CT Center for Patient Safety Newsletter

June 2015

In This Issue

Overdiagnosis and Overtreatment

June Health Hint

Billing Transparency

Research done for the patients!

Patients..... The Most Underutilized Resource in Healthcare

Overdiagnosis and Overtreatment

The New Yorker 5/11/2015

In a recent New Yorker Article, Overkill, Atul Gawande explored the effects of unnecessary medical care. He says that unnecessary medical care is harming patients both physically and financially. He points to the frequency that patients received tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful.

The list includes items that have been identified by the Choosing Wisely initiative where national organizations representing medical specialists asked their providers to "choose wisely" by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed. It is hoped that the resulting lists of "Things Providers and Patients Should Question" will spark discussion about the need-or lack thereof-for many frequently ordered tests or treatments.

In just a single year, researchers have reported twenty-five to forty-two per cent of Medicare patients received at least one of twenty-six identified useless tests and treatments.

In 2010, the Institute of Medicine issued a report stating that waste accounted for thirty per cent of health-care spending - more than our nation's entire budget for K-12 education. The report further found that higher prices, administrative expenses, and fraud accounted for almost half of this waste. The biggest item, however, was the amount spent on unnecessary health-care services. This newer, far more detailed study confirmed that such waste was pervasive. Research suggests that, at one time or another, most people have been subject to overtesting and overtreatment in some form. An unintended consequence of overtesting has been overdiagnosis - the correct diagnosis of a disease that is never going to bother you in your lifetime. An example that Dr. Gawande offers is certain cancer screening which has dramatically increased the detection of breast, thyroid, and prostate cancer during the past quarter century. He points out however, that with all the additional treatment there has been only a tiny reduction in death. H. Gilbert Welch, in his new book, "Less Medicine, More Health," points out that while we've tripled the number of thyroid cancers we detect and remove in the United States, we haven't reduced the death rate at all.

There are some innovative programs that are more critically evaluating the necessity of procedures and surgeries before they are done and findings support that the biggest savings and improvements in care are coming from avoiding procedures that shouldn't be done in the first place. The passage of the Affordable Care Act, in 2010 created other opportunities such as for physician practices to establish themselves as "accountable-care organizations," where they will receive up to sixty per cent of any savings they produce.

Since the ACA went into effect, twenty per cent of Medicare payments are being made to physicians who have enrolled in alternative-payment programs. If government targets are met, these numbers will reach thirty per cent of Medicare payments by 2016. Waste is not just consuming a third of health-care spending; it's costing people's lives. But as Dr. Gawande points out, "As long as a more thoughtful, more measured style of medicine keeps improving outcomes, change should be easy to cheer for. Still, when it's your turn to sit across from a doctor, in the white glare of a clinic, with your back aching, or your head throbbing, or a scan showing some small possible abnormality, what are you going to fear more-the prospect of doing too little or of doing too much?"

June Health Hints - Summer Health Hazards (Modified from WebMD)

Summertime Stings and Ticks

Three in 100 adults in the United States -- or nearly 7 million people -- have life-threatening allergies to insect stings, according to the Journal of Allergy and Clinical Immunology.
To avoid stinging insect bites including mosquitos:

Avoid heavy perfumes and scents (especially florals)
Wear light-colored clothing with no floral patterns (stinging insects are attracted to dark colors and flowers)
Guard food and sugary drinks like sodas

Doctors have warned that the "Powassan Virus" a rare tick-borne illness is newly showing up in CT. The symptoms are similar to Lyme disease, but they are more severe. To reduce your risk:

wear pants and long sleeves outside
avoid bushy and wooded areas
check your body for ticks
use bug spray

Mower Injuries

Beware of mower injuries -- toes, hands, and fingers getting caught in blades, and things like rocks and sticks getting flung out of them

Wear closed-toed shoes
Keep kids away from the push mower and off the riding mower.
Get a professional to service your mower or learn how to do it properly.

Boating Accidents
Boating accidents, often related to drinking and boating, are really no different than auto accidents -- with the added risks of falling out of boats, getting hit by propellers, and drowning.

Don't drink and boat
Wear life jackets
Know your lifesaving skills

Dehydration
Symptoms include feeling dizzy and lightheaded, and your mouth tastes like cotton. You may be dehydrated -- taking in less fluids than you've been sweating out. Heatstroke (body temperature raises too high) is the most severe form of dehydration. Someone with heatstroke may pass out, have hallucinations, or suffer seizures.

Drink plenty of fluids, especially water
Take regular breaks in the shade
Schedule vigorous outdoor activities for times when the heat is less

Sunburn
Your risk for melanoma doubles if you've had just five sunburns in your life. A sunburn is a first-degree thermal burn and can sometimes be a second-degree thermal burn when people are exposed to way too much sun.

Wear sunscreen that protects against both UVB and UVA rays
Wear long-sleeved shirts, and wide-brimmed hats,
Stay out of blistering midday rays

Picnic Poisoning
Food poisoning puts about 300,000 people in the hospital every year, hitting its peak in the summer months. Mayonnaise, dairy, or eggs and any meat products can develop some pretty nasty bacteria after only a couple of hours unrefrigerated.

Clean -- Wash your hands as well as the surfaces where you'll be preparing foods.
Separate -- Wrap raw meat securely and keep it stored away from other food items.
Cook - Make sure that food is cooked to the proper internal temperature.
Chill -- Keep everything refrigerated as long as possible.

Dear Members,

There are several exciting things going on in Connecticut and at CTCPS.

As this newsletter is being written, the 2015 legislative session is wrapping up. During this session there was a bipartisan effort in the state senate to put through a number of bills that will support greater transparency in health care costs and quality. The primary bill that we are keeping our eye on is SB 811. As of this writing, it has passed the state senate and an amended version has passed the house. The bill now goes to back to the senate, where they must vote again since the original bill was amended. For more information see a recent CT Mirror article, Revised health care bill passes House, despite hospital opposition.

This coming Friday, June 5th, I will be co-presenting at

the Better Health Conference at Foxwoods. Please join me and Sara Guastello from Planetree at our presentation: The Patient's Role in Patient and Family Engagement from 11:15 - 12:15.

The 2015 Better Health Conference is a regional event focusing on advancing the movement towards a more engaged consumer of healthcare. This conference will provide an opportunity for consumers to learn together with providers, administrators, and health plan personnel from national and local thought leaders about trends in the healthcare industry.

Registration is $10 and includes breakfast and lunch. For more information, including a complete listing of breakout sessions, click here.

CTCPS is currently undertaking a significant expansion of our education program and we are actively developing a curriculum to share patient stories, patient engagement strategies and patient safety strategies with medical residents, nursing, medical and other health science students. Please contact us if you have any patient experiences that you would be willing to share with us.

Please continue to keep up with our activities and various news stories that we feel are important by "liking" our Facebook page. This is a format where we welcome your comments and you can share our posts with others to easily spread the word.

Feel free to contact us to share any thoughts that you might have, things that you would like to see us cover or any participation in our organization that you wish to offer.

Lisa Freeman

Billing Transparency

You often hear us at the CT Center for Patient Safety speak about the need for transparency in healthcare. How different might it be if billing was more transparent? It might impact our choices between two different care options if one cost substantially less than another and yet they both worked as well. Or, between two different care locations that your doctor worked out of if one was going to include a facility fee and the other not.

Let's take this to another level. How often do you understand all the information that is on your bill, particularly if it is from a hospital? You would need to decode each item, understand a number of terms related to coverage, better identify line items that may be significant and yet are labeled "miscellaneous" and have lots of time to figure it all out.

There is not yet a lot of standardization as Elisabeth Rosenthal points out in her NY Times article, The Medical Bill Mystery. Did you know that Good Morning America reported that up to 90% of hospital bills contain errors. Fortunately, Rosenthal also shares with her readers that there are some resources to get help. Before you start trying to decode your bill, you might want to look at a tutorial - Understanding Your Medical Bill - produced by the Khan Academy, an online educator, and the Brookings Institution in Washington. Also, Rosenthal mentions that NerdWallet is a financial service company that offers educational tools and experts to talk patients through their bills.

Research done for the patients!

This past week, as a member of the PCORI Improving Healthcare Systems panel, Lisa Freeman, Executive Director at CTCPS, attended an in-person meeting in Washington DC. The Patient-Centered Outcomes Research Institute (PCORI) is a nonprofit, nongovernmental organization. Congress authorized the establishment of PCORI in the Affordable Care Act of 2010. Through funding from PCORI, research designed to improve the quality and relevance of evidence available to help patients, caregivers, clinicians, employers, insurers, and policy makers make informed health decisions is awarded grants.

I have observed two things, which I want to share. First, in the research community, PCORI has made Patient-Centered Outcomes Research a well-recognized concept and "patient-centered" is the operative term here including patients and caregivers. The second point is that PCORI itself operates as a true patient-centered organization setting an example for others to follow. What I saw was that business there, at all levels, takes place with the patient and not just for the patient. My meaningful inclusion, along with the other patient advocates on the Improving Healthcare Systems panel and elsewhere throughout the organization, advances the role of patients in the changing landscape of healthcare.

I encourage patients and family members to involve themselves in healthcare policy through the different avenues that are open to them, or to forge new ones. Patient and Family Councils at hospitals, long-term care facilities, and other practices and providers are great local programs to look into. If you are interested in further involvement and are not sure where to turn, please contact us.

Patients..... The Most Underutilized Resource in Healthcare

In a recent US News & World Report, Mining Patients' Wisdom for Safer Care, Peter Pronovost, a practicing anesthesiologist and critical care physician and a recognized patient safety advocate wrote, "Health care will be safer, and patients' goals will more often be met, if we partner with patients and their loved ones, offer them the opportunity to share their ideas for improving care and listen and respect their wisdom." This is something that patients and their families appear to know intuitively, but something that many in the medical community seem to be first embracing.

Dr. Pronovost talks about the need to engage patients, to learn more about them than just their condition and not just treat them as a condition but as a member of their care team. What if they have COPD and have no way to get the medications that are prescribed, or don't understand the directions for taking the medication (an inhaler for example), or can't get to their follow-up appointment? That could land them in the hospital. We must treat the whole person.

As patients, it is more important than ever for you or a family member to be engaged in your care. Start the conversations if your providers don't. One way to accomplish this is to ask the questions set out by the National Patient Safety Foundation:

What is my MAIN PROBLEM?
What do I NEED TO DO?
Why is it IMPORTANT for me to do this?

With a clear understanding of your provider's answers, and your engagement as a patient you will be more likely

to experience better outcomes. For more strategies that you can use, visit our website resource page and our homepage feature, Becoming a More Empowered Patient.

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