Tuesday, October 26, 2021

Strong primary care leads to better COVID-19 outcomes

According to an analysis from the Primary Care Collaborative, counties with greater access to primary care, more robust public health, and fewer social vulnerabilities had better COVID-19 outcomes than those which did not. These counties make up 17 percent of the total U.S. population.

The analysis looked at county-level primary care access, strength of public health, and degree of social vulnerability to construct a new Community Health Index (CHI). The CHI was then used to look at the relationship between this county-level data and vaccination rates, incidence of COVID-19 infection before and after vaccines were made available, and COVID-19 deaths before and after vaccines were made available.

Those counties that scored in the lowest on CHI had worse COVID-19 deaths and incidence rates and represents 20 percent of the population. As CHI scores increase the rate of vaccination also increases with populations in the highest quintile being 26 percent more likely to be vaccinated than those living in the lowest CHI quintile, according to the report.

The researchers note that while COVID-19 incident and deaths fell across the country following the introduction of vaccines, it did not fall equally across the country. Those living in counties with the highest CHI were 12 percent less likely to get infected after COVID-19 vaccines were introduced and were 42 percent less likely to die from the virus compared to those in the lowest CHI quintile, the report says.

The three factors are likely highly interrelated, and the data seems to show that vaccination against COVID-19 matters as the introduction of the shots lowered incidences and deaths across all counties regardless of their CHI. Vaccines are not a silver bullet, though, as seen by counties with low access to vaccines or with patients who chose not to get vaccinated, the report says.

COVID-19 outcomes after the vaccines were made available show that other factors, those examined in the analysis, are associated with keeping people from getting COVID-19 and dying, according to the report.

“The findings suggest that primary care and public health leaders need to join forces to strengthen community resistance in advance of the next pandemic and to better address health inequities, with research beginning to emerge that in states and counties where primary care and public health had a more coordinated COVID-19 response outcomes were better,” the report says.


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Monday, October 25, 2021

Six steps to hiring great medical practice staff

Investing time and attention in the medical practice staff hiring process can reduce costs and boost staff retention.


In a busy medical office, an empty staff position can be a real problem. Days that were already full and often hectic are even more so. Patients are complaining. The instinctive response is to fill the slot ASAP. Resist the impulse! Any short-term relief will almost inevitably produce long-term aggravation and higher employment costs.

The data vary widely, but it is generally agreed that filling a staff position costs more than the associated annual salary. Most of these costs are “soft costs” that have a real impact on productivity and operating costs but do not require the practice to write a check to cover them. They include
Lost productivity and increased overtime while the position
is vacant
Time associated with interviewing candidates
Even more lost productivity and increased overtime while the new hire is learning the ropes

The biggest soft cost, however, is making a hiring mistake. Hiring carefully is worth the investment. Here are six steps to significantly reduce hiring costs:

Step 1: Define your requirements


Experience and credentials are important but they are the easy part of describing requirements. The more difficult requirements are the ones not apparent in a résumé or transcript. They include

Personality. For instance, should the individual be cheerful? Optimistic? High-energy? Empathetic? Independent?

Work ethic. Do you want a self-starter? Team player? Leader? Someone who is detail-oriented?

Appearance and manner. Should the individual speak up? Look people in the eye? Be poised? Youthful? Mature?

Step 2: Describe the ideal candidate



It will be useful to flesh out the attributes by actually describing how your ideal candidate would respond in two or three hypothetical situations. (You can use these hypotheticals in the eventual interviews.)

I also recommend describing the ideal candidate from the candidate’s point of view. To whom would the job be most appealing? To whom might the appeal be short-lived? Your best source of this information is your impression of staff, current and past. What type of person at what age and stage has performed well, been happy and stayed a long time? What are the attributes of people who have not worked out well?

The object of the exercise is to have something definite against which to measure candidates. It is unlikely that you will find an ideal candidate, but you will get much closer if you know what you want and hold out for a reasonably good fit.

Step 3: Make adjustments


You may discover that the highly professional, well-turned out, mature person you would really like to hire has no interest in the duties of the job and finds the compensation inadequate. A long-term solution requires adjustments to your requirements, the job, or both.

Think about more than adjustments in monetary compensation. More flexible hours, the opportunity to learn, educational benefits, a pleasant workplace, and discounts on care and services are all examples of perks that have real value to candidates without necessarily increasing costs. Once you know the desired attributes, it becomes relatively easy to tailor the job to attract the ideal candidate.

Step 4: Establish a process that weeds out candidates for you


Before anyone looks at candidate submissions, have someone respond to every one with a request for some action on the part of the candidate. The action should be related to the position so that the request maintains your credibility, but the task itself is unimportant.

The objective is to let casual candidates self-select out of the process. If you still have too many candidates to seriously consider, assign another task. About 90% of the pool will drop out with each request.

Step 5: Verify selected résumé and application information


If something on a résumé or application is important to you, independently verify the assertions. Otherwise, ignore the contents of those documents.

Step 6: Give new hires an easy way to quit after a short trial period


It is not at all unusual for a new hire to discover that accepting the job was a mistake. The sooner the new hire can admit it and move on, the less you will have lost in integrating the new person into the practice.

A bonus is that your second choice may still be available and willing.

Hiring is a necessary evil. Investing time and attention in the process so that your hires are smart ones reduces the costs substantially.


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Sunday, October 24, 2021

Pink October video shines light on women’s health — and their right to know prices

Every October, the pink ribbons and flamingoes come out to raise breast cancer awareness. However, Pink October should go beyond breast cancer awareness to shine the light on women’s health overall, and, as important, the huge responsibility women bear as chief decision makers for their families’ health care.


In the United States, women make 80% of the health-care decisions for their families, yet many of these same women forego their own health care.

A new video released in honor of Pink October is highlighting the fact that a new law has gone into effect that should help women not only better manage their families’ health care, but also help them take better care of themselves. This is critical, as national health-care spending consumes one fifth of the average household budget, and represents nearly one-fifth of GDP, meaning Americans must work the equivalent of one day per week just to pay for their health care.

The video starts with good news: “Thanks to a new federal rule, we Americans have won the right to know the cost of our healthcare before we get it,” says the chipper female narrator. “Imagine that? We get to know the price of our health care before we get smacked with a huge bill we could not see coming.”

Now the chief financial officers of households across America can finally shop for health care the way they shop for everything else: cars, houses, clothing and groceries.

Eventually, a mobile app will let these women buy health care on their devices. Once they no longer have to worry about receiving care that could result in getting a “scary, giant mystery bill” they can stop delaying getting the care they need. Then, maybe fewer women would die of, say, breast cancer.

If that seems too good to be true, so far it is.



Although the new Hospital Price Transparency Final Rule, which went into effect Jan. 1, requires hospitals to post their actual prices — including their discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges,— online in an easily accessible format, most are not. A recent report found that that 94.4% of hospitals weren’t following the rule.

Most analysts agree that once health-care price transparency is widespread, which depends on hospitals and ultimately insurers following the transparency rules, competition will enter our price-opaque health-care market, causing prices for care and coverage to plummet. Comparing prices will allow women to find more affordable care, and employers to find more affordable health-plans. Those realized savings could turn into more household income, more jobs, and higher wages.

Yet hospitals are still keeping patients in the dark. Their non-compliance, researchers found, takes many forms:
  • Some are simply not posting their prices at all.
  • Some, if they are posting prices, are making them impossible to access.
  • Some are posting incomplete lists.
  • Others are making the price lists unnecessarily confusing.
  • The few hospitals that are posting prices are showing that prices for the same service ranges dramatically. A C-section can be $6,000 or $60,000 at the same hospital, depending on the insurance plan. Oddly, cash prices are often lower than the prices private insurance companies negotiate for us.
  • Some hospitals are providing only estimates, which are meaningless since an estimate is not a guaranteed price.
  • Many hospitals are only providing prices after patients cough up a bunch of personal information, like their name, email address and insurance plan, even though the rule states hospitals must provide prices “without barriers.”

Making matters worse, the government has yet to fine a single hospital for not complying with the government’s own rule.

As a result, women who finally think they can get the care they and their families need with a guaranteed price cannot.

Fortunately, a national movement is underway to demand prices and it’s gaining traction. From NASCAR to unions, from boardrooms to bedrooms, America is waking up to the fact that they have won the right to know prices.

Now, the government needs to listen to voters not lobbyists and enforce the rule. They need to impose costly fines on hospitals that don’t post actual prices. And the rest of us need to hold our hospitals accountable, demand real prices, not estimates.

It’s time. Our hospitals should put us in the pink, not in the red.


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