Analyst briefing revised 11 4 11 (new demo link)

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

http://www.emmisolutions.com/engage/


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CHALLENGES OF HEALTHCARE COMMUNICATION

Average length of a patient visit is between 6 and 17 minutes.



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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







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




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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




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


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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



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– 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



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




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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


Time Engaged in

Teaching Activities (Percentage of Day)

24% for Nurses

34% for Clinical Specialists

Oncology Interactive

Patient Education Series



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



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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




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– “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



Analyst briefing revised 11 4 11 (new demo link)

Health & Medicine

Transcript of Analyst briefing revised 11 4 11 (new demo link)