Tuesday, March 29, 2005

From the Patient's View

In the day to day hustle and bustle of our work its easy to get caught up in the minutia of it all. In doing that, sometimes we forget the plight of the cancer patient and what they experience when they are referred for our services. Thanks to the Hospice Blog this is brought back to mind with a patient's detail of their encounter for cancer treatment.

The following link details a patient's initial experience with a brain tumor and the subsequent treatments which are followed by their last days in hospice. The wife of the patient saved all of her email concerning her husband's battle with Glioblastoma and decided to create an online diary to help others with a similar fate. I think it also serves us well in remembering the plight of our patients when in our care.

Diary of a Brain Tumor Patient's Wife

Wednesday, March 09, 2005

CT/PET Leads to More Accurate Radiation Therapy....Maybe?

In the article below, a rather small study in Europe suggests that combined CT/PET scans can reduce the amount of radiation exposure to normal tissue. While this is true, what they don't discuss is that we may be missing microscopic disease by focusing down to only the hot spots detected on the PET. Don't get me wrong, PET/CT has definitely helped our planning abilities with lung cancer but we still need to take into consideration microscopic extension that is undetectable by PET.

Combining PET and CT scans leads to more accurate radiation therapy for lung cancer patients

Monday, March 07, 2005

Much Ado About Nothing

You ever have one of those days where you feel like you get nothing accomplished? I'm starting to have quite a few those of late, including today. It seems like the majority of days I go from one fire to the next and before I know it the 'things to do list' for that day stares conspicuously at me around 4 o'clock shouting "Where ya been!"

It is totally amazing the one time issues that occur day to day in an Oncology department. From software glitches to physician disappearances they all suck up the hours. I'm starting to think I'm an issue juggler. I''m constantly throwing one issue up and catching another. Sometimes I throw one up high, another even higher in hopes it takes a while for them to come down. Right now I have policies and procedures way up there, even higher is new Information System HIPPA standards, new procedure coding, staffing issues, coding issues, construction, Relay for Life event, and the list goes on and on.

Am I complaining? The more I read this the more I think why would anyone else read this? I bet most would be thinking why would anyone want to do this? I'll save that one for another day.

Thursday, March 03, 2005

I Can't Get No Satisfaction

I've been researching literature on satisfaction surveys of late in hopes of developing one that we can use in our centers. One book I've been referencing is "If Disney Ran Your Hospital - 9 1/2 Things You Would Do Differently" by Fred Lee. Which, by the way, was recently awarded the "book of the year" award by the ACHE (American College of Healthcare Executives). It is definitely an interesting read if you work in a medical environment. I'd like to speak about many issues it discusses but, today I'll keep it to satisfaction surveys.

Most satisfaction surveys have scales from 1 to 5. With 1 being poor and 5 being excellent. When results are tabulated, the majority of institutions consider a 3 or above as a successfully satisfied customer. What is interesting about Disney's model is how they report the results of their surveys. Their surveys list responses basically on a scale of 1 to 5 like most others. But where they differ is that they only consider a response of 5 as a success. When their results are reported it may read that only 70% of their customers replied with a rating of 5. Why track only 5's and not 4's (very good) you may ask? Because to quote Fred Lee, "they are not measuring customer satisfaction; they are measuring customer loyalty." Interesting, huh?

To receive a 5 a customer must have an experience, a story. Without an experience or story a customer may be just merely satisfied because their expectations were met. But if their expectations where exceeded then there is an experience or story behind it and because of that you've likely gained a loyal customer. I could delve much further but, you can begin to see the premise of the book. That Disney's success stems from customer loyalty and believe it or not the same principles can be applied to the healthcare field.

On a side note, although I'm not a Disney fan, I had a 5 level experience with our stay at one of their resorts a couple of years ago. We stayed at the Wilderness Lodge and it was well worth it. But what definitely assisted in making the trip a success was this website, Tour Guide Mike. If your planning a trip to Disney this is the ticket. I highly recommend it.

Back to building a good satisfaction survey. Below are some of the top 10 drivers of patient satisfaction according to Press, Ganey (August 03) and Gallup (1999).

1. How well staff worked together to care for you
2. Overall cheerfulness of the hospital
3. Response to concerns/complaints made during your stay/procedure
4. Amount of attention paid to your personal and special needs
5. Staff responded with care and compassion
6. Staff advised you there were going to be delays

What's interesting to note is none of these speak to the offerings of the latest technology or procedures. Lee's rationale for this is that patients expect hospitals to offer the same technology, procedures, and services. What they are most concerned about is their experience while they are there.

The most interesting one I find above is number 6. How many times have you sit in a doctor's office for an hour without one iota of why you're having to wait. In our centers we make it a practice to inform the patient of the actual reason for the delay. We've found that if informed the patients are very appreciative and much more patient.

Needless to say, after consulting this reference and others my own ideas for survey questions paled in comparison. I'm going to try a few of these questions and await the results. And by the way, we're only going to report 5's.

Tuesday, March 01, 2005

Medicare Morass

The government is killing me. In their much maligned efforts to control costs they end up accomplishing just the opposite. I spent the majority of my day today sorting through the morass of developing a coding plan for a new procedure.

Part of the problem is Medicare (CMS) can't call an ace an ace and a spade a spade. They hire fiscal intermediaries (FI), usually insurance companies, who develop there own local medical review policy (lmrp) for a region of the country. For the most part, the individuals that develop these policies have no clue about the procedures they're making decisions on, especially in Radiation Oncology.

So for one part of the country you can charge for this procedure but, maybe not in another part of the country. I've contacted our FI for guidance on procedures and they don't even have an LMRP for the procedures I was inquiring! Let alone what we can charge for it and what we can't.

Its so bad a cottage industry has sprouted to just try to interpret the rules for us. For a small fee no doubt. What happens then is that this consultant says you can charge for this, another says no, and chaos abounds in the world of cancer coding. In addition, if you do charge for a procedure the documentation required to prove you did indeed do the charges associated with it is ludicrous. Our charts and have doubled in size in the last five years. Thus, increasing our paper, charts, and storage costs.

Adding insult to injury, there are these insane code edits( regulations)that if you perform x on this day you cannot charge y or z unless it is on another day. Even if the charges are totally unrelated. Huh?

Thus it is easy to see that it is a very grey area on what can be charged and what cannot. What I've described here is only the tip of the iceberg. If only Medicare could state in black and white you can charge x,y, & z but not n for this procedure the costs of healthcare would instantly decrease. And my productivity would inversely increase. Not to mention the positive effects on my frustration levels