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    Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates stand head and shoulders above the competition.

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Engaging Patients in Palliative Care

Engaging Patients in Palliative Care

In celebration of National Hospice/Palliative Care month, it seems fitting to point out the record growth in palliative care over the past decade.  Increasing by more than 100%, these programs typically provide chronically ill patients relief from pain and stress.  While hospice provides support for patients in the final stages of terminal illness, palliative care can be delivered to children and adults in a variety of settings.  In a nutshell, palliative care providers can address specific physical or psychosocial symptoms efficiently and reduce time spent in the inpatient ICU, oncology or outpatient setting.  And by quelling a patient’s suffering and length of stay, quality, survival and patient satisfaction improve while readmissions and expense are minimized.

As noted in the recent AHA Guide, Palliative Care Services: Solutions for Better Patient Care and Today’s Health Care Delivery Challenges, the Joint Commission initiated a new certification program for palliative care in 2011.  Based on clinical practice guidelines and national standards for delivering high-quality palliative care, the certification emphasizes:

  • A formal, organized palliative care program led by an interdisciplinary team whose members possess the requisite  training and expertise
  •  Use of evidence-based guidelines or expert consensus to guide patient care
  •  Leadership endorsement and support of the program’s goals for providing care, treatment and services
  • A special focus on patient and family engagement
  • Rigorous and continuous quality improvement efforts
  • Processes that support the coordination of care and communication among all care settings and providers

With a tremendous void in the number of physicians trained in palliative care, nurse practitioners offer an alternative for palliative team membership, particularly in rural settings.  Already proven to provide complimentary skill sets in the ICU, hospitalist and oncology settings, a recent Mayo study concluded that Nurse Practitioners were effective in bridging the difficult discussions regarding advance directives and improving patient’s well-being during treatment.  And with these discussions, those advancing to hospice would be fully prepared for their next stage of illness.  Regardless of provider type, a significant opportunity exists to engage patients in their mental and physical health.  As noted in the Agency for Healthcare Research & Quality (AHRQ) video below, engaging patients through interactive media is instrumental in improving the palliative patient’s quality of care and life.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Giving Thanks for Connections to a Healthy Future

Giving Thanks for Connections to a Healthy Future

Taking a moment to pause at this time of Thanksgiving, I wanted to share a recent interview Kaiser Permanente CIO, Philip Fasano during the NASA mHealth workshop, about how advances in digital health are getting people the care and information they need when, how, and where they want it.  And as you will see in the accompanying video, there is much to be excited and thankful for regarding the advancements in this space.

Advance Practice Nurse Led Clinics – Coming to Your Medical Neighborhood Soon?

Advance Practice Nurse Led Clinics – Coming to Your Medical Neighborhood Soon?

In celebration of National Nurse Practitioner week, Drs. Norah Johnson and Kristin Haglund provide a glimpse into a developing trend between academic nursing institutions and nurse led clinics.  In their overview of Marquette Neighborhood Health Center (MNHC) in Wisconsin, they illustrate the symbiosis that can be found between a nursing school seeking resident NP training and the desire to improve the communities that they serve.  Through its affiliation with the Marquette University College of Nursing, MNHC delivers primary care, health promotion, physical exams and diagnosis and treatment of common illnesses in a federally designated primary care health professional shortage area, located in downtown Milwaukee.  Since 2007, this NP led clinic has treated local residents, Marquette University students and employees, clients of the Salvation Army, and clients of the Milwaukee Center for Independence.

Predominantly serving a Medicaid population, this nurse-managed health center now finds itself facing many issues regarding sustainability.  Not meeting the current requirements of a federally qualified health center (FQHC), no matching federal funding opportunities exist.  Rather, nurse led clinics often rely on the support of university funding via an academic partner, leaving it in competition for dwindling dollars.  And while Medicaid does reimburse for Nurse Practitioner services, it is generally at a rate one-third less (66%) of a standard primary care visit.  Medicaid reimbursement rates are projected to improve for 2013/14; however, only those delivered by a physician specializing in family medicine, internal medicine, pediatric medicine OR a nurse practitioner working and billing under the supervision of a qualifying physician. While this is a positive step for increasing the Medicaid provider panel, it will not generate additional revenue for MNHC since the NPs bill under their own Medicaid provider numbers.

Having recently written about the dwindling number of Medicaid providers in the state with the highest uninsured rate, I would be curious to know how the Centers for Medicare and Medicaid Services (CMS) would view the inclusion of nurse led clinics in the medical home?  By developing affiliations with accountable care organizations, nurse practitioners gain access to referral sources for higher acuity services and capital for infrastructure and improvements.  Additionally, drawing this vulnerable population into a continuum of care paves the way for reducing inappropriate utilization of more expensive outlets for primary care – namely the emergency department.  Thus, savvy hospitals, healthcare systems, physician groups and payers participating in or modeling new payment arrangements not only reap the benefit of prevention, wellness and subsequent reduced readmissions, they also have the opportunity to engender loyalty amongst an influential group of expanding primary care providers and expand their recruitment pool.  Most importantly, with a new entry point into these redesigned delivery mechanisms, increased numbers of un/underinsured persons have the potential to receive care; albeit not without the changes to the Medicaid reimbursement rate for the NP led clinic clinician in a medical home.

In addition to funding challenges, MNHC struggles with a high no-show rate.  In working with a medical home, MNHC would have the ability to employ an electronic medical record and participate in direct messaging or a health information exchange, services not typically found in a siloed NP led clinic.  Layer in population health management tool and these front-line providers begin to have the ability to improve their breadth and depth of services rendered.  Marry this with appropriate messaging for appointment reminders, medication maintenance and others identified in the webinar below and the potential exists to transform the manner in which this critical population accesses healthcare – a fundamental necessity for bending the cost curve and transforming the way healthcare is delivered today.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Driving Down the Real Cost of Healthcare: Pediatric and Teen Medical Homes

Driving Down the Real Cost of Health Care:  Pediatric and Teen Medical Homes

At last, the presidential race has concluded and, as a nation, we can prepare to move forward.  With President Obama’s election to a second term, implementation of the Accountable Care Act (ACA) moves full steam ahead.  In light of the fiscal cliff – perpetuated by the expiration of the Bush tax cuts, the 2009 Economic Stimulus provisions, the payroll tax holiday and 67 other tax provisions – the question still remains, how do we make a significant impact on cost reduction in healthcare?

While much has been written about the spiraling cost of chronic care, I found it surprising to learn that spending on healthcare for commercially insured children under age 18 grew faster than spending for adults from 2007 to 2010. After examining more than three billion insurance claims from three major carriers, the Healthcare Cost Institute reported that consumer spending on pediatric and teen healthcare increased 12% to nearly $88 billion dollars from 2007-2010, while spending on adults increased at a slower rate of 8%.  Even more intriguing, it seems that spending for children’s healthcare increased despite decreasing numbers of children covered and a utilization of expensive healthcare services, such as hospital stays and brand-name drugs.

If utilization is not driving this increase in healthcare cost, then what is?  According to the report, a number of activities are contributing to this trend, including increased use of consults, procedures and testing facilities. Digging deeper into the data, the study also revealed that two groups are incurring the highest cost:  infants, three years and younger and teenagers, aged 14-18.  While the increasing expense associated with pre/peri/post-natal births and associated outcomes is comprehensible for the infant cohort, what makes les sense is the skyrocketing expense for prescription drugs for central nervous disorders, such as anti-depressants, anti-anxiety disorders and drugs used to treat ADD or ADHD in the teenage population.

By and large, families were spending the greatest amount on primary care visits, immunizations, and preventive medicines (40.3%), followed in short order by outpatient procedures (24%), inpatient procedures (22%) and prescription drugs (14%).  Sufficed to say, this study did not include children participating in the Medicaid or CHIP programs, so it is difficult to discern if similar trends occurred in this population.  As the author points out, regardless of payer, children with exponential healthcare costs grow into adults with unsustainable expense.  Recognizing the benefit of medical homes for low risk pregnant women and children, it would be a fascinating case study to enroll willing participants currently attending a MindUp program that were committed to learning how to cook healthy food options using locally grown fruits and vegetables and engage in healthy exercise regimens.  Last but not least, reaching this critical and vulnerable population will be key.  Incorporating text messaging, voice, email, video and animation in efforts to successfully communicate important healthcare messages, similar to the program below, will ensure that mothers, infants and teens seek wellness and prevention, in efforts to reverse this frightening trend.

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website

Leaning Forward in Health Care

Leaning Forward in Healthcare

In a few short days, the presidential race will conclude, forever determining the fate of Mitt Romney and President Obama.  With the weight of this decision comes potentially heady change for the Affordable Care Act (ACA).  Despite having made laudable healthcare delivery advances in the state of Massachussets, former Governor Romney wants to appeal ACA.  And in the event that President Obama is voted into a second term in office, one wonders how the U.S. can continue to provide millions of stimulus dollars at a time when we are poised atop a  fiscal cliff?  On a positive note for both Republicans and Democrats, a single unifying mantra continues to exist – and it is the need to bend the cost curve in healthcare.

From a global perspective, the authors of this New England Journal of Medicine article, point out that a move in health spending from 18% to 25% of the gross domestic product (GDP) with a correlate increase in federal spending to 40% is not sustainable.  Furthermore, continuing on this trajectory will only serve to reduce funding for education and infrastructure while accelerating national debt.  In order to effectively reign in this skyrocketing cost, the following recommendations have been made:

  • Promote payment rates within global targets
  • Accelerate use of alternatives to fee-for-service payments
  • Use competitive bidding for all commodities
  • Require exchanges to offer tiered pricing and be active purchasers
  • Simplify administrative systems for providers and payers
  • Require price transparency
  • Make better use of non-physician providers

In order to improve quality and reduce cost at the local level, many hospitals and healthcare systems have been actively engaged in Lean methodology, with roots in the Toyota production system best known for promoting efficiency.  In an effort to determine the impact of Lean in healthcare, the Agency for Healthcare Research and Quality (AHRQ) recently commissioned the first independent comparative study of Lean implementation among organized delivery systems.  In Stephen Garfinkel’s review of the study, he notes that kaizens, or rapid cycle improvements, were the most commonly utilized form of the Lean technique.  By engaging employees and other stakeholders in the kaizen method, upstream, downstream and parallel processes are considered when examining a specific process in a value stream.

While kaizen events were generally rooted in process improvement, the study found that capital and operating costs can vary widely.  Without a concrete method for calculating an activity’s cost-benefit ratio, healthcare leaders, instead, chose to adopt Lean for its malleability.  And the majority – both CEOs and staff – were pleased with the results since it provided an opportunity for problem solving, employee collaboration across ranks and units, efficiency improvements, opportunities to spend more time with patients and improved patient experience.

Losing money for the first time in 2002, the newly appointed Virginia Mason Medical Center CEO, Dr. Gary Kaplan, knew that change needed to occur at his institution.  As seen in the PBS special below, Dr. Kaplan states, “the case for change is compelling. The resistance to change and the anchoring in the status quo is still very strong. And so that’s our objective here. We talk at Virginia Mason about transforming health care. And some might say, well, it’s delusions of grandeur. And, really, all we really want to do is show what’s possible.”

Principle Healthcare Associates is an expert resource and dedicated advocate for Nurse Practitioner, Physician Assistant, Physician and Healthcare Executive job seekers. With many years of recruiting experience, we deliver strategies to help clients identify diamonds in the rough and candidates that stand head and shoulders above the competition.

Contact us at PHA email and be sure to visit us at PHA Website