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The Startling Impact of Appropriate Utilization

red_barchartBy Gina Tabone – MSN, RNC-TNP

Today’s healthcare environment mandates the optimal utilization of all available resources. Every organization is scrambling to figure out how high quality care can be provided at a lower cost. Many organizations have hiring freezes, are suffering from decreased 2014 reimbursements and are relying on innovative administrative teams to work with budgets that are lower than previous years. Emergency Medicine Departments can be one of the most expensive venues for the provision of care and must come up with immediate solutions to the dilemma of unnecessary visits. Initiatives need to focus on offering patients the most appropriate level of care available that does not involve showing up at the ED. The safest, most cost effective, and easily implemented option is to provide nurse triage to potential patients, prior to them showing up.

The primary beneficiary of having a triage nurse available for advice is definitely the patient. Patient who leave their home and seek care in the ED, are often seeking a level of care that is not necessary for the degree of severity they are experiencing. Having an option to speak with a nurse trained in the specialty of telephone triage represents an access to care that most callers appreciate and end up complying with. They may be able to remain home, and either be referred to a provider in an office setting, or receive home care that will alleviate the current problem. Diverting Patients from the ED is not the goal. The goal is to direct patients to the most appropriate level of care for the symptoms they are experiencing, so that their treatment is continuous and aligned with their primary care providers. In addition to the health benefits of nurse triage there is also a copay savings that would occurs if care was provided in any setting other than the ED. Other stakeholders that would benefit from a pre-ED triage call include health plans, managed care plans, self-insured employers and organizations currently offering ACO’s. The National Hospital Ambulatory Medical Care Survey cites the additional cost of an ED visit vs a PCP office visit to be $580. There is significant opportunity for payer savings as well.

EDs are busy. They are over-crowded, understaffed, 24/7/365, and required by law to treat any patient who shows up. The Emergency Medical Treatment and Active Labor Act (EMTALA) is an act of Congress passed in 1986. It requires hospitals that accept payments from Medicare to provide emergency health care treatment to anyone who believes they need to be seen. There are no reimbursement provisions in the Act. The consequence of ED overuse is threatening the existence of hospital Emergency Departments across the country. The study of Avoidable Emergency Department Usage Analysis estimates that 76% of ED visits made by commercially insured patients are not medical emergencies and can be better treated with skilled and opportune outpatient care. In some states, Medicaid payments for certain ED diagnosis are no longer being reimbursed. Decreased payments, compounded with the fact that from 1991-2010 there was an 8% decline in the number of hospital ED’s in the United States poses a considerable threat to those that remain open. Integrating Telephone Triage is the solution to keeping those 76% of patients who don’t need to be there out of your ED waiting rooms. The specialty of Telephone Triage is practiced by registered nurses using years of experience, critical thinking skills, and evidence based decision support tools. Safe outcomes result from an adherence to the nursing process, a detailed assessment, analysis of symptom specific medical criteria and finally by providing the patient a recommendation to the most appropriate level of care. Offering patients this service provides high quality care at the lowest cost possible. Hospitals need to consider having telephone triage nurses as a component of their Emergency interdisciplinary teams.

TeamHealth Medical Call Center is a nationally recognized, premier provider of remote patient care with enhanced outcomes for a variety of specialty departments including the ED. If you are interested in strategies that best utilize the resources of your organization please contact Karen Brown at Karen_Brown@teamhealth.com to discover how the Triage Nurses at TeamHealth can be your immediate solution.

gina_taboneGina Tabone, MSN, RNC-TNP, is Director of Clinical Solutions at TeamHealth Medical Call Center.   Prior to joining TeamHealth, she served as the Administrator of Cleveland Clinic’s NURSE on CALL 24/7 nurse triage program. Under her direction, ED utilization declined, continuous care coordination improved, performance metric targets dropped from 33% ABD to less than 5%, URAC accreditation was achieved, and the call center grew from covering 350 physicians to the integration of more than 1,500 employed and affiliated providers.

By |March 19, 2015|Blog, Quality Improvement|Comments Off on The Startling Impact of Appropriate Utilization

Could This Easy-to-Implement Service/Benefit Help to Prevent Physician Burnout and Improve Your Physician Recruiting Success?

78715046_smallBy Jeanne Griffin – Director of Business Development

Evidence supports that physician dissatisfaction and burnout is a serious and growing problem. According to the Medscape Physician Lifestyle Report 20151, US physicians suffer more burnout than other American workers. At the top of the list are our front-line physicians—Critical Care, Emergency Medicine, Family Medicine, and Internal Medicine, ranging from 50 to 53 percent of responding physicians in each of those specialties. Medscape Psychiatry2 reports that “45% of primary care physicians would quit medicine immediately if they had the financial means.” These statistics may be alarming to some, but it is the reality for those front-line physicians and healthcare administrators tasked with recruiting and retaining physicians. Physician burnout will not only impact individual practices and healthcare systems, but it also is likely to have dire consequences on our entire healthcare infrastructure.

The good news is that physician burnout is not going unnoticed. It’s top of mind among healthcare professionals who are publishing numerous articles, focusing on identifying root causes and proposing potential solutions. I recently attended a national healthcare conference and found issues related to physician burnout to be hot topics. Physicians and healthcare administrators, visiting our TeamHealth Medical Call Center exhibit, were searching for options and discussing potential solutions that would provide some relief to what they referred to as their overwhelmed and overworked providers.

What benefits and programs are offered to address physician burnout and to help physicians reduce stress and improve work-life balance? To find answers, I searched the Internet to see what perks are offered, either in the recruiting process to attract top talent or used to retain physicians. My findings included the important, but standard benefits, such as different types of insurances, continuing education reimbursement, relocation allowances, signing bonuses, etc. I did not find any benefits or offerings that would positively impact work-life balance and address stress, which is a major cause of burnout among physicians.

During one of the informal huddles at our conference exhibit, someone mentioned the idea of using afterhours telephone triage as a recruiting benefit. Once this idea was presented to the group, consisting of providers and administrators, it was as if a light bulb turned on for several participating in the discussion. Some said they already planned to implement after hours telephone nurse triage to bring relief to their physicians, but they never thought to mention it during the recruiting process or list it as a benefit.   A health system CEO in the group told us that he’s been courting a physician for some time, but he hasn’t been able to get a commitment, and he believed that freeing her from afterhours call duty could make the difference. Several administrators said that their younger physicians have been asking for this afterhours support and were not expecting for afterhours on call to be part of the job.

Being able to offer the provider flexibility to attend family events, get an uninterrupted night’s sleep, and know that they can confidently make leisure time plans is a powerful benefit. For the facility, it can improve provider performance when they have had adequate rest and leisure time. The performance of a rested provider will be reflected in patient satisfaction and quality of care delivered. Carving the 24/7 access out of the provider’s core responsibilities is a powerful physician recruitment and retention game changer.

1Carol Peckham, Medscape Physican Lifestyle Report 2015, January 26, 2015.
2Herdley O. Paolini, PhD; Burt Bertram, EdD, LMFT, LMCH; Ted Hamilton, MD, MBA, “Antidotes to Burnout: Fostering Physician Resiliency, Well-Being, and Holistic Development,” Medscape Psychiatry, April 19, 2013.

 

Jeanne GriffinJeanne Griffin, Director of Business Development at TeamHealth Medical Call Center, holds a marketing degree from the University of Tennessee and 20-plus years of sales and business development experience. Throughout her career, Jeanne’s mission has been to work with each prospective client as a potential partner and ensuring that each client receives high-quality services that are customized for each client’s specific needs, thereby improving client satisfaction as well as the client’s customer/patient experience. 

 

By |March 9, 2015|Blog, Miscellaneous|Comments Off on Could This Easy-to-Implement Service/Benefit Help to Prevent Physician Burnout and Improve Your Physician Recruiting Success?