and fall preventionAmerican Journal of Infection Control, 2004
– Improved self-management
– Providing patients with information, skills,
and support to manage diabetes is a critical
issue for health care providers and systemsGale Group, 2008
– Training and simple education can change
patient behavior in asthmaPatient Education Counsel, 2008
QUALITY AND PATIENT SAFETY
© 2011 Emmi Solutions, LLC
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Responding 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
– Enhanced discharge counseling
– Interactive, multi-media education tools
QUALITY AND PATIENT SAFETY