August 2016

Operating Room

Patient Connection

CMS hospital OPPS changes to better support physicians and improve patient care

The Centers for Medicare and Medicaid Services (CMS) proposed updated payment rates and policy changes in the Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System.

Several of the proposed policy changes would improve the quality of care Medicare patients receive by better supporting their physicians and other healthcare providers. These proposals are based on feedback from stakeholders, including beneficiary and patient advocates, as well as healthcare providers, including hospitals, ambulatory surgical centers and the physician community.

The proposed rule would address physicians’ and other healthcare providers’ concerns that patient survey questions about pain management in the Hospital Value-Based Purchasing program unduly influence prescribing practices. While there is no empirical evidence of this effect, CMS proposes to remove the pain management dimension from the Hospital Value-Based Purchasing program to eliminate any potential financial pressure clinicians may feel to overprescribe pain medications.

CMS continues to believe that pain control is an appropriate part of routine patient care that hospitals should manage and is an important concern for patients, their families, and their caregivers. Thus, CMS is also currently developing and field testing alternative questions related to provider communications and pain to include in the program in future years. We will solicit comment on this alternative in future rulemaking.

In addition, CMS is proposing policies to implement section 603 of the Bipartisan Budget Act of 2015, which provides that certain items and services provided by certain hospital off-campus outpatient departments would no longer be paid under the OPPS.

Currently, Medicare pays for the same services at a higher rate if those services are provided in a hospital outpatient department, rather than a physician’s office. This payment differential has encouraged hospitals to acquire physician offices in order to receive the higher rates.

CMS is supporting physicians and other providers through the rule by increasing flexibility for hospitals and critical access hospitals that participate in the Medicare electronic health records (EHR) Incentive Program.

Finally, CMS proposes to add new quality measures to the Hospital Outpatient Quality Reporting Program and the Ambulatory Surgical Center Quality Reporting Program that are focused on improving patient outcomes and experience of care.

To learn more about the proposed rule, please visit


Comfort, convenience and compliance

Products for patient satisfaction require all three

by Kara Nadeau

Patient satisfaction has gained far greater importance in the minds of healthcare providers since the Centers for Medicare & Medicaid Services’ (CMS) introduction of Hospital Value-Based Purchasing (VBP). Under this program, CMS links reimbursements to the quality of care delivered for inpatient stays in over 3,500 hospitals across the country.1

Patient satisfaction is one parameter used to measure care quality under the VBP program. To help hospitals measure patients’ perceptions of their care experience, CMS created the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It includes 27 questions for discharged patients about their recent hospital stay, everything from the cleanliness and quietness of the hospital environment to communication about medicines.2

Hospital rating information is publicly available on Medicare’s Hospital Compare website so that consumers can make "objective and meaningful comparisons of hospitals," which in turn "creates new incentives for hospitals to improve quality of care."2

With patient satisfaction now playing a critical role in the financial health of hospitals, many are turning to new products that can influence favorable attitudes about patient care delivery and customer service. In this article, we explore some of the latest offerings in this area.

It’s all about location

Hospitals can be challenging to physically navigate. The inability to find locations for appointments, lab tests and other services can leave patients feeling frustrated with their healthcare experience. To address this issue, MobileSmith offers hospitals a way to quickly and inexpensively deploy a custom wayfinding app to meet their specific needs.

Wayfinding app by MobileSmith

The apps employ beacons and geofencing from Gimbal to implement a variety of custom contextual messaging scenarios — from location-triggered welcome messages to special offers and announcements, from automatic check-in to visitor and personnel tracking.  

"You can develop a customized, more responsive mobile patient experience and humanize your brand," said Janna Badalian, Marketing Director at MobileSmith. "Best of all, you don’t have to spend hundreds of thousands of dollars on sophisticated wayfinding infrastructure and programming."

Patient tracking

Location isn’t just about patients finding their way around a hospital, but also the hospital keeping track of them. CenTrak’s 31-day disposable patient tags, which may be worn on standard issued medical ID bracelets, can be used to track, locate, protect and identify a patient in seconds. Designed to operate for one month, these tags can be used for patient flow applications and patient monitoring at any time, anywhere in a facility.

CenTrak’s 31-day disposable patient tag

The tag’s waterproof, thin, lightweight and modular design and low price provide an economical solution to a wide variety of patient management challenges. It can help confirm identity and reduce errors before medication is administered or a procedure is performed. The tag can measure patient wait times and time spent with providers. The tag also enables increased patient mobility and safety by quickly alerting staff if patients enter or leave restricted areas giving patients the freedom and flexibility to move as supported by their care plan.

"The use of Real-Time Locating Systems (RTLS) for monitoring patients is increasingly recognized as a pivotal component to improving patient satisfaction and maximizing reimbursement," said Ari Naim, President and CEO of Centrak. "Using patient tags provides greater visibility into a patient’s status and location, helping staff be more responsive to meet patient needs. This increased visibility also increases efficiencies allowing staff to spend more time caring for the patient, which enhances the patient experience and, in turn, improves HCAHPS scores."

Communication is critical

An analysis of nearly 35,000 online reviews of doctors nationwide revealed that 96 percent of patient complaints were because of poor communications, disorganization and excessive delays in seeing a physician.3

CareWire’s secure text messaging application

A text-first mobile patient engagement platform, CareWire, takes advantage of the immediacy, simplicity and ubiquity of text messaging to improve communication and boost patient satisfaction. Using CareWire’s HIPAA-compliant messaging software, healthcare providers are able to communicate personalized, precisely timed, service-specific education, instructions and alerts to patients — before, throughout and after care.

By blending SMS text, secure messaging and web applications to support a customer’s population health, patient preparation and recovery, and satisfaction initiatives, CareWire lowers operational costs, improves patient adherence and enhances the overall patient experience, says CareWire’s President and CEO Ken Saitow. From message content, to delivery sequence and timing, the company leverages the insights gleaned from millions of consumer interactions to inform its design to reliably deliver results.

"Gathering patient feedback has always been a challenge - consider that less than 2 percent of paper surveys are ever filled out and oftentimes responses are received weeks after a patient’s encounter," said Saitow. "Using a combination of text message and mobile web surveys, CareWire delivers focused ‘text-first’ surveys immediately after a patient’s visit. With this quick, easy and cost effective tool, response rates can be greater than 50 percent with the majority of responses received within 15 minutes of survey delivery."

Health plan support

Navigating the complexities of a health plan is another challenge faced by patients. Determining which healthcare providers are covered, and what is the fastest and easiest path to securing care and medications, can be complex and confusing. Through RxEOB’s Mercury Messaging platform, health plans can deliver branded, personalized and contextualized communication to members, using the method of the member’s choice. The platform can help patients access their benefits, find the best place to get care, and understand how best to get and use their medications.

RxEOB Mercury Messaging platform

"RxEOB Mercury Messaging can help a plan reach their entire patient population the way I used to when I was a retail pharmacist — one patient at a time," said Robert S. Oscar, RPh, CEO and President of RxEOB. "Mercury Messaging helps patients select the right network provider or pharmacy, understand their medications and why they have been prescribed, and how best to access their benefits. Taking into account the patient’s individual benefit plan and individual clinical circumstances is the basis for thoughtful and effective patient communication."

Patient comfort and convenience

Catheterization is an unpleasant fact of many hospital stays, including those involving surgeries. PureWick Inc. offers an alternative to the invasive Foley catheter, which provides an avenue for pathogens to travel inside the body and set up infection. The patient can place the PureWick herself or it can be managed by unskilled labor, saving the cost of nursing care. According to Camille Newton, MD, President, its use reduces back injuries, pressure sores, rashes, and catheter-associated urinary-tract infections.

PureWick external female catheter

Newton described PureWick as an external female catheter that comfortably and externally wicks away urine while keeping the patient cool and dry. "Postop patients often have a hard time toileting and end up lying in a wet diaper or resorting to Foley catheters for incontinence management. Diapers hold moisture and heat next to the skin, creating a micro-environment that leads to infection and skin break-down. PureWick minimizes the need for diapers and Foley catheters, increases air circulation, and prevents the need for super pads, which eliminates the benefits from airflow mattresses."

PureWick works through vacuum-assisted wicking action. A thin tube is placed between the labia and gluteus muscles, and the tube is attached to a wall vacuum at the lowest setting. "The cool air flowing promotes wound healing and prevents infection. When the patient urinates," explained Newton, "the urine is drawn into the center of the tube through wicking action. From the center of the tube, the urine is whisked away to the vacuum canister, where it can be used for testing or disposed of." The patient does not feel the vacuum.

A better imaging experience

More than 100 million Americans suffer from chronic pain, which can have a devastating impact on quality of life. Patients with pain sometimes experience a fluctuation in location, type and intensity of pain throughout the day or over time. The Precision Montage MRI SCS System allows patients to undergo a full-body MRI while benefiting from the pain relief of MultiWave Technology. MultiWave Technology enables delivery of multiple waveforms, including burst and higher rates, intended to help respond to changes in pain over time. In an analysis of registry information from 800 patients, it was determined that 72 percent used multiple waveforms to customize their therapy and optimize pain relief.

Precision Montage MRI SCS System
from Boston Scientific

"The Precision Montage MRI SCS System is a key addition to our Illumina 3D portfolio, offering patients more choices to manage and personalize their therapy," said Maulik Nanavaty, Senior Vice President and President, Neuromodulation, Boston Scientific."This important advancement underscores our commitment to meet the individual needs of chronic pain patients."

Promoting a better stay

Cardinal Health is helping to improve a patient’s stay with Presource Products and Services standard and custom admission and amenity kits. For example, the company’s Better Stay Kit is designed with HCAHPS standards in mind to promote a positive patient experience and restorative stay for patients. The kit includes the following to help ensure a more positive experience:

Cardinal Health’s Better Stay Kit

• Ear plugs to help encourage a quiet, restful atmosphere

• Lip balm and eye mask to help establish comfort

• Better Stay journal and pencil to help promote meaningful patient/care provider communication

Accommodating ICUs

Caring for patients with disabilities presents a unique set of challenges when it comes to patient satisfaction. Medical manufacturer GCX recently collaborated with Virginia Commonwealth University (VCU) Health to create a mobile cart that can hold a laptop so mobility-challenged patients can use the internet safely while in the ICU.

The GCX Patient Engagement Table is an over-bed, hospital-grade table that holds a tablet and optional USB charger. It is designed to improve the patient experience by providing more entertainment and education opportunities at the bedside. Social networks and web apps help patients connect with friends and families, understand care plans and even remotely control a room’s climate.

GCX over-bed Patient Engagement System

"The VCU cart reduces clutter and removes hazards from caregivers and family members’ walkways, while bringing technology right in front of the patient," said Kent Hochgertle, GCX Director of New Business Development. "Through the cart, severely limited patients are able to reconnect with vital support systems and gain some independence and control over their activities and environment."

Patient gowns get a makeover

"Patients, doctors and nurses have expressed their frustrations with the current hospital gown time and time again—they don’t provide medical professionals with easy access to monitors and IVs while patients are left feeling exposed, vulnerable and uncomfortable," said Mary Apple, CEO of Pretty Pushers. "Pretty Pushers prioritizes the need to improve patients’ hospital experiences. When patients wear a Pretty Pushers gown, they will be wearing a garment that is functional, comfortable, modest and fashionable. These attributes can help to improve hospitals’ satisfaction rates by restoring a feeling of dignity that the traditional gown can often take away from patients."


Pretty Pushers labor and delivery patient gowns

Pretty Pushers offers a line of labor and delivery patient gowns for a new generation of pregnant clientele; these patient gowns are offered in one size and plus size with adjustable features to accommodate all body types. Soft knit fabric provides comfort and support while stretching to accomplish a better fit than the traditional hospital gown. Every style of Pretty Pushers gowns—including the Comfort, Select and Simplicity Labor & Delivery Patient Gown—incorporates subtle openings that allow for fetal monitors, IVs, epidurals, and skin-to-skin contact and nursing with discretion and modesty.

Increasing satisfaction through education

Giving patients the information they need to make informed decisions and stay healthy is a key driver in improving the care experience. Elsevier Interactive Patient Education provides an expansive library of text and video content designed to support regulatory compliance, including Meaningful Use requirements for patient education and quality initiatives. The video library contains short videos that allow the care team to create personalized playlists for each patient to help explain diagnosis, treatments, medications, lifestyle modifications and much more.

"Elsevier elevates patient engagement with solutions that help care providers build relationships and change patient behaviors by delivering evidence-based content that providers use and trust via interactive patient-friendly tools and technology," said Sonika Mathur, Senior Vice President and General Manager, Elsevier Patient Engagement. "We are proud to provide these solutions to more than 2,000 organizations across the U.S., and see the positive impact providing the right education at teachable moments has during the care process."

Educating the caregiver

Clinician education is equally important when it comes to improving care delivery. The i-Human Case Player, from i-Human Patients, is a comprehensive, cloud-based patient simulation platform. It provides 200 lifelike avatars and over 400 fully-interactive case scenarios developed by leading medical experts. These represent a broad range of symptoms and diseases. Clinicians learn to quickly, accurately and cost-effectively diagnose patients so they can be treated appropriately. Did they ask all and only the relevant history questions? Perform the right exams? Consider the right differentials? Order the right tests? Develop the right treatment plan? Objective, personalized feedback, coaching and data analytics is automatically provided on performance.


The i-Human Case Player, from i-Human Patients

"Diagnostic error is unfortunately prevalent in medicine with average misdiagnosis rates of 5 percent to 25 percent," according to Norm Wu, CEO of i-Human Patients. "Improving diagnostic competencies amongst clinical staff not only generates higher patient satisfaction, but helps provider organizations thrive in an increasingly value-based purchasing world." HPN





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5. Data on file, Ethicon, Inc.: Kumar A. AST 2012-0290 Completion Report: Study to compare the tissue holding strength of PRINEO Skin Closure System with conventional would closure techniques, 2012.