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When I first started getting involved in online education I had a mentor from a graduate program in education. We co-produced an online course, Business and Finance in Academic Medicine. It was designed for physician residency directors who were earning a Master’s in Ed. to improve their teaching skills. By popular demand, they asked for an elective on business. My mentor introduced me a a wealth of literature on learning, best practices, and it was reviewing the studies that I realized the limitations of single face to face encounters. Elementary through high school is all face to face, reinforced by homework, repetition, and testing to produce an effective knowledge transfer.
1. cost – thanks for sharing that information! That would definitely be helpful and you’re right, compliance is definitely an important factor. Thank you!
2. I never thought about the comprehension and retention of this information. I probably have an inflated view of the rapport being built as I talk at my patients. I also think it would be easy for me to transition to quickly describing something while offering follow up materials for them to use on their own time. Thank you so much!
About face to face. As a surgeon I always thought myself very proficient at education and explaining the intricacies of a surgical procedure to patients. Patients nod and react well to in person discussions and I was very happy with myself. Then I discovered the efficacy of face to face education, 50% comprehension and 25% retention after one week, independent of the educator. The key factor in education that is retained is repetition. Our face to face is a one off. If may be different for each patient. Not much chance exists to repeat the message or test for comprehension and yet we devote less and less resources every year. How much time did EHRs take away for your education efforts.
We are working with this platform to education patients. Check out these links, knee and hip replacement patient education courses. Easy access, pre and post testing, and readily available for review. Guess what the most common device is? These are 60 – 70 years and their favorite device is an iPhone. https://meded-stat.com/courses/hip-replacement-patient-education/
https://meded-stat.com/courses/total-knee-replacement-patient-education/
We have a course in value based care that teaches activity based cost analysis. It takes your top revenue producing CPT codes and breaks them down to discover hidden efficiencies and costs. 20% of your activity produce a majority of your revenue, so it is not as intimidating as you would think. As for drug pricing. Do you know how drug prices are set. I didn’t when I was in practice. We also have a course in Medication Compliance which spells out the “hidden” process and give you a solution to reducing your patient’s drug costs. My ENT, a close friend who I have played hockey with, diagnosed an external Otitis and prescribed brand name otic antibiotic solution. I took a paper script to CVS and found it costs $250 for 10cc of medication. I refused to pay and went home. After an hour on the computer I found a manufacturers coupon that reduced the cost to $45. I also found an alternative that cost $25. I am sure he simply wrote a script for what he thought was best with no consideration of the cost. That process results in more than 30% non-compliance in picking up a script. It inspired me to investigate the drug pricing system and use the practice improvement methodology to offer solutions. https://meded-stat.com/courses/medication-compliance-truth-and-consequences-1-5-cme/
“The cost of that care is our responsibility. We have the power to drive down costs by understanding value, pricing, and utility.”
This would be so helpful, however, I find it very difficult to understand the cost. Of course I know that the new brand name medication is more expensive than what’s on wal-mart’s $4 list. However, so much of this cost is dependent on the insurance. I completely agree that understanding the value and utility of something is good medicine. It is my responsibility to know what a certain lab will tell me, how it is going to affect my management, and if it is necessary. But how can I possibly know if insurance will pay for something? Some things you learn with experience if insurance never pays, but when it’s variable it’s very difficult. Do you have recommendations for how to better understand and predict the cost aspect?
“We used to think the face to face education was the best. Not so, online technology has surpassed the traditional modes and patients at all ages prefer to use their connected devices to learn.”
I am among those people who prefer online technology for education. I find myself preferring to explain endometriosis face to face because 1. it helps build rapport (many of my reviews say something about how I explain things) 2. then I know for a fact that the patient has heard it. If I email them information of endometriosis or give them a pamphlet, I find myself doubting that they actually read it (and I may be wrong in assuming this). So how do you build this into your practice if it is tied to rapport and true understanding if you doubt that your patients are actually using your materials to educate themselves at home?
You question is really about engaging the patient. It is getting harder and harder to establish a trust relationship with patients. It starts with the employees in your practice. Do they feel empowered? Employee engagement in their work is the leading indicator toward patient engagement. I would start there. Next up is patient education. Patients have so many sources of information available to them, but it doesn’t mean they are becoming educated on their health issue. We might acquire education resources that are easy for them to access, and then followup to make sure they are doing their homework. We are losing touch with best education practices. We used to think the face to face education was the best. Not so, online technology has surpassed the traditional modes and patients at all ages prefer to use their connected devices to learn.
Solutions in any organization can be bottom up despite the control exerted by the admin. It can all start with a single provider. I placed an extra course in your account on Medication Management. How can we change what we do every day and reduce non-compliance dramatically. In the third course on practice improvement, you will see how small incremental change can add up to something remarkable.
This is interesting, because more and more I find that patients directly ask and/or demand for what they want, sometimes successfully overtaking what the physician should control. How do providers remain the stewards of healthcare in the time of patient satisfaction survey linked to physician quality reimbursement and liability ?
I placed a post in Facebook asking who the main purchasers were in U.S. healthcare. In every other industry, the main driver of commerce is the customer. If your customers see value in the product you tend to be successful. In most cases the customer, (purchaser) is the user of the product.
Who is the customer in healthcare: patients, patient’s family, insurance company, government, providers, others? Most common reply was patients of course. WRONG! My wife, a physician said insurance companies. WRONG!! The Facebook crowd gave a myriad of other answers, ALL WRONG!! The fact is we are the customers, we make all of the purchasing decisions and let someone else pay. Patients may pay, especially those with large deductibles, for what we buy them but rarely are they included in the decision. How many times do we hand them a prescription and neither of us know the cost until the bad news comes to the patient at Rite Aid.
Patients present to us with a problem. History and physical later we begin purchasing lab tests, imaging, surgery, medications, and any number of other medical services. We do all of the purchasing with little attention to cost, ans sometimes only a mild attention to value. New medications that are much more expensive often win out over the tried and true. We need to think of ourselves as the purchasing agent. It is kind of like having your neighbor go out and buy a car for you and telling you that you will find out the price when you go to the dealer to pick it up.
The cost of that care is our responsibility. We have the power to drive down costs by understanding value, pricing, and utility. We need to use our business skills in practice every day. And start by viewing every patient encounter as an income statement that characterize the financial consequences of the encounter. Improve your own awareness of those consequences and let the patient participate. It won’t take long before you see the value of care improve and who doesn’t like that.
Thanks for the attention, I hope all of you are doing well. As usual, if you need anything, don’t hesitate to reach out to me.
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