Harry W Severance, MD’s Post

"Does our US healthcare & patient care experience need transformation? From my personal perspective and recent experiences, let me start by thanking all the doctors, nurses, and other hospital staff serving our communities during the pandemic, working day and night to save millions of people. With all due respect, I want to share my recent personal story. Six weeks ago, I fell ill, called my primary care physician, but there were no appointments available for 3 weeks. I ended up going to urgent care. The doctor spent only five minutes with me, prescribed antibiotics after one lab test, and sent me on my way. By day 3, my symptoms worsened, and I had to visit ones again urgent care facility. This time, the doctor spent around 15 minutes with me, ordered two more lab tests, and informed me that my primary lab test results were negative. They changed my antibiotics, and my symptoms improved for a week, after that returned again. On a Friday afternoon, I had one more lab test ordered, informed me results available in 2 hours. I called the urgent care on Saturday morning to check my results but was told a nurse would call me back. I waited until 2 pm and called again, receiving the same message. Finally, on Sunday morning, received a call from an urgent care nurse, who advised me to go to the ER. I went to the ER, where a Nurse Practitioner treated me for 6 hours, but no doctor was available. At this point, I became frustrated with the lack of doctor availability and returned home. During this process(prior week), I fortunately reached out to a specialist's office, but they had no appointments available for two months. After some effort, I managed to secure an appointment with a specialist within a week. When I arrived at the specialist's office, I was surprised to see many patients waiting. I had arrived 30 minutes early, and there was a patient who came in 45 minutes late; they were rescheduled for an appointment two months later. I felt disheartened witnessing this situation. From the above story, you may have noticed that the current shortage of healthcare providers and the lack of timely appointments are pressing issues. Why am I sharing this story? 1. Healthcare systems, especially patient engagement systems, have tremendous opportunities for improvement. 2. Providing better technology to doctors and nurses can help them serve more patients by reducing paperwork, examining past records, lab results, xrays, CT scans, etc., and facilitating the seamless transfer of health records between different healthcare providers. 3. There is a need for more transparency regarding medical bills and insurance coverage before patients visit hospitals. I hope that emerging technologies like Generative AI, Blockchain, the Metaverse, and quantum computing will transform the healthcare sector to enhance the patient experience with informed decisions. We as technology thought leaders to brainstorm ideas to transform healthcare! Let's all try for this!

Saying physician owned hospitals shouldn’t exist is like saying we don’t need a filter on an aquarium. And only THESE fish please. Physician owned number 249 vs 6129 hospitals 1/25th the numbers. https://lnkd.in/g4WT_Y8N. https://lnkd.in/gs6Y-a5B. and 640 of 8469 surgery centers are independent of monopoly and duopoly systems in 90% of metros. https://lnkd.in/gdMVnbFS. Is American Hospital Association not satisfied enough by a $1.1T CARES Act bailout that was based on a lie ? Rurals needed it but Bigs used the lions share of that to buy 200,000+ independent medical practices mostly in Texas, Florida and Georgia consolidating 70% ownership of docs. To double strategic reserves. The lie was they needed it. Another they faced volume issues. Neither were true. Independent surgery is a vital cost saver for cash paying self insured employers -81% of jumbo employers over 1000 emp. The savings over monopoly run systems is 40-60% less. Infection rates and readmission rates are often better sometimes worse like anything. The Dobson report cherry picks it’s winners and losers. Match the top tier of both and the worst tier for a fair report. It ignores burnout and doc/ nurse satisfaction too. Here’s what American Medical Association says about it. Excerpt More alarmingly, hospital market consolidation has been shown ◾️to produce poorer health outcomes for patients…deaths following heart attacks were significantly higher high level of hospital concentration metros …also a correlation between higher hospital market concentration and increased mortality rates for patients with CVD. Reduced competition can lower the incentive to boost quality and improve outcomes to attract new patients. ◾️greater hospital market concentration harms both patients and our nation’s overall health care system through increased prices, higher costs for federal programs as well as for patients and their families through increased premiums and cost sharing, and lower quality outcomes. That’s the conclusion by the AMA, and Medicare Payment Advisory Commission, the Congressional Budget Office and multiple, independent academic research studies. ◾️Charges at existing physician-owned hospitals for eight common procedures were one-third lower than what a traditional hospital charged in the same markets, according to a peer-reviewed analysis published in JAMA Network Open this summer. https://lnkd.in/gjygXXQq

How do you reverse your patient flow challenges? That’s exactly what’s happening at one of the country’s busiest NHS trusts. Nottingham University Hospitals NHS Trust is accelerating the safe transfer of patients through its hospitals using reverse bed chains. The model is enabled by system-wide visibility of data routinely captured by clinicians using Nervecentre. It’s allowing the transfer of care from ED to an admission ward earlier in the day. In turn, that’s releasing beds hours sooner in ED. Historically, patients awaiting a transfer from ED to admissions were the last to go in a sequence of moves. They were held in ED whilst patients leaving base wards were moved to the discharge lounge. Then, patients on admission wards were transferred to the base wards. At that point, the patients held in the ED would finally be transferred to admissions. This process often took around four hours, even when a bed was available at the end of the chain. The trust searched for a new way to transfer patients that could mitigate risk and improve capacity and flow. Flipping the script led to the realisation of reverse bed chains. In the new model, patients in ED are the first in the chain to move and can be admitted from ED hours sooner. Put simply, all patients in the chain move simultaneously. AI functionality in Nervecentre discovers and proposes bed moves in real-time, highlighting linked patients in colour-coded groups. Charlie Hunter, Lead Nurse for reverse bed chains, liaises with wards, cleaning, and patient movement services to set the train in motion. Crucially, the entire team is connected by Nervecentre. Everyone, including porters and cleaners, is instantly alerted to tasks via their mobile devices. NUH believes the approach has reduced the risk of delay-related harm by reducing crowding in ED. Significantly, the time it takes to carry out a three-part sequence of transfers has reduced from around 4 hours to 1 hour. That’s releasing an estimated 3 hours of ED staff time to focus on care - and prevents emergency patients from waiting for hours in ED. Mark Simmonds, Deputy Medical Director at NUH, says the operational gains of reverse bed chains wouldn’t be achievable without the visibility teams are getting through Nervecentre: “Queens Medical Centre runs at 98-99% bed occupancy pretty much all the time. You can’t run a hospital at 99% occupancy if you don’t have real-time visibility of what’s going on. If you can’t see where the empty beds are, and you can’t see where the challenges and opportunities are, you’ll never truly be able to make things more efficient. Nervecentre gives us that visibility.” Read the full case study below. #EPR #DigitalHealthcare #TheTimeForCompromiseIsOver

"A union for doctors? Physicians at Salem Hospital just created one" - Boston Globe Media Emergency physicians, along with their hospital-based colleagues, voted to form the Salem Physicians Union within Mass General Brigham, Massachusetts' largest healthcare system. From the article: Like many union workers, the doctors in Salem are fighting for a greater voice, but, they say, they are also fighting for something bigger: the ability to push back against corporate power and "take back medicine," as one physician put it. "This is not an MGB problem. This is not a Boston or a Massachusetts problem. This is a nationwide healthcare system problem," said Sean Codier, an emergency room physician at Salem Hospital. "This is something that a local group of physicians can do to try to reassert their voice and reassert our stake in our patient's care." ... The number of physicians who are no longer their own bosses has also risen sharply in recent years. In 2012, less than 6 percent of physicians worked directly for hospitals, according to the American Medical Association. But by 2022, following a surge in acquisitions of physician-owned practices, that share had soared to more than half, with another 22 percent employed by corporate entities such as insurers or private equity firms, according to a Physicians Advocacy Institute study. ... "Physicians need to run their house, but that house has been taken away from us," said ER physician Kelley A. Wittbold, MD, MHCM. "No matter how talented our individual nurses or doctors are, none of us can operate and provide the care that patients really need if we don't create a comprehensive system where it really works for everyone." ... Doctors have become "cogs in a machine designed to maximize return in a field fundamentally designed to alleviate illness," as Sameer Shah, a pulmonary and critical care specialist at Salem Hospital put it. "We are using our voice here to try to advocate for patients to get the care that they deserve on a more systemic level," Shah said. ... #emergencymedicine American College of Emergency Physicians American Academy of Emergency Medicine (AAEM) Society of Emergency Medicine Physician Assistants (SEMPA) Emergency Medicine Residents' Association (EMRA)

❤️🇨🇦Revolutionizing Ontario Healthcare: Dual Streams for Better Access and Efficiency❤️🇨🇦 What is the bureaucracy waiting for? 🤔 Ontario urgently needs two distinct streams of care within our healthcare system: Physician-led Care” and ��Primary Care Practitioner-led Care. Complementary systems that can resolve healthcare issues from beginning to end independently and also in collaboration. Since Bill 179 received royal ascent in 2009, physiotherapists have been waiting for the bureaucracy to update the regulations for OHIP and the Radiology Act! The Legislature did its job in 2009, we need today’s government to tell bureaucrats to get this over the line! These long overdue updates would have made better care a reality for the people of Ontario long ago! When it comes to healthcare, creating bottlenecks doesn’t save money. People will wait for healthcare, so the idea that we can ration healthcare and save money is flawed. Instead, we end up spending more on administrative support, red tape, paperwork, “advisory boards”,“special committees”, “care alliances”, “special networks” and community programs that aren't performed by healthcare professionals and provide absolutely no value to the system. Our Bureaucracy is bringing to life the expression, Penny Wise and Pound Foolish. In the past we created jobs and work that bloat the bureaucracy yet that money is not supporting any direct healthcare delivery to our province. We must accept that there should be TWO different pathways to entering the healthcare system. One for physician related issues and another other serious concerns that can be addressed by physiotherapists, pharmacists, or nurse practitioners. By providing multiple access points to the healthcare system, we reduce the burden on physicians and save money on publicly funded administrative programs that are essentially glorified waiting lists. These programs do not add real value to the overall health and wellness of our province. As Michael Poling highlighted, the real issue isn't a doctor shortage but healthcare funding and fully utilizing the scope of practice of all healthcare professionals. Physiotherapists, for example, should handle MSK issues in ERs and primary care practices, freeing up physicians to focus on their specialties. PTs are also adept at ordering imaging, often more accurately than physicians. However, for this to be effective, the OHIP and Radiology Acts need to be updated to allow physiotherapists to refer directly and the REQUEST to be covered by OHIP. This change would unclog the system and eliminate unnecessary physician referrals. It’s time to update our healthcare system to reflect these realities, streamline care, and ensure better health outcomes for all Ontarians. Minister Sylvia Jones, if you see this, we know that in 2009 you were not the Minister of Health, yet this is something we need you and the Ford government to get done! Ontario Physiotherapy Association and People want this

Understanding Healthcare Worker Collaboration and Patient Outcomes Excerpt: Some interventions designed to improve healthcare worker collaboration may not result in improved patient outcomes, according to a recent trial published in the Annals of Internal Medicine. While it’s widely accepted that increased healthcare worker teamwork is essential for safe and high-quality medical care, research aimed at understanding how collaborative interventions impact patients has been inconclusive. “Our research group has been investigating #interprofessional #teamwork for years. We have done some interventions here at Northwestern Memorial Hospital that were successful in improving interprofessional teamwork and lowering the rate of adverse events,” Kevin O’Leary said. “This trial was a way to deliberately combine interventions that could be complementary, mutually reinforcing and transformative. Because this area is not well researched, this was designed to be a major contribution to the literature and knowledge around this.” In the current study, healthcare professionals in two general medicine units at four different U.S. hospitals assigned physicians to specific units and installed nurse-physician leadership teams who were jointly responsible for the quality of care on their respective units. The participating units then established interprofessional rounds, which were redesigned with input from frontline healthcare professionals to optimize collaboration and patient engagement. Frequent unit-level reports were then given to unit leaders to provide them with relevant and actionable data on their unit’s performance. Among healthcare workers who completed pre- and post-intervention surveys, nurses indicated that the teamwork climate improved, but physicians reported no change, according to the study. “This was not too surprising, because it’s usually #nurses who are most aware of teamwork deficiencies,” O’Leary said. There was no reduction in the number of patients who experienced adverse events after the intervention than before, according to the trial, and the length of stay, rate of readmission and overall patient experience all remained unchanged. “We had a really rigorous model, but we just didn’t see any association with improvement in patient outcomes,” O’Leary said. “This might be explained by the fact that there was perhaps not a lot of room for improvement. The rate of adverse events before the intervention was already low and in line with national trends, following campaigns and new policies, that have led to improvements over time for hospital adverse events.” The findings underscore the need for more research around healthcare worker collaboration and how it relates to patient safety and outcomes, O’Leary said. Read ➡ https://lnkd.in/ecef_xCS #patientcare #hospitals #workcollaboration

2024 is shaping up to be a transformative year for health care filled with new advancements and challenges. Hear from several industry leaders, including DaVita’s chief nursing officer, share their priorities for the year ahead: https://ow.ly/mwF830sAGU5

2024 is shaping up to be a transformative year for health care filled with new advancements and challenges. Hear from several industry leaders, including DaVita’s chief nursing officer, share their priorities for the year ahead: https://ow.ly/ot4n30szZ76

2024 is shaping up to be a transformative year for health care filled with new advancements and challenges. Hear from several industry leaders, including DaVita’s chief nursing officer, share their priorities for the year ahead: https://ow.ly/XYMa30sA4EB