Archive for August, 2018

Study: Doctors Reduced Opioid Prescriptions after Learning a Patient Overdosed

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Study: Doctors Reduced Opioid Prescriptions after Learning a Patient Overdosed

Will clinicians become more careful in prescribing opioids if they are made of aware of the risks of these drugs first-hand? That was one of the core questions researchers set out to explore in a new study published in the August 2018 issue of Science. In doing so, they found that many clinicians do not learn of the deaths of those patients who overdose as they just disappear from their practice, outcomes unknown.

This disconnect from the personal experience of losing a patient due to fatal overdose, related to a prescription for opioids to relieve pain, makes the problem of the nation’s opioid crisis seem remote – statistics happening elsewhere. While the epidemic continues to exert its outsized impact, opioid prescription-writing levels have not responded with adequate risk-benefit analysis by prescribers tasked with caring for patients with complaints around pain.

“Clinicians may never know a patient they prescribed opioids to suffered a fatal overdose,” explained lead author Jason Doctor. “What we wanted to evaluate is whether closing that information gap will make them more judicious prescribers.” Doctor is the Director of Health Informatics at the USC Schaeffer Center for Health Policy & Economics and Associate Professor at the Price School of Public Policy.

The study leverages behavioral insights and psychology to give prescribers personal experience with the risk associated with opioids and finds that when a clinician learns one of their patients had suffered a fatal overdose they reduced the number of opioids prescribed by almost 10 percent in the following three months.

Doctor and his colleagues conducted a randomized trial between July 2015 and June 2016 of 861 clinicians who had prescribed to 170 patients who subsequently suffered a fatal overdose involving prescription opioids. Half the clinicians, who all practiced in San Diego County, were randomly selected to receive a letter from the county medical examiner notifying them that a patient they had prescribed opioids to in the past twelve months had a fatal overdose. The letter, which was supportive in tone, also provided information from the Centers for Disease Control and Prevention on safe prescribing guidelines, nudging clinicians toward better prescribing habits.

In the three months after receiving the letter, prescribing decreased by 9.7 percent compared to the control group who didn’t receive a letter. Furthermore, clinicians who received the letter were 7 percent less likely to start a new patient on opioids and less likely to prescribe higher doses.

The results are particularly exciting given that numerous, more traditional state regulations which often involve mandated limits on opioids have not been shown to have much impact. The authors point to numerous reasons why this study showed more promising results including its simplicity, that the letters still allows clinicians to decide when they will prescribe opioid analgesics and that it provides an important missing piece of clinical information to them.

This intervention is easily scalable nationwide as existing state and national resources already track the information necessary around overdose deaths associated with prescription and illicit drugs.

“Interventions that use behavioral insights to nudge clinicians to correct course are powerful, low-cost tools because they maintain the autonomy of the physician to ultimately decide the best course of care for their patient,” said Doctor. “In this case, we know opioids, though beneficial to some patients with certain conditions, come with high risks that the doctor may not fully grasp when observing patients in the clinic. Providing information about the harm that would otherwise go unseen by them gives physicians a clearer picture.”

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Co-authors include Andy Nguyen, Roneet Lev, Jonathan Lucas, Tara Knight, Henu Zhao, and Michael Menchine. Funding for the study was provided by the California Health Care Foundation and the National Institute on Aging at the National Institutes of Health (R21-AG057395-01).

The Leonard D. Schaeffer Center for Health Policy & Economics, one of the nation’s leading health policy centers, aims to measurably improve value in health through evidence-based policy solutions, research and educational excellence, and private and public sector engagement. The Center is a unique collaboration between the USC School of Pharmacy and the Sol Price School of Public Policy at the University of Southern California (USC).

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CVS Health to Begin MinuteClinic Video Visits through App

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CVS Health to Begin MinuteClinic Video Visits through App

CVS Health is rolling out a new virtual health care offering for patients with minor illnesses and injuries, skin conditions and other wellness needs through the company’s MinuteClinic section of the CVS app. MinuteClinic Video Visits, a telehealth offering via Teledoc, will provide patients with access to health care services 24 hours a day, seven days a week from their mobile device.

A video visit can be used to care for patients ages 2 years and up who are seeking treatment for a minor illness, minor injury, or a skin condition. Each patient will complete a health questionnaire, then be matched to a board-certified health care provider licensed in their state, who will review the completed questionnaire with the patient’s medical history, and proceed with the video-enabled visit.

During a MinuteClinic Video Visit, the provider will assess the patient’s condition and determine the appropriate course of treatment following evidence-based clinical care guidelines. For patients who require a prescription as part of their treatment plan, the provider will submit the prescription to the patient’s preferred pharmacy. If it is determined the patient should be seen in person for follow-up care or testing, the provider will recommend that the patient visit a health care provider in their community, such as their primary care provider or a nearby MinuteClinic.

A MinuteClinic Video Visit costs $59, which is currently payable by credit card or debit card. Insurance coverage will be added to the experience in the coming months. The service is currently available in nine states – Arizona, California, Florida, Idaho, Maine, Maryland, Mississippi, New Hampshire and Virginia – and Washington D.C. and is expected to be available nationwide, where allowed, by the end of 2018.

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Brookwood Baptist Medical Center Medicare Certification Extended

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Brookwood Baptist Medical Center Medicare Certification Extended

Brookwood Baptist Medical Center, the second largest hospital in the metro Birmingham area, received an 11th-hour reprieve Thursday night with regulators from the Centers for Medicare and Medicaid Services accepted the facility’s action, thus allowing the hospital to continue its Medicare and Medicaid billing privileges. However, the facility is not out hot water just yet.

“The immediate jeopardies have been removed at this time, but the hospital remains in noncompliance status and must work to correct the deficiencies cited to protect the health and safety of the facility’s patients,” according to a CMS statement, which also noted the survey review process can be extended over the next 60 days.

Brookwood Baptist CEO Keith Parrott said the hospital will continue to fully participate in the Medicare and Medicaid programs without further interruption. Even a short-term interruption in participation could pose a significant financial challenge given the large amount of revenue and jobs at stake. Parrott also said the hospital will be resurveyed in the future.

In May, Brookwood Baptist received a notice stemming from an April incident in its psychiatric unit. The May CMS order was rescinded after a follow-up inspection determined Brookwood Baptist was in compliance with guidelines. Brookwood Baptist received a termination notice in late July that gave the hospital until Aug. 9 to become compliant with CMS guidelines pertaining to government body, patients’ rights and nursing services.

It was the second notice the hospital has received this year.

According to CMS, Brookwood’s immediate jeopardy notice was based on “the hospital’s failure to staff to implement its elopement policy resulting in the death of one patient; failure of staff in the telemetry monitoring unit to notify registered nurses of a patient who had no heart rate for 15 minutes and subsequently died; and a failure of staff to notify the physician of a patient’s low blood pressure readings resulting in the patient being found unresponsive and not breathing.

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Front Office Transformation – First Impressions

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Front Office Transformation – First Impressions

I recently visited a specialty practice at a major health system. As I approached the registration desk, a posted sign directed me to a standing kiosk to sign in. The family member I accompanied to the appointment was unable to stand at the kiosk, so I provided the needed information and signed her in. Although it was a quick and seamless process, I was concerned because if I needed assistance, there were no employees to ask.

Many practices have implemented kiosk sign-ins and have someone to assist a patient with the process if needed. Practice administrators have made the decision to implement a kiosk to assure verification of the current insurance policy and to prompt the patient to pay any out-of-pocket expense before they see the doctor. Many of the kiosk solutions allow a pre-registration via email permitting the patient to populate data and upload information from their own device at their convenience.

Benefits of Kiosk Sign-in include:

  • reduction in the staffing at the front desk
  • decrease in patient wait time
  • and most impressively, the increase of time of service collections.

You may not be ready for a kiosk at your registration desk, but you should review key areas for process improvements to assure you are preparing your practice for success at the front line. The MGMA Connection magazine reported an increase in the patient out-of-pocket expense by 30 percent in the last two years. Previous reports had already noted significant increases in patient deductibles and co-pays outside of the office co-pay. Failure to educate your front office staff, evaluate workflows, review software for accurate verification of benefits, and the lack of consistent financial policies could cost you at the end of the revenue cycle, and hurt your practice in the long-run.

All this to say, first impressions are vital to a practice. A second experience I had is when I walked into a practice, the first thing I saw was each of the front desk staff members was on the phone and did not acknowledge the patients walking in until they hung up. They were scheduling tests, getting pre-certifications and poorly collecting information and money. The staff had so many tasks that they were unable to perform any of them well and with intention.

Focus your front office staff on key functions: greet the patient, collect data, verify data, and collect money. Setting goals and seeing improvement will engage your staff in the big picture and train your patients to expect quality and consistent service and furthermore, be willing to pay for it.

The changes in health care have caused us to focus on efficiency and high-quality services at a reduced cost. As administrators, physicians, and/or staff members, you rarely enter the office from the front door so you may fail to see your operations from the patient’s perspective. Understanding how patients view your practice can put your practice at the next level.

Paper registration is a hassle to update and likely skipped if the phones are ringing off the hook. Patient satisfaction is vital in any medical practice and patients are learning technology can enhance their experience. The primary goal of the front desk should always be to provide great customer service because it is easier to collect from a happy patient.

Once you assure education, define processes, and establish best practices for the front office, it is time to set goals. Track performance (such as co-pay collection rate), reward success, monitor compliance, and watch your practice grow!

 

Article contributed by Tammie Lunceford, Healthcare and Dental Consultant, Warren Averett Healthcare Consulting Group. Warren Averett is an official Gold Partner with the Medical Association.

 

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Six Association Members Inducted into Alabama Healthcare Hall of Fame for 2018

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Six Association Members Inducted into Alabama Healthcare Hall of Fame for 2018

MONTGOMERY — This year the Alabama Healthcare Hall of Fame inducted 12 new members into the Class of 2018, six of which are currently or were previous members of the Medical Association. We are very proud of our physicians, and we would like to extend our best wishes to these medical pioneers for their amazing contributions to the field of medicine in Alabama. The Alabama Healthcare Hall of Fame was founded in 1997 with the purpose of recognizing those persons, living or deceased, who have made outstanding contributions to, or rendered exemplary service for health care in the State of Alabama.

Gerhard A. W. Boehm, M.D., FACS

Dr. Gerhard Boehm’s distinguished career spans more than 47 years as a general surgeon, including the performance of more than 7,000 breast surgeries primarily for cancer patients. His practice continues today. Through his vision and selflessness, he was instrumental in the development of a multidisciplinary Tumor Conference at Mobile Infirmary to advance cancer collaboration and treatment options. His work and leadership led to Mobile Infirmary’s achieving accreditation by the National Accreditation Program for Breast Centers. In addition to his private practice, Dr. Boehm served as an adjunct professor of surgery at the University of South Alabama School of Medicine. Active in many professional areas, he served as president of the Alabama Medical Alumni Association, and in 2017 he received its Distinguished Alumnus Award. Dr. Boehm also served as Alabama chapter president of the American College of Surgeons.

Boyde J. “Jerry” Harrison, M.D.

Dr. Jerry Harrison is a family physician from Haleyville, Ala., having served the community for more than 35 years. He received his medical degree from the University of Alabama School of Medicine. Continuing his interest in biochemical research, he has participated in more than 120 clinical research trials, including opioid dependence research. In 2008, Dr. Harrison helped develop a board-sponsored and approved prescribing course, which he has presented to more than 7,000 Alabama prescribers. The course was awarded the Administrators in Medicine National Award for Excellence in 2015. He has served as the president and chairman of three statewide medical associations: the Alabama Medical Directors Association, the Alabama Academy of Family Physicians, and the Medical Association of the State of Alabama. He has also served as chairman of the Alabama State Board of Medical Examiners. Dr. Harrison was the recipient of the Garber Galbraith Medical Political Award from the UAB Medical School Alumni Association. He is a private pilot, a talented musician, and a tireless advocate for rural physicians in Alabama.

William Lawrence Hawley, M.D.*

A native of Belle Ellen, Ala., Dr. Hawley grew up in Bessemer. He excelled as a student at the University of Alabama and graduated from Harvard Medical School. After Pearl Harbor he joined the U.S. Army Medical Corps and served in both the European and Pacific theaters, working in epidemiology and environmental medicine. For his service, Dr. Hawley was awarded the Order of the British Empire for meritorious military service by King George VI. Dr. Hawley was a kind, caring physician who was a pioneer in the clinical use of radioisotopes. He was the first to use radioisotopes for cancer treatment in Birmingham, Alabama. He established an isotope lab at the Birmingham Veterans Hospital and worked with skilled physicians providing radioisotope therapy to patients with breast cancer, ovarian cancer and thyroid disease. Dr. Hawley influenced and guided many young men and women and was widely known as a role model for fellow physicians.

Martin Lester, M.D.

Dr. F. Martin Lester is a pioneer in cardiovascular care and beloved by thousands of patients. Still practicing medicine full time, it is estimated that Dr. Lester has read more than 250,000 EKGs and seen almost 200,000 patients, many of which are fourth and even fifth generation. Considered Mobile’s “Dean of Internal Medicine” he became founder and clinical director of the Operation Bounce Back cardiac rehabilitation program, the first in Alabama and now one of the top 10 programs in the U.S. Dr. Lester advanced medical care while retaining the Hippocratic values and principles of his calling. An Auburn graduate, he studied at the Medical College of Alabama and completed his training under the tutelage of Dr. Tinsley Harrison. An avid sportsman, Dr. Lester is a member of the Auburn Football Letterman’s Club and one of the trustees that established Mobile Little League Football. He has served as team doctor for the Senior Bowl and the Alabama-Mississippi All Star Game.

Richard O. Russell Jr., M.D.*

For more than 55 years on local, state and national levels, Dr. Richard Russell was considered a preeminent leader in the field of cardiology. He received rigorous academic training at Vanderbilt University’s School of Medicine, then pursued post-doctoral training at Harvard University and the Medical College of Alabama. After service as an Army Captain, he returned in 1962 to the Medical College of Alabama (now UAB). Over the next 55 years he worked as UAB Professor of Medicine and as a physician at Cardiovascular Associates of North Alabama. At UAB Dr. Russell directed the first Myocardial Infarction Research Unit and co-authored the first comprehensive textbook on coronary artery disease. Dr. Russell was a nationally recognized leader of the Alabama and American Colleges of Cardiology. His other great legacy was with the Boy Scouts of America where he received the awards of Silver Beaver and Silver Antelope and was a Distinguished Eagle Scout.

William R. Willard, M.D.*

Born in Seattle, Wash., Dr. William Willard received his medical degree from Yale University in 1934. Dr. Willard built a distinguished record of service as founding dean of the College of Medicine at the University of Ky., where he established the first department of Behavioral Sciences and Community Medicine. In 1966, Dr. Willard chaired the American Medical Association’s committee on family practice. Their “Willard Report” is credited with recommending and establishing Family Medicine as the 20th medical specialty in the United States. In 1972, University of Alabama President David Mathews coaxed Dr. Willard out of his Kentucky retirement to move to Tuscaloosa and develop the University of Alabama College of Community Health Sciences. Today’s family medicine in Alabama is largely a product of the school Dr. Willard founded. One in eight family physicians in Alabama has trained at the Family Medicine residency program at CCHS. The program has provided more than 360 family practice physicians to the state with 50 percent remaining in Alabama.

*Deceased

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Remembering Ronnie Lewis, M.D.

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Remembering Ronnie Lewis, M.D.

FT. PAYNE — Dr. Ronnie Lewis was the fifth of seven children. Growing up, according to his sisters Kathy Bell and Peggy Croft, they may not have had much, but they had each other and their faith. But on Tuesday, May 29, 2018, Dr. Lewis succumbed to throat cancer, which had metastasized to his lung. He left behind friends, family, colleagues and a lot of wonderful memories.

“Ronnie worked from the time he was 16. He carried out groceries, but he was such a good and honest person the store’s owner would let him close the store at night. That was a huge responsibility for a 16-year-old,” Kathy said.

That 16-year-old became the valedictorian of his class, and his motto was, “Why make a B when you can make an A.” He managed to put himself through medical school as one of 162 graduates of the University of Alabama School of Medicine. Dr. Lewis took his determination to Huntsville as he embarked on his internship…but first he needed a trailer to get there.

“When he graduated medical school and went to Huntsville, he was going to buy a trailer but the bank was going to make our father co-sign the loan with him. Ronnie didn’t like that and said no. He didn’t want our father tied up like that. We weren’t rich. We didn’t have much, and we worked very hard for what little we did have. Ronnie told that bank if they couldn’t let him have that loan then he wouldn’t get it. Then they went to another bank, and all Ronnie had to do was to sign the papers. It was taken care of,” Kathy said.

As soon as he could come home to Fyffe, he opened his first medical practice, but he had no intention of being the average physician. He loved people, and no matter what ailment brought his patients to his clinic they always got the best care…and a hug.

“There’s never a week that goes by when someone doesn’t tell us how Ronnie impacted their life,” Peggy said. “There are numerous people who have said he saved their lives, but Ronnie always said, ‘No, God did that. He just used me.’ He never took any credit and that’s why he was such a great doctor. If you came for a bad cold, you got a hug. If you came for a catastrophic disease, you got a hug. It didn’t matter what you came for, you got a hug. He had patients who would just come to the office just for those hugs. He didn’t make you feel just like another patient. He made you feel like family. He loved people, all people, and they loved him. It was like he never met a stranger.”

In fact, when he was elected Vice President of the Medical Association’s Board of Censors, he didn’t make a fuss over it, and he didn’t want anyone else to either. He wasn’t hiding his accomplishment, he just saw it as a way to better fight for his patients. It wasn’t about him, said his practice manager, Julia Acrey.

“That was just his way. It was never about him. When we found out, we had cake…and then he gave us that LOOK! It was all in good fun to celebrate him!” Julia said.

Faith was a large part of Dr. Lewis’ life. He would often pray for and with his patients He prayed for his patients and with his patients. Kathy remembered when her brother was on call at the hospital and met a patient named Maggie.

“When he walked in he said, ‘Miss Maggie, my name is Dr. Lewis, and I’m going to be your doctor.’ The first thing she said to him was, ‘Doctor, will you pray for me?’ He knelt beside her bed, held her hand and prayed for her. She never went anywhere else. Her daughter told us that some mornings she would get up and tell her that she needed to go see Dr. Lewis because she needed a hug. But that was Ronnie,” Kathy said.

Not only did Dr. Lewis have a gift for the medical arts but also a gift for the musical arts. Dr. Lewis was president of the Alabama School of Gospel Music. As much as he loved his patients, singing old-fashioned, convention-style gospel music and playing the piano gave his heart and soul immense joy.

“He loved ‘convention style’ gospel sings,” Peggy said. “ Ronnie would go to these sings every Friday night, stay all day Saturday and Sunday, and come back in the office on Monday and could hardly talk because he had sung his heart out over the weekend.”

According to Kathy, one of Dr. Lewis’ most prized possessions was his piano.

“When he went home at night, he would play for hours because it brought him so much joy,” Kathy said. “He’d played piano just about his entire life. God blessed him because he used his talent for Him, and he used every ounce of that talent for Him. That made him a great doctor, a great musician, and just a wonderful, special person.”

The Alabama School of Gospel Music held a special place in Dr. Lewis’ heart. ASGM hosts students for two weeks each June who are interested in pursuing a higher instruction in gospel music. The school is on the campus of Snead State Community College in Boaz and this year’s students traveled from seven states and Israel for the course.

It was Dr. Lewis’ final wish not for flowers but for donations to the Alabama School of Gospel Music to help pay the tuition for future students. So far since the end of May, the school has collected around $5,000 in his name. Donations can be mailed to the school at P.O. Box 199, Fyffe, AL 35971 or online at www.alabamagospel.com.

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