3 Breakthroughs In Pediatric Care Over The Past Decade

Any way you look at it, the field of pediatrics has grown in exponentially ways. It didn’t even come into its own as a distinct branch of modern medicine until the 1930s.1 Even then, it took several more decades before the first pediatric subspecialty — cardiology — received its own board recognition in the 1960s.2

oxygen was administered to newborns via large mask in 1939, in Berlin, Germany
This is how oxygen was administered to newborns in 1939, in Berlin, Germany. Source: Huffington Post

The years since then have been full of medical innovations that have saved the lives of countless children. As the end of this year approaches, here’s a look back at some of most significant technological advancements over the past 10 years.

3D Printed Hearts

3D printing is becoming the next frontier of organ-transplant medicine. For instance, this year, a soft silicon-made, 3D printed heart beat for about 30 minutes in a Zurich lab.3

Although 3D printing is still far from creating a full replacement for a human heart, this technology has significantly improved the outcomes of heart surgeries for children.

For example, cardiologists and surgeons at Children’s Hospital & Medical Center use printed replicas of patient hearts as models to help prepare for surgery.4 Using MRI and CT scan images, Children’s physicians create models and enlarge them to study a patient’s heart defects more closely.

Surgeons then have the opportunity to practice on these printed models, which leads to more precision during surgery and fewer complications for children afterward.

The continued improvement of 3D printing technology offers a glimpse at an even brighter future for the smallest cardiology patients.

Gene Therapy For Leukemia

Even though leukemia is the most common type of cancer in children and teens, its exact causes have eluded researchers.5 However, at least some types have been linked to gene mutations.6

Last summer, the US Food and Drug Administration approved the first type of gene therapy in the United States, which was designed to treat certain children and young adults with B-cell acute lymphoblastic leukemiasup>7.

The treatment “reprograms” the DNA of a patient’s own T-cells8 to recognize cancer cells. These reprogrammed cells are then infused back into the patient’s body. In a clinical trial with 88 patients, 73 went into remission within 3 months.

Physicians and researchers saw the advance as a new class of cancer therapy that might eventually be adapted for all cancer patients.

Bridge-Enhanced ACL Repair (BEAR)

While ACL tears are some of the most common sports injuries,9 they’re notorious for the time and effort they require for full healing. Reconstruction surgery10 usually requires taking grafts from other parts of a patient’s tendons, and recovery typically takes several months.

For the past 2 years, Boston Children’s Hospital has been using an alternate approach that appears to have great promise. Rather than relying on tendon grafting, the new surgery11 uses a sponge bridge to connect the torn ends of the patient’s ACL. In about 6 to 8 weeks, the ligament grows back and replaces the sponge.

The full potential of this new surgery is still being studied,12 but it has sparked interest among physicians and patients alike. In addition to a quicker recovery, the surgery is less invasive than traditional ACL repair and has the potential to become a game-changer for young athletes.

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  • What Do Healthcare Consumers Value Most? 4 Key Insights
1 Verywell (April 2017)
2 Nature (August 2004)
3 CNN (July 2017)
4 Smallbeats (September 2016)
5 American Cancer Society
6 Cell (September 2015)
7 FDA (Aug. 30, 2017)
8 LA Times (August 2017)
9, 10 American Academy of Orthopedic Surgeons
11, 12 Boston Globe (March 2016)

3 Trends That Will Change How You Run Your Practice

It’s no secret in the healthcare industry that provider reimbursements have been shrinking.¹ At the same time, health care costs are expected to rise 6.5% through 2017, outpacing the rate of inflation.²

In light of this, many analysts believe it was inevitable that health systems would start moving toward integrated network models, with their focus on reduced costs and optimized patient care.³

Here are 3 trends to watch for in integrated networks in the next few years.

1. A Growing Number Of Value-Based Care Contracts

The fee-for-service model continues to dominate the landscape, but that model is slowly changing.4

By the end of 2016, 30% of fee-for-service Medicare payments will move to a value-based payment model.5

These contracts essentially give providers an incentive to reduce expensive or unnecessary procedures and promote preventative care.

Private insurance plans are making a similar shift:6

  • In 2013, 11% of payments in commercial insurance plans were value-oriented.
  • By 2020, a new coalition of private insurers, including Aetna and Blue Cross, aims to transition 75% of their contracts into alternative reimbursement models.

For providers in clinically integrated networks like Children’s Health Network, the good news is that these organizations are positioned to protect physicians in this cost-conscious environment through:

  • Quality improvement projects led by physicians
  • Care standards driven by sophisticated population data
  • Clinical efficiency studies
  • Preventative care outreach programs

2. Improving Analytics

When a network’s reimbursements depend on data and outcomes, analytics are becoming even more critical.7 Watch for more business intelligence, predictive analytics, and population health management.

Also expect to see more healthcare wearables and interactive tools, such as FitBit or weight scales, that transmit data to physicians. This “Internet of Things” market segment is expected to reach $177 billion by 2020.8

At the same time, Electronic Medical Records (EMRs) are becoming “smarter.” Beyond simply displaying patient raw data, they’re running quantitative models that flag physicians on risk and other information relevant to the patient’s care.9

Read more about Children’s Health Network’s Healthy Planet data warehouse.

3. New Avenues For Engaging Patients

Correct analytics depend upon the health system’s ability to see the patient at every touchpoint of care, from routine physicals to complex surgery.

When patients go outside the health system, this can complicate the network’s ability to track data, adjust care standards, and manage costs.10

As time goes on, watch for clinically integrated networks to forge creative new paths to their patient populations, such as virtual care.11

All About Connections

Healthcare Financial Management Association mentions outside-the-box smartphone technology that lets diabetic patients upload their blood sugar readings to their electronic health records and get feedback from a healthcare coach.12

Then, there’s old-fashioned face-to-face outreach.

Partners for Kids, an accountable care organization based in Ohio, offers a program that lets children receive their asthma medication at school.13 It also trains parents in how to dispense the medication at home.

The organization says this effort has raised school attendance rates and reduced emergency room visits. And it has provided valuable population data for the health system.

Expect to see more innovative patient outreach as the payer-reimbursement focus keeps shifting to wellness. Physicians say developing programs like these is a chance to make a strong impact on health policy and patient care for many years to come.

1 Hospitals & Health Networks (Jan. 13, 2015)
2 Fortune (June 21, 2016)
3 Medical Economics (Feb. 10, 2016)
4 Becker’s Hospital Review (March 7, 2016)
5, 6 Committee for Economic Development (August 2016)
7, 8 Healthcare IT Leaders (Jan. 11, 2016)
9 HealthData Management (Dec. 21, 2015)
10 Healthcare Financial Management Association (2016)
11, 12 HFMA (June 29, 2016)
13 Nationwide Children’s (August 2016)

4 Time-Saving Strategies For Your Medical Practice

It’s been a long day, and once again, you’re struggling to finish up documentation and paperwork that you couldn’t finish at the office. Where did the day go?

Administrative tasks can change your job from being solely a physician to being a physician who’s also a data entry clerk, medical assistant, and technician. As these duties pile up, spending clinical time with patients can seem like a luxury.

A 2016 study found that most physicians spent 13 to 16 minutes with each patient1—and physicians across the country think less time with patients is hurting the doctor-patient relationship.2

What causes time drains at your office? For most physicians, the roots are multifaceted — ranging from hidden opportunities to improve practice management to unexpectedly malfunctioning technology.

No matter what the culprit, the bottom line is that time drains subtract facetime with patients … and can be financially costly.

Here are potential time-saving solutions to 4 common challenges that physicians face.

1. Problem: Patient Time Hijacked By Electronic Health Records (EHR)

According to one recent study, in a typical day at the office, physicians spend only 27% of their time face to face with a patient, and almost half of their time managing EHRs.3 Physicians also devote an additional 1 or 2 hours to completing EHRs4 after the office has closed for the day.

Solution:

Ask patients to share part of the data entry burden for you.5 They can fill in basic information through the patient portal — such as which medications they’re taking — before their visit.

Don’t settle for the default settings. Work with your EHR vendor to customize the workflow6 for you. This can minimize unnecessary steps and streamline the process.

2. Problem: Endless Refill Requests

Handling refill requests may not seem like a significant distraction, but the amount of time it takes adds up. On average, a practice’s refill requests can take up to 200 hours per year.

Solution:

Adopt synchronized bundled prescription renewal7: The physician renews all of a patient’s chronic medications (except narcotics and benzodiazepines) at the annual physical, and prescribes refills that will last until the next visit.

3. Problem: Explaining Medical Concepts Slows Down An Appointment

Sometimes, even the most clearly worded explanations of medical concepts still confuse patients. For physicians, this can mean extra time spent re-explaining ideas — possibly several times — until patients understand.

Solution:

A picture is worth a thousand words: Consider using a visual aid.8

Many iOS and Android apps, such as drawMD, can help physicians make their point and save time. Physicians can save images to a patient’s EHR or share them with patients through the app.

4. Problem: Nurses And Staff Can’t Get Off The Phone

Patients want to know all of the details about their healthcare, so it is inevitable that they call your medical staff for answers. Consequently, your staff becomes busy taking phone calls and doesn’t always have time for their other tasks.

Solution:

Leverage your website to cut down on phone time.9 Make sure your information, such as hours and location, is up to date.

Consider publishing a section for frequently asked questions, uploading pre-visit forms, and, if possible, online scheduling. This easy-to-find information can mean fewer calls and more time for your staff.

Saving time is just one aspect of practice management. Subscribe to the CHN newsletter and receive more practice management tips.

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CHN Group Purchasing: A Path To Major Savings For Your Practice
Electronic Health Records: 7 Ways To Hook The Right Patient Data In The Digital Ocean

1 ASC Review (April 7, 2016)
2 PBS (July 21, 2017)
3, 4 Annals of Internal Medicine (Dec. 6, 2016)
5, 6 Medical Economics (Jan. 10, 2017)
7 American Academy of Family Physicians (November/December 2012)
8,9 Physicians Practice (Oct. 8, 2013)

4 Ways To Manage The Pediatric Physician Shortage

It’s no secret that the demand for pediatric care in the US has steeply outgrown the number of practicing physicians.1 “Our next appointment is four weeks from now” has become a familiar refrain at pediatric offices across the country.

The statistics help tell the story:

The shortage is, in part, a reflection of the fact that becoming a pediatric physician takes about 6 years of additional training. But a pediatrician may well earn less than a specialist, a fact that makes medical students think twice before they specialize in pediatrics.

Faced with this pediatric physician shortage, your practice might need to take creative approaches to meeting young patients’ healthcare needs. Here are 4 strategies to consider.

1. Remove Barriers For Non-MD Providers4

From a patient’s perspective, “doctor” generally means a physician with an MD. However, many nurse practitioners (NPs) are trained as primary care providers in pediatric care.5

Not only have nurse practitioners been providing many primary care services to pediatric patients, they’ve also expressed willingness to take the lead in patient-centered medical homes.6

Hiring NPs might ease some pressure on your office, particularly during the winter months as more patients present with viral illness symptoms.

Another option: medical assistants, who can perform advanced medical duties, such as:7

  • Serving as a contact person for patients with chronic diseases
  • Providing customized health education for parents
  • Serving as a “health coach” for older children (e.g., young athletes)

Practices are recognizing this opportunity, with perhaps surprising results. For instance, New Jersey’s Atlanticare Special Care Center (a practice for adult patients) reduced emergency room visits percent8 by adopting a medical home model that uses medical assistants as health coaches.

2. Let Doctors Be Doctors

It’s a problem that keeps growing for physicians nationwide: administrative tasks take too much time away from patients. This is when practice management strategies become critical.

In our last blog, we talked about ways to improve management at your practice to save time and deliver better care. For example:

  • Add synchronized, bundled prescription renewal through your patient portal
  • Use visual aids to explain medical concepts, which can save time
  • Leverage your website to answer patient questions and reduce the amount of time your staff spends on the phone

Keep seeking out strategies like these and, if necessary, consider hiring a practice consultant. Even a few minutes of time saved per day can significantly add up on a monthly or yearly basis.

3. Embrace Telemedicine

Telemedicine9 may be another low-cost solution to help manage the pediatric physician shortage. And, its technology evolves, providers may be able to diagnose a wider range of issues more accurately.

Telemedicine is already addressing a major root of the shortage problem — uneven geographic distribution of providers. It’s often difficult for rural hospitals to support many specialists.

Telemedicine allows small hospitals or practices to connect to bigger medical centers and make more specialists available to their patients.

The American Academy of Pediatrics supports the increased use of telemedicine10, touting its potential for:

  • Improving access to care
  • Increasing communication among providers
  • Enhancing continuous care by linking primary and specialty care providers

4. Make An Impact On Education And Training

Medical school enrollment is increasing every year, but many students make their residency choices out of practical necessity instead of personal preference.

This might drive them away from pediatrics, a field that doesn’t generally offer as many residency programs as other primary care fields, such as family medicine, general surgery, and obstetrics/gynecology.11

Medical practices could emulate some private organizations and consider establishing scholarship and fellowships to encourage more young physicians to pursue pediatrics.

All of these steps combined may help reduce the physician shortage in pediatrics and make excellent care available to more young patients nationwide.

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  • 4 Time-Saving Strategies For Your Medical Practice
  • What Do Healthcare Consumers Value Most? 4 Key Insights
1, 2 Health Capital (March 2014)
3 American Academy of Pediatrics (June 2014)
4 Wall Street Journal (June 2013)
5 New England Journal of Medicine (June 2013)
6 New England Journal of Medicine (May 2013)
7, 8 Fortune (August 2015)
9 Becker’s Hospital Review (January 2013)
10 American Academy of Pediatrics (June 2015)
11 Residency Place

5 Factors That Define Clinical Integration

Health systems and networks are marching toward clinical integration — but if you ask five healthcare experts what clinical integration is, you’ll get 10 different answers.

Most agree that clinical integration aims to stem the loss of reimbursements, find more routes to efficient medical care, and move patients toward prevention and wellness. But what does a clinically integrated network look like? And what does it mean for physicians?

According to industry media that have been tracking the shift, here are 5 strategies commonly found in clinically integrated networks.

1. “Soup To Nuts” Care For Patients

A successful clinically integrated network “links all or most of the health care components a patient might encounter.”1 For example, the network would seamlessly provide a patient with primary care, specialists, hospitals, pharmacy services, and post-acute care.

These areas all share patient data and guidelines about how to treat certain conditions.

“Independent physicians can be a key component,” Hospital & Healthcare News said in January 2015. “If these doctors are not brought into a close relationship with the others, the network’s improvement aims may not be possible.”1

2. Physician Leadership

It’s critical for clinically integrated networks to empower physician leaders and integrate physician expertise into organization-wide operations, industry experts say.1

Physician leaders also can encourage communication, dialogue, and partnerships among members of the network. This can further help the network meet its goals and objectives.1

3. Shared Performance Standards

Clinically integrated networks engage physicians in determining best practices.1 And because physicians who are part of these networks get involved in setting performance data for the network, there is an incentive for everyone to aim high.

These networks also ensure that each business unit plays a role in strategic planning.2 Each business unit then sets an action plan detailing how it will contribute to the network’s goals.

4. Shared Savings

A successfully integrated network is better able to increase efficiency and cut costs, while still offering quality care.2,3 Network members also can benefit from shared savings contracts.1

Also, providers have access to group purchasing organizations, which offer medical supplies and other services at discounted rates.

5. Access To Data, Data, And More Data

Updated IT platforms are also important in any clinical integration endeavor. This might mean an enterprise-wide electronic health record system, or a health information exchange, which leverages existing EHR systems but allows for a data exchange between providers and business units.4

Some networks might choose a blend of the two, depending on patient needs and financial demands.4 In any case, logging performance data helps physicians track patient outcomes, driving better patient care and more efficient practice management—the ultimate goal for everyone involved.1

Read about Healthy Planet, the data tool offered by Children’s Health Network.

Contact Children’s Health Network to learn more about its goals as a clinically integrated network.

1 Hospitals & Health Networks (Jan. 13, 2015)
2 Hospitals & Health Networks (July 2, 2015)
3 Hospitals & Health Networks (May 14, 2015)
4 Modern Healthcare (Jan. 23, 2015)

Blueprint For Success In Clinical Integration

Clinical Integration: 7 Myths and a Blueprint for Success, a white paper from athenahealth, calls attention to three key areas of alignment in order to achieve a successful clinically integrated network. In our early stages as a pediatric-focused clinically integrated network, we are spending time to focus on each of them:

  • Incentives: Members of a clinically integrated network work together to establish a clear, measurable picture of success so they know the exact goals and benefits of what they are individually and collectively trying to achieve. CHN’s Clinical Management Data & IT Committee is responsible for selecting areas for focused clinical improvement, as well as developing, implementing and monitoring compliance with evidence-based clinical practice guidelines, designed to achieve high-quality patient care and cost containment objectives.
  • Knowledge: One major goal of CHN is to share information across multiple practices in our community, resulting in more coordinated care for our pediatric patients. Collaborating in this way provides an outstanding opportunity for CHN and its members to progress to the next level of integration.
  • Behavior: The goal of aligning incentives and sharing knowledge is to produce a change in behavior, one that ultimately results in integrated care for patients that lowers costs. By aligning incentives, sharing information and standardizing processes in active and ongoing management of pediatric diseases, members of CHN will ultimately improve the overall health of our pediatric population.

CHN Group Purchasing: A Path To Major Savings For Your Practice

As healthcare costs have risen, medical supplies are taking larger pieces out of the budget for physician practices.

Fortunately, members of Children’s Health Network have access to group purchasing organizations (GPOs). GPOs cut supply costs, saving the US healthcare system over $36 billion each year.

CHN has partnered with Medline Industries to offer a savings cooperative to its members. John Kenny, VP of Physician Office Corporate Team, Medline Industries, explains how the cooperative works, and why it benefits CHN members.

Q: CHN is comprised of two groups of physicians: those employed directly by CHN, and those who are independent, but associated with CHN. Are group savings available to both groups?

John Kenny, VP of Physician Office Corporate Team, Medline Industries: Employed physicians do sometimes have access to greater savings, as they get to utilize the hospital’s leverage to get good contracts, higher volume of supplies at discounted rates, etc. It’s a little bit more difficult for independent physicians to get the same amount of savings, but they are absolutely able to get them through our program.

Q: How much can practices expect to save?

John: That’s a difficult question to answer, as each office has different needs. Today, physicians within an affiliate are paying wildly different prices for the same medical/surgical items. So, we begin with an analysis to start to see how much each office we can save.

We do guarantee that every practice will have at least a 7% savings, but it’s usually more than that — we normally see 15% to 20% or higher. And depending on how closely the office is monitoring supply costs, we have even seen some offices have 40% to 80% savings.

There are other ways to save a practice money as well, such as increasing lab reimbursements, savings on vaccines, and reduction in pricing for ancillary services (cell phones, copiers, computers, etc.) This program could potentially reduce costs in everything except labor and rent.

Q: That guaranteed 7% savings—is that for every item?

John: No, it’s an aggregate amount. Some items may be discounted more, some less. But in total, it will be a 7% savings.

Q: What types of supplies can physicians save on with the CHN/Medline partnership?

John: We provide savings on commodity items, like exam table paper and gloves. Anything that isn’t clinically sensitive, but could make a big difference in spending in the long run.

Q: Is there a way to save on clinically significant items through CHN’s group purchasing?

John: Yes, definitely. We have access to companies like Provista, who have national contracts on other medical items. So, if you want to buy a certain type of syringe, you can access a nationally negotiated price on product through Provista.

At Medline, we also make similar products. If you find them clinically acceptable, we can provide them at a lower cost, as well.

Q: What about savings on non-medical items, like supplies for the office?

John: We can help with that, too. We’re sort of the door — you come in, and we’ll help you save, or connect you with people who can. With contacts like Provista, we’ve been able to help physicians save on plenty of non-medical supplies, like shipping costs, cell phones, new computers for EMR systems, copiers — anything.

For example, one customer needed to purchase all new computers for the entire group. When connected with group purchasing, they saved over 55% — over $100,000.

Check with your representative before writing any check — even if you think it’s ridiculous, or has nothing to do with group purchasing.

Q: How is Medline able to provide so much in savings?

John: We make our products, we don’t just sell them — and savings are a lot better when they go directly from us to the consumer. Our products have become a leader in the healthcare market, from hospitals, to physician offices, to nursing homes.

Our exam gloves are an example of this — right now, we make 40% of the entire world’s exam gloves.

Q: Will savings stay the same throughout the cooperative, or will they continue to grow?

John: We start with minimum savings, but we’ll bring you as much as we can. As a privately held company, with no stockholders, we’re able to think long-term. We want you to be our costumer for 30 years. We’ll continue to drive value as long as you’re here.

Q: How does group purchasing impact patient care?

John: Group purchasing can make a significant contribution to improving patient care.

With the CHN/Medline cooperative, we focus on consistency and staying with patients through the entire continuum of care. This helps because there is more standardization of products.

The patient journey often involves going to several different locations, like a follow-up appointment or a rehabilitation center. Without standardization, they may be exposed to different types of products. And since different products can have different outcomes, the patient’s outcome can be unpredictable.

The goal of medicine and healthcare is to prevent bad outcomes, and not having patients come back with complications. Of course, there are many factors that go into it. But streamlining and standardizing supplies throughout the continuum helps physicians meet that goal.

Q: Why is it more important to participate in a GPO than ever before?

John: We’re very aware of how the healthcare landscape has been changing. Five to ten years ago, a GPO wouldn’t have been as necessary—it didn’t really make a difference how much supplies cost, and reimbursements were better. But today, things have changed.

It’s much harder for physicians to earn as much as they used to, and to maintain the quality of life they want. Saving has become more important than ever, and supplies are the low hanging fruit.

Q: Does Medline work directly with physicians, or with the administration?

John: Whenever possible, we love to work directly with physicians. It’s their money at the end of the day. That’s definitely easier with independent physicians, as they’re often the ones who want to make decisions about supplies.

It’s a little harder with employed physicians, since we usually work with administrators in bigger systems. But if we can, we really do enjoy working with physicians directly.

Data-Driven Decisions: Using The Right Numbers To Manage Your Practice

Remember when medical records switched from paper to digital copies? As technology has advanced, there has been a shift in how these digital records are used.

It’s no longer just about storing patient data. It’s about using it. The ultimate goal is to integrate this data into your entire practice, from purchasing supplies to providing patient care.

The Healthy Planet Data Warehouse offered by Children’s Health Network helps physicians make strategic decisions.

Healthy Planet: A Dose Of Preventative Medicine In Patient Care

This tool is a platform for collecting patient data from a variety of sources, such as electronic health records or pharmacies. The program gives physicians a centralized set of data to:

  • Understand the needs of their patient population
  • Address gaps in care
  • Learn more about costs in order to better manage resources, like vaccines
  • Improve population health

Example: Patterns In Diabetes Care

Consider children with uncontrolled diabetes who find themselves in the emergency room several times a month.

With Healthy Planet, physicians can examine their health records and treatment history, and compare them to those of other diabetic children who rarely have diabetes-related emergencies. This might reveal patterns in those who need emergency services.

For example, if their parents have received little education about the roots of uncontrolled diabetes, the physician might implement parent education programs every 6 months as a new standard of care.

A 360-Degree View Of The Patient’s Health

Healthy Planet offers comprehensive data on patient demographics and population health trends, including:

  • Standard treatments given for various illnesses
  • Patient satisfaction scores
  • Vaccine prevalence in various patient populations

Looking Beyond The Child’s Own Home

This tool also allows providers to look at social determinants of health, from whether children have been abused to the types of resources available to them, such as social service agencies.

As any pediatrician knows, this type of information is critical for holistic care and preventative medicine—two key components of value-based care contracts.

A 2015 article from the Kaiser Family Foundation even reported that together, both individual behavior and social/environmental factors have a greater impact on health outcomes such as premature death than healthcare does.1

Optimizing Care, Saving Costs: The Win-Win Scenario

The information provided by Healthy Planet has other benefits as well, including:

  • A tool for evaluation—With patient data clearly laid out, it’s easier to review outcomes and determine whether treatment protocols are effective.
  • Reduced costs—Since the data allows physicians to focus on prevention and improved health outcomes, long-term costs can decrease (e.g., fewer emergency room visits and surgeries).

Keep following CHN’s newsletter to learn more about how these data tools provide financial benefits and improve patient care.

1 Kaiser Family Foundation (November 2015)

December 2018 Pediatric Population Health News & Resource Round-Up

The field of pediatric population health is constantly evolving. To help pediatricians stay on top of new developments, here are some of the latest news and resources to be aware of:

Population Health (American Academy of Pediatrics)

This AAP resource highlights practical applications of population health interventions for pediatric practices to consider.

Quality Management (CHN Care Management & Clinical Collaboration Committee)

This pdf provides an overview of HEDIS (Healthcare Effectiveness Data and Information Set) and the importance of tracking quality measurements.

Integrated Care for Kids (InCK) Model (Centers for Medicare & Medicaid Services)

CMS recently announced the Integrated Care for Kids Model, which aims to both lower expenditures and increase the quality of care for children “through prevention, early identification, and treatment of behavioral and physical health needs” at the state and local levels.

Webinar: Integrated Care for Kids (InCK) Model – Overview (Centers for Medicare & Medicaid Services)

This webinar provides an overview of the Integrated Care for Kids Model.

Electronic Health Records: 7 Ways To Hook The Right Patient Data In The Digital Ocean [Slideshow]

When electronic health records (EHRs) started mushrooming on the landscape in the early 2000s, they were met by significant resistance.1 That wasn’t a surprise. Poor usability, expense, and time-consuming training made an unappealing package for physicians.

Now, it’s almost impossible to find a healthcare facility that doesn’t use EHRs. Almost 90% of office-based physicians, and 96% of hospitals, use some sort of EHR system.2,3

While they’ve improved over the years, they still present some challenges. EHRs hold a vast amount of patient data, which has the potential to improve public health. But with so much information, and with the complexity of EHR systems, extracting the most meaningful data can be overwhelming.

As a physician, how can you make EHRs more helpful tools to your practice? Here are 7 recommendations.

1 Health Affairs (March 2004)
2 Health IT (December 2016)
3 Modern Healthcare (May 31, 2016)

Execution: The Key To Turning Your Business Vision Into Reality [Podcast]

Transforming your business vision into reality might seem like a daunting task when you’re running a medical practice. That’s especially in the face of so much uncertainty about where healthcare is headed. But with the right tools, your practice’s potential can become its future.

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on what it takes to turn ideas from dreams to reality in healthcare practices.

Topic Breakdown

1:43—Dr. Brabec on the importance of leadership with healthcare experience

4:20—Seizing opportunities for growth

7:52—Understanding the past to plan for the future

11:22—Overcoming resistance to change through education

Takeaways

  • In addition to business-mindedness, experienced physician leadership is key to successful practice growth.
  • Planning for the future of your practice and knowing when to seize opportunities for growth requires an understanding of past trends in healthcare.
  • Providing opportunities for education and involvement can help hesitant providers become more open to change.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.

Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location into, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska.

Combining Business And Healthcare Experience In Leadership

CHN News: One of the things you mentioned was the importance of clinicians as leaders. You mentioned having that business management experience. And you mentioned that, so many times, there are great ideas from clinicians and great strategies that may even come about. But the execution piece is missing — they don’t always come to fruition.

So, for those independent physicians who are looking to grow — or for physicians who are looking to establish their own independent practices or even become leaders in a hospital system, what do you think is the reason that so many good ideas never actually make it to that execution step and actually become real?

Dr. Brabec: I think that nowadays in some of our hospital systems and commercial carriers and managed care organizations, finding leadership — and not just an executive type of leadership, like someone who has a lot of business experience or a Master’s in healthcare administration or anything like that — but someone who has physician leadership is becoming key.

When you have that experience of having actually been in the trenches, so to speak, and having cared for patients and seen what that takes in terms of the time and effort to provide good customer service and good quality care for your families, I think that physician leadership is more and more key nowadays.

Organizations have to provide not only good business-mindedness, but also the clinical side of healthcare and experience in delivering that, too.

You’re seeing a fair number of physicians nowadays who are going off and getting Master’s in healthcare administration, which is certainly very helpful as well. And then you see physicians who have surrounded themselves with good people who have good business experience.

And that’s what’s been key for our practice in particular: having a good business-minded healthcare administrator who is very strong financially at forecasting and helping develop the business plan in terms of growth and how you look at your practice’s statistics.

So, I think having a good chief financial officer of sorts has been very key for our practice in terms of our ability to do forecasting and sort of predict that growth — and then hit it accurately.

If you just try to go about blindly without looking at numbers and statistics and information that’s coming in, you’re not going to be very successful. You have to be very calculated about growth in medicine today.

Planning For Growth

CHN News: You are a doctor, but you also own several practices. So, you’re also an entrepreneur. How on earth do you balance those two? Do you have certain days where you have your administrator hat on and then other days when you have your physician hat on?

Dr. Brabec: We just recently had a retreat to address that. We went from being a practice with myself and four employees in one office to, currently, four offices with 140 employees: 17 pediatricians, 9 physician extenders, 5 child psychologists, a couple of hospitalists.

That desire to grow came from my former partner in Seattle who was very business-minded. So, when I moved back home, my initial desire was just to move my family back here to raise them around family.

But then I saw that I didn’t have an opportunity to get into any of the other practices. They said, “We need more pediatricians but right now we just don’t have any more room to grow within our practice.”

So, I set out and went to the bank to borrow so money to open up my own practice. I spent time talking to some of the local commercial insurance carriers about products they were offering and how they were having a hard time getting some of the pediatric practices to sign up for their products — particularly an HMO product that was first offered in Nebraska.

I could see that there was opportunity to grow and develop practices.

And the other big experience I brought from just being in a practice where my fellow partners had that entrepreneurial spirit, was that we had also built our own office building out there in Washington.

So, part of the business plan when we built our third office location in Lincoln, Nebraska — after initially being in a couple of buildings where we paid rent to somebody else — the idea was “we’re going to be at this for a while, so why don’t we just pay ourselves?” So, we currently own three of the four buildings.

We’ve also developed a real estate entity for what we’re doing. We’ll basically own four buildings and one of those will be paid off in a couple of years.

Again, that comes from experiences I had with prior mentors to see that opportunity.
Then, in 2006, I also developed a company called Midwest Children’s Health Research Institute that currently performs clinical trials — in particular with regards to vaccines, drugs, and various commercial products like baby formula or diapers that also provides a revenue stream.

Adapting To Change

CHN News: There are so many things you’ve already mentioned that you’ve done: “We want to buy a building for our practice. We want to open more locations.” For so many physicians, those stop at the idea stage. They don’t necessarily keep moving forward. What steps can doctors or practice managers take to make sure that their projects do indeed move forward and become actual goals?

Dr. Brabec: Again, I think the most important part of that is really being very careful and calculated in the things that you do in this day and age. Compared to 28 years ago when I started to do this, and seeing that we weren’t going to head into socialized medicine, we’ve kind of circled back around now with different terms and mnemonics: Integrated Delivery Systems as opposed to Health Maintenance Organizations, and PPOs and PHOs.

I think of us as physicians feel like we’re just circling back around to what already was in the mid 90s and what was being described back in the 70s. I think the difference today with regards to what’s going to happen with healthcare — and the concerns in the 90s were the same: that I’d have to do more but get paid less — but this time I think people really mean it.
CMS means it, Medicaid means it, our commercial carriers mean it. We have to mean it on behalf of our patients and the cost of care more than anything else. We cannot continue to sustain the level of cost of care that’s occurring and how strapped it is for some families as well.

In terms of these opportunities to own your own building and still have your practice exist, I think you’re going to have to be very cautious about growth. I think we’re going to see a fair amount of our care being replaced with telehealth.

I actually foresee that potentially in 3 to 5 or maybe 7 years at the latest, I’m not going to need four office locations anymore. I think I’ll need maybe only three office locations.

Why? Because the care management that I’m going to have to start to deliver to my families — what’s known as the patient centered medical home — and PCMH came about because of the American Academy of Pediatrics being started on behalf of children with chronic healthcare needs — is going be to care management on steroids, if you will.

We’ll start to deliver more and more of that care through telehealth and working to keep patients from having to come into the office. So I think I’ll be delivering even more effective, higher quality, lower cost care by means other than having the patient come to my office all of the time.

CHN News: Whenever goals are set or a vision is put out there, there’s always resistance to change. Healthcare is known as an old, stodgy industry where people often don’t embrace change and innovation as quickly as the market does. How do you counteract that?

When you put forth a vision to your team members and say, “Here’s the direction we’re going,” how do you deal with those folks who may not be on board or may be resistant to change?

Dr. Brabec: Well, I think what’s most important when you see that happening is to try to engage them the best you can to help them understand the change and why it has to happen.
When you look at approximately $9,900 per capita cost in the United States compared to some other countries whose longevity may even be a bit longer than ours but with per capita costs being half of what we spend — though many of those are socialized medicine — I think it’s important to engage and educate rather than letting people sit back and formulate their own opinions that allow their fears to happen.

I think it’s important to be involved wherever you’re at — in particular with an organization that’s going to continue to provide you with the education that’s going to help you evolve towards less fear and less panic in terms of what’s happening with medical care in the United States.

And I think the more informed you are by being involved in an organization that gives you that opportunity and, to some degree, hopefully help to shape what happens, will result in a lot less fear and panic than if you just sit back and let it happen to you.

Right now, there are, unfortunately, a lot of physicians who are close enough to retirement who I have seen even at some of the local hospitals here, when they switched to electronic medical records, and these were good physicians, but they said, “I’m done. I’m not going to do this. It’s just not what I’m used to.”

So, constant education and getting them involved rather than all of sudden — for lack of a better way of putting it — ramming it down their throats and forcing it at them is going to result in a lot less anxiety and fear.

Our medical schools also have to to be involved at the forefront by providing some history of medical care in the United States as well. I think that they will be better prepared. I never had that in medical school. But if I could have seen how the terms and the type of care and how insurance even came about, that understanding would result in a more well-rounded and better prepared physician for the changes that this industry is undergoing and will continue to undergo for years to come.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, NE, and Chairman of Children’s Health Network.

Thanks so much for listening.

This podcast was brought to you by Children’s Health Network.

Hiring Millennials For Your Practice — And Keeping Them There

By 2020, your staff may look a little different.

As we head into the 2020s, the Millennials (those born between 1981 and 1997) are poised to make up over half of the American workforce.1 They will make up a significant portion of your staff, whether as physicians, nurses, receptionists, or maintenance workers.

You want your practice to have the best and brightest. So, how can you hire Millennials — and keep them?

[INSERT ALSO READ]

  • The Business Of Healthcare: Should Physicians Get An MBA?
  • 3 Trends That Will Change How You Run Your Practice
1 Pew Research Center (April 25, 2016)

How Mobile Technology Can Drive Care Management [Podcast]

In today’s technology-dominated world, social media and the internet are playing an increasingly larger role in healthcare. But what does this mean for physician practices and care management?

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on the relationship between the internet and healthcare for both providers and patients.

Topic Breakdown

1:06—Dr. Brabec on social media and what’s next for Children’s Health Network
1:50—The role of physicians in an internet-dominated world
7:00—Challenges physicians face with electronic medical records
7:45—Managing your online reputation as a healthcare provider

Takeaways

  • The spread of misinformation online is a challenge physicians must confront head-on by engaging patients in conversations and involving them in the medical decision-making process.
  • Maintaining electronic medical records can be challenging for practices as certain systems become obsolete — but the benefits of electronic access for patients are numerous, especially if a child has complex medical needs.
  • Technology can help streamline pre-appointment information gathering, which gives providers more time to help patients in-office.
  • Online reputation management is important for providers — but not something that medical schools necessarily prepare new physicians for.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.

Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location to, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska.

The Evolving Role Of Physicians In A Digital World

CHN News: Our topic for this podcast is how mobile technology can drive care management. How are you seeing your patients and families use mobile apps, social media to be patients or to be healthcare consumers?

Dr. Brabec: We’re obviously seeing that more and more nowadays. Families come in and say, “Well, I was on the internet and …” Or “What about this, Dr. Brabec? I read this on the internet …” Or, unfortunately, the things that steer patients in the wrong directions — in our opinion — sometimes with their medical decision-making, such as choosing to not vaccinate their child.

It is something that we have to constantly learn to deal with. Probably the most important piece of information I could give anybody is just to make sure you develop as close of a working, medical professional relationship that you can with your families.

And also guide them in their decision-making and care. All too often, I’ll hear families say, “This doctor I went to for my care as an adult basically gave me some choices and options and left it up to me.” I try to help guide the patient’s decisions, ultimately, in terms of what they decide to do with their child.

Now, mind, you, the discussion regarding the choice to not vaccinate, I give my strong beliefs. But, ultimately, families have to make a choice and decision about what they’re going to feel most comfortable with in regards to their child. I respect that, but I also let them know that we firmly believe in the need to vaccinate, as an example.

But I think when it comes to that knowledge out there, having that relationship with your patient families is most important. Discussing in a congenial manner the information that they’ve found on the internet can help them make the best choice they can for the healthcare they’re going to receive.

There are many apps and websites out there. As a provider, I think you just have to be ready and develop a style for how you’re going to address that when it comes to you.

The Dangers And Benefits Of Technology In Healthcare

CHN News: There are some ways that your practice is using technology to understand patients better. You probably have an electronic records system. Tell me how you guys are using technology to understand your patient population and make care management decisions.

Dr. Brabec: The rudimentary Facebook we have is up and going. And I think, again, the key with that is making sure you have people who know how to use Facebook and deal with the comments as they come in from patients. I think a good, knowledgeable user who can manage that is most important as well.

After 22 years at this practice here in Lincoln, we’re actually getting ready to go to new electronic medical records. This has always been a stressful thing for physicians in terms of trying to find the ideal electronic medical records system to use in your office.

Sometimes the product that you thought was going to be around forever has been bought by a large company that is going to be shelving the product and driving practices to their product. We decided against that and spent close to 10 months looking for a new product that we’re getting ready to evolve toward that as well.

What we want to do here in our practice — and again, this has to do with the amount of time patients have to spend getting off of work to come into the office — is to drive more of the information gathering process that we all experience to before the office visit.

Things like giving your insurance card, filling out a two- or three-page form that updates demographic information, filling out a form about the child’s check-up that day — we’re hoping to drive a lot of that data gathering pre-office visit through our website or other mobile devices.

This will allow us to streamline the process and spend more time when they come into the office educating them and talking to them about their medical problems, rather than most of the visit being about collecting the data.

So for us, what’s going to be key is using the website and various apps that interact with our electronic medical record system to provide that information gathering ahead of time, so we can improve on the patient experience and the care they receive when they come in the office.

Likewise, we also have to — through federal mandates and initiatives — allow our patients access to their medical records, which will be done through the website or apps that link in with the electronic medical records.

This allows them more portability with their medical information, so that whether they’re in Lincoln or whether they’re in Orlando, Florida, if their child gets sick and has medically complex needs and medications, they are able to easily pull that information up and extend that information to other healthcare providers who may otherwise not be familiar with that child’s care.

Then, they can provide the best quality medical care, even though they’re not the child’s regular provider.

CHN News: You may have already answered this question about the greatest dangers and benefits surrounding technology and medical care. It sounds like the danger can be the misinformation that can be spread when it’s not vetted by your actual pediatrician.

Dr. Brabec: Yeah, the misinformation is huge. We all know about that because we’ve all used the internet to search for information and resources. So, first of all, misinformation is a big concern.

But another big concern is social media management of your reputation online. That’s another huge, huge issue and concern that probably drives some practices and physicians away from wanting to be involved with social media and utilizing it for their practices or themselves individually.

There are so many resources out there — Healthgrades.com is one example — where all it takes is for one negative comment to pop up and that can mean a lot for your reputation.
And it may be a situation where you provided adequate medical care but yet for some reason somebody was dissatisfied with the care or the outcome. That’s a huge concern that we’re going to have to learn to manage more and more as time goes on as well.

Transparency is something that’s being put out there more and more by everybody —including the federal government — and I don’t think there’s anything wrong with transparency. It’s just you have to be prepared to manage that.

But, when it comes to medical school, none of us were prepared for that. For those of us who have been in practice for several years now, things have evolved. These are aspects of medical education that need to occur through time.

And then when it gets to residency, more education about the business of medicine and what it means for you if you’re in private practice or working for a larger hospital system. And again, social media management is something that is going to have to be implemented within our medical education system as well.

CHN News: Absolutely. Well, we look forward to getting tweets from you soon.

Dr. Brabec: We’ll start working on that, maybe, next week.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, NE, and Chairman of Children’s Health Network.

Thanks so much for listening.

This podcast was brought to you by Children’s Health Network.

How Much Does Group Purchasing Save Healthcare Providers?

If you’re managing a physician practice, you’re familiar with the daily high-wire act of balancing patient care with controlling costs.

This dynamic undoubtedly explains the rise of group purchasing organizations, which are saving healthcare systems billions of dollars each year.1

Children’s Health Network members have access to Child Health Advantage (CHA), a group purchasing organization that serves 43 pediatric hospitals in North America. Here’s a look at the data behind group purchasing organizations.

Contact Children’s Health Network for more information on Child Health Advantage.

Becker’s Hospital Review (July 2014)

Improving Outcomes And Lowering Costs For Asthma

Asthma affects nearly 26 million Americans, according to the American Lung Association. More than 7 million children have asthma. It’s the third leading cause of hospitalization among children and results in millions of lost school days every year.

While there’s no cure, managing the condition is possible so children can lead a productive, normal and healthy life.

A roundtable was convened in March 2015 by the Brookings and Asthma and Allergy Foundation of America (AAFA), which published a report on the opportunities that exist for improving outcomes and lowering costs by better addressing the social determinants of asthma. Innovations around coordinated asthma care are happening nationwide. The report notes that the most successful community-based asthma programs:

  • Target the highest risk patients
  • Provide education and home-environment assessment
  • Coordinate community, public health, and social services
  • Plan for sustainability

Nebraska Pediatric Clinical Trials Unit: How Children’s is Contributing to Pediatric Research [Podcast] – Part 1

For many years, pediatric research has not been at the forefront of clinical trials. The Nebraska Pediatric Clinical Trials Unit (NPCTU) aims to fill the hole and provide much-needed research in the field of pediatric medicine.

At Children’s Hospital & Medical Center, Russell “Rusty” McCulloh, MD, has made clinical trials for pediatric research his mission. He is the Director of the NPCTU, and the Division Chief for Pediatric Hospital Medicine at Children’s and the University of Nebraska Medical Center.

Dr. McCulloh explains more about NPCTU and a trial that Children’s is participating in — Pharmacology of Understudied Drugs in Children (POPS Study).

Topic Breakdown

0:26 — What is the Nebraska Pediatric Clinical Trials Unit?

7:00 — Types of medications being studied at Children’s trial

10:55 — Addressing ethical concerns with children and clinical trials

15:38 — How to get patients and families involved in the study


Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast.

We are speaking with Dr. Rusty McCulloh, who is the Director of the Nebraska Pediatric Clinical Trials Unit, and the Division Chief for Pediatric Hospital Medicine at Children’s Hospital & Medical Center and the University of  Nebraska Medical Center. Dr. McCulloh, thank you so much for here with us today.

Dr. McCulloh: Well, thank you so much for having me. It’s great to be here.

CHN News: In a nutshell, what is the Nebraska Pediatric Clinical Trials Unit?

Dr. McCulloh: The Nebraska Pediatric Clinical Trials Unit is a program funded by the National Institutes of Health whose objective is to extend clinical trials opportunities for children and their families in our region and to increase the ability of institutions in our region to develop conduct high-quality pediatric clinical research for the benefit of children and families in our community.

It is part of the Environmental Influences on Child Health Outcomes (ECHO) program that’s funded by the National Institutes of Health, whose overarching objective is to identify important and pragmatic ways to improve the healthy growth and development of children through better understanding of what influences the development of children in five general main areas.

These include: pediatric obesity; neurodevelopment (brain development and nervous system development); respiratory diseases and development; pre-, peri-, and post-natal exposure and outcomes — which includes anything from healthy pregnancies to safe deliveries to exposures that moms or infants can experience that impact their growth or development; and positive child health outcomes — which includes a variety of things ranging from the influence of technology on healthy brain development and behaviors to sleep hygiene.

CHN News: All of these things you’ve just mentioned are part of the ECHO program, correct?

Dr. McCulloh: That’s part of the ECHO program. Our piece of it — the Nebraska Pediatric Clinical Trials Unit — participates with 16 other states across the US in a clinical trials network called the IDeA States Pediatric Clinical Trials Network. The aim of this network is to identify and implement high-quality pediatric clinical trials to help ensure that the best treatments are available for children and their families from communities like ours and like the other states that are participating.

These states range all over the country. They are IDeA states — meaning that they participate in the Institutional Development Award program that the National Institutes of Health conducts.

These are states that don’t get as many federal dollars for research as their peer states. This way, we are supporting the development of high-quality researchers from within those states. So people who grow up in Nebraska have just as good a chance as folks who grow up in Illinois or Iowa or other non-IDeA states to pursue a career in scientific research and health sciences and health-related research.

These states include places like Alaska and Hawaii on the west coast to places like Vermont, New Hampshire, and South Carolina on the east coast, and then a bunch of states in the middle — including North Dakota, South Dakota, Nebraska, Kansas, Oklahoma. Lots of states — about ⅓ of the country — are participating in this network.

We’re focused on just a few clinical trials right now to help us get things started because we’ve only been around for the last 2 years or so. We’re building the car as we’re driving it, so to speak.

CHN News: And those 2 that you’re working on now are the POPS study and Vitamin D study?

Dr. McCulloh: Yes, and both of them are really great examples of clinical trials that are practical and can improve the lives of children and their families.

The POPS study — also called the Pharmacology of Understudied Drugs in Children study — focuses on improving our dosing of medicines that are commonly used in children. What I think is important to note is that 80% of all medicines that are used in children are used off-label, meaning that there’s not clear dosing guidance in the same way that there is for adults.

This means that what we’re providing in terms of the doses of medicines to children may not be the best fit for the treatment of the conditions. The analogy I give is: a newborn baby wears a certain size sock and an adult wears a certain size sock. No one would expect that the sock that fits a newborn baby would be the appropriate fit for an adult, so why would we expect that that adult sock should fit those children’s feet? And that’s the way that these medicines are: they’re the adult sock that we’re trying to put on that kid’s foot.

We participate with about 50 other sites across the country — and a few international sites. This project focuses on medicines that children are already taking — they’re not getting put on anything new — and we’re asking for a little blood sample to study the drug levels of the medicines they’re taking to see whether the dose they’re getting is the best dose for those medicines for them.

We don’t use any extra or experimental medicines. We’re looking at what we’re already doing and trying to improve that dosing.

The study had been going on long before we got involved — the last 10 years or so. And it’s helped change some of the labelings for certain medicines and it’s improved our understanding and our dosing for dozens of medicines over time: common things, like antibiotics, things like antiseizure medicines, blood pressure medicines — all sorts of things that kids get that if you give them the right fit, they’ll do much better.

CHN News: You mentioned blood pressure and seizure medications. There are so many different drugs and conditions that are being studied in the trial — are there any that are particularly being studied at Children’s right now?

Dr. McCulloh: There are a few that we’re looking at more closely at Children’s. A lot of the medicines that we’re focusing on have to do with safely putting a child to sleep for a procedure — so sedation medicines — particularly in young infants.

There are also some medicines where we’re looking at both the level of the medicine in the blood and also in the spinal fluid. For children who happen to be giving spinal fluid samples while on this medicine, we’re looking at those drugs as well. And those are typically antibiotics.

And the reason why that’s important is because — particularly for antibiotics — the level of the medicine in your blood, only a small fraction of that gets into your spinal fluid. So, having a better understanding of how much gets in there is really important to ensuring we give the right dose. Because that’s how we treat those severe bacterial infections that we require antibiotics: you give those antibiotics through the blood and then it gets filtered to the spinal fluid.

Ones that we’re looking at in the future are medicines used in children who undergo open-heart surgery — particularly babies who have to undergo open-heart surgery. As you can imagine, the research in that area is very slim because of how few of those babies at any one place in the country are experiencing those surgeries at any given time. So, we’ll be working on that as a focus. It’s good because the medicines that we use there — steroids — can help a lot with how children do after open-heart surgery.

We’re also looking at the use of steroids in premature infants as well. Those medicines often get used in the Neonatal Intensive Care Unit, so ensuring that we’re using the best doses there is really important to make sure these kids do as well as possible and benefit as much as possible from the medicines.

CHN News: Have you been able to use any of your research and results at Children’s so far?

Dr. McCulloh: Not yet. We just started work in this POPS study in the last 6 months or so and we’ve had a few folks enrolled. It takes time to have enough children enrolled in the study to have enough information to present out to change practices.

But we do have results that have gone into the larger study that will be used for future research publications that will help change guidance on dosing.

I think it’s important to note that one of the reasons that our network even exists is that most pediatric clinical trials don’t successfully enroll all of the children necessary to complete the clinical trial.

And not as many clinical trials get started in the first place for children because they’re more expensive to run, there are lots of differences in how children respond to medicines based on their age, and — unlike adults — there’s a much smaller market for those medicines. So, drug companies often don’t have as much of a financial interest to support that sort of research.

This is why 8 out of 10 drugs have not been studied robustly or fully in pediatric populations. So we have to go back and try to fix that.

CHN News: Are there more ethical concerns about doing clinical trials involving children?

Dr. McCulloh: They’re a bit different. For children under the age of 7 and those who don’t have decision-making capacity, their parents are essentially making the decision on their behalf whether or not to participate in that clinical trial.

And what goes into that decision-making is different for parents than if that parent was the research subject themselves. There’s a lot more interest in the benefit or how uncomfortable the study is going to be. Some parents have a lot of concern regarding comfort in participating in a clinical trial — more than they would potentially if they were participating or making the decision for themselves to participate.

When children are older and have some decision-making capacity, but are not yet adults, their perceptions of the study get taken into account as well.

So, it’s a different sort of consent process. Although what other researchers have found in surveying children and families is that there’s a strong desire to participate in clinical trials among children and families — particularly families with children who have chronic medical conditions — because it helps them better understand their own medical condition, and because it feels like they’re contributing toward a greater good. And that in and of itself can be therapeutic and provide benefit to the individual, even if the study they are participating in may not benefit them directly.

CHN News: You also mentioned that dosing changes by age. Do you follow these kids that you’re working with as they get older or do you take a one-time sample?

Dr. McCulloh: That’s a great question. The way that this study works is that, rather than try to follow the same child over many years, they recruit different age groups of children — about 25 kids for each of the age groups — and those age groups include young infants in the first few months of life, infants who are born premature, and then by clusters of years.

There are also special populations focused on children with obesity because obesity has an impact on where medicines go throughout your body. And also, [we have a special grouping for] children who are on a heart-lung machine — because those medicines often may stick to the plastic of the tubing — and these are some of the sickest patients.

So, making sure we get the right dosing for the sickest patients is super important for them as well. Not that it’s not important for everybody, but in this group, in particular, the risk of not getting the right dose may have a larger impact because of how sick they are.

CHN News: If they have multiple conditions or are on multiple types of medications, can they be in this trial or does it have to be someone who’s really just on one medication?

Dr. McCulloh: They can be on multiple medicines. They can even be on multiple medicines that are being focused on in the study as well. We obtain samples — with their permission — for each of the drugs of interest that they are on. There’s not a limitation from that standpoint. The only limitation is: are you on a medicine of interest already — because we don’t want to put you on any medicines — and are you in a right age category or medical condition category to participate in the study.

The study is pretty straightforward. For many of the children we see, they already have IV access, so we can get the blood without having to do a poke. For other children, we can do it with as small amount of blood as possible — like a finger poke, not having to put a needle in the vein.

CHN News: When you are working with kids who are on multiple medications, do you also get good information on drug interactions?

Dr. McCulloh: We do. It’s not a primary focus of the study, but we do get a lot of information about how those drugs may interact when they’re given at the same time. And that’s information that can be shared with people who are focused on improving on dosing or learning more about drug-drug interactions as they are developing new medicines.

CHN News: You’d mentioned some of the upcoming tests you’ll be doing at Children’s. Is there anything else on the horizon for this study?

Dr. McCulloh: The really good news is that the National Institutes of Health said this program has been so successful that they’re renewing it for another 8 years. We anticipate participating in this study for many years to come.

We also have the ability to propose new drugs of interest through the network with our participating researchers. There is always the opportunity for patients and families to make their voice heard and say, “These are medicines that are important to us and our community.”

We would love to hear more of that because I think the more input from the community on research a) the better people understand the process and b) the more trust there is in the process. It should be this cycle where we try to answer important questions based on what the community tells us is important — at least in part — and that we share what we find back to the community, so they understand what happened and what we learned.

The last piece is that for folks who are interested in learning more about the study, we do have it listed on the Nebraska Pediatric Clinical Trials Unit website, which has a lot of patient and family information. And folks can also express their interest if they sign up for the Nebraska Pediatric Participant Registry.

CHN News: And is this also where providers should go if they think they have a patient who might be interested in this?

Dr. McCulloh: Yes. I will say that we’re conducting the study right now at Children’s Hospital & Medical Center and the clinics that are connected, and at the University of Nebraska Medical Center’s main campus — because there’s a bit of a time limit on when the blood sample has to be put in the freezer, so that we make sure we get accurate drug levels from that blood sample.

But absolutely, if folks are interested and they aren’t on those campuses, they can feel free to reach out if they’ve got some interest in learning more about the study.

CHN News: Can providers who are not a part of Children’s refer patients to Children’s for this study?

Dr. McCulloh: They can. That’s absolutely something we would be happy to talk about. We can obtain consent from a child and their family and obtain the blood sample here at Children’s with the help of our research coordinators.

CHN News: Dr. McCulloh, thank you so much for your time today, and for telling us more about the Nebraska Pediatric Clinical Trials Unit and the POPS Study.

Dr. McCulloh: Thanks for having me.


If you are interested in learning more about the Nebraska Pediatric Clinical Trials Unit, email Dr. McCulloh at rmcculloh@childrensomaha.org.

 

Patient Experience 10.0: What Can Physicians Learn From The Hottest Companies? [Podcast]

Top notch. World class. Gold standard. Such expressions are often used to describe a positive customer experience with good outcomes. But what does that experience actually look like, and how can we apply that to patients in healthcare?

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, offers some insights.

Topic Breakdown

1:37 — Dr. Brabec on how the service in his favorite restaurant inspired him on running a healthcare practice

3:40 — Be respectful of your patient’s time

4:56 — Avoid redundancy

5:30 — Provide the value perceived by your patients

Takeaways

  • Running a healthcare practice is no different from running a restaurant in terms of providing a good customer experience. Fostering a culture of working as a team is important.
  • To provide the ultimate patient experience, be attentive to their needs, respectful of their time, and aim to reduce redundancy in information gathering.
  • 99% of the referrals are word of mouth. Quality care and positive experience bring more business to your practice.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec. Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Lincoln, Nebraska. The practice is called Complete Children’s Health that I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location into, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Nebraska, as well.

CHN News: Talking about patient experience, as you know that’s sort of a huge distinguishing factor for many companies. You know, everybody watches movies, for example. But for some reason, there’s something about Netflix that took over and now there’s no more Blockbuster. And it’s not that it’s so much that there are so many different movies. It’s the experiences are different. And we started to see a lot of that translate into healthcare, just focusing more on the actual patient experience. Before we talk about the healthcare part of it though, can you think of a company you really admire because of the experience they give their customers?

Dr. Brabec: Well, you know I love food, so one of them that comes to my mind immediately was, when we moved from Seattle, Washington to the Midwest, particularly Lincoln, Nebraska, we saw a distinct difference in the level of customer service you received in a restaurant. Any by that, people who constantly fill up your water, people who take dirty plates right away, people who took your order right away. All of those things. Yeah, one of our favorite restaurants here in Lincoln, Nebraska, called Lazol’s, provided an incredible level of service, customer service that we even found to be in paralleled some of the finer restaurants in Seattle, Washington. And what did they, [it’s] what makes you want to come here eating there, doesn’t it? So, what did they put forth that created that experience or fostered that culture?

And that’s what’s important, culture. They all work together as a team. So, whether you are actually waiting the table and taking the order, or you are that person who was assigned that table but you are walking by another table you are not assigned to, for instance. One of the several key initiatives to be working efficiently and providing excellent experience was that you never come back to this kitchen without a dirty plate in your hand. So, even though I just took the order over here, I walk by that table, they are on my way back and even though it’s not my table, I pick up the dirty dish that I see right away.

So anyway, providing that ultimate level of service and customer care, and to this day, that restaurant is what I put in front of my staff and say what do you think about the Lazlo’s experience, and what we need to provide here in terms of the customer services and experience for our families? Because it’s really no different. One of the first things we should say is “How can I help you?” And being able to follow through with how can I help you by giving them a solution once they started to tell you about what their needs are. I never want to hear, for instance, somebody schedule and say “You know I’m sorry. All of our appointments are filled up for the day. If your child needs to be seen today, you have take him somewhere else.” You just don’t want to do that. You just absolutely don’t want to do that.

You find a way to help the patient for the day with the child who has ear infection rather than make them wait until tomorrow and saying all the appointments are filled for the day and you have to take them to the urgent care center. So customer experience, all too often, there just hasn’t enough attention paid to that obviously in terms of providing the ultimate customer service and experience. Time is of the essence for them just like it for anybody else, so being respectful of their time more than anything is very very important, number one.

Number two, also trying to avoid redundancy in the care we deliver or in information gather. I alluded to that early on about the forms you constantly having filled out and filled out again, we need to get better reducing redundancy in the healthcare because we see that happening. Why do I just got to tell them that doctor about that, now I have to tell you again about this. So, trying to reduce the redundancy there and trying to deliver again good quality healthcare, being able to spend more time talking and educating on the reason and the problem why you came to the office today as well.

I tell my nurses, when you go to call the family back and you see there’s a mom with a toddler and also happens to have a little baby and a carrier. Help the mom. Offer to take the carrier. Take the diaper bag. Take the toddler by the hand and help guide them back as well. Get patients back to the exam room right away rather than having them sit out and hustling and bustling waiting room with others. Children who are sick and their child isn’t sick.

There’s a lot of different aspects to customer service and experience. And basically when you look at the AAA. What’s the value, what’s the value of the medicine I’m receiving today? Everybody defines value differently and we have to cognize that, of that varying definition of value for everybody and try to serve the perception of what value is to all of our families in the way they perceive that.

CHN News: And that’s great for the patient. Like you said you know what gives them a good experience, they feel valued. How does that help the practice to focus on the patient experience?

Dr. Brabec: Now they again too, Lincoln again there’s a time when you know our growth here and practice continue to be good as well, but our local hospital systems both of them have continued to employ their own physicians and open up their own practices. Other pediatric practices have continued to add pediatricians to their practices as well. So, we are competing more and more in particular for the commercial paying patients and for the Medicaid patients as well. So, you want to provide again AAA medicine. You want to be able to provide good service and good quality care. And I founded this practice here when we started to look at how people got referred to the practice. Literally 99% of referrals were word of mouth. It’s not putting an ad in the paper that’s getting patients to come to our practice. It’s word-of-mouth referral. So, you know a good experience will be told through for others. A bad experience will be told to others.

CHN News: That’s right. That’s absolutely right.

Dr. Brabec: So, provide a good experience and care that you put forth in your practice and the customer service that you are giving as well.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, Nebraska, and Chairman of Children’s Health Network.

Practice Management: How To Get Ready For … Whatever Is Next From Washington [Podcast]

As 2017 continues to unfold, the future of healthcare policy in the United States remains a mystery. What changes will Congress propose to the Affordable Care Act, how extensive will they be, and how will they affect independent physician practices?

Brad Brabec, M.D., Chairman of Children’s Health Network and President of Complete Children’s Health, an independent physician practice, shares his thoughts on how physicians can prepare for the months ahead.

Topic Breakdown

0:38—Reaction to election results
2:44—How independent physicians can be prepared for the future
5:07—Reasons physicians don’t always get involved in public policy
7:42—How a repeal of the Affordable Care Act might impact independent practices financially
10:27—How families can protect their continuity of care

Takeaways

  • The future of US healthcare policy is widely unknown, among patients, lawmakers, and healthcare professionals alike.
  • One of the most important steps that physicians can take to prepare for the changes ahead is to get involved with local medical associations, hospitals, and managed care organizations.
  • Among the biggest frustration that physicians share is having direction for medical care dictated by policy-makers who are not physicians, and have never had experience in caring for patients.
  • “How can we do more for less?” is a conundrum for healthcare professionals as we aim to lower healthcare costs.
  • Quality care involves educating patients about health insurance, and helping them navigate it. Physicians should encourage families to stay in contact about changes to their insurance.

Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Brad Brabec.

Dr. Brabec, can you give us an introduction to who you are and what you do?

Brad Brabec, M.D.: Absolutely. I’m a general pediatrician in a private practice, here in Nebraska. The practice is called Complete Children’s Health, which I first founded coming on 22 years ago, back in 1995, after having been in private practice for six years in Seattle, and having trained out there at a children’s hospital and medical center.

With regards to this practice, we have taken it from one office location to, currently, four office locations. We have plans to expand to a fifth office location in the next couple of years here in Lincoln, Neb.

What Is Happening With Healthcare Policy In The United States?

CHN News: The first topic that we want to talk to you about is, how to prepare for “whatever.” And this topic ties into the election results. We now have President Donald Trump, who is talking about — and in some cases already taking steps towards — changing a lot about our healthcare system.

First, let me ask you — do you remember what you were doing when the election results were coming through?

Dr. Brabec: Oh, boy. I was, interestingly, sitting intently in front of the TV most of the evening, listening very carefully. And then, I very clearly remember hopping into bed, getting ready to go to sleep, thinking, “Well, you know, this is probably not going to go the way we want it to.” But then, at about that time, starting to see, all of a sudden, how the election results were coming through …

And long story short — here it is, 3 a.m. and I’m still wide awake, and in disbelief in terms of what had happened with the results at that point in time.

And I’m not going to make any political comments, good or bad, about that, mind you. But at any rate, I was wondering, “What is this now going to mean for healthcare?” Because it was the same thing back in ‘94/’95, when I moved home. And again, remembering Hillary Clinton standing up there, showing her card, and saying, “You’re all going to have health insurance someday,” and thinking, “Here comes socialized medicine.”

Now, with the potential repeal of Obamacare, and with what may replace it — which will probably be known as Trumpcare or whatever — we are back into a similar mindset of the unknown that we had back in ‘94 and ‘95. And, so, again — your forecasting is going to be just as accurate as my forecasting at this point in time.

Preparing For The Whatever

CHN News: I think that’s what we want to get at. Because regardless of what side of the aisle you fall on, or what your thoughts are on the direction healthcare should take, there are always some things that independent physicians should be doing to prepare for “whatever.”

Can you talk a little bit about some of the changes, or some of the practices, that independent physicians need to just establish as habits to be prepared, regardless of what happens with the Affordable Care Act?

Dr. Brabec: Well, I think most importantly, you have to be involved in some degree or another, and not sit back and be complacent in letting it come to you, more than ever before. And I think that that comfort level and that experience comes with time.

I mean, I’m coming on 28 years in private practice this summer. I would tell everybody, regardless of whether you’re just starting out or you’ve been in practice, “You really need to stay involved. Get involved and stay involved, if you can.”

That means, certainly, with your local medical society — in Nebraska’s case, the Nebraska Medical Association. But I think also with your local healthcare systems. What are they doing to prepare for it? How are they reacting to it? Are they starting to hire more of their own physicians, or are they developing other practices?

Be involved in your pediatric divisions within the hospitals. But more importantly, try, if you can, being involved, to some degree, with the various managed care organizations that are around. So you have some idea about what’s going on.

We also have to understand that in the state of Nebraska, in particular Lancaster County, 40% of our kids, approximately, are on Medicaid. In Lancaster County and the Lincoln area, that pretty much mirrors national statistics. Approximately 40% of our kids in the United States are on Medicaid, so that’s almost every other child.

And it’s very important to be involved with the various managed care organizations. Be involved in committees that will also start to determine quality care parameters and indicators. And try to be in the forefront of those things that are happening with these various managed care organizations.

CHN News: What is the top excuse that you hear physicians give for not being involved? And not going to those meetings, and not being involved in those committees? What are the excuses that some physicians give?

Dr. Brabec: Well, I think that some of the issues you hear are that they’ve maybe been involved in the past, and they feel frustrated. That they were trying to move mountains, and just weren’t able to do so. That they weren’t being listened to.

That you have organizations that have non-medical, non-physician, and non-provider-related people making decisions about the type of care that’s going to be delivered. And I would probably say that’s the most frustrating thing you encounter as a physician, having the type of care being dictated to you.

In particular, being dictated to by somebody who is a non-provider, and hasn’t been involved in direct medical care to serve a patient, and seeing how that gets shaped and formed — and sometimes, not in the best interest of patient care.

Also, the amount of paperwork nowadays that physicians are having to fill out has become monumental. I just recently spent the other day on a child with chronic healthcare needs for a healthcare plan — I spent basically about an hour and fifteen minutes filling out the paperwork for continuing medical care on this child. And all of it obviously not being reimbursed, as well.

So there’s the amount of paperwork, and rules and regulations that have continued to get put forth here through the years, making it more frustrating. Making it more tiring to want to continue to work adequately in medicine.

You’ll hear doctors say, “I just want to take care of my patient. I just want to see my patient, and take care of my patient.” And then I think, you have the increasing concerns about medical legal and malpractice occurrences and situations. That, to this day, has continued to result in the practice of defensive medicine. That, also, will continue to worry many of our fellow providers.

Repeal, Replace, Reassure

CHN News: So, let’s say the Affordable Care Act is repealed. And you mentioned being able to have a strategy, you mentioned having foresight. How would you foresee that impacting independent practices financially, if the Affordable Care Act is really repealed?

Dr. Brabec: Well, what’s being talked about nowadays with many of your managed care organizations and your hospitals, and then again within your physician groups and independent physicians, is basically this concern:

We want to reduce healthcare costs. But when you’re looking at almost 18% of your gross domestic product, $3.2 trillion in healthcare expenditures in 2015, and only 11.8% of that spend being on pediatrics in particular — when you look at how you’re going to decrease the cost of care, improve the quality of care, improve the patient experience, impact the health of a population of people — you’re going to have to learn to do it with less money, in general.
Somebody’s going to have to end up getting paid less, whether it’s the hospital, whether it’s the physician. And I think that that’s the hard part for all of us to swallow, who are in practice at this point in time — how are you going to get by doing more for less? Because how else are you going to decrease the cost of care that’s being delivered to somebody?

So, I think that’s the hardest part that I see hospitals struggle with. That’s the hardest part that I see physicians struggle with.

And it’s going to take an evolution of how we deliver that care over a period of time, that needs to occur with regards to, in particular, working much more closely with the carriers.
And then, the states that administer Medicaid, see how you can achieve the triple aim, and hopefully decrease the cost of that care. It has got to be a really strong coming together at the table, more than anything.

CHN News: For the patients, who are concerned about losing their current coverage and having to go to different physicians, and reestablish those relationships—what do you tell them? What do you do to reassure them?

I certainly know of families who have had a new physician every year for the last three years. They have had to switch physicians or switch practices because their insurance changed. What can you say to those families to help ensure that their continuity of care will go uninterrupted and go smoothly, and their children can still get the care they need?

Dr. Brabec: What we appreciate is families staying in touch with us constantly about what’s happening with their health insurance. Because sometimes, we’re not aware ourselves, as providers, what’s happening, what’s being offered out there.

We just recently encountered this, as a matter of fact. In a matter of two weeks, we had nine families contact us and say, “We want to keep you as our children’s provider, and the medical practice for our children, but we have just picked a new commercial product that’s being offered and is brand new in the market. And we don’t see you on the provider list.”

And so that resulted, obviously, in phone calls to the provider. Through families contacting us and keeping us aware of situations like that — that was a situation where we were able to negotiate and contract with the commercial carrier on a product, that we had no idea what the impact could be financially to our practice. Fortunately, it wasn’t a significant issue that we had to deal with at the time.

But tell those families to let us know, and let them know: If you have any questions about your insurance — because insurance is very complicated — we want to try to be the providers who can educate our families on insurance, and hopefully help to guide them.
It’s a very, very complicated world out there at this point time with regards to how you navigate your insurance.

There was a study that was done that showed people will change their primary care physician for as little as $600 a year in savings on their health insurance plan. So that’s also something that we have to be very cognizant and mindful of.

That families who are looking for less expensive payments in their premiums, and their deductibles, and things like that — we have to realize that sometimes, despite the loyalty and care that we hope we’re providing — for some families, that is a significant dollar amount that may be necessary for them to make that choice and decision.

So, we’re hopeful that we can continue to help educate them and provide triple-aim medical care for them. And that’s an education process for these families more than anything.

CHN News: You’ve been listening to the Children’s Health Network podcast. That was Dr. Brad Brabec, President of Complete Children’s Health in Omaha, NE, and Chairman of Children’s Health Network.

Thanks so much for listening.

This podcast was brought to you by Children’s Health Network.

Project ECHO: Behavioral Health [Podcast]

Dr. Jennifer McWilliams, Division Chief for Psychiatry in the Department of Behavioral Health at Children’s Hospital & Medical Center in Omaha, provides details on Project ECHO Behavioral Health.

project echo logo

Topic Breakdown

2:25 — Project ECHO offers resources to primary care providers to address pediatric mental health provider shortage in Nebraska

4:32 — Project ECHO will look at common issues, such as depression, anxiety, and ADHD

8:15 — Why it’s crucial for providers to address common mental health issues in children early on

9:02 — Screening for mental health concerns in primary care settings


Transcript

CHN News: Hello, everyone. Welcome to the CHN podcast. We are speaking with Dr. Jennifer McWilliams, who is the Division Chief for Psychiatry in the Department of Behavioral Health at Children’s Hospital & Medical Center in Omaha, Nebraska.

We are talking to her about Project ECHO Behavioral Health, which goes from all of 2018 to the spring of 2019. Thanks so much for being here.

Dr. Jennifer McWilliams: Thank you for having me.

CHN News: In a nutshell, can you describe Project ECHO generally, and then a little more specifically about the Behavioral Health ECHO?

Dr. McWilliams: Absolutely. ECHO is a really exciting program that’s spread throughout the country, where specialists engage with primary care providers through a series of talks and case studies to help support primary care providers with feeling more comfortable with a specific specialty area.

So, as an example, what we’re going to be doing in behavioral health is a series of 11 lectures — or 11 sessions, rather — which are going to be comprised of a 15- to 20-minute lecture where an expert in a topic from Children’s will be discussing that area — whether it be depression, anxiety, etc.

The next 20 minutes of the session will be a case study where people will be able to present cases — real patients that they’re dealing with — so that the group as a whole can talk through those concerns and what they’re experiencing, and how to handle them.

And then, finally, we end each session with a question and answer time period where people can ask other questions that may have come up.

The goal overall is that as the 11-session series goes on, the primary care providers will not only begin to feel more comfortable in treating pediatric patients with mental health concerns, but they’ll also develop a network of colleagues with whom they can share their experiences and bounce ideas off of.

We’re really trying to build a community of learning as much as providing direct knowledge.

CHN News: Why is this so important for primary care providers, especially pediatricians in Nebraska?

Dr. McWilliams: One of the biggest challenges that we’re facing in Nebraska — and even in the Omaha area — is that there simply aren’t enough pediatric mental health providers. Similarly, looking at psychiatrists, there are only a handful of us in the state of Nebraska. And while we all are dedicated to seeing patients and love our work, we recognize that it’s really hard for patients to get in and see us in a timely manner.

As a result, a lot of primary care providers are left in the trenches having to manage these kids on a day-to-day basis. Many times, they end up feeling overwhelmed, undereducated, unsupported — and this is an opportunity for us to try to help build up that foundation, so that they can feel more comfortable with treating the kids that they end up seeing on a day-to-day basis.

CHN News: Is this something that has been going on for a while in Nebraska — this shortage of child psychiatrists and behavioral health specialists?

Dr. McWilliams: Unfortunately, it’s a chronic problem that’s going on across the country, not even in just Nebraska. The areas of the country that have the highest per-capita population of child mentalists and psychiatrists are still woefully underserved.

But in Nebraska, it’s particularly profound because of some of our geographic issues. Almost all of the child mentalists and psychiatrists live and work primarily in Omaha and Lincoln, leaving the vast majority of the state with virtually no access to pediatric mental health care or pediatric care — unless the patient is willing to drive to Omaha.

CHN News: So, these sessions are particularly useful for pediatricians in rural areas?

Dr. McWilliams: Absolutely. We’re offering it to pediatricians across the state, including the Omaha area, but my goal is that we’ll be able to reach out to our colleagues who are practicing in rural parts of the state.

CHN News: What are some of the topics that you’re going to be covering?

Dr. McWilliams: We’re looking really at a lot of the bread-and-butter disorders that affect kids, realizing that primary care providers are never going to want to be in the position — nor would we want them to be in the position — to treat some of the more significant, chronic mental health concerns like schizophrenia and bipolar disorder, etc.

So, we’re focusing on depression, anxiety, ADHD. We’re going to have a session touching on autism, a session on disruptive behavior disorders. We’re also going to be looking at some more processed-based things: How to do a suicide risk assessment, how to screen for mental health concerns in the primary care setting, looking at the effects of adverse childhood experiences.

CHN News: Are these sessions eligible for CME credit?

Dr. McWilliams: Yes. We have gotten each of the sessions approved for CME credit through Children’s Hospital & Medical Center. CME will be offered for each session individually. And in addition, providers who participate in a certain number of the sessions will be able to participate in a maintenance of certification project, which will give them credit towards board certification and recertification.

CHN News: Since this is very beneficial for rural providers, are they going to have to come into Omaha to do this, or is this through teleconferencing — how does it work, exactly?

Dr. McWilliams: That’s what makes ECHO so cool. We recognize that it’d be impossible to get everybody to come and even spend a day with us. The way the sessions are structured is that we use web-based technology — Zoom technology. So, it’s all on people’s local desktops or some groups, if there’s more than one provider in a setting that want to sit down together in a conference room and project the screen, all they have to do is be able to log into the web.

And then, for better or worse, they’ll be able to see us as we give our presentations and we go through the case reviews. They’ll be able to participate and work with us through the video conference call — all from the comfort of their office or their home.

We’ve tried to set the sessions up so that they’re consistently going to be on Thursdays from noon until 1:15, with the hope that over the lunch hour we’ll hopefully be least restrictive for people — and we’ll do that every few weeks.

CHN News: Can people listen in afterward if they aren’t able to attend?

Dr. McWilliams: Yes, we’re going to be recording all of the sessions and then posting them on our website so that eventually we’ll have the full series up there for people to review. Currently, we have the sessions from the ECHO series that we did on pediatric obesity on the web as well.

So, long-term, our goal is to have an archive of different topics that people can refer back to.

CHN News: Which of these topics are you most excited about? Which topic do you think is going to be the most surprising for people who are participating?

Dr. McWilliams: That’s hard, but obviously I’m a child psychiatrist and mentalist, so I love it all. I think really focusing on depression and anxiety — I think those two sets of topics are going to be the most profound. I think there’s a lot of misperceptions among providers that it’s risky and dangerous to treat kids with those disorders.

In reality, the sooner kids can get treatment for depression and anxiety, the sooner they respond, the better their long-term outcomes. And the treatment options that we have are very safe and very effective. So I’m really hoping, personally, that we can hit home what a huge population health problem depression and anxiety are for children and adolescents — and how important it is that we all work together to treat these kids as early and as effectively as possible.

CHN News: How do you anticipate participation in these sessions will impact patient care?

Dr. McWilliams: One of the topics that we’re going to be talking about is screening in primary care settings. We’re going to be specifically looking at the PHQ-9, which is a depression screening tool that a lot of primary care providers are already aware of, if not completely comfortable with.

Our goal — and we’re actually folding this into the maintenance of certification piece and project — is that as people get more comfortable with using the PHQ-9 and screening more patients in their clinics, that they will recognize some of the more subtle, subclinical cases where depression is either just starting to develop or where the kids are doing a good job of masking those symptoms. So that we’ll be able to identify kids earlier and more effectively, so that we can start getting them the treatment they need.

CHN News: Do you know of any other programs in the country that have done something like this that have been successful?

Dr. McWilliams: ECHO is a nationwide program. It started out in New Mexico, I believe with adult gastroenterology. There have been ECHO projects that have been done across the US and there are a number that have been looking at behavioral health, but I’m not aware of any others that are specifically focusing on pediatric mental health.

But, the more the merrier. I think we need to get this out everywhere across the country.

CHN News: Is this program only open to primary care providers or is it open to anyone who is involved in care of children?

Dr. McWilliams: Right now our target audience is primary care providers — so pediatricians, family practice doctors, advanced nurse practitioners, physician assistants, and all of the staff that work with those folks.

CHN News: How can people get more information or sign up to participate in Project ECHO?

Dr. McWilliams: People can go to Children’s Hospital & Medical Center website for Omaha and they’ll see a link to the ECHO program. The registration is linked in there. It’s free, it’s easy, and if anybody has any questions, they’re more than welcome to the Behavioral Health Department here at Children’s: 402-955-3900 and ask to speak either to myself or my partner in crime, Dr. Vance. We’d be happy to help guide people on how to get registered and participate as well.

CHN News: Dr. McWilliams, thank you so much for being here with us today.

Dr. McWilliams: Thanks for having me. I really enjoyed it!

CHN News: You have been listening to the Children’s Health Network podcast. That was Dr. Jennifer McWillams from the Children’s Hospital & Medical Center in Omaha, Nebraska.

The Business Of Healthcare: Should Physicians Get An MBA?

Patients are often referred to as “healthcare consumers,” so it’s hardly surprising that hospitals and medical practices have shifted from a “practice of medicine” mindset to a “business of healthcare” approach.

Physicians have adopted this mindset as well.1 Combined MD/MBA programs have more than doubled since 2000, and more physicians than ever before are returning to school to earn an MBA after years of practice.

An MBA is costly, to be sure: It can easily reach over $100,000, depending on the school. But for physicians who are eager to launch their own practice, an MBA can make the process easier and even improve the likelihood of success.

For physicians who are in private practice — and are not looking to open a new business — an MBA may have different benefits.

If you are an independent physician, here are 7 signs that it may be time to hit the books and receive a formal business education.

1 The American Journal of Managed Care (June 9, 2016)

Value-based Care: 3 Ways To Leverage It To Benefit Your Practice

Value-based care has been a breakthrough idea for payers. But to many physicians, it might seem like the vampire that just won’t die.

Yes, it’s designed to lower costs in the long run, a goal most of us can support. But there’s always a fear that it might not align with optimum patient care … and can put a significant burden on your practice.

Still, value-based care seems to be creeping into more contracts as payers, particularly the government, work to get costs under control. So, the question arises: Are there ways to leverage it for the good of your practice? Here are 3 strategies to consider.

1. Amp Up Your Patient Satisfaction Rates

The shift toward value-based care has put a stronger emphasis on patient satisfaction rates. In that capacity, you’ve always been ready to deliver excellent medical care. But maybe you could look at some extra details that are part of the care experience at your office.

For example, you might see opportunities to:

  • Improve your scheduling system
  • Make your billing statements easier to understand
  • Increase your number of follow-up calls and appointment reminders

You also might consider providing financial counseling to patients, or referrals to payment assistance programs, if you’re not already doing so.

Value-adds like these can boost patient satisfaction rates and improve health outcomes in the process.

2. Launch Quality Improvement Projects

It’s an old formula: Prevention saves money. If your reimbursements will be tied to your patients’ long-term health, maybe it’s time to take a look at some new quality initiatives in your practice.

value-based care

Your quality improvement projects can provide valuable data to payers in the value-based care arena and tie into parallel projects, such as complying with HEDIS quality measures.

3. Make A Stronger Impact On Population Health

It’s no secret that payers have taken a stronger interest in population health management as they move toward value-based care. This gives physicians an opportunity to look more broadly at their patient populations — for example, children with chronic conditions like asthma or diabetes.

To “move the needle” toward better health for these patients, the Health Information and Management Systems Society (HIMSS) suggests three keys to a successful population health management program2:

  • Data analytics
  • Technology adoption
  • The inclusion of the patient as a partner

In particular, consider new technology that provides real-time data and predictive analytics. These tools can drive clinical decisions that better support your patient populations, HIMSS notes. Contact a health information technology consultant to discuss how to implement tools like these with your EMR and workflow.

When your at-risk patient populations start to show better numbers — fewer hospitalizations, more days without asthma attacks, lower blood sugar — you’ll not only create grateful parents. You might also make value-based care contracts easier to manage over time.

Share this article with a colleague who is implementing value-based care contracts into his practice.

1 AAP News (March 9, 2017)
2 HIMSS News (June 20, 2016)

What Do Healthcare Consumers Value Most? 4 Key Insights

It’s a question that’s on the mind of every health professional who’s ever run a clinic, hospital, or other medical business: What do patients want? And how do you retain their loyalty, even through life events like job changes and insurance shake-ups?

Deloitte’s 2016 Consumer Priorities in Health Care Survey helped decode this issue by asking patients what mattered most to them.

The survey yielded four “clusters” deemed important to patients:

  • Personalization expected via providers (personalized care)
  • Economically rational insurance coverage and care choices
  • Convenience-driven access and use of care
  • Digital connections (tools) to help manage healthcare

Here are some of the key insights from Deloitte.

1. Personalization Expected Via Providers

Patients want to feel known and understood by their providers.

Patients Look For Providers Who …

  • Do not rush through appointments
  • Listen and show they care
  • Clearly explain what they are doing, and what the patient will need to do in the future
  • Provide understandable, helpful information about diagnoses and conditions healthcare consumers

2. Economically Rational Insurance Coverage And Care Choices

Patients want affordable healthcare and all-inclusive networks—and they don’t want to be in the dark.

Patients Want …

  • All providers and medications covered and in-network
  • Transparency about when a provider or service will be out-of-network, or will not be covered
  • Clear, accurate cost information for specific services and procedures at particular hospitals healthcare consumers

3. Convenience-driven Access And Use Of Care

Patients look for healthcare that is available at the right time, in the right place.

Patients Look For …

  • Short or no wait times at doctor’s offices, hospital waiting rooms, etc.
  • Providers who are available at a specific date and time
  • Customer service or billing agents who will fully resolve issues healthcare consumers

4. Digital Connections (Tools) To Help Manage Healthcare

Patients use digital tools or trackers to manage their health—but for most patients, digital health is not a priority.

Patients Use Digital Tools Or Trackers To…

  • Schedule appointments
  • Share data from activity trackers with providers or families
  • Web chat to quickly solve issues
  • Seek advice about reliable online health resources
  • Manage health, fitness, and chronic conditions healthcare consumers

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