Medicare Annual Wellness Visit Association With Healthcare Quality and Costs

Analytics are essential when making decisions in health care.  When I was a young physician I was told the annual wellness visit for patients was a waste of time.   Today, not so !



In the context of 2 primary care physician–led accountable care organizations, Medicare Annual Wellness Visits were associated with lower healthcare costs and improved clinical care quality for beneficiaries. Although use of the Medicare Annual Wellness Visit (AWV) is increasing nationally, it remains unclear whether it can help contain healthcare costs and improve quality. In the context of 2 primary care physician–led accountable care organizations (ACOs), we tested the hypothesis that AWVs can improve healthcare costs and clinical quality.


Between 2014 and 2016, we examined the association of an AWV with healthcare costs, ED visits, hospitalizations, and clinical quality measures. The sample included Medicare beneficiaries attributed to providers across 44 primary care clinics participating in 2 ACOs.

Results: Among 8917 Medicare beneficiaries, an AWV was associated with significantly reduced spending on hospital acute care and outpatient services. Patients who received an AWV in the index month experienced a 5.7% reduction in adjusted total healthcare costs over the ensuing 11 months, with the greatest effect seen for patients in the highest hierarchical condition category risk quartile. AWVs were not associated with ED visits or hospitalizations. Beneficiaries who had an AWV were also more likely to receive recommended preventive clinical services.

Conclusions: In a setting that prioritizes care coordination and utilization management, AWVs have the potential to improve healthcare quality and reduce cost.



Sources:

Periodic health visits by primary care practice model, a population-based study using health administrative data.

Evaluation of Pharmacist Involvement in Medicare Wellness Visits.

The Medicare Annual Wellness Visit.
Improvement in preventive care of young adults after the affordable care act: 
Practices Caring For The Underserved Are Less Likely To Adopt Medicare's Annual Wellness Visit.




Medicare Annual Wellness Visit Association With Healthcare Quality and Costs:

Music: The part of your brain that will never get lost to Alzheimers - Big Think

Study: Memories of music cannot be lost to Alzheimer's and dementia

Have you ever noticed how nursing home patients will respond to music when they do not recognize or remember relatives ?  This story elaborates on the neuroscience of music.

Some music inspires you to move your feet, some inspires you to get out there and change the world. In any case, and to move hurriedly on to the point of this article, it's fair to say that music moves people in special ways. 

If you're especially into a piece of music, your brain does something called Autonomous Sensory Meridian Response (ASMR), which feels to you like a tingling in your brain or scalp. It's nature's own little "buzz", a natural reward, that is described by some as a "head orgasm". Some even think that it explains why people go to church, for example, "feeling the Lord move through you", but that's another article for another time. 

Turns out that ASMR is pretty special. According to a recently published study in The Journal of Prevention of Alzheimer's Disease (catchy name!), the part of your brain responsible for ASMR doesn't get lost to Alzheimer's. Alzheimer's tends to put people into layers of confusion, and the study confirms that music can sometimes actually lift people out of the Alzheimer's haze and bring them back to (at least a semblance of) normality... if only for a short while. ASMR is powerful stuff! 

This phenomenon has been observed several times but rarely studied properly. One of the most famous examples of this is the story of Henry, who comes out of dementia while listening to songs from his youth:

Jeff Anderson, M.D., Ph.D., associate professor in Radiology at the Univerity of Utah Health and contributing author on the study, says  "In our society, the diagnoses of dementia are snowballing and are taxing resources to the max. No one says playing music will be a cure for Alzheimer's disease, but it might make the symptoms more manageable, decrease the cost of care and improve a patient's quality of life."

Man In Nursing Home Reacts To Hearing Music From His Era comments by Oliver

Sacks,M.D.

YOUNG ONSET ALZHEIMER DEMENTIA

VIDEO

Music: The part of your brain that will never get lost to Alzheimers - Big Think: The part of your brain responsible for ASMR catalogs music, and appears to be a stronghold against Alzheimer's and dementia.

Smart Apps and A.I. may be the best way to track . your Nutritonal Intake

Forget government-issued food pyramids. Let an algorithm tell you how to eat.

The Food Pyramid

Nutritional Algorithms

Algorithms To Personalize The 'Best Diet' Are Not Yet Ready For Prime Time

There is no diet which is perfect for everyone. Any algorithm will have to take into account age, weight, height, initial weight, amount of weight to be lost, as well as individual personalized information such as food allergy, diabetes, lactic acid intolerance, gluten sensitivity.  The combinations may be unlimited. An algorithm may be able to approach an optimum diet.

Some months ago, I participated in a two-week experiment that involved using a smartphone app to track every morsel of food I ate, every beverage I drank and every medication I took, as well as how much I slept and exercised. I wore a sensor that monitored my blood-glucose levels, and I sent in a sample of my stool for an assessment of my gut microbiome. All of my data, amassed with similar input from more than a thousand other people, was analyzed by artificial intelligence to create a personalized diet algorithm. The point was to find out what kind of food I should be eating to live a longer and healthier life.

The results? In the sweets category: Cheesecake was given an A grade, but whole-wheat fig bars were a C -. In fruits: Strawberries were an A+ for me, but grapefruit a C. In legumes: Mixed nuts were an A+, but veggie burgers a C. Needless to say, it didn’t match what I thought I knew about healthy eating.

It turns out, despite decades of diet fads and government-issued food pyramids, we know surprisingly little about the science of nutrition. It is very hard to do high-quality randomized trials: They require people to adhere to a diet for years before there can be any assessment of significant health outcomes. The largest ever — which found that the “Mediterranean diet” lowered the risk for heart attacks and strokes — had to be retracted and republished with softened conclusions. Most studies are observational, relying on food diaries or the shaky memories of participants. There are many such studies, with over a hundred thousand people assessed for carbohydrate consumption, or fiber, salt or artificial sweeteners, and the best we can say is that there might be an association, not anything about cause and effect. Perhaps not surprisingly, these studies have serially contradicted one another. Meanwhile, the field has been undermined by the food industry, which tries to exert influence over the research it funds.

Now the central flaw in the whole premise is becoming clear: the idea that there is one optimal diet for all people.

Only recently, with the ability to analyze large data sets using artificial intelligence, have we learned how simplistic and naïve the assumption of a universal diet is. It is both biologically and physiologically implausible: It contradicts the remarkable heterogeneity of human metabolism, microbiome and environment, to name just a few of the dimensions that make each of us unique. A good diet, it turns out, has to be individualized.

We’re still a long way from knowing what this means in practice, however. A number of companies have been marketing “nutrigenomics,” or the idea that a DNA test can provide guidance for what foods you should eat. For a fee, they’ll sample your saliva and provide a rudimentary panel of some of the letters of your genome, but they don’t have the data to back their theory up.

Opinion | The A.I. Diet - The New York Times: Forget government-issued food pyramids. Let an algorithm tell you how to eat.

Your Thoughts and Feelings Have Power

Healium is a biometrically-controlled, drugless solution for stress, a $300B profit and people killer. This digiceutical is powered by the user's feelings of love and calm via their wearables and our proprietary technology. These therapeutic stories packaged in a portable, digital kit allow users to see their feelings heal virtual world.

Frontiers in Psychology and the Journal of Neuroregulation both published studies on Healium’s ability to quickly reduce anxiety and increase feelings of positivity in as little as four minutes using real-time EEG feedback and heart rate. Healium is used worldwide in areas of acute, workplace, 

According to the World Health Organization, stress is the 21st-century EPIDEMIC. Healium is a reminder that your thoughts and feelings have power. Our immersive media channel helps users become more self-aware of their feelings, their ability to control their stress level, and the brain patterns associated with neuromeditation. With our loving-kindness and quiet mind content, Healium is a powerful tool for people who might struggle with traditional meditation .

Think of Healium like power steering for mindfulness. You can SEE your brainwaves and heart rate empowered as easy to remember stories. A headband worn on your forehead senses electrical activity in your brain, your smart watch detects your heart rate and allows you to see those patterns represented inside virtual reality, mixed or augmented reality. (The headband is only *listening* to your brain. It's not transmitting anything to it.)  Don't want to use goggles? Healium's augmented reality experiences work without goggles and just your smart phone or smart watch. 

Change is what is occurring in most aspects of our lives, including how medical care is accessed and delivered.  It has required an intensive effort of both time and money for providers to engage the new improvements.

The Future of Medicine . (2012)

Most people are no strangers to these changes during the past ten years. Some of the following have become extinct or nearly so.

1.  Telephone books
2.  Print Newspapers
3. Taxi cabs (replaced by Uber, Lyft)
4.  Checks, and even cash in some circumstances
5.  Sears, Kmart and other brick and mortar retail outlets.
6. Physical mail

The largest search engines

Google
Amazon

Other resources:

HealthGrades
Yelp
WebMD
Google Maps

Future of Medicine, an ongoing encyclopedic source for future changes in healthcare.

Artificial intelligence is being used in some limited capacity for interaction on chatbots, and promises to revolutionize engagement on the internet.  It may assist physicians with diagnosis and treatment of diseases.

Health portals for insurance, clinics, messaging apps and smartphones all expedite our healthcare. Anyone not using these new tools faces serious issues in obtaining appointments, getting lab results, or ordering prescription renewals.   All of these tools eliminate waiting on hold on the telephone or standing in line.

Health Train Express will be offering an interactive chat to teach patients how to obtain these apps and how to use them.  Look for the new tab on future posts.  CONVERSATION

Only digital health can bring healthcare into the 21st century and make patients the point-of-care. We prepare everyone in healthcare for the adoption of innovative, disruptive and smart technologies while keeping the human touch. – Dr. Bertalan Meskó

Human Errors

Drug Companies and Doctors Battle Over the Future of Fecal Transplants

Your doctor tells you "You need a Poop Transplant" . Really ???

Donated fecal material in the middle of the processing procedure at OpenBiome, a nonprofit stool bank.

There’s a new war raging in health care, with hundreds of millions of dollars at stake and thousands of lives in the balance. The battle, pitting drug companies against doctors and patient advocates, is being fought over the unlikeliest of substances: human excrement.

An oral fecal microbiota transplantation product made by OpenBiome, a public stool bank 

The clash is over the future of fecal microbiota transplants, or F.M.T., a revolutionary treatment that has proved remarkably effective in treating Clostridium difficile, a debilitating bacterial infection that strikes 500,000 Americans a year and kills 30,000.

The therapy transfers fecal matter from healthy donors into the bowels of ailing patients, restoring the beneficial works of the community of gut microbes that have been decimated by antibiotics. Scientists see potential for using these organisms to treat diseases from diabetes to cancer.

Frozen processed samples at OpenBiome.

At the heart of the controversy is a question of classification: Are the fecal microbiota that cure C. diff a drug, or are they more akin to organs, tissues and blood products that are transferred from the healthy to treat the sick? The answer will determine how the Food and Drug Administration regulates the procedure, how much it costs and who gets to profit. If the FDA gains regulatory authority over FTM the cost would escalate significantly.  The question remains is this a drug, alternative therapy and does the manufacturing process need to be regulated. There are strong reasons on both sides for the decision making process.

What Is a Fecal Transplant, and Why Would I Want One?

Would you like to become a poop donor?

WARNING Experts offer this final piece of sage advice: “It is not recommended to perform stool transplantation at home without guidance from a physician.”

SOURCES:

Pubmed

New York Times, Washington Post

Drug Companies and Doctors Battle Over the Future of Fecal Transplants - The New York Times: As pharmaceutical companies seek to profit from the curative wonders of human feces, doctors worry about new regulations, higher prices and patients attempting DIY cures.

The Momo Suicide Challenge: A dangerous game on the internet

The internet and social media are risky places for young people who are still in their formative years. This is true of other media, including movies such as "Thirteen Reasons" a story about an isolated teen girl who commits suicide as a result of bullying by  classmates.

Now there are viruses and malware that attack young people's social media introducing frightening games such as "Blue Whale", 

The Blue Whale Game

"Momo Suicide Challenge"

Return of 'Momo suicide challenge' sparks fear among parents. It was uploaded to What's App a social media platform.

Parents and children are challenged by the addictive nature of social media.  Neuroscientists such as Andy Doan M.D. PhD have detailed the release of powerful neuro-modulators, endorphins, which give a feeling of pleasure and euphoria exactly like other addictive disorders such as substance abuse, and  pleasurable activities such as exercise.

Dr. Doan has authored, "  "Digital Vortex Survival Guide: Behaviors, Digital Media, & the Brain" - by Julie Lavier Doan, RN, Christie Walsh, and Andrew Doan, MD, PhD https://amzn.to/2EouFl0 

as well as a video

The videos that go along with the workbook (narration by Andrew Doan):
http://www.digital-vortex-survival-guide.com/

Hospital-Physician Vertical Integration Has Little Impact on Quality of Care; Greater Market Concentration Reduces It

Vertical integration between hospitals and physicians has had very little impact on quality of care, according to a new study by experts at Rice University's Baker Institute for Public Policy.

The study comes as healthcare provider organizations are becoming more complex, with hospitals acquiring physician practices and physician organizations getting larger. At the same time, hospitals are merging with each other to improve bargaining power with insurers, the authors said.

The researchers analyzed information from the Centers for Medicare and Medicaid Services' Hospital Compare database for 2008 to 2015. Among the 29 data points studied, the researchers analyzed hospital readmission rates, process of care measurements that gauge how well a hospital provides care to its patients, and patient satisfaction scores. Using that information, they tested whether patient outcomes are influenced by greater hospital market concentration or vertical integration between hospitals and physicians.

"Weighing the Effects of Vertical Integration Versus Market Concentration on Hospital Quality" was co-authored by Marah Short, associate director of the institute's Center for Health and Biosciences, and Vivian Ho, the James A. Baker III Institute Chair in Health Economics and director of the center. It will be published in Medical Care Research and Review.

Before they launched their study, the researchers hypothesized that decreased fragmentation, meaning better coordination among a patient's primary care physician, specialists and admitting and attending hospital physicians, could improve patient care. Instead, they found that vertical integration has a limited effect.

On the other hand, increased market concentration, which lowers market competition, is strongly associated with reduced quality measured in terms of patient satisfaction, the authors said. With fewer competitors, it seems there is less incentive to keep patients happy. Given the nature of some satisfaction measures, such as explaining medications and communicating well with patients, overall clinical quality could suffer if patients do not properly understand care recommendations during their hospital stay or post-discharge, the authors said.

"Although better patient experience may not always correlate with higher clinical quality, measuring quality based on patient perception is increasingly important as more consumers use online physician ratings and reviews of patient experience to select providers," Short said. "Therefore, we need further research on the ability of patient satisfaction to reflect clinical quality, and if it does not, we need to develop and provide to patients better measures in terms that patients can understand and use."

"Our overall recommendation is one shared with previous researchers: Regulators should continue to focus scrutiny on proposed hospital mergers, take steps to maintain competition and reduce counterproductive barriers to entry," the authors wrote in a summary of their paper.

The complexity and rapidity of health care organizational changes are a conundrum of events. Each step promotes varying degrees of improvement and/or impairment for clinical outcomes.  These results display a surprising result from mergers, vertical integration, and the formation of large health organizations.

• Facebook
• Twitter
• Email
• Print
• Save

http://tinyurl.com/y5wm8o6w

Survey Finds Prior Authorization Hurdles Have Led to Serious Adverse Events

More than one-quarter of physicians (28%) report the prior authorization process required by health insurers for certain drugs, tests and treatments have led to serious or life-threatening events for their patients, according to a new survey by the American Medical Association(AMA).

The survey of 1,000 practicing physicians found that prior authorization continues to have a distressing impact on both patients and physician practices. Despite widespread calls for meaningful reform from the California Medical Association (CMA), AMA and others in organized medicine over the last two years, the survey illustrates that prior authorization programs and existing processes remain costly, inefficient, opaque and hazardous in some cases.

Critical physician concerns highlighted in the AMA survey include:

• 91% say that prior authorization programs have a negative impact on patient clinical outcomes.
• 65% report waiting at least one business day for prior authorization decisions from insurers – and 26% said they wait three business days or longer.
• 91% said that the prior authorization process delays patient access to necessary care, and 75% report that prior authorization can at least sometimes lead to patients abandoning a recommended course of treatment.
• 86% said the burdens associated with prior authorization were high or extremely high, and 88% believe burdens associated with prior authorization have increased during the past five years.
• Every week a medical practice completes an average of 31 prior authorization requirements per physician, which take the equivalent of nearly two business days (14.9 hours) of physician and staff time to complete.
• To keep up with the administrative burden, 36% of physicians employ staff members who work exclusively on tasks associated with prior authorization.

“The AMA is committed to attacking the dysfunction in healthcare by removing the obstacles and burdens that interfere with patient care,” said AMA Chair Jack Resneck Jr., MD. “To make the patient-physician relationship more valued than paperwork, the AMA has taken a leading role by creating collaborative solutions to right-size and streamline prior authorization and help patients access safe, timely and affordable care, while reducing administrative burdens that pull physicians away from patient care.”

In January 2017, AMA urged industry-wide improvements in prior authorization programs to align with a set of 21 principles intended to ensure that patients receive timely and medically necessary care and medications and reduce the administrative burdens. CMA and more than 100 other healthcare organizations have supported those principles.

ACEP Presents Framework To Protect Emergency Patients From Out-Of-Network Billing Issues - Jan 28, 2019

As legislators on Capitol Hill prepare to address the surprise billing issues that are affecting millions of patients across the country, the American College of Emergency Physicians (ACEP) today released a framework of proposed solutions to protect emergency patients.  

"By oath and by law, emergency physicians will treat any patient, regardless of their ability to pay," said Vidor Friedman, MD, FACEP, president of ACEP.

 "In fact, that federal law, the Emergency Medicine Treatment and Labor Act (EMTALA) actually forbids emergency care providers from discussing with the patient any potential costs of care or details of their particular insurance coverage until they are screened and stabilized. Patients can't choose where and when they will need emergency care and they should not be punished financially for having emergencies."

Dr. Friedman adds that with this framework of proposed solutions, we are ensuring that patients are truly taken out of the middle of billing issues that can frequently arise around insurance coverage of emergency care.

ACEP's proposed solutions include:

1. Prohibit balance billing — When a patient receives out-of-network emergency care, the provider will make no demand for payment from the patient.
2. Streamline the process to ensure patients only have a single point of contact for emergency medical billing and payment — Under ACEP's proposal, insurers will directly pay any coinsurance, copay, and deductible for emergency care to the provider, and can then collect back these amounts from the patient. This will put an end to patients receiving and having to reconcile the multiple, confusing bills and explanation of benefits that result from the many providers who often need to be involved in a single emergency episode.
3. Ensure the patient responsibility portion for out-of-network emergency care is no higher than it would be in-network — When facing an emergency, patients or their family members don't have time to try and figure out where their care will be in-network, so they shouldn't be punished financially for being unable to do so. Under current law, while copays and coinsurance must be the same for emergency patients whether they are in- or out-of-network, deductibles can be much higher—often double! We think that needs to change.
4. Require insurers to more clearly convey beneficiary plan details — This would include printing the deductible on each insurance card. While a simple step, it can help patients understand the limits of their insurance coverage and reduce the surprise when they later get a bill.
5. Require insurers to more clearly explain their rights related to emergency care — Policyholders deserve to have this in plain, easy-to-understand clear language.   
6. Take the Patient Out of Insurer-Provider Billing Disputes — ACEP wants to prevent provider/insurer billing disputes. To expedite and simplify this process, ACEP is calling for the creation of an arbitration process to settle network issues.

For more specific information on these proposals, please click here. 

ACEP is the national medical specialty society representing emergency medicine. ACEP is committed to advancing emergency care through continuing education, research and public education. Headquartered in Dallas, Texas, ACEP has 53 chapters representing each state, as well as Puerto Rico and the District of Columbia. A Government Services Chapter represents emergency physicians employed by military branches and other government agencies. 

ACEP Presents Framework To Protect Emergency Patients From Out-Of-Network Billing Issues - Jan 28, 2019

ER doctor shares why social media is a powerful tool in helping him cope with death.

Yes, even doctors must cope with death, be it sudden, and/or unexpected.

Physicians early in their training are told to be imperturbable and treat each situation with equanimity. Simply said most physicians form an emotional withdrawal from a clinical situation, such as childbirth, sudden death, and situations in the intensive care unit, or dealing with family crises.

One physician who deals with unfamiliar patients is to use social media platforms to obtain background information for a patient in front of them, dead or alive.  This may create potential problems with the family as they may interpret genuine interest as invasion of privacy.

Telling someone their child has just died has to be one of the most difficult things a human can do. For an emergency room physician, it’s part of their day-to-day lives. Every day there’s a chance they’ll deliver horrifying news that will forever change someone’s life.
It’s not a responsibility to be taken lightly. But it’s understandable that an emergency room physician would become calloused after years of delivering tragic news.

I'll Look at Your Facebook Profile Before I Tell Your Mother You're Dead

You see, I’m about to change their lives — your mom and dad, that is. In about five minutes, they will never be the same, they will never be happy again. Right now, to be honest, you’re just a nameless dead body that feels like a wet bag of newspapers that we have been pounding on, sticking IV lines and tubes and needles in, trying desperately to save you. There’s no motion, no life, nothing to tell me you once had dreams or aspirations. I owe it to them to learn just a bit about you before I go in.

I check your Facebook page before I tell them you’re dead because it reminds me that I am talking about a person, someone they love—it quiets the voice in my head that is screaming at you right now shouting: “You mother f--ker, how could you do this to them, to people you are supposed to love!”

ER doctor shares why social media is a powerful tool in helping him cope with death.: Stories that connect us and sometimes even change the world.