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3 posts from May 2018

05/18/2018

The Current State of Nursing Care: A Conversation with Dr. Barbara Ihrke (May 16th)

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Nurses, today numbering over four million, represent the largest segment of the healthcare workforce and deliver the majority of direct patient care.   Their role in determining care quality (and safety) cannot be under-estimated.  Absent adequate nursing care patients can face a long list of nonfatal and fatal outcomes.  The profession however suffers a number of challenges due in part to both an aging population and one that is increasingly co-morbid.  For example, not only are hospital patients more sick (i.e., have higher acuity) but because of financial pressures their lengths of stay have decreased.  Among other issues facing the profession are the increasing demand for nurses (there's presently a nurse shortage that is only expected to grow worse), the increasing demand for higher educational attainment, increasing administrative burdens (that takes away from their ability to provide direct care), an aging nurse population, career burnout, long standing/persisting scope of practice issues that limits their ability to "practice to the top of their licence" and the lack of nurses in organizational leadership positions. 

During this 27 minute conversation Dr. Ihrke discusses nursing education, the nurse shortage, nurse job satisfaction, scopes of practice issues and the under-representation of nurses on hospital and related health care institution boards.   

Dr. Barbara Ihrke is currently Vice-President for Academic Affairs, School of Nursing, at  Indiana Wesleyan University.  She Ihrkehas been on faculty at Indiana Wesleyan University (IWU) since 1994 as Professor, Division Chair, and Executive Director before serving as Dean of the School of Nursing in 2010.  Dr. Ihrke's research focus includes trans-cultural experience and spiritual care.  Her writings have also covered nursing education, clinical informatics and nurse leadership.  Dr. Ihrke overseas work includes serving on an IWU research team that studied Zika on the Island of Gonave, Haiti.   Dr. Ihrke received her doctorate from Purdue, her Masters in community health nursing from IWU and her undergraduate in nursing from St. Cloud School of Nursing.  She earned another under graduate degree in Missions from Crown College and a certificate in Tropical Medicine. 

Cited during  this interview are research findings, in part, by the National Academies of Science, see, for example, "The Future of Nursing: Focus on Education (2011): http://www.nationalacademies.org/hmd/Reports/2010/The-Future-of-Nursing-Leading-Change-Advancing-Health/Report-Brief-Education.aspx. 

05/09/2018

Dr. Tim Williams Discusses the Use of Patient Reported Outcome Measures (PROMs) in the United Kingdom: May 8th

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Healthcare payment models have been increasingly evolving to include quality performance in determining reimbursement.  For example, the Medicare program, including Medicare Advantage, is today littered with quality performance measurement.  Measuring quality in healthcare is, however, not as simple or straight forward as frequently assumed.   Among other challenges, measures developed to date overwhelming measure healthcare process, not outcomes.  Providers typically report on measure sets unique to each payer causing them undue collection and reporting burden, which measure is attributed to which provider can be or is an inexact and under pay for performance agreements comparatively higher quality scores does not always translate to comparatively greater financial reward.  Because of these problems and related others, Patient Reported Outcome Measures (or PROMs) are increasingly seen as a solution.  They reduce provider reporting burden, they are largely outcome based, are more responsive to patient care goals, help to better engage or activate the patient, PROMs data can be, or is, reported real time and can enable more efficient and more timely care delivery.

During this 27 minute conversation Dr. Tim Williams discusses how/why My Clinical Outcomes was formed, how PROMs measures are used in the clinical practice setting and for primarily what disease conditions, what opportunities or advantages they present to improve care delivery and outcomes, the extent to which they've been adopted in the UK, and what might American payers and providers learn from My Clinical Outcomes' PROMs experience.     

Dr. Tim Williams is currently CEO (and cofounder) of My Clinical Outcomes a London-based, an IT company that automates for Williams health care providers, via a web-based platform, the collection and analysis of Patient Reported Outcome Measures (PROMs).  He founded My Clinical Outcomes in 2011 to help bridge the gap in patient-centered care data available to inform clinical care.  Previously, Dr. Williams worked as a physician for the UK's National Health Service and as a healthcare management consulting also for the NHS.   

For more information on My Clinical Outcomes go to: http://www.myclinicaloutcomes.com/

See also this recent April 19 essay by Dr. Williams and myself in The Health Care Blog, "Patient Reported Outcome Measures: Progress Across the Pond," at: http://thehealthcareblog.com/blog/2018/04/19/patient-reported-outcome-measures-progress-across-the-pond/

05/08/2018

Clarification: Per My April 17th Interview with Kip Sullivan, Is the ACO Program Reducing Medicare Spending?

Per my April 17th conversation with Kip Sullivan concerning the Medicare Shared Savings Program/MSSP (ACOs), I noted an August 2017 OMB report that concluded the MSSP saved a net $1 billion in its first three years, i.e., gross savings, OMB reported, equaled $3.4 billion, losses (or reimbursements above benchmarks) equaled $2.4 billion, for a net savings of $1 billion.   OMB also reported, however, CMS paid out $1.3 billion in earned shared savings thereby implying the program lost $300 million. 

I've disputed whether the MSSP actually lost $2.4 billion for several reasons including moreover there's no comparison group and we cannot know what these providers would have spent, the counterfactual, had they not participated in the ACO program.

In back and forth with Mr. Sullivan subsequent to our discussion, he has made the very valid point that if we cannot know if the program lost money we cannot equally know if it produced Medicare savings.