Doctors for years have struggled to get people to change unhealthy behaviors and to care about their own health. Yet people continue to smoke, eat poorly, neglect to fill prescriptions and avoid preventive care.
Various health care reform initiatives, including the imperative for accountable care under the Patient Protection and Affordable Care Act – commonly known as Obamacare – as well as the shift from paper to electronic record-keeping, might not get people to ditch their bad habits, but these changes are forcing providers to get creative, lest they get hit where it hurts the most: in the pocketbook.
Notably, the $27 billion federal incentive program for "meaningful use" of electronic health records (EHRs) moves into its second of three phases as soon as Oct. 1 for some hospitals.
In Stage 2, providers have to offer at least half of their Medicare populations online access to their own records and, significantly, 5 percent of these patients actually have to log in and either enter their own data or send unsolicited messages back to providers.
For the first time, there is a financial incentive to "engage" patients in their own care: Hospitals and health care professionals must meet all the requirements or they lose out on extra Medicare and Medicaid payments (there is no partial credit). That has a lot of executives concerned.
"Having a physician penalized for something a patient doesn't do is troubling," says Dr. Howard J. Luks, chief of sports medicine and arthroscopy at Westchester Medical Center in Valhalla, N.Y.
A strong proponent of social media in medicine, Luks publicizes his email address and Facebook, Twitter and Google+ accounts on his website and on his business cards. The response has been underwhelming. "The number of people who reach out are very low," Luks reports. He forges ahead because he sees the promise of patient-doctor communication.
As an orthopedic surgeon, Luks encourages post-operative patients to send him photos to show how incisions are healing. "I have picked up blood clots earlier than I would have had I not been available electronically," Luks says.
Post-op and post-acute care is where a lot of providers are looking to meet that 5 percent requirement, especially since Medicare no longer pays for certain "preventable" readmissions within 30 days of hospital discharge. Many also see potential in engagement platforms such as Web portals and patient-controlled personal health records (PHRs) for patients with chronic diseases.
A portal is great for delivering test results, for post-surgical care, patient education and for patients to ask questions, according Charles E. Christian , vice president and chief information officer at St. Francis Hospital in Columbus, Ga. "I think it's going to be a source of information for patients who have a lot of questions after they leave the hospital," he says.
The bottom line, according to William Montgomery, VP and CIO at Springfield, Ill.-based Hospital Sisters Health System, is that patients will use a portal or a PHR if they perceive value in doing so.
Hospital Sisters, which has 13 hospitals in Illinois and Wisconsin, is trying to provide some value by working with a pharmacy information service called Surescripts to collect and deliver complete, up-to-date medication histories to patients via personal health records tied to the organization's EHRs. This, Montgomery says, helps eliminate the need for individuals to keep their own medications lists current, saving time, hassle and, potentially, lives.
Value also applies on the provider side. In a traditional fee-for-service reimbursement model, doctors won't bother with portals, PHRs or patient-supplied data unless they get paid for their time. Accountable care and "bundled" payments for managing entire episodes of care flip this around, shifting risk from insurer to provider.
"You're really going to get the value if you're in a risk environment," Montgomery says. He suggests that online communication could be a convenient alternative to office visits for chronic disease care or routine follow-ups.