Tag: hospital

Care transitions: Interview with Curaspan CEO Tom Ferry

April 15th, 2015 by
Tom Ferry, Curaspan co-founder and CEO
Tom Ferry, Curaspan co-founder and CEO

When Tom Ferry co-founded Curaspan back in 1999, discharge planning wasn’t the sexiest arena for a Harvard MBA to jump into. But he was on to something because 15 years later “transitions of care” is a mainstream term, there is a major focus on readmissions prevention, and post-acute care is universally recognized as the greatest opportunity for cost savings. Curaspan is right in the thick of it.

Though we both live in Boston, I met up with Tom at the #HIMSS15 conference in Chicago. Curaspan is exhibiting at HIMSS for the first time, and its booth is seeing a steady stream of traffic. In this podcast interview, Tom discusses the importance of care transitions and how Curaspan plays a role in addressing the challenges.

  1. Why are transitions of care important? (0:08)
  2. How does the hospital discharge process typically work? How should it work? (0:42)
  3. There is tremendous variation in cost and quality in post acute care. Why? (1:23)
  4. What role are new payment arrangements such as ACOs and bundled payments having on the discharge process? (1:53)
  5. Hospitals are typically paid on a DRG basis for what happens in the hospital. If we move to an episode based system what will happen to post-acute providers such as skilled nursing facilities? (2:41)
  6. Do you plan to incorporate data and analytics to determine where a patient should go based on their individual characteristics? (3:42)
  7. How do patient and family engagement play into the discharge process? (5:16)
  8. Why did you start Curaspan? How has the concept evolved since then? (6:25)
  9. What products and services do you offer on the Curaspan platform? (7:23)
  10. What are your objectives for the HIMSS conference? (8:42)

By healthcare business consultant David E. Williams, president of Health Business Group.

Improving the Hospital Compare website

January 17th, 2014 by

HealthLeaders’ Cheryl Clark has done a commendable job in identifying 12 changes she’d like to see on Hospital Compare, the quality reporting website run by the Centers for Medicare and Medicaid Services. You should read the article for the details.

I don’t disagree with any of the recommendations, but there are four in particular that I’d like to highlight. The recommendation #’s and bolded titles are from the article.

  • #1 Lake Wobegon Syndrome. Something is wrong when 95% or more of the hospitals are listed as average with very, very few in the below or above average category. But this does present an opportunity to really call out the outliers for special treatment or shunning. My hope is that we’ll get to finer gradations as the quality of the data increases.
  • #2 Report by Bricks and Mortar. Too many facilities are allowed to be grouped under one identifier, which tends to hide both good and bad performers. It’s related to issue #1 above.
  • #3 Military Hospitals and the VA. Very little information is presented for many federal hospitals. Actually, we should expect them to report more than the private sector since they are accountable to the taxpayer. And they should set the example for the rest of the system.
  • #7 Stop Avoiding Children. Hospital Compare is Medicare-centric. That’s an issue for the non-Medicare population as a whole, but especially for pediatrics. This is a more difficult hole to fill.

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By David E. Williams of the Health Business Group.

Patients should not be responsible for telling doctors to wash their hands

October 1st, 2013 by

Hospitals struggle to get doctors and nurses to wash their hands. That’s a serious problem, since hand washing is one of the keys to reducing healthcare acquired infections that afflict more than a million patients a year and kill over 100,000. And it’s one of the reasons you should try your best to stay out of the hospital.

For the past few years I’ve heard suggestions that patients should take a more active role, and in fact have the responsibility to speak up. Today’s Wall Street Journal (Why Hospitals Want Patients to Ask Doctors, ‘Have You Washed Your Hands?’covers the topic again, with a pretty strong message that patients need to take charge.

I strongly disagree.

Here’s one excerpt from the article:

The CDC has provided 16,000 copies of a video, titled “Hand Hygiene Saves Lives,” to be shown to patients at admission. In one scenario, a doctor comes into a room and the patient’s wife says, “Doctor, I’m embarrassed to even ask you this, but would you mind cleansing your hands before you begin?” The doctor replies, “Oh, I washed them right before I came in the room.” The wife says, “If you wouldn’t mind, I’d like you to do it again, in front of me.”

And here’s another:

“We’ve been focusing on intensive interventions to improve hand hygiene among health-care workers for decades, yet we’ve really shown very little progress,” says Carol McLay, a Lexington, Ky., infection prevention consultant and chair of the committee that designed the campaign [to get patients to speak up]. “We are trying to empower patients and families to speak up and understand their role.”

Am I the only one that thinks the situations described above are absurd?

Here’s how I see it:

  • If infection control specialists have been failing to make progress with health care workers for decades then they need to figure out what’s wrong and fix it, not throw the problem onto patients. Here are some ideas: education to get more buy-in from clinicians on the idea of frequent hand washing, technology to track whether hand washing is occurring, harsh penalties for lack of compliance –like closing down a hospital floor, or firing or suspending staff, or making lack of hand washing subject to malpractice claims. If you believe the conventional wisdom (which I don’t –but that’s another story) then physicians will be so focused on avoiding lawsuits through defensive medicine that they’ll instantly get to 100% compliance on hand washing
  • The scenario in the video of first asking a doc if he washed his hands –and then not accepting his answer that he just did it but instead wanting to see him “cleanse” his hands again– is ridiculous. That’s not my vision of patient engagement
  • Lack of hand washing is reasonably visible to the patient, but what about all the other things that occur? Is it practical to verify that my doctor performed all the correct diagnostic tests, interpreted the results correctly, made the right differential diagnosis, prescribed the most appropriate antibiotic and dosing level,  that the hospital stored the medications properly and disinfected their equipment, that the nurses didn’t fake their credentials and that their immunizations are up to date, that I was referred to the right specialists, etc.? All of these things –and many, many others– are important, but I count on the hospital to deal with it and the regulators to oversee that it’s done. I want quality ratings that take into account these issues and I don’t mind payment incentives that reward certain behaviors and penalize others

Don’t get me wrong. I hate the idea of doctors and nurses not washing their hands. If I’m in the hospital and I see something I’m unsure of I do speak up. I bring an advocate when I’m a patient and act as one for others. I would even bring up hand washing in certain circumstances.

But I really resent the idea that I’m supposed to be the handwashing police. Hire someone else to do the job.