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The Future of Hospital Medicine: The Tools and Integrations Shaping the Specialty

Posted on Tue, Dec 22, 2015
The Future of Hospital Medicine: The Tools and Integrations Shaping the Specialty

By Francisco Loya, MD
 
The technologies we are using to improve the delivery of care in hospital medicine are showing great promise – if not outright success. EmCare’s Hospital Medicine team is deploying innovations that improve operational efficiency, enhance quality of care, ease staffing challenges and upgrade billing and coding practices. As these tech tools become more prevalent, I would argue that the future of hospital medicine has arrived, and with it the promise of better care and lower costs.
 
Operational Efficiency in a VBP World

The value-based purchasing environment has increased pressure on hospital medicine teams. The onus is largely on us to try to prevent readmissions while still being expedient with inpatient care and discharge to help increase patient satisfaction. Through automation, we have been able to reduce wait times for patients, streamline the admissions process and improve rounding and charge capture.
 
Through technology, we have created a platform for emergency physicians and hospitalists to meet and confer virtually so that the hospitalist may admit patients without having to visit the emergency department. This platform has allowed for a decrease in boarding times by 2.5 hours, an 8 percent reduction in “left without treatment” rates and overall improvement (to nearly 100 percent) in CMS core measure compliance. A by-product of the reduced wait times for patients is an increase in E.D. volume of nearly 27 percent. This has meant more volume for the hospital without any additional strain on resources.
 
Another technology we use coordinates admissions between hospitals and primary care physicians. This direct admit system is enacted with a click of a button by the primary care physician, who can then complete an online form to admit the patient to the hospital. The platform also generates a “boarding pass” for the patient to bypass the E.D. and go straight to the inpatient floor. Not only does this technology improve cohesion between hospitals and primary care physicians, it also improves patient satisfaction since wait times are reduced. That, in turn, leads to a decrease in E.D. crowding and an increase to the hospital’s referral base.
 
These tools certainly don’t substitute for human interaction and can’t guarantee improved quality of care, but they do allow for greater control and management over various administrative protocols. The results from these tools have been positive – both for hospitals and patients. Doctors are able to increase their focus on patient care, and most hospital medicine support staff and caregivers say their jobs are easier and more efficient.
 
Telemedicine Can Ease Staffing Woes

Telemedicine is another futuristic technology that’s growing in use and importance. Hospitalists are benefitting from virtual care and robotic caregivers who can help hospitals meet staffing and practice challenges.
 
“Five years ago, the technology wasn’t there,” said Angel Iscovich, M.D., a divisional CEO of staffing and innovation for EmCare. “The safeguards for patient privacy to protect encounters conducted over video just weren’t ready.”
 
Now we have cybersecurity that allows doctors to engage with patients via a video screen and webcam. The practice is easing staffing shortages for hospitals and putting patients at ease since they’re able to meet with highly qualified specialists no matter where those physicians are.
 
And, patients are responding positively to robot doctors. Robots are slowly taking over rounding duties in some hospitals, acting as nocturnists that provide after-hours care. Companies that provide "robodocs," such as InTouch Health, report that its robots can monitor heart sounds and connect to EMRs to improve care and efficiency. The robots are controlled with a tablet, so a caregiver can operate the robots onsite, or doctors can control the robots remotely for virtual visits. The robots can easily round on the intensive care unit, interface with the equipment and provide more expedient and effective rounding than some of their human counterparts.
 
Cameras for the “robodocs” provide enough mobility and resolution to offer high-quality care. One doctor, through the use of video screens and robots, can cover multiple facilities while staying in one place. Hospitals can reduce costs by “sharing” the off-site physicians. And patient satisfaction scores have, so far, not suffered because of the technological intermediaries. If anything, early studies show that patients believe the robodocs and tele-visits provide access to quality providers that otherwise would be unattainable.
 
Bundled Payment Initiative Requires Integration

The Bundled Payments for Care Improvement (BCPI) initiative is a federal government program designed to help manage costs for Medicare patients. BCPI allows disparate organizations to combine services and arrange for payment models that include financial and performance accountability for episodes of care. The program includes four broadly defined models of care to include various combinations of pre-acute care, acute care and post-acute care.
 
With this recent inducement for organizations to work together, clinical integration is more important than ever. Companies will need to attain certain levels of synergy outside of their own organizations. There are, however, some companies that are diversified enough to maximize the potential benefits of BCPI for themselves, their clients and patients. This type of self-integration tends to be more reliable because they have more control over more pieces of the BCPI integration – they are better able to manage quality of care across the care continuum. Through integrated services – for example, a post-acute care company working with hospitalists – costs are reduced, which increases patient satisfaction, since that patient is less likely to need readmitting and can receive care at home (where the patient generally prefers to be). With the cost offset, reimbursement from CMS can be more meaningful for the hospital as well.
 
Medical Command Center Provides Remote Care Coordination

Technology is allowing post-acute care companies greater control over the care offered in a patient’s home as webcams and video screens put caregivers face-to-face with patients. Our parent company, Envision Healthcare, has pioneered the Medical Command Center, a new concept that allows healthcare providers to check in with patients to regulate prescriptions, check vitals and confirm operation of in-home medical devices. Medical Command Center staff use their high-tech control rooms to manage care for patients in a number of states and can quickly dispatch a caregiver, such as a mobile integrated paramedic or physician assistant, to a patient’s home when necessary.
 
These software advancements, tech tools and integrated services are becoming more pervasive as technology advances and providers find new ways to effectively integrate their services. By focusing on operational protocols like admissions, rounding and discharge, along with streamlined billing practices and more seamless care, patients reap the benefits of high-quality personal care provided by caregivers while waiting less, paying less and visiting hospitals and doctors’ offices less.
 
By embracing the technologies that are available now and those on the horizon, hospitalists create more efficient practices for themselves and their patients, and are better able to focus on patient care, as opposed to the administrative processes that often keep us from the bedside - where many physicians prefer to be.

Francisco Loya
 
Francisco Loya, MD, MS, is chief executive officer of EmCare Hospital Medicine. In addition to his EmCare duties, Dr. Loya serves on several committees for the Society of Hospital Medicine, including the Practice Administrators Committee, the Hospital Quality and Patient Safety Committee and the Information Technology Committee. As a physician, Dr. Loya specializes in internal medicine. He earned his undergraduate degree at Rice University, earning a B.S. in Biochemistry and Molecular Biology. His M.D. came from the University of Texas Southwestern Medical School in Dallas and his internal medicine residency was completed at Brigham and Women’s Hospital in Boston – an affiliate of Harvard Medical School. Dr. Loya has also earned his Master of Science degree in Healthcare Management from the Harvard School of Public Health. After earning his master’s degree, Dr. Loya created the technology he named CMORx, which is now offered exclusively by EmCare.
 

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Operational Integration

Posted on Thu, Apr 02, 2015
Operational Integration

An excerpt from the EmCare white paper, Operational Integration

What strategies are in your arsenal to combat and conquer the thorny challenges of healthcare reform? Reducing costs? Improving quality, productivity and efficiency? Redesigning processes? Strengthening relationships with key stakeholders? Entering into new collaborative arrangements? Improving the patient experience? Transforming your organization from one that delivers episodic sick care to one that nurtures wellness and personal responsibility is daunting, but absolutely necessary.
 

What may seem like new challenges for the C-suite are, in reality, the same issues that have perplexed healthcare executives for years. While consultants have prospered by touting the “solution-of-the-day,” a handful of approaches have gained traction. One of those is clinical integration.
 

Just as healthcare continues to evolve, the concept of clinical integration also is maturing. Today’s focus on efficiency, cost effectiveness and quality has put coordination and collaboration at center stage. In fact, visionary healthcare organizations are realizing that integration of services and care requires a macro approach. That’s why many are pursuing a strategic path toward operational integration.
 

What is Operational Integration?

The concept of operational integration springs from the philosophy of clinical integration that traces its roots to cost containment efforts of the 1980s and 90s. In 1996, the Federal Trade Commission (FTC) defined clinical integration by establishing the legal parameters within which greater physician-hospital alignment could occur. The American Medical Association has defined clinical integration as “the means to facilitate the coordination of patient care across conditions, providers, settings and time in order to achieve care that is safe, timely, effective, efficient, equitable and patient-focused.”1
 

In a January 15, 2013 presentation to the American Hospital Association’s Physician Leadership Forum, Integrated Healthcare Strategies™, a healthcare consulting firm, defined organizational integration as “not just structural, but operational synchronization of services to provide optimal, efficient, effective patient-centered care.”
 

The Affordable Care Act of 2011 and the Institute for Health Improvement’s Triple Aim framework have accelerated the development of organizational integration with the emphasis on coordination across the entire episode of care through collaboration and non-traditional partnerships.
 

The concept and importance of integrated health services is a global phenomenon. The World Health Organization defines integrated service delivery as “the organization and management of health services so that people get the care they need, when they need it, in ways that are user-friendly, achieve the desired results and provide value for money.”2
 

Building a Highly-Integrated Organization

Most CEOs have a common vision for their organization – a future state where patients receive the highest quality care in a highly satisfying environment in the most cost-effective manner. But, as most healthcare leaders have discovered, culture trumps vision and the norms within the culture can make or break efforts to achieve the vision. Carefully plotting a roadmap that leads your organization to organizational integration is critical. Six key influencers determine, to a large extent, the degree of success a hospital or health system will enjoy:

Cultural readiness
Physician alignment and leadership development
Identification of waste and eliminating it wherever it exists in the organization
Alignment of processes and demolition of silos horizontally and vertically across the organization
Clear, concise communication between patients, physicians, staff and hospital employees
Elimination of variance and adherence to consistency in care delivery and operational processes to increase patient safety and reduce costs

Read the white paper

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HOW TO: Transform your organization today with Operational Integration

Posted on Tue, Jun 17, 2014

What strategies are in your arsenal to combat and conquer the thorny challenges of healthcare reform? Reducing costs? Improving quality, productivity and efficiency? Redesigning processes? Improving the patient experience? Transforming your organization from one that delivers episodic sick care to one that nurtures wellness and personal responsibility is daunting, but absolutely necessary. While consultants have prospered by touting the “solution-of-the-day,” a handful of approaches have actually gained traction. One of those is clinical integration.

Read our free whitepaper below to discover:

  1. How to build a highly integrated organization
  2. Implementation strategies
  3. Real-world examples of clinical integration

OPERATIONAL INTEGRATION: CREATING A HIGH-PERFORMING HEALTHCARE ORGANIZATION from EmCare

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