Medicare Updates: Doctors See Benefits and Risks in Medicare Changes via NYT

Academy of Family Physicians, made little effort to contain his glee Wednesday over the news that Congress had voted to end a reviled payment system for doctors, simultaneously averting a 21 percent physician pay cut and overhauling the way Medicare will pay doctors in the future.

“I just can’t be more positive about it,” said Dr. Wergin, who is a family doctor in rural southeast Nebraska. “The one word is yahoo.”

Then he added: “Now, what next?”

President Obama has signaled that he will sign the bill, resolving an issue that frustrated lawmakers in both parties for more than a decade because it repeatedly required Congress to step in to avert cuts to doctor fees. Doctors and health policy experts have begun to take stock of the practical implications of the legislation, which seeks to move away from paying doctors solely on the volume of their services and toward reimbursing them based on the quality and value of the care they provide. Many said the legislation was short on details about how such quality will be measured, and others expressed apprehension about whether the system will be fair.

“It’s very important legislation in that it aims to support better care and lower costs, but there are a whole lot of details that still need to be filled in,” said Dr. Mark McClellan, a senior fellow at the Brookings Institution and a Medicare administrator in the George W. Bush administration.

Under the new legislation, Medicare will increase the amount it reimburses doctors by 0.5 percent for the next five years. Doctors will earn a 5 percent bonus if they participate in newer payment models that seek to better coordinate care. One example is the so-called medical home, in which a medical team coordinates a patient’s care. They could also work in groups, called accountable care organizations, that receive a set fee to take care of a patient while still meeting quality standards.

“It’s a very big boost to these models,” said Paul B. Ginsburg, a health economist at the University of Southern California, although he and others noted that how these payment models will be defined is still not clear.

Excerpt from NYT, written by Katie Thomas and Reed Abelson, April 15, 2015

Read the whole article here.

Patient Satisfaction – With Medicare Pay On The Line, Hospitals Push Harder To Please Patients – NPR

One thing we can all agree on is that patient satisfaction is at a premium in today’s medical landscape.  NPR and author Jordan Rau have published a great article highlighting this and just how valuable knowing your patients’ experience is to keeping your HCAHPS scores high.  They also highlight using standardized patients to teach doctors better interpersonal skills. Did I mention I have over ten years experience in the simulation training and incorporate this style of training for our secret shopping team?  Click here to read more about my background.

Below is just the first few paragraphs, click the link below to read the entire article.

Lillie Robinson came to Rowan Medical Center for surgery on her left foot. She expected to be in and out in a day, returning weeks later to the Salisbury, N.C., hospital for her surgeon to operate on the other foot.

But that’s not how things turned out. “When I got here I found out he was doing both,” she said. “We didn’t realize that until they started medicating me for the procedure.” Robinson signed a consent form and the operation went fine, but she was in the hospital far longer than she’d expected to be.

“I wasn’t prepared for that,” she said.

Disappointed patients such as Robinson are a persistent problem for Rowan, a hospital with some of the lowest levels of patient satisfaction in the country. In surveys sent to patients after they leave, Rowan’s patients are less likely than those at most hospitals to say that they always received help promptly and that their pain was controlled well. Rowan’s patients say they would recommend the hospital far less often than patients elsewhere.

Feedback from patients like Robinson matters to Rowan and to hospitals across the country. Since Medicare began requiring hospitals to collect information about patient satisfaction and report it to the government in 2007, these patient surveys have grown in influence. For the past three years, the federal government has considered survey results when setting pay levels for hospitals. Some private insurers do as well.

With Medicare Pay On The Line, Hospitals Push Harder To Please Patients – Click here to read the article.

Medical Mystery Shopping – Hospital Food Service Case Study

Medical Mystery Shopping – Hospital Food Service Case Study

A Success Story in Hospital Food Service

Verify HealthCare conducted a comprehensive hospital-wide food service audit to determine vendor compliance to performance standards and contractual obligations.

The client: a prominent metropolitan hospital in the Southwest in the process of major expansion.

The Engagement:

The hospital had already attained a national reputation for excellence in pediatric care but wanted to improve support services performance and quality, particularly in food service.

Hospital administration was disappointed with its contracted food service vendor and, over a period of time, discovered that food quality, service, and sanitation were falling short of desired expectations. The vendor’s three-year contract, worth approximately $3.75 million annually, was up for renewal in 6 months. Administration felt that a comprehensive performance review could help determine if the contract should be renewed, but leadership lacked sufficient time and experience to conduct such an assessment.

Hospital administration retained Verify HealthCare to:

  1. Review hospital’s and vendor’s established food service standards;
  2. Develop and implement processes to evaluate performance;
  3. Observe food service operations for 90 days and present findings;
  4. Offer recommendations for improvement.

Outcomes:

Working with hospital administration and the vendor’s management team, Verify HealthCare identified five (5) obstacles to success:

  1. Poor sanitation levels and working environment
  2. Inadequate / faulty equipment
  3. Extravagant use of temporary employees
  4. Under-staffing / shortage of FTE’s
  5. Lack of effective training

Verify HealthCare used the following methodologies to pinpoint performance issues:

  1. Specific vendor and hospital standards for food service were identified and revised to serve as performance benchmarks to measure quality of products and services.
  2. On-site inspections were conducted during each working shift to assess department adherence to established standards, including customer service, product quality, sanitation, food safety, and work environment.
  3. Confidential questionnaires were administered to food service employees, hospital staff, visitors, and patients to rate satisfaction levels and help identify areas for improvement.
  4. “Mystery shopper” audits were conducted in all food service outlets to determine compliance to established policies and performance standards.
  5. Mystery shopper visits were conducted at competitor food service outlets for comparative analysis.
  6. Performance “Scorecards” were published and shared with leadership, based upon audit findings and feedback from interviews with food service vendor management, supervisors, and HR representatives.
  7. Recommendations for improvement were categorized by priority level and presented to hospital administration and vendor representatives.

Key Results:

After the initial benchmarking study, which produced an overall performance score for food service, improvement initiatives were considered. Hospital administration in turn placed the vendor on probation, pending a follow up audit 6 months later.

Verify HealthCare presented a detailed action plan, which was implemented by the vendor in response to the audit. Key staff changes were made, and performance improved dramatically.

  1. During the past 4 years, follow up assessments have been conducted on a bi-annual basis. Key results that have emerged from the evaluations include the following:
  2. The department’s overall quality score increased from a low score of 54% to a high score of 94%, a 74% improvement.
  3. Sanitation levels improved 60%.
  4. Product quality improved 32%.
  5. Customer service ratings improved 40% and are at their highest level ever.
  6. The department earned Press Ganey’s highest satisfaction scores for outstanding performance within 3 years of Verify’s initial audit.
  7. The department earned the highest award for the NSF food safety audit in the region.
  8. Use of temporary employees on the payroll has been eliminated, saving the department over $200K per year in payroll expenses.
  9. The room service team won the CHCA award for customer service initiatives.
  10. Employee turnover decreased nearly 40%, saving thousands of dollars in payroll costs.
  11. Quality standards are updated and reviewed twice per year to ensure a consistent focus on food service excellence, helping to strengthen the hospital’s brand of excellence.
  12. Standards for the newly established room service program have been implemented.
  13. The main cafeteria servery and dining areas underwent a major renovation, and kitchen equipment was significantly upgraded. The cafeteria won a national design award.