Telehealth Saved Providers $2,750 per Patient, New Study Says

The results of a long-awaited study has found that telehealth saves providers nearly $3K per patient when used for post-discharge knee replacement PT.

Telehealth saves healthcare providers nearly $2,750 per patient when used in place of in-person physical therapy for post-discharge knee replacement patients, according to a long-awaited study by the Duke University School of Medicine’s Duke Clinical Research Institute (DCRI).

The VERITAS (Virtual Exercise Rehabilitation In-home Therapy: A Research Study) project began in 2016 and followed nearly 300 people who had undergone a total knee replacement surgery. Researchers split the group into two groups; half of participants received traditional in-person physical therapy, and the other half received physical therapy via a remote patient monitoring platform known as VERA.

Researchers found that both methods of treatment were similarly effective in reducing knee instability and improving knee function, but that providers using the telehealth platform with clinical oversight saved an average of $2,745 per patient.

The findings of the study strengthen the case for physical therapists who are considering telemedicine as a way of expanding their businesses and boosting patient engagement.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Majority of Patients Expect Opioids After Surgery

Despite campaigns by the therapy community, and the government, to loosen the grip of opioids in the U.S., patients still expect them after surgery.

Despite the mounting opioid crisis in the United States, a staggering 77% of patients expect opioids, such as morphine, fentanyl, and dilaudid, after surgery, according to a study presented at the American Society of Anesthesiologists annual meeting.

Researchers surveyed 503 adults who were scheduled to have surgery for the back, ear-nose-and-throat, abdomen, or hip or knee replacement. Survey results showed that all 503 patients expected to receive pain medication after surgery—77% expected opioids, 37% expected acetaminophen, and 18% expected a non-steroidal anti-inflammatory.

“Patients often assume they will receive opioids for pain, believing they are superior, and therefore may pressure physicians to prescribe them after surgery. But research shows opioids often aren’t necessarily more effective. Clearly, we need to provide more education to bridge that gap and help patients understand that there are many options for pain relief after surgery, including other pain medications such as acetaminophen and ibuprofen.” Nirmal B. Shah, D.O., lead author of the study and an anesthesia resident at Thomas Jefferson University Hospital, Philadelphia, is quoted as saying.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

$16M: The Record Breaking Cost of a Data Breach

Anthem is being held accountable, to the tune of a record breaking $16,000,000, for cyber attacks that compromised protected health information.

Anthem is being held accountable, to the tune of a record breaking $16,000,000, for cyber attacks that compromised protected health information in the largest health data breach in U.S. history.

The staggering payment, which will be made to the Department of Health and Human Services, Office for Civil Rights, is to settle HIPAA violations that results after a series of cyberattacks led to close to 79 million people having their health data stolen. This is the largest settlement related to a data breach, towering over the previous high of $5.5M.

Indianapolis-based Anthem, an independent licensee of the Blue Cross and Blue Shield Association, is one of the largest healthcare entities and the nation’s second-largest health insurer, providing coverage to one in eight Americans through its health plans, making it a desirable target for hackers the world over.

“Anthem takes the security of its data and the personal information of consumers very seriously,” Anthem said in a statement released on Monday. “We have cooperated with [the government] throughout their review and have now reached a mutually acceptable resolution.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Two Healthcare Majors Ranked “Most Valuable”

Two medical and health sciences and services fields of study were ranked in the top 10 most valuable college majors according to a new survey.

Two medical and health sciences and services fields of study were ranked in the top 10 most valuable college majors by Bankrate.com, a personal finance website. Health and Medical Preparatory Programs ranked fourth on the list, while Pharmacy, Pharmaceutical Sciences, and Administration was ranked sixth.

To determine the rankings, Bankrate.com examined the most recent data from the U.S. Census Bureau American Community Survey. The data was used to rank 162 majors based on a variety of factors, including the degree holder’s average annual income, the unemployment rate for college graduates with that degree, and whether a degree holder’s career path required a higher degree, such as a master’s degree or doctoral degree.

According to Bankrate.com, Health and Medical Preparatory Programs degree holders earn an average annual salary of $130,308, and their unemployment rate is only 2.3%, while Pharmacy, Pharmaceutical Sciences, and Administration graduates earn $103,350 on average annually, and have an unemployment rate of 1.8%.

Comparatively, the least valuable major is Miscellaneous Fine Arts, ranking at #162 on the list, with an average annual salary of $40,855 and an unemployment rate of 9.1%.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nurses Still Underrepresented as “Expert Sources”

Though nurses are well-educated and intelligent, they are cited as expert sources in health news stories less than 2% of the time, according to a new study.

New research conducted by the George Washington University School of Nursing’s Center for Health Policy and Media Engagement has found that nurses “continue to be underrepresented as sources in heath news stories despite their increasing levels of education and expertise.”

The study, which is a replication of the 1997 Woodhull Study on Nursing and the Media, identified nurses were listed as sources in only 2% of health news stories, a decline from the original Woodhull Study, which found representation of nurses “in less than 4% of health news stories.”

Though nurses are well-educated and intelligent, the study shows a bias exists. The researchers noted that participants indicated prejudices endure in terms of positions of authority, and that “rock-star doctors” are a preferred source. It was noted that this mindset stems from “newsroom cultures,” and some participants said they have had to defend using a nurse as a source in the past.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Great Side Hustles for Nurses

Though RNs make an average annual salary of $70,000, sometimes, a little extra cash can go a long way. Here are four side jobs perfect for nurses.

Though Registered Nurses make a strong average annual salary when compared to that of the national average ($70,000 versus $44,564), a little more money in your pocket couldn’t hurt, be it to make getting by a little easier or to save for a big purchase or a rainy day. Fortunately, RNs have a specialized skill set that makes them a natural fit for some great side jobs, in addition to their day-to-day roles (and paychecks). Here are four options to consider, if you want to make a little more cash on the side.

Give Flu Shots
Flu season is upon us, and with it, nurses are needed to administer flu shots in clinics, doctors’ offices, grocery stores, pharmacies, and more.

Teach CPR and First Aid
CPR and First Aid classes are available year-round, through a variety of organizations, so the work can be fairly steady. Though you’ll need to be certified as an instructor first, the cost is low and the process is fairly quick.

Tutor Nursing Students
Set your own hours and rate, and tutor the next generation of nurses for NCLEX prep, either in-person or online.

Per Diem Shifts
Per diem nursing offers a flexible work schedule, for a typically higher wage. And, bonus, taking on freelance shifts in underserved areas can be rewarding in more ways than just the pay.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Dementia And Guns: When Should Doctors Broach The Topic?

As the number of Americans with dementia rises, health professionals are grappling with when and how to pose the question: “Do you have guns at home?”

Melissa Bailey, Kaiser Health News

Some patients refuse to answer. Many doctors don’t ask. As the number of Americans with dementia rises, health professionals are grappling with when and how to pose the question: “Do you have guns at home?”

While gun violence data is scarce, a Kaiser Health News investigation with PBS NewsHour published in June uncovered over 100 cases across the U.S. since 2012  in which people with dementia used guns to kill themselves or others.  The shooters often acted during bouts of confusion, paranoia, delusion or aggression — common symptoms of dementia.  Tragically they shot spouses, children and caregivers.

Yet health care providers across the country say they have not received enough guidance on whether, when and how to counsel families on gun safety.

Dr. Altaf Saadi, a neurologist at UCLA who has been practicing medicine for five years, said the KHN article revealed a “blind spot” in her clinical practice. After reading it, she looked up the American Academy of Neurology’s advice on treating dementia patients. Its guidelines suggest doctors consider asking about “access to firearms or other weapons” during a safety screen — but they don’t say what to do if a patient does have guns.

Amid a dearth of national gun safety data, there are no scientific standards for when a health care provider should discuss gun access for people with cognitive impairment or at what point in dementia’s progression a person becomes unfit to handle a gun.

Most doctors don’t ask about firearms, research has found. In a 2014 study, 58 percent of internists surveyed reported never asking whether patients have guns at home.

“One of the biggest mistakes that doctors make is not thinking about gun access,” said Dr. Colleen Christmas, a geriatric primary care doctor at Johns Hopkins School of Medicine and member of the American Neurological Association. Firearms are the most common method of suicide among seniors, she noted. Christmas said she asks every incoming patient about access to firearms, in the same nonjudgmental tone that she asks about seat belts, and “I find the conversation goes quite smoothly.”

Recently, momentum has been building among health professionals to take a greater role in preventing gun violence. In the wake of the Las Vegas shooting that left 58 concertgoers dead last October, over 1,300 health care providers publicly pledged to ask patients about gun ownership and gun safety when risk factors are present.

The pledges came in response to an article by Dr. Garen Wintemute, director of the Violence Prevention Research Program at the University of California-Davis. In response to feedback from that article, his center has now developed a toolkit called What You Can Do, offering health professionals guidance on how to reduce the risk of gun violence.

In a nation bitterly divided over gun ownership issues, in which many staunchly defend the right to bear arms under the Second Amendment, these efforts have met dissent. Dr. Arthur Przebinda, director of Doctors for Responsible Gun Ownership, framed Wintemute’s efforts as part of a broader anti-gun bias on the part of institutional medicine. Przebinda said asking physicians to sign such a pledge encourages them “to propagandize Americans against their constitutionally protected rights to gun ownership and privacy.”

Przebinda said he gets several requests a day from patients looking for gun-friendly physicians. Some, he said, are tired of their doctors sending them anti-gun YouTube videos and other materials. His group, which he said has over 1,400 members, has set up a referral service connecting patients to gun-friendly doctors.

For doctors and other health professionals, navigating this politically fraught issue can be difficult. Here are the leading issues:

Is it legal to talk to patients about guns?

Yes. No state or federal law bars health professionals from raising the issue.

Why don’t doctors do it?

The top three reasons are lack of time, being unsure what to tell patients and believing patients won’t heed their advice about gun ownership or gun safety, one survey of family physicians found.

“There’s no medical or health professional school in the country that does an adequate job at training about firearms,” Wintemute argued. He said he is now working with the American Medical Association to design a continuing medical education course on the topic.

Other doctors don’t believe they should ask. Przebinda argues that doctors should almost never ask their patients about guns, except in “very rare, very exceptional circumstances” — for example, if a patient is despondent or homicidal. He said placing patients’ gun ownership information into an electronic medical record puts their privacy at risk.

When should they broach the subject?

The Veterans Health Administration recommends asking about firearms as part of a safety screening when “investigating or establishing the suspected diagnosis of dementia.” The Alzheimer’s Association also recommends asking, “Are firearms present in the home?” as part of a safety screening. That screening is part of a care planning session that Medicare covers after initial dementia diagnosis and annually as the disease progresses.

The American College of Physicians recommends physicians “counsel patients on the risk of having firearms in the home, particularly when children, adolescents, people with dementia, people with mental illnesses, people with substance use disorders, or others who are at increased risk of harming themselves or others are present.”

Wintemute said he does not suggest all doctors routinely ask every patient about firearms. His group recommends doing so when risk factors are present, including risk of violence to self or others, history of violent behavior or substance misuse, “serious, poorly controlled mental illness” or being part of “a demographic group at increased risk of firearm injury.”

What should health care providers recommend patients do with their guns?

The National Rifle Association and What You Can Do both offer tips on how to store guns safely, including using trigger locks and gun safes.

The Alzheimer’s Association advises that locking up guns may not be enough, because people with dementia may “misperceive danger” and break into a gun cabinet to protect themselves. To fully protect a family, the organization recommends removing the guns from the home.

But health professionals may be reluctant to recommend that due to legal concerns, said Jon Vernick, co-director of the Johns Hopkins Center for Gun Policy and Research. Most states allow the temporary transfer of firearms to a family member without a background check. But seven states don’t: Connecticut, Hawaii (for handguns), Massachusetts, Michigan, New Jersey, North Carolina and Rhode Island, according to Vernick. He recommends health professionals look up their state gun laws on sites such as the NRA Institute for Legislative Action or the Giffords Law Center to Prevent Gun Violence.

In addition, 13 states have passed “red flag” laws allowing law enforcement, and sometimes family members, to petition a judge to temporarily seize firearms from a gun owner who exhibits dangerous behavior.

What happens when clinicians ask about guns?

Natasha Bahr, an instructor and social worker who works with geriatric patients at a clinic focusing on memory disorders at the University of North Texas Health Science Center, said as part of a standard assessment, she asks every patient, “Do you have firearms in the home?”

“I get so much pushback,” she said. About 60 percent of her patients refuse to answer, she said.

Patients tell her, “It’s none of your business,” “I have the freedom to not answer that question” or “It’s my Second Amendment right,” she said. “They make it sound like I’m judging, and I’m really not.”

Dr. John Morris, director of the Knight Alzheimer’s Disease Research Center at Washington University in St. Louis, said he asks his patients about firearms in the context of other safety concerns. When safety is at risk, he typically advises families to lock up firearms and store ammunition separately.

“People with dementia typically lack insight into their problems. So they will protest,” he said. Dementia is characterized by “the gradual deterioration not just of memory but of judgment and problem-solving and good decision-making,” Morris noted.

In one case, Morris said, he had to persuade the daughter of a dementia patient to secure her father’s hunting rifles. Uncomfortable with the role reversal, she was reluctant to do so.

“It’s very difficult to tell your father he can no longer have his firearms,” Morris said. The father responded: “I have never misused my firearms. … It’s not going to be a problem,” Morris recalled. “But, he’s remembering his past history — he can’t predict the future.”

Eventually, the daughter decided to remove the rifles from the home. After a few weeks, her father forgot all about them, Morris said.

Morris said the story highlights how difficult it is for families to care for people with dementia. “They’re forced to make decisions, often against the persons’ will,” he said, “but they have to do it for the person’s safety and well-being.”

KHN’s coverage of these topics is supported by Gordon and Betty Moore Foundation, John A. Hartford Foundation and The SCAN Foundation

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Physicians Are Plagued by EHR, but Few Are Asking Them How to Improve It

Despite documentation burden being a leading factor of physician burnout, organizations and EHR vendors are barely asking physicians how to improve.

EHRs are a common pain point for physicians, with multiple studies singling out documentation burden as a leading factor of physician burnout. However, a new survey of U.S. physicians by Deloitte found that only about a third of organizations and EHR vendors sought physician feedback on how to improve EHR processes.

Approximately 624 U.S. primary care and specialty physicians participated in the Deloitte 2018 Survey of U.S. Physicians, and of those respondents, only 34% of surveyed physicians indicated their organization or EHR vendor sought their feedback, though 58% of responding physicians said there is a big opportunity for improvement in clinical documentation, and it was the number one area physicians indicated could be done more efficiently in their day.

51% of physicians who were not asked for feedback said they were unaware of EHR optimization efforts either by their organization or through their EHR vendor.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Demand for Newly Certified PAs is Strong

Demand is high and the job market is strong for newly certified PAs, according to a new report by the National Commission of Certified Physician Assistants.

Demand for and the job market remain strong for newly certified PAs, according to new data released in the 2017 Statistical Profile of Recently Certified Physician Assistants by the National Commission of Certified Physician Assistants (NCCPA).

The robust report, which is based on survey responses received from 6,843 of the 8,788 PAs who obtained certification in 2017, aims to offer insight into the future of the PA workforce, as well as its current state.

Highlights from the report include:

  • On average, PAs made $95,000 as a starting salary in 2017.
  • Recently certified PAs are practicing in all 50 states and the District of Columbia.
  • The top states with the greatest number of recently Certified PAs are New York (902), Pennsylvania (699), Florida (567), California (548), North Carolina (440), and Texas (440).
  • 67.2% of respondents accepted a clinical position as a PA in 2017.
  • 77.4% of PAs who accepted a position received two or more job offers, and 79.3% of newly employed PAs indicated that they did not face any challenges when searching for a job.
  • 52.8% of recently certified PAs who have accepted a position work in a hospital setting and 29.9% are working in an office-based private practice setting.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Kim’s Blog: What If The Priority of Our Visit is Addressing Social Needs and Non-Compliance

Kim Spering encourages you to look for the real reasons patients don’t show up on time, don’t take their medications, and seem to go against medical advice.

by Kimberly Spering, MSN, FNP-BC

In my palliative care work, making home visits, we often find patients’ needs to be dire for basic necessities. What if simply being able to EAT was one of those needs? What if, for example, a patient’s reasons for not going to office visits was simply – he couldn’t afford transportation?

It was my second visit with a thin, elderly gentleman. During the first visit, he shared that his HUD housing management had sent him a written eviction notice for “multiple infractions.” I reviewed the multi-page document they sent him. Frankly, none of these so-called incidents seemed to warrant eviction.

Speaking softly, muffled due to his lack of teeth and his Parkinson’s disease, I pieced together his story.

He had been diagnosed with PD years ago, after many years with vague symptoms. He was prescribed Sinemet TID, but takes it QID on his own, as the tremors and gait freezing worsened after 3 hours of each dose. Which means… he runs out of medication before the next refill. So, he suffers more during the last week of the month. He also has subsequent cognitive short-term memory deficits as a result of the disorder.

He has had multiple mental health issues, addiction, and other social problems over the years. He sees a psychiatrist, addiction specialist, and therapist to help him through these problems.

He does not drive, and relies on public bus transportation for appointments. Guess what: now, he cannot afford the tickets. As a result, he often no-shows for appointments, thus getting him a “reputation” for “non-compliant behavior.” And let’s face it, no one looks into the details. It doesn’t matter if he can’t afford that bus pass – he is now “labeled” as “non-compliant.” He does not always know what number to call to cancel his appointments. (by the way… side bar. I loathe that term. I prefer, “non-adherent.” It’s less judgmental, in my opinion.)

In recent months, he forgot that he put pots on the stove while heating up his food. One incident led to the local fire department being dispatched. After that, his building management decided they would disconnect his stove. So now, he can’t even heat up any meals that he may get.

Also, financially, he has no extra money to pay for food, after medication co-pays. For some reason, even though he had Medical Assistance, his plan did not cover his medications. So an albuterol inhaler costs him $58… which he did not have. He has an enlarged cervical lymph node, which I presume is cancer-till-proven-otherwise, given his ETOH use/smoking, but I wrote a Rx for Keflex, hoping against hope it would help. It did, albeit marginally. He still needs evaluation for the mass. He can’t afford the bus fare to go for a visit. He also was visibly short of breath when I saw him, which likely would have improved by using that inhaler — had he been able to afford it.

I then found out that he ONLY eats when going to local soup kitchens. THREE TIMES PER WEEK, Tuesdays through Thursdays. He barely eats in-between. He had one can of tuna in the apartment. He has lost over 40 lbs… 16 lbs in the previous 6 weeks from my first visit. He is at the brink of being emaciated at this point.

Our one local food bank will deliver a food box to anyone in the apartment complex who needs it – once per month. He never got one, because he has been at the soup kitchen for his meal when the group arrives. He was told by management that they would not save a box for him, nor deliver it to his door, because “people would steal it.”

I was not only appalled, but incensed that this was the case.

So… here is a man who eats three hearty meals per WEEK, living sparingly on a can of tuna here-and-there in-between. He has no other recourse. There is minimal family involvement. He can’t access outside resources. I wanted to cry when viewing his situation.

Fortunately, he is enrolled in our Community Care Team (encompassing nurses, social workers, pharmacists, mental health specialists) through his PCP office. I sent a message to the RN on his case, detailing the grim realities of not having food. He has a community health worker at the one local church who tries to help him where possible.

On the day of my second visit, I had a palliative care fellow with me. He suggested Meals on Wheels.

On the inside, I kicked myself for not thinking of this sooner. Then I discovered that if he was frequenting soup kitchens (even only 3 days per week), he may not qualify for it. So… go to soup kitchens with a guaranteed meal three times per week… but still, he should qualify for two meals per day from MOW based on his income.

Alas, there is the logistical nightmare of trying to follow him if/once he gets evicted.

“I’ll be homeless,” he stated firmly.

“What about the Mission?” – a local resource for homeless men. They have to leave during the day, but can return for hot meals and a place to sleep in the evening, counseling, and help to get back on track.

“Nope. No way,” he said. From reading between-the-lines, and knowing he hadn’t conquered his addictions, I knew that a Christian organization would clash with his wishes for care, particularly if he used drugs.

“What about your family?”

“Eh, one daughter drops by on occasion with food. The others – they don’t call me, ever.”

What is a provider to do when faced with this scenario?

Well… for one: focus on what you can do immediately. In contacting the CCT team, I tried to enlist others in support for this patient. I fully realize… I can only do so much myself. Get the team involved.

Second: reiterate the positive issues with the patient. There may be only ONE, but try to find a positive way to reinforce great behaviors: staying clean, staying sober, calling to make and keeping appointments, etc.

Third: realize that taking these steps is truly a process… one fraught with roadblocks, challenges, and fortunately, sometimes, successes.

For every roadblock encountered, think of how you are helping that person.

Let’s broaden the perspective, shall we? This applies in my patient’s case.

For every provider who faces frequent no-shows or late patients, or patients who don’t “follow orders:” consider looking for the real reasons that patients don’t show up on time, don’t take their medications, and seem to go against medical advice. Often there is a good reason for their actions (or inactions). I admit – I used to chafe and get mad when no-shows occurred… or when patients showed up 30 minutes late, throwing the day’s schedule in disarray. It took some time and patience to dig deep, to find out the reasons. It was NOT simply that patients were inconsiderate or lazy (something I continue to hear from other providers to this day). Perhaps the bus was running late. Perhaps their ride no-showed or had other, more pressing issues. Back in the days of seeing patients in the office, I would be annoyed at the so-called lack of “consideration” of patients showing up on time.

I’ve seen a new side of the patient experience by seeing them in the home. Believe me when I say, the LEAST of many people’s concerns is getting to their office visit on time.

I’m fortunate that I finally can see things as they are for many patients. Fortunate to have the resources to try to help them any way we can.

Patients’ social history may seem like a thing to bypass, to ignore. Please… as one “in the trenches,” seeing their reality, hearing their stories – those stories are crucial to their care. Take the time to hear them. Advocate for them. Use your own resources in your practice to delegate aspects of their care.

Listen and acknowledge their social history. It’s vital to understand what patients face. But above all, please don’t label them “non-compliant,” particularly if you don’t know the whole background story.


Kim Spering has been a nurse for over 25 years and worked as an NP over the past 15 years in Family Medicine, Women’s Health, Internal Medicine, and now Palliative Medicine. She serves as an editorial board member of Clinician 1 and submit blogs to the website, with a goal of highlighting both the clinician and patient experience in health care.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.