Notes & Links: October 1, 2013

Is Your Hospital Website Costing You Revenue?
Nicola Ziady posting at HealthWorks Collective points out that 8 out of 10 consumers are visiting hospital websites but 90% are going somewhere else making an appointment. The reasons for this are:

  • Competition
  • Confusion
  • Dissatisfaction

The lead in to the dissatisfaction bullets is the statement that “8 out of 10 Prospective patient will visit your website before converting.” 

I shared this with a good and wicked smart colleague Scott. His thoughts on this were:

Since it is impossible that 83% of hospital patients are going in for elective reasons where they could choose, and the primary driver is physician privileges at a particular institution, the reason consumers are visiting hospital websites before converting into patients has to be to fill out paperwork, or gain more information about what to expect – not to choose a hospital.

I agree with that and I would add that conversion is the wrong goal. The goal for the hospital especially going forward is improving outcomes since that is what and where they will be competing. The forward facing message for a hospital to patients should be to continually engaged with them so they learn, improve self care, and drive improved outcomes. I would look at improving expanding retaining and showing GREAT outcomes from current patients. Current patients are where your message to new patients should come from. 

Remember hospitals have spent millions to buy physicians practices. Half the patients in those physician practices do not need hospital care. And when they do since that MD is an attending w/privileges will get them. My goal would be to get current patients engaged w/the hospital as a healthcare knowledge provider because that meta data from those active and engaged patients I am currently treating will inspire conversion. Make sense?

Patient Engagement, Negaclaims Can Rehabilitate Health Insurance
Dave Chase a contributor to Forbes has a deep dive on cost for care and patient engagement and how HCP are ‘selling’ care in the fee for service model. Chase introduces the concept of Negaclaim which is TM’d. And what is that? It is when patients are fully educated on trade-offs with interventions and they choose the less invasive approach which is generally less expensive. Chase lists a number of examples showing the benefit of curbing unnecessary care while improving patient experience. 

  • Direct Primary Care
  • High Cost Procedures
  • End of Life

Clearly incentives driven by a flawed reimbursement system is driving waste in spending. And another confounding factor are health insurance providers. Most people consider them the Darth Vader of healthcare. Most people consider health insurers to only want to deny deny deny. They need to fix that image. 

Chase ends on a topic near and dear to me. 

Leonard Kish made the case that if patient engagement was a drug, it would eclipse all blockbuster drugs before it.

 Chase offers this interesting insight. Insurers should stop denying claims and invest in getting customers to engage in healthcare and with their physicians because these customers would self-deny their own claims. 

As I said this is deep dive but rewarding in that Chase is looking at the value of patient engagement not only it being the new black in healthcare.

The issue is summed up nicely in an AP story by Marilynn Marchione:
Obese people are less likely to survive cancer, and one reason may be a surprising inequality: The overweight are undertreated.

Doctors often short them on chemotherapy by not basing the dose on size, as they should. They use ideal weight or cap the dose out of fear about how much treatment an obese patient can bear. Yet research shows that bigger people handle chemo better than smaller people do.

Even a little less chemo can mean worse odds of survival, and studies suggest that as many as 40 percent of obese cancer patients have been getting less than 85 percent of the right dose for their size.

Now, the largest organization of doctors who treat cancer, the American Society of Clinical Oncology, aims to change that. The group has adopted guidelines urging full, weight-based doses for the obese.

Orac presents a lot of data and logic on why clinical oncologist may feel it is necessary to dial back dosing for obese patients with comorbidities etc. Further there is some great information where in healthy weight patients dose reduction was 9% to 37% in obese patients. This was from a study in 2005 Jennifer Griggs, MD from University of Michigan. And from that study this finding:

Interestingly, Griggs also found that severe obesity was actually associated with a lower likelihood of being admitted for febrile neutropenia (fever with a low white blood cell count, indicating potential infection in an immunosuppressed patient), was actually less common (odds ratio, 0.61; 95% confidence interval, 0.38-0.97) in the severely obese even in patients who received full dose, and there was a trend towards less admissions for febrile neutropenia associated with increasing body mass index that only became statistically significant at a BMI ≥ 35.

There is a considerable amount of data here which is well presented and documented. It is a great place to continue your education on weight and chemo. 

Dermatology Smartphone Apps No Substitute for Doctor’s Visit
Bill Crounse posting on Healthworks Collective gives us some solid advice which comes on the heels of the FDA guidance for medical apps. I would give you a link to it but since those morons in Congress shut down the government in order to ensure only the privileged have healthcare the FDA site is working like crap.

Crounse makes the case for seeing a trained dermatologist and not leaving possible life and death decisions to an app. He has cred having been diagnosed with three of the most common types of skin cancer, basal cell, squamous cell, and melanoma. His melanoma was caught early and he was cured. 

Researchers tested four different smartphone skin cancer apps. One of the apps sends photos to board certified dermatologists for review. In the research study, that particular app was, as you might expect, quite good. It missed diagnosing just one of 53 pictures of melanoma that were used to test its accuracy. However, taken together the accuracy of all four smartphone apps was determined to be just 33 to 42 percent.

His primary point is that a smartphone app should not replace a trained dermatologist. I concur because I am reminded of a comment at a dermatology advisory board I ran with some nationally KOLs. One physician chair of her department said that when they are offering residents and fellows a position they have found those with an interest or background in art are better at diagnosis since their eyes are well trained and tuned by an art background. When you think about that it rings true. The majority of dermatology diagnosis is based on visual not lab values or listening to the heart or an MRI. I would not trust me to look at an app and my skin and say nah that is not that. Would you?

Cancer Chemotherapy and Obesity
Orac writing on ScienceBlogs takes a long hard well balance look at this recent mainstream press topic of obese patient and cancer chemotherapy. 

The topic is straight forward enough most chemotherapy is dosed based on weight and obese patient are not always getting full weight-based doses.

The issue is summed up nicely in an AP story by Marilynn Marchione:
Obese people are less likely to survive cancer, and one reason may be a surprising inequality: The overweight are undertreated.

Doctors often short them on chemotherapy by not basing the dose on size, as they should. They use ideal weight or cap the dose out of fear about how much treatment an obese patient can bear. Yet research shows that bigger people handle chemo better than smaller people do.

Even a little less chemo can mean worse odds of survival, and studies suggest that as many as 40 percent of obese cancer patients have been getting less than 85 percent of the right dose for their size.

Now, the largest organization of doctors who treat cancer, the American Society of Clinical Oncology, aims to change that. The group has adopted guidelines urging full, weight-based doses for the obese.

Orac presents a lot of data and logic on why clinical oncologist may feel it is necessary to dial back dosing for obese patients with comorbidities etc. Further there is some great information where in healthy weight patients dose reduction was 9% to 37% in obese patients. This was from a study in 2005 Jennifer Griggs, MD from University of Michigan. And from that study this finding:

Interestingly, Griggs also found that severe obesity was actually associated with a lower likelihood of being admitted for febrile neutropenia (fever with a low white blood cell count, indicating potential infection in an immunosuppressed patient), was actually less common (odds ratio, 0.61; 95% confidence interval, 0.38-0.97) in the severely obese even in patients who received full dose, and there was a trend towards less admissions for febrile neutropenia associated with increasing body mass index that only became statistically significant at a BMI ≥ 35.

There is a considerable amount of data here which is well presented and documented. It is a great place to continue your education on weight and chemo.

 

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