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Complicated Communication: Discussing Unexpected Outcomes with Patients Print E-mail
Written by Marshaleen King, MD | Mutual Matters   
Tuesday, 13 February 2018 19:14

Case Scenario
 
A 32-year-old woman underwent emergency cesarean section due to fetal bradycardia. Her C-section was complicated by an injury to her bladder which was repaired immediately by her obstetrician. Post-operatively, the patient was not informed of this complication as the obstetrician reasoned that this was included as a possible complication on the consent form. In addition, the obstetrician was of the opinion that the bladder repair was successful thus the patient was unlikely to experience any future problems related to this complication.
 
Ten days following delivery the patient presented to her primary care physician complaining that an increasing amount of fluid was draining continuously from her vagina. The patient's primary care physician examined her and reviewed the records that had been faxed over by the obstetrician following her delivery.

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Last Updated on Tuesday, 13 February 2018 19:15
 
Usage remains low for HIV infection prevention pill Print E-mail
Written by AP via STAT   
Tuesday, 09 January 2018 19:09
 
Marketed in the United States as Truvada, and sometimes available abroad in generic versions, the pill has been shown to reduce the risk of getting HIV from sex by more than 90 percent if taken daily. Yet worldwide, only about a dozen countries have aggressive, government-backed programs to promote the pill. In the U.S., there are problems related to Truvada's high cost, lingering skepticism among some doctors, and low usage rates among black gays and bisexuals who have the highest rates of HIV infection.
 

Last Updated on Tuesday, 09 January 2018 19:16
 
Closing the patient care loop with the Next Generation ACO telehealth Medicare waiver Print E-mail
Written by ACO-FL.com   
Wednesday, 27 December 2017 17:00
 
Medicare is making it easier to keep tabs on patients with chronic conditions and those just discharged from the hospital utilizing the Next Generation ACO telehealth Medicare waiver. With its blessing, patient appointments are going virtual in urban areas.

Mobile devices with enhanced capabilities can in real time measure vitals and send alerts to primary care physicians. While that sounds very 21st century, the system poses more challenges than plugging in a voice-activated system like Alexa, Siri or Google Home. The equipment is often installed following a hospital discharge. For our physicians, we send a registered nurse for a post-discharge evaluation and a paramedic to set up and test the telehealth equipment.

Once connected, the primary care physician conducts a virtual office visit that goes beyond a simple check-up. The doctor completes a head-to-toe assessment with the onsite input from the registered nurse and his or her assistant.

From there, a staff member at the doctor’s office reviews patient data daily for improvement. If regular reports do not show progress, the primary care physician re-establishes online contact with the patient to discuss any changes in condition and alter treatment. In this system, the onscreen interaction becomes a way to adjust a plan of care on the fly.

Let’s say that that a patient’s ankles are swelling. The individual can point the tablet’s camera at the joints. The doctor can observe that and other conditions such as breathing patterns. With better information from visual inspection, the physician can make more informed choices on the patient’s level of care.

To encourage usage of the next generation telehealth Medicare waiver, Medicare has expanded its position to allow the patient to initiate contact with the primary care physician regarding a symptom or to ask a question. That opens the door for further assessment. It also relieves the patient of having to make multiple office appointments with specialists who can consult on the telehealth visit such as dermatologists. We’ve discovered that transportation is a huge issue for the patient population in our accountable care organization. Many don't drive and transportation providers are not always reliable.

With distance no longer an obstacle to care, patients can better manage themselves. As family members and other caretakers need to be involved, they join a virtual telehealth session. That closes the loop with the doctor and those who provide support while improving patient outcomes.

Last Updated on Wednesday, 27 December 2017 17:04
 
Next Generation ACO post discharge home visit waiver: Who should be on the team? Print E-mail
Written by ACO-FL.com   
Thursday, 21 December 2017 11:00

As CMS focuses on keeping patients healthy at home, Next Generation ACO primary care physicians are being encouraged to conduct more regular follow-up visits. While the next generation ACO home visit waiver encourages that, the question remains as to who should visit the home and when.

Next generation accountable care organizations like ours are coming up with innovations that can deliver quality care without overextending staff. While an experienced registered nurse is a must for the first visit to a discharged patient, follow-up care can be handled by others.

A paramedic can make sure that in-home equipment is working, that patients have been taking their vitals, and that they're comfortable with their plan of care. If at any point that level of care needs to be elevated, a registered nurse can step in. By matching the medical qualifications to individual needs, patients remain as independent and safe as possible within their home environment while office staff are put to best use.
 
Paramedics make sense not as a substitute for a registered nurse, but as a complement to that individual’s care. If a patient were to be in distress and called 911, paramedics would respond. They are trained to assess acuity and to contact the primary care physician to determine whether the patient is stable enough to stay at home or must go to the emergency room. In this and similar situations, paramedics are performing the roles for which they are trained while the physician maintains full control over the patient’s care.

For example, a patient who has  congestive heart failure experiences weight gain. Equipment that the paramedic installed in the home notifies the doctor’s cellphone, who then communicates with the patient, advising the person to take a water pill and the paramedic to conduct  a re-evaluation. If the patient is stable, the physician instructs the patient to schedule a follow up office visit the next day.

Does every physician’s  office require  a paramedic? No. Some physicians like to have their own teams during office hours. Others outsource the service. The ultimate benefit is better quality care and better use of people’s training and skills.

Accountable Care Options (www.ACO-FL.com) is one of a select group of physician directed organizations organizations accepted into the Medicare Shared Savings Program to improve patient access, medical quality and care coordination in South Florida.

Last Updated on Thursday, 21 December 2017 11:04
 
Next Generation ACO post-discharge home visit Medicare waiver Print E-mail
Written by ACO-FL.com   
Thursday, 14 December 2017 08:37

To lower readmission rates, the number of incident to billable visits will jump next year to nine in the first 90 from the current two in the first 30 days.
 
The new rules eliminate the time intervals between visits. If a patient requires more upfront attention, a post-discharge team can evaluate her or him three times in the first two weeks, and therefore reduce costs by preventing an avoidable readmission. 
 
Not all nine home visits may be needed and the first in-home assessment is the most critical. The doctor should send an experienced registered nurse, someone who has done either case management or social services and thus knows how to assess the patient physically, functionally and socially.
 
That professional will find out how much the patient can do on her or his own, whether a caretaker or family is there to assist, and whether certain measures are in place such as power of attorney and notification of next of kin. The nurse will also assess the patient’s condition, which will then dictate the next visits and follow-up office appointment.
 
Again, much depends on the initial assessment: What types of care would help the patient stay in the home? How much assistance does the individual need? How would the doctor be alerted to send a care team so the patient doesn’t need to call 911?
 
The answers can help the patient stay healthier and more independent, and could bring down the national 18 percent Medicare readmission rate.

Last Updated on Thursday, 14 December 2017 08:40
 
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