Could clinical laboratories use texting to improving patient compliance with the medical laboratory test orders given to them by their doctors?
California’s largest physician-owned medical practice has
employed text messaging to reduce patient no-shows. Just as other innovations such
as same-day walk-in clinical laboratory
testing and patient at-home self-testing made it easier for patients to comply
with physicians’ lab test orders, text messaging appears to help get more
patients through the doors and into doctors’ exam rooms.
At least that’s the experience at Riverside Medical Clinic
(RMC) in Riverside, Calif. The multi-specialty practice has more than 170
providers who see more than 400,000 patients annually. After struggling to
lower its 15% baseline no-show rate using a phone-only reminder system, RMC turned
to a two-way texting appointment reminder system from Santa Barbara, Calif.-based
WELL Health (WELL).
According to a case
study, prior to the texting
system implementation, no-shows were costing RMC more than $3 million per year.
“The problem we were trying to resolve was getting a hold of our
patients in an expedient manner without having to do redundant work,” Diego
Galvez-Ramirez, Associate Vice President, Patient Business Services at
Riverside Medical Clinic, told Healthcare IT News. “We wanted to
give time back to our staff. A big frustration was not having enough time for
staff to accomplish their duties.”
After RMC implemented WELL’s HIPAA-compliant text-based reminder
system, front office efficiency and productivity improved, and the practice
experienced a 33% decrease in appointment no-shows.
Additionally:
No-shows decreased from 15% to 10% within the
first month of going live across the enterprise.
Confirmed appointments rose from 29.45% to
94.45%, translating to a savings of more than $40,000 in two months.
91% of patients who confirmed via WELL presented
for their visit.
Phone volume at RMC’s two call centers decreased
by 4% to 6%.
Galvez-Ramirez suggests that healthcare providers—including
clinical laboratories and anatomic pathology groups—keep pace with the
realities of today’s connected world. “Most of the time, the cell phone is not
used to make phone calls,” he told Healthcare IT News. “You have to adapt
to the new ways that your patients want and are used to communicating.
“In our environment,” he continued, “you also have to be
quick to respond to your patients. No patient wants to spend unnecessary time
on a phone call. Being able to send them their appointment to their phone is
not a new concept, it’s an expectation.”
Based on an Axway survey of 1,200 smartphone users aged 18-60, the graphic above supports the view that text messaging is now the preferred method of communications for most people. Could clinical laboratories employ text messaging to lower patient no-shows and increase the proportion of patients who actually show up at a patient service center to provide a specimen in response to the medical laboratory test orders given to them by their physicians? (Graphic copyright: MakingCharts.com/Axway.)
The WELL messaging app draws a patient’s information from the
physician’s electronic
health record (EHR) system to configure the appointment reminder. This
includes appointment type, date/time, and location. Based on the patient’s
preferred method, the system sends reminder messages via phone, text, or e-mail.
As Healthcare IT News noted, WELL’s competitors in the
patient communication space include:
Texting Reduces No-Shows at Other Healthcare Networks
Other healthcare organizations also have replicated RMC’s
success in reducing its no-show rates by moving away from telephone-based
reminders.
An Athena Health
study examined 54.3 million patient visits in 2015 and found no-show rates
dropped to 4.4% when patients received a reminder text from their provider. By
comparison:
Athena patients who received a phone call
instead of a text failed to show up 9.4% of the time;
E-mail reminders resulted in a 5.9% no-show rate;
and,
10.5% of patients who received no form of
reminder message missed their appointments.
Is Texting Secure and HIPAA Compliant?
A 2018 poll conducted by the Medical
Group Management Association (MGMA) found that 68% of healthcare organizations
used text messaging to communicate with patients about appointments. But is it
secure?
An MGMA
article notes that according to HIPAA Journal,
“Recent changes to HIPAA
have introduced new rules relating to how Protected
Health Information (PHI) should be communicated and many healthcare
organizations and other covered entities are now at risk of financial sanctions
and legal action should an avoidable breach of PHI occur.” The MGMA goes on to
state that, “As text messaging is not typically a fully-secure channel for the
communication of PHI, practices must be vigilant when sending information via
text messages.”
With proper training and precautions, clinical laboratories and
pathology groups might want to add text messaging to their patient outreach
programs. Data indicate that doing so could improve patient compliance with the
medical lab test orders given to them by their physicians. Industry experts
estimate that for every 100 medical lab test requests written by providers,
only about 60% of patients show up to provide the specimens needed for a lab to
perform those tests. Improving on those numbers would help clinical
laboratories and patients alike.
This new atlas of leukemia proteomes may prove useful for medical laboratories and pathologists providing diagnostic and prognostic services to physicians treating leukemia patients
Researchers at the University of Texas at San Antonio (UTSA) and the University of Texas MD Anderson Cancer Center created the online atlases—categorized into adult and pediatric datasets—to “provide quantitative, molecular hallmarks of leukemia; a broadly applicable computational approach to quantifying heterogeneity and similarity in molecular data; and a guide to new therapeutic targets for leukemias,” according to the Leukemia Atlases website.
In building the Leukemia Proteome Atlases, the researchers identified and classified protein signatures that are present when patients are diagnosed with AML. Their goal is to improve survival rates and aid scientific research for this deadly disease, as well as develop personalized, effective precision medicine treatments for patients.
To perform the study, the scientists looked at the proteomic screens of 205
biopsies of patients with AML and analyzed the genetic, epigenetic, and
environmental diversity in the cancer cells. Their analysis “revealed 154 functional
patterns based on common molecular pathways, 11 constellations of correlated
functional patterns, and 13 signatures that stratify the outcomes of patients.”
Amina Qutub, PhD, Associate Professor at UTSA and one of the authors of the research, told UTSA Today, “Acute myelogenous leukemia presents as a cancer so heterogeneous that it is often described as not one, but a collection of diseases.”
“To decipher the clues found in proteins from blood and bone marrow of leukemia patients, we developed a new computer analysis—MetaGalaxy—that identifies molecular hallmarks of leukemia,” noted Amina Qutub, PhD (above), UTSA Professor of Biomedical Engineering and one of the UTSA study’s authors. “These hallmarks are analogous to the way constellations guide navigation of the stars: they provide a map to protein changes for leukemia,” she concluded. (Photo copyright: UTSA.)
To better understand the proteomic levels associated with AML, and share their work globally with other scientists, the researchers created the Leukemia Proteome Atlases web portal. The information is displayed in an interactive format and divided into adult and pediatric databases. The atlases provide quantitative, molecular hallmarks of AML and a guide to new therapeutic targets for the disease.
The NCI predicts there will be approximately 21,540 new
cases of AML diagnosed this year. They will account for about 1.2% of all new
cancer cases. The disease will be responsible for approximately 10,920 deaths in
2019, or 1.8% of all cancer deaths. In 2016, there were an estimated 61,048
people living with AML in the US.
“Our ‘hallmark’ predictions are being experimentally tested
through drug screens and can be ‘programmed’
into cells through synthetic manipulation of proteins,” Qutub continued. “A
next step to bring this work to the clinic and impact
patient care is testing whether these signatures lead to the aggressive growth
or resistance to chemotherapy observed in
leukemia patients.
“At the same time, to rapidly accelerate research in
leukemia and advance the hunt for treatments,
we provide the hallmarks in an online compendium [LeukemiaAtlas.org] where fellow
researchers and oncologists worldwide can build from the resource, tools, and
findings.”
By mapping AML patients from the proteins present in their
blood and bone marrow, the researchers hope that healthcare professionals will
be able to better categorize patients into risk groups and improve treatment
outcomes and survival rates for this aggressive form of cancer.
The Leukemia Proteome Atlases are another example of the
trend where researchers work together to compile data from patients and share
that information with other scientists and medical professionals. Hopefully, having
this type of data readily available in a searchable database will enable
researchers—as well as clinical laboratory scientists and pathologists—to gain
a better understanding of AML and benefit cancer patients through improved
diagnosis, treatment, and monitoring.
As physicians continue to re-evaluate their career strategies, clinical laboratories must closely monitor changes to test ordering from formerly self-employed doctors
For the first time, more doctors are employed by health networks than are in private practice. That’s according to a recent report from the American Medical Association (AMA). In a press release, the AMA describes the event as “the continuation of a long-term trend that has slowly shifted the distribution of physicians away from ownership of private practices.”
This trend impacts independent clinical
laboratories and anatomic
pathology groups because hospital-based physicians have reasons to order
tests from in-house medical
laboratories. Thus, a reduction in independent self-employed doctors could also
mean reductions in test orders from those physicians.
To make its conclusions, the AMA drew on six years’ worth of
Physician
Practice Benchmark Survey data, gathered from 2012-2018. In its published Policy
Research Perspectives report, the AMA describes the findings as “one of the
more dramatic changes over this six-year span.”
Independence versus Employment
According to the new release, employed physicians made up
47.4% of all patient care doctors in 2018—an increase of 6% since 2012. Meanwhile,
self-employed doctors represented 45.9% of physicians in patient care—down 7% (from
53.2%) since 2012.
“Due to this swing, for the first time in 2018, there were
fewer physician owners than employed physicians,” the AMA researchers wrote in their
report.
The AMA has conducted its benchmark surveys every other year
since 2012. They are nationally representative surveys of doctors to record
employment status, practice size, specialties, and ownership.
“Change continues in the delivery of healthcare and physicians are responding by re-evaluating their practice arrangements. Physicians must assess many factors and carefully determine settings they find professionally rewarding when considering independence or employment,” said Barbara L. McAneny, MD, FASCO, MACP (above), in the AMA news release. McAneny is a board-certified medical oncologist/hematologist, President of the American Medical Association, and CEO/co-founder of New Mexico Cancer Center. (Photo copyright: HMP.)
Who Employs Doctors?
Physicians can be employed by other doctors in
physician-owned practices, by hospitals directly, and by hospital-owned medical
practices.
Most, however, work for other doctors, reported Fierce Healthcare. In a summary of
the latest AMA survey data, Fierce noted that:
54% of doctors are owners, employees, or contractors
in practices owned by physicians—compared to 60% in 2012;
8% of doctors work directly for a hospital—up
from 5.6% in 2012;
26.7% of doctors are employed by hospital-owned
practices—up from 23.4% in 2012; and
34.7% of doctors work for a hospital or a
practice partly owned by a hospital in 2018—up from 29% in 2012.
The AMA partly attributed the increase in employed physicians
to age: 70% of doctors under the age of 40 reported as employees in 2018,
compared to 38.2% of doctors 55 and over who reported as employed.
Family Practice Physicians
Most Likely to Become Employed by Hospitals
Other intriguing data points include the percentages of practice
ownership among medical specialties.
Pathology was not broken out. However, the AMA’s report did state
that, “surgical subspecialties had the highest share of owners (64.5%) followed
by obstetrics/gynecology (53.8%) and internal medicine subspecialties (51.7%).
“Emergency medicine had the lowest share of owners (26.2%)
and the highest share of independent contractors (27.3%). Family practice was
the specialty with the highest share of employed physicians (57.4%),” the
report concluded.
The AMA
researchers also noted that the number of doctors seeking employment in
healthcare networks may be decreasing. “The trend away from physician-owned
practices and toward working directly for a hospital or for a hospital-owned
practice appears to be slowing—more than half of that shift occurred in the first
two years of [the benchmark survey] period [2012 to 2018].”
The AMA also noted that the success or failure of accountable
care organizations (ACOs) could have an effect on hospital acquisition of
private practices. “Should evolving models of care not deliver on their theoretical
savings or improvements, that might put a break on consolidation,” the researchers
wrote.
It’s critical that clinical laboratories continue to improve
the quality and efficiency of outreach services to retain and grow medical
laboratory testing business that increasingly may come from health networks
versus physician-owned private medical practices.
However, research published in JAMA Internal Medicine suggests outpatients with primary care doctors have better healthcare experiences and receive “significantly more” high-value care. These findings come on the heels of a Kaiser Family Foundation (KFF) Health Tracking Poll which revealed that 26% of 1,200 adults surveyed did not have primary care physicians. And of the millennials polled (ages 18-29), nearly half (45%) had no primary care provider.
Why is this important? High-value care include many
diagnostic and preventative screenings that involve clinical laboratory
testing, such as colorectal and mammography cancer screenings, diabetes, and
genetic counseling.
And, this is where clinical laboratories can help.
In the Millennial’s World, Convenience Is King
Millennials are Americans born between the early 1980s to
late 1990s (AKA, Gen Y). And, as Dark
Daily reported, they value convenience, saving money, and connectivity.
Things they reportedly do not associate with traditional primary care
physicians.
According to the KFF poll:
45% of 18 to 29-year-olds,
28% of 30 to 49-year-olds,
18% of 50 to 64-year-olds, and
12% of those age 65 and older, have no
relationship with a primary care provider.
Thus, it’s not just millennials who are not seeing primary
care doctors. They are just the largest age group.
When this many people skip visits to primary care doctors, medical
laboratories may see a marked decline in test volume. Furthermore, shifting
consumer preferences and priorities means clinical laboratories need to reach
out and serve all healthcare consumers, not just millennials, in new and
creative ways.
“We all need care that is coordinated and longitudinal,” Michael Munger, MD, FAAFP, a family physician in Overland Park, Ks., and President of the American Academy of Family Physicians, told the Washington Post. “Regardless of how healthy you are, you need someone who knows you.” (Photo copyright: American Academy of Family Physicians.)
Consider Changes in
Lab Business Model
Dark Daily advises
clinical laboratory leaders to consider changes in how they do business to
better serve busy consumers. Here are a few ways to appeal to people of all
ages who seek value, fast service, and connectivity:
Offer walk-in testing with no appointments.
Create easy-to-navigate online scheduling tools.
Enable patients to request tests without doctors’ orders as the lab’s market allows.
Make results quickly available and in easy-to-understand reports.
Post test results online for patients to securely access in patient portals.
Make it easy to interact with personnel or receive information through lab websites.
Use social media to promote the lab and respond to online reviews.
Younger Americans Do
Not Perceive Value of Primary Care
The JAMA researchers studied 49,286 adults with primary care and 21,133
adults without primary care between 2012 and 2014. The methodology entailed:
39 clinical quality measures,
Seven patient experience measures, and
10 clinical quality composites (six high-value
and four low-value services).
“Americans with primary care received significantly more
high-value care, received slightly more low-value care, and reported
significantly better healthcare access and experience,” the JAMA authors
wrote.
Healthcare Dive notes that the JAMA study may be the first time researchers have substantiated the higher value of primary care, which generally provides services for:
Cancer screening (colorectal and mammography),
Diagnostic and preventive testing,
Diabetes care, and
Counseling.
“Poor primary care supply or access may be hurdles, or some
Americans do not perceive the potential value of primary care, particularly if
they are younger … and healthier,” the JAMA
researchers noted.
The study found that “Only 60% of outpatient antibiotic
prescriptions dispensed in the United States are written in traditional
ambulatory care settings [defined as medical offices and emergency departments].
Growing markets, including urgent care centers and retail clinics, may
contribute to the remaining 40%.”
A Washington Post analysis of this JAMA study reports that “nearly half of patients who sought treatment at an urgent-care clinic for a cold, the flu, or a similar respiratory ailment left with an unnecessary and potentially harmful prescription for antibiotics, compared with 17% of those seen in a doctor’s office.”
This drives home the importance of having a primary care
doctor.
“Antibiotics are useless against viruses and may expose patients to severe side effects with just a single dose,” notes Kevin Fleming, Chief Executive Officer of Loyale Healthcare, a healthcare financial technology company, in its analysis of the earlier JAMA study. “Care that’s delivered on a per-event basis by an array of unrelated providers can’t match the continuity of care that is achievable when a patient receives holistic care within the context of a longer-term physician relationship,” he concluded.
Clinical laboratory leaders and pathologists are advised to
regularly engage with primary care physicians—not just oncologists and other
specialists—and keep them informed on what the lab is doing to better attract
millennials and develop long-term relationships with them based on their values.
Though federal law requires hospitals to publicly display their prices, including their medical laboratory test prices, the information can be confusing, hard to find, and overwhelmingly complex
Hospital chargemaster prices can vary dramatically among hospitals that share the same healthcare markets. That’s what California Healthline found in a recent survey of hospitals in Los Angeles and Oakland, Calif. The price differences were huge and could keep patients located in certain areas within those health systems from accessing critical healthcare services.
Price transparency for healthcare services is an important
trend and this survey demonstrates the wide disparity in prices charged by
different hospitals for the same clinical service. This is also true with clinical
laboratory testing services, where the most expensive price for a routine,
highly-automated lab test can be up to 20 times more than the cheapest price.
California Healthline (CHL) is a news service of the California Health Care Foundation (CHCF). CHL recently compared the chargemasters of four hospitals in the Oakland area and four hospitals in the Los Angeles area. It found huge variances in the hospitals’ price lists.
A hospital’s chargemaster lists the full prices of specific
products and services billable to patients or their health plans following
provider care. Although chargemaster rates differ from the lower negotiated
rates insurers pay, they are a guideline for what patients without insurance,
or those seeking out-of-network treatment, could pay for services.
“List prices, chargemaster prices—like a hotel room rate that you might see posted on the door of a hotel room—hardly anybody ever pays that list price,” Barbara Feder Ostrov, Senior Correspondent for California Healthline, Kaiser Health News (KHN), told NBC Los Angeles. “Usually, it’s negotiated,” she added.
Nevertheless, the price differences are considerable. A historical list of the state’s hospital chargemasters, with downloadable spreadsheets, is available on California’s Office of Statewide Health Planning and Development website.
CMS also requires that the data be machine-readable,
downloadable to a spreadsheet, and updated at least annually.
These lists can be lengthy, with some hospitals providing
pricing for tens of thousands of procedures, services, drugs, medical devices, medical
laboratory tests, and other miscellaneous items.
CMS implemented the law to ensure price transparency for healthcare
consumers and to enable patients to compare prices before selecting which
hospitals to use for medical treatments. The final rule, which CMS says also
benefits policymakers and insurance providers, can assist patients with the
budgeting of any out-of-pocket costs for care.
“[Transparency] allows policymakers to review the prices that are out there,” Barbara Feder Ostrov (above), Senior Correspondent for California Healthline, Kaiser Health News, told NBC Los Angeles. “It lets them say, ‘These are starting prices for negotiations with government and with insurers, and maybe you’re starting a little too high. Can you really justify this price?’” (Photo copyright: Kaiser Health News.)
Transparency Can Confuse Healthcare Consumers
While listing chargemaster prices may serve a valuable
purpose in price transparency, the plethora of billing data and medical codes
can be confusing to healthcare consumers. Usable insight may be lacking in the
multiple screens of data patients encounter.
To determine the exact cost for a healthcare encounter, a patient
would need to know, locate, and calculate all the components of the visit. That
could include which tests will be required, which medicines will be dispensed, and
the facility fee and physician’s charges. Few people would know where to begin
hunting down such information.
Thus, though chargemaster price comparisons can help
patients select a facility for medical tests and services, it is important to
note that chargemasters merely serve as a guideline for what hospitals intend
to charge for their services. People generally do not pay those published rates.
Dark Daily previously published an e-briefing regarding the opportunities and risks for clinical laboratories and pathology groups surrounding chargemasters. It’s important to note that serious enforcement and compliance issues can impact hospitals not prepared to comply with CMS’ transparency guidelines. And medical laboratories are part of that equation.
