Cancellations in Bad Weather? You May Need A Specialist to Help Fill Open Slots

Cancellations in bad weather? You may need a specialist to help you fill open slots. If you work in operations in a healthcare provider organization, then you know how bad it can get when the weather gets bad. Patients cancel or need to be rescheduled. Holes in the calendar have to be filled to avoid costly downtime. The phones are jammed and you might also be short-staffed.

Here’s how an actual medical practice in Baltimore is responding with technology:

We are a busy practice, and patients expect to wait at least three to four weeks for an appointment in the best of circumstances. Like any practice in our area, we get cancellations as soon as there is a hint of bad weather. But we hardly get stuck with any open slots. At least not for very long. As soon as someone cancels, the opening is posted on Everseat, and usually not more than a minute or two later an existing patient or even a new patient clicks on it to indicate they want to take that appointment. Our office is notified in real time and can determine in a matter of minutes whether it makes sense to fit them into that slot or to accommodate them in some other way. How do these patients know our available appointments are posted on Everseat? When they call us or visit the office, we tell them about it. We say that they can opt in for digital notification of available open slots. At any given time, we have dozens of people who have chosen to be pinged on their smartphone when something convenient for their specifications opens up. When they get in, they feel like they won the appointment lottery. And we are delighted because we are here to take care of our patients and there is nothing we would rather be doing.

Here are a few thoughts to consider as you cope with weather chaos or think about what you will do when it next comes your way:

When patients start canceling, you need an efficient and reliable way to replace them with the right patients in the right slots.
Using the phones to find the right patients on short notice is not easy. And it’s probably not working. At least not well enough.
If your practice is closing due to weather, re-booking all of those patients will tie up your staff and your phones for hours.
As great as your EHR or other tools are for many things, for this job you need technology, strategy and expertise
With Everseat, you can automate the entire process. You will get more done in less time; for the practice and the patients.

Everseat partners with health and wellness provider organizations of all sizes across the United States. We want to work with you. Email us at providers@everseat.com. We can have you up and ready before bad weather hits again.

Patient Access Problems Get Under Her Skin—Everseat Sits Down with Boston Dermatologist Dr. Emmy Graber

Posted by James Kanka on May 25 with 2 Comments

Memorial Day weekend is here and that means more sun and more time exposing your skin to its pleasing but also potentially harmful rays. In fact, May is Melanoma Awareness Month and a good time to reflect on the challenge of getting an appointment with a dermatologist – not an easy task.

A survey of 7,499 patients who saw U.S. dermatologists from 2011-2012 found that 31% of patients reported a problem with scheduling their appointment. Of those who had an appointment problem, 47% said it took too long to get an appointment.

Cities across the United States consistently show long wait times for getting dermatology appointments. According to the Commonwealth Fund, the average wait time for a dermatology appointment in Philadelphia is 47 days; in Minneapolis the average wait time is 56 days; and in Boston, it is 72 days.

Everseat asked highly regarded Boston Dermatologist Dr. Emmy Graber for her perspective on the challenge of patient access in dermatology. The following are our questions and her answers, edited only for clarity.

Are you familiar with the phenomenon in dermatology of long waits for new patient appointments?

Oh yes! Absolutely. I frequently get complaints from patients that they have had to wait weeks and often months to see a dermatologist. Not only do I hear this from patients but also from primary care physicians who want to refer patients to a dermatologist. A primary care physician might see a rash or a lesion that he or she thinks needs attention from a dermatologist but can’t find a dermatologist that has any openings for months. It is frustrating both for patients and for primary care physicians.

What do you think is contributing to this trend?

There is an increasing demand for dermatologists. As the public becomes more educated about skin cancer, patients are looking to dermatologists for skin examinations to catch and treat any suspicious lesions. Years ago not as many people went to the dermatologist for preventative services like skin checks. Today many people have a dermatologist that they see regularly for skin cancer screenings. It is great that more people are aware of the need for preventative screenings but it also increases demand for dermatologists and thereby increases the wait for an appointment. The resulting delay can be especially problematic for those that have an acute problem such as a rash or painful growth that needs to be treated immediately.

What kinds of innovations are you seeing in the field to expand access to the care of dermatologists?

I see two main types of innovations geared towards those seeking the attention of dermatologists. First, there are scheduling innovations. These may be in the form of apps such as Everseat, that can help people find an available appointment. By using the app, a patient can easily see what office in their area has an opening without having to call each individual office. Second, teledermatology is an innovation that enables patients to get dermatologic care without visiting a dermatologist. Patients send photos of their skin to a dermatologist who can then review the images and remotely instruct the patient on the best course of action.

How are you choosing to differentiate your practice from others that patients can choose from, and how will you make sure they can get in to see you?

I strive to create a convenient, enjoyable experience for all of our patients and I want this positive experience to start even before a patient steps in the door. To that end, we aim to be as accessible as possible. I have tailored our office hours to accommodate early risers who want to come in before work or school and also have evening hours and lunchtime appointments. Patients can find us through the Everseat app to get an appointment at a moment’s notice.

For our existing patients, we have a patient portal so that they can communicate with us via email without having to call into the office with questions or concerns. In the next few months we are rolling out a telemedicine initiative so that we can advise patients who can’t physically get to our office. Many people do not think that going to a doctor’s office is a pleasant experience and I am trying to change that. The whole experience starts with booking an appointment and I want to make it a seamless, easy process.

Dr. Emmy Graber is the founder and President of the Dermatology Institute of Boston. She is a former Assistant Professor of Dermatology at Boston University School of Medicine where she was Director of the BU Cosmetic and Laser at Boston Medical Center. Visit www.DermBoston.com for additional information.

To book an appointment with a dermatologist, or another type of provider, check out available appointments on app.everseat.com.

Top 5 Inefficiencies in Hospital Operations

Posted by James Kanka on February 17 with 131 Comments

In the face of sweeping changes to care delivery due to the Affordable Care Act, concerns over hospital efficiency and access to services are unsurprising. Indeed, though more Americans are insured today than ever before, over 20% report that nonfinancial barriers have led to “unmet needs or delayed care,” with accessibility to hospitals cited as one of the primary reasons. That’s despite the fact that admissions are, in fact, continuing to go down.

So, what’s going on here? The answer is complicated.

Shortage of clinicians
The dearth of primary care doctors and nurses was anticipated, and solutions have been suggested and tested, including the greater use of physician assistants and nurse practitioners to handle lower-level care decisions. But by some estimates, the shortage will become even more pronounced in the next five years — upwards of 20,000 missing primary care providers by 2020, and as many as 90,000 by 2025.

With 16.4 million newly insured and sometimes chronically ill patients now covered under Obamacare, bottlenecks of quite sick people are likely to continue to occur in hospitals across the country. And a clinician shortage affects more than just efficiency. For obvious reasons, well-staffed hospital departments see lower patient mortality rates and higher care quality scores, too.

Poorly-managed patient flow
For over a decade, smooth patient flow has been recognized as one of the most critical factors in preventing overcrowding, delays in care delivery, and maintaining efficiency in hospital settings. Yet data shows that hospitals, particularly emergency departments, remain overcrowded and marked by lengthy average wait times. Part of this is certainly attributable to the ongoing provider shortage.

Lengthy hospital stays, or delayed discharges
Whether because patients aren’t being discharged as soon as they can be, hospital inpatients are sicker than ever before, or planning and coordination among specialists is poor, the length of the average hospital stay has been gradually increasing, standing in 2015 at just under five days. These longer stays aren’t just costly, running between about $1,800 and $2,300 patient per day — they also cost hospitals beds, resulting in fewer spots for inbound patients.

High readmission rates
Despite the provisions of the ACA’s Hospital Readmission Reduction Program, which implements Medicare payment reductions for hospitals with too many readmissions, the number of hospitals being penalized for 30-day readmissions were higher in 2015 than in prior years. What’s causing this “u-turn” or “revolving door” syndrome? According to a report by the Robert Wood Johnson Foundation, avoidable readmissions often occur because inpatient care quality and care coordination is poor.

Poor communication
At the root of poor patient flow, lengthy stays, and high readmission rates may well be inefficient communication among care teams. A survey from the Ponemon Institute of more than 400 providers found that poor communication is costing upwards of $11 billion industry-wide. What is causing communication breakdowns? Some point to shortcomings in or total lack of technology — inadequate pagers or wireless connectivity, for instance.

Others blame cumbersome processes, like those around patient admissions and transfers. The same Ponemon survey revealed, for example, that more than half of the amount of time required for admitting one patient (51 minutes) was wasted on communication inefficiencies. And it’s not just communication between doctors, nurses, and other medical staff that’s affecting the bottom line. Poor communication between patients and providers has been shown to lead to costly readmissions.

In the face of a multifaceted problem, where do solutions lie? One option may be found in focusing on the “handful” of conditions that are the costliest in terms of time and money to treat, the top five being septicemia, osteoarthritis, complication of device implant or graft, newborn infants, and acute myocardial infarction. Scheduling optimization, including the use of better tools to help schedule outpatient procedures and manage patient flow from department to department, presents another avenue of improvement. Regardless, options would be best sought quickly given the number of newly insured patients sure to enter the market in years to come.

To learn more about models of care efficiency and tools that can help improve care delivery, contact Everseat.

How to Determine ROI for Health IT Investments

Posted by James Kanka on February 3

It’s an encounter that nearly every independent physician has had by now at least once: the sales pitch for a tech solution that will improve the way the practice runs. The promises are big — simplicity, efficiency, “painless” billing, seamless appointment-booking — and as the medical technology industry continues to grow, it seems likely that the capabilities of these products will, too. It’s certainly growing: EvaluateMedTech’s World Preview 2015 forecasts that worldwide sales will reach over $477 billion by 2020.

Another familiar moment for doctors? The sticker shock when glimpsing the price tag on a shiny new EHR, patient portal, or online scheduling tool. For example, HealthIT.gov quotes the cost of purchasing and installing an EHR at as high as $70,000. But by some estimates, implementing an EHR could cost over $163,000 for a single doctor. And that’s before factoring in software licensing, training, and maintenance fees, not to mention unforeseen costs. Patient portals, too, are expensive to initiate, yet can ultimately encourage your patients to be more engaged with their care.

With all this money — and time, for training, onboarding, and testing — the inevitable question arises: Is this new technology I’m about to invest in worth it? Or, to put it another way, how can I determine the return on my investment? Though every software product and service out there is a little different, it is possible to calculate the ROI of your tech investment by considering the following framework.

Identify cost centers the technology is meant to alleviate — and calculate how much those pain points are costing you today.
What functions of your practice are the most time-consuming — and ultimately the costliest? Is it fielding patient phone calls on your scheduling line? Or are bottlenecks in your recordkeeping process disrupting the flow of patient paperwork? If you’re already keenly aware of where operational inefficiencies lie in your practice, then begin to investigate just how much these inefficiencies are costing you on a monthly and yearly basis. Knowing where a new solution is needed and knowing how much a given process is costing you now gives you a measuring stick against which to compare any costs associated with a new technology.

Make a reasonable estimate of what costs will be post-implementation.
Of course, vendors selling you EHR technology and other software will promise the moon, including low costs for getting up and running, then maintaining the system they tout. You’ve heard it before: “cut your collection time in half,” or “reduce average hold times to less than 30 seconds per caller.” Remember, companies want your money and your signature on the dotted line, and if their reps think that quoting phenomenal results will put the pen in your hand, they won’t hesitate to tell you about the absolute best performance scenarios they’ve got. So remember to apply a healthy dose of skepticism to whatever sample numbers you’re being given. That said, those numbers aren’t a bad place to start when you sit down to make your evaluation of how a given piece of software will affect your monthly and yearly costs.

Don’t forget to factor in time.
Many doctors on the other side of a tech adoption process don’t take into account how much time it takes to prepare for, implement, and train staff on its use. During the ramp-up phase, you might be less productive than you were before you added the technology. Additionally, in the case of a new EHR implementation, depending on the size of the practice and technology used for converting existing patient records into digital files, it can take months (and staff overtime or outside help) to successfully scan and properly store every record. And remember — just because your patients’ data is saved in electronic form doesn’t mean that their paper files can be destroyed immediately. Depending on the state and the capability of your EHR to provide full copies of a patient record, you may still be required to retain paper records for up to five years.

Be realistic about the degree to which the technology will be used.
One of the longstanding concerns associated with technology in the healthcare sphere is that patients and providers will shy away from use — for doctors because of fears that it may hinder their efficiency and communication with patients more than it helps, for patients because they don’t see the benefit, and for both because the technology may feel too difficult to learn. Indeed, Deloitte reports that while nine out of 10 doctors say they are interested in mobile health technology, only about 24 percent are actually using such tools. And the majority of Americans say they aren’t yet using a patient portal. So it’s important to be mindful of how quickly adoption will follow implementation.

Despite the cost and effort associated with a successful implementation, health IT tools are undeniably the wave of the future, especially as patients get more plugged in and their expectations begin to change. And there are major payoffs to using tools that work well — 79 percent of providers said that an EHR improved their practice efficiency. It’s critical to use the framework above to guide your decision-making about any new technology to make sure that the product is realistic to your practice and its unique expenses. There are also lots of good ROI templates and forecasting calculators out there these days that can help you navigate. If you’d like to talk more about low-cost ways to improve efficiency and patient satisfaction, we’re here to help, so reach out today.

Your Next Doctor Appointment Will Be Done by Your Dishwasher

Posted by James Kanka on May 13

Imagine a medical assistant with the bedside manner of a microwave but the intelligence of 400 Einsteins.

And while you don’t have to pay him, you do have to pay for him, and he is kind of an energy hog. Is that someone you’d want to have on your staff?

His name is Watson, and he’s one of the most advanced pieces of artificially intelligent software in the world. Whether you’re ready for him or not, he just inked several big deals to make his way into medical care offices across the world.

Watson is one of the biggest projects to come out of the computer giant IBM to date, but it may surprise you to know that Watson was originally developed not for medical practices or physics problems, but to compete on Jeopardy!

Watson was first introduced in 2011 to compete against two of Jeopardy’s biggest winners, Ken Jennings and Brad Rutter. Watson had two matches against these human competitors, and amassed $112,881, more than 3 times the earnings of the 2nd place winner Brad Rutter[1]. You can see him competing here:

To put Watson’s power into perspective, consider this[2]:
Watson has access to 4 terabytes worth of data. Compare this to Apollo 11, which used about 4 kilobytes of data. 4 terabytes = about 4 billion kilobytes, which means Watson uses a billion times more data than the first mission to the moon!
Or, for a more modern comparison, the iPhone 5 can store 64 GB worth of data — about 62 times less than Watson’s 4000 GBs.
If you think the storage capacity is insane, look at the processing stats — while the Apollo 11 computer had a 1 megaHertz processor, Watson has a 2,625,000 gigaHertz processing engine.
Again to bring that back to a 2015 comparison, the iPhone 5 works with a mere 1.3 gigaHertz processor.

Apollo 11's guidance computer — Apollo 11’s guidance computer

The leap to practical applications was only natural — if this supercomputer could outplay humans in Jeopardy, what else could it do?

Watson’s first foray into the healthcare field was as a decision support application for Memorial Sloan Kettering Cancer Center in New York City:

When utilizing Memorial Sloan Kettering’s unmatched breadth and depth of experience, gained from treating more than 30,000 patients with cancer every year, Watson will take information about a specific patient and match it to a huge knowledge base incorporating published literature and the treatment history of similar patients. Watson’s ability to mine massive quantities of data means that it can also keep up — at record speeds — with the latest medical breakthroughs reported in scientific journals and medical meetings. Additionally, because it utilizes cognitive computing, Watson continually “learns,” thereby improving its accuracy and confidence in the treatment options it suggests.[3]

That 400-Einstein-sized “brain” of Watson’s is able to take a patient’s unique health profile and tailor both diagnostic and treatment options to deliver the best medical outcome to them. The applications for this kind of decision support are limitless — even the simplest health problems have hundreds of factors that go into their diagnosis and treatments. Watson is able to take a lot of the guesswork out of these medical decisions, reducing the chance of a misdiagnosis or providing the wrong treatment.

So that begs the question — what does this mean for the medical professional?

First of all, you don’t have to worry about robots taking over your job anytime soon. While machines may be better at accessing information, they’re still a long way off from being able to tell patients how to best utilize that information.

Machines also can’t deliver the kind of professional bedside manner or social and moral support that human doctors can. There’s something about talking with a doctor about your medical problem that helps to relieve a lot of stress and anxiety about it.

Despite our best efforts to stay strong in the face of things like cancer and Alzheimer’s, it helps more than we think to hear the calm and collected voice of an experienced physician instead of the cold robotic diagnosis of an advanced supercomputer.

Only time will tell to what extent we’ll see supercomputers and artificial intelligence in your practice and in our lives.

I for one plan on embracing the robot love.

Yours in tech,

Ken Swearengen

P.S. Just when you thought he couldn’t get any greater, it turns out Watson is a philanthropist as well. As the Christian Post reports:
[Watson’s builder] IBM had announced in January that 100 percent of its $1 million prize from “Jeopardy” would go to charity. Half went to World Vision and the other half went to World Community Grid, a nonprofit that seeks to build the world’s largest public computing grid benefiting humanity.

References:
[1] http://en.wikipedia.org/wiki/Watson_%28computer%29
[2] http://www.thedailycrate.com/2014/02/01/geek-tech-apollo-guidance-computer-vs-iphone-5s/
[3] https://www.mskcc.org/blog/msk-trains-ibm-watson-help-doctors-make-better-treatment-choices

The “Uberization” Healthcare

Posted by James Kanka on April 23

Just as the driver-passenger dynamic shifted in the taxi industry with such mobile app-based transportation networks as Uber, so too will the caregiver-patient dynamic shift in healthcare.

In a speech delivered at MD&M West in February, Stuart Karten, the president of the product innovation consultancy Karten Design, predicted the “Uberization” of healthcare: “While medical technology lags behind consumer technology development due to more regulatory oversight, the Uber model is becoming analogous to what we are currently seeing at our design firm: more and more companies come to us in an effort to ‘disrupt’ existing models.”

It would seem that passengers and patients aren’t so different. Both are consumers, after all—people who expect to get what they want when they want it. As was the case for the taxicab model in the transportation industry, the current appointment-making model in healthcare is inefficient, not mobile, often times even unpleasant for the consumer.

Mobile technology had existed for more than a decade before Uber entered the fray, but the taxi industry had simply refused to accept it. Times are different now, but big change is rarely recognized right away. “Healthcare hasn’t yet seen its version of Uber,” said Karten, “But the signs are there: within the next decade, Uber-like companies will emerge.”

But what are the signs? They are manifested in two main forces that are presently transforming healthcare: cultural forces—as seen in the need of an aging population for daily management and care, as well as in Accountable Care’s pressure on many healthcare systems to quantify and measure results; and socio-economic forces—as seen in the widespread connectivity that has emerged across all economic classes in recent years. Today, some 6.9 billion cell phones are estimated to be in use worldwide—that’s up from 2 billion about a decade ago, according to Wireless Intelligence.

Products like Everseat stem from a culmination of these forces coupled with the growing consumer demand for access. Trends show more and more people want to become actively engaged in their own healthcare. Now patients expect to be able to research their doctors, access their own health data, or monitor symptoms quickly & easily.

The shift begins now. As Karten says, “Just as Uber has demonstrated with putting the passenger first, ignoring the patient will be fatal for health solutions companies: they will be the new taxi drivers, baffled by how the world has passed them by.”

Tag: trends in healthcare