12 ways to cut healthcare costs. Tell your patients and their families.

March 2009

Economists agree that American health care reform will falter unless health care spending is brought under control. Moreover, even people with good health insurance are paying a larger fraction of their health care bills these days, in the form of co-pays, deductibles, and other out-of-pocket expenses. The editors of the Harvard Health Letter, in consultation with the doctors on its editorial board, propose 12 ways you can help curb health care spending, saving society—and perhaps yourself—some money. The recommendations, published in the March 2009 issue, include these:

Develop a good relationship with a primary care physician. A primary care doctor who knows you, your medical history, and your circumstances stands a better chance than a stranger does of making decisions and giving advice that will keep you healthy. He or she can take care of you in context.

Don’t use the emergency department unless absolutely necessary. Call your doctor and try to get some advice over the phone or in person.

Get and stick with the program. Taking prescribed medications, getting regular check-ups, and adhering to lifestyle changes can keep chronic diseases under control at relatively modest cost.

Don’t go directly to a specialist without checking with your primary care doctor, even if insurance allows it. Whenever possible, let your primary care physician coordinate your care. If he or she doesn’t know what’s going on, it can lead to wasteful—and possibly harmful—overtesting and duplication of treatments.

Go generic. Generic drugs cost less than their brand-name equivalents. Also, most insurers have higher co-pays for brand-name drugs. Check with your doctor about generic options.

Fight inertia. If you’re taking a medication, discuss with your physician how long you’ve been taking it, whether it’s working, and, if it isn’t, not taking it anymore.

Question the need for expensive tests. Don’t push to get new, expensive tests just because you think new is better. If your doctor orders an expensive test like an MRI or CT scan, ask why it’s necessary and how it will make a difference.

Stay healthy. Quit smoking, eat right, exercise, and get enough sleep. You’ll reduce your risk for conditions that require medical care.

Read More: Read the full-length article "12 ways to cut health care costs" >>

Ontario Government To Create 25 Nurse Practitioner-Led Clinics

Toronto, February 23, 2009 - Three new nurse practitioner-led clinics in Belle River, Sault Ste. Marie and Thunder Bay are strengthening family health care for Ontario families.

The three clinics focus on comprehensive primary care services, including chronic disease management and health promotion. They are the first of 25 new clinics that will come into operation by 2011/12. The remaining 22 clinics will begin to move forward in the spring.

Nurse practitioner-led clinics are a team-based approach to front line health care. Nurse practitioners work with other health care professionals, such as family doctors, to provide quality care closer to home.

Ontarians will be connected to nurse practitioner clinics through:

* Health Care Connect, a new program to help people find a family healthcare provider
* Your Health Care Options,a new source that enables Ontarians to make informed decisions aboutwhere to go for minor illnesses or injury


"Nurse practitioners bring unique and valuable skills and expertise to patient care teams across Ontario. By moving forward on 25 new, nurse practitioner-led clinics, we are ensuring that more Ontarians have access to this innovative health care option," said Dalton McGuinty, Premier of Ontario.

"I am excited and proud that we are moving ahead on our next round of nurse practitioner-led clinics. These clinics are helping to provide quality health care closer to home for thousands of Ontarians and are part of our priority to improve access to care for all Ontarians," said David Caplan, Minister of Health and Long-Term Care.

"There is a tremendous need for better access to primary care in these communities and this announcement is the answer thousands of people have been waiting for. We look forward to the opening of these NP-led clinics as soon as possible and to the announcement of the next 22 sites in the spring," said Wendy Fucile, President of the Registered Nurses' Association of Ontario.

The UK. Choose and Book: learning lessons from local experience. Taken Directly from Hansard UK - 4 Feb 2009

NHS Appointments
2.30 pm

(Pour yourself a virtual glass of port and enjoy this blow by blow description of one patient's experience with the UK's Choose and Book system)

Andrew Stunell (Hazel Grove) (LD): I am pleased to have the opportunity to bring this important issue to the House and look forward to the Minister’s response. It has affected the medical histories of many of my constituents.

The system has been a problem for me and my constituents ever since it started. In turn, I have been in touch with the local foundation trust, the primary care trust and NHS Direct, and I have asked parliamentary questions—in fact, because my December question was too long, Mr. Speaker kindly offered an Adjournment debate. I shall try to do the issue some justice.

After I was told last week of the time of the debate, entirely serendipitously, the British Medical Association produced a report entitled, “Choose and Book: learning lessons from local experience”. I am not so arrogant as to think that my probing put the BMA up to it, but the report is interesting, and I hope the Minister addresses it when he responds to the debate. It talks about learning lessons from local experience, and I want the Minister to learn from my constituents’ local experience.

I will start with a disclaimer: MPs hear of the worst cases. Nobody writes to me and says, “I had a brilliant experience of choose and book” or indeed of public transport or any other public service. The scheme provides a comparatively easy route to medical care and treatment, but there is a significant minority for whom it is a major problem. I want to bring the cases of a number of my constituents to the Minister’s attention, and to draw one or two national lessons from them.

My worst case illustrates many of the features of choose and book that drive patients to distraction. Mr. I was first sent to choose and book on 19 July 2007, and first contacted me on 9 August 2007. Nine and a half months later, after much correspondence in many directions, he wrote to me again on 12 May 2008 and said:

“Me, I’m giving up but if you wish to carry on the saga be my guest!!!”

I suppose that the debate is me being Mr. I’s guest. I spoke to him yesterday, and I can report that he received his treatment last month. For him, the saga that started with a doctor’s diagnosis in July 2007 has now been completed with treatment in January 2009.

As I said, Mr. I is my worst case. What happened? On 19 July 2007, his general practitioner referred him to choose and book, gave him the telephone number, the address of the website and the password, and told him what to do. When he phoned the number, he was told that he should phone again because of a high volume of calls. He repeated that experience many times. He was referred to the website, but it did not respond to him. He did what many patients do, much to the irritation of their doctors: in frustration, he went back to his GP, because he thought that he might have got the number or password wrong. Having established that they were correct—he had a letter of confirmation from the system in due course—he tried again. Once again he was told that he should try the website because of a high volume of calls.

He eventually got on to the website, but it told him that no bookings were available for the period he had chosen, and that he should try again and seek another date. He did not want to make it hard for choose and book, so he did not try to make an appointment for the week after; instead, he tried to make an appointment for three months after his first choice. Anyone who knows choose and book knows what that means. The system would not give him an appointment because the date he selected was beyond the 18-week period in which it will accept an appointment.

Mr. I is articulate and persistent. After that trouble, he went to his GP for a third time. His GP said, “I’ll tell you what. Why don’t you phone up NHS HealthSpace?” That sounded like something to do, so Mr. I did it. What did it tell him? It told him that no appointments were available.

On 1 August, he got the first of his letters from Appointments Line criticising him for failing to book a choose and book appointment—that was when he first wrote to me. He told me that he wanted to tell Appointments Line that he had been trying to book, but he could not do so because the standard letter from Appointments Line has no address on it—he showed me a copy of the letter to prove it. The only way in which a patient can contact Appointments Line was by phoning the number that tells them that they cannot get through. It is absolutely ridiculous.

Patients might not be able to write to Appointments Line, but MPs can. I now know that it is run by NHS Direct. The chief executive of NHS Direct, Mr. Matt Tee—that is not an abbreviation—sent me a letter. He invited me to comment on the application of NHS Direct for trust status. I told him in no uncertain terms that until he sorted out Appointments Line, it would not be sensible to give it such status. The letter he wrote back to me is interesting in many ways, but I like this bit:

“The Appointments Line takes over 280,000 calls a month and at present receives 0.56 complaints for every 10,000 calls.”

I thought that that was an interesting way of expressing things, but I marvel at how half a complaint managed to sneak through. How would Appointments Line know that people wanted to complain if they cannot write or phone? There is no address to write to. People have to know that it is run by NHS Direct before they can get anywhere.

I also marvelled at another part of the letter that delightfully passes the buck for the problem:

“I agree that services should be user friendly and less bureaucratic and will do all I can both to ensure that this is the case for the services I control (such as The Appointments Line) and to encourage others to do so with the services that I do not control (such as the national Choose and Book system).”

I thought that that was a pretty neat sidestep from my constituent’s concerns. Who runs the national choose and book system? Mr. Tee said:

“We are working closely with colleagues both in the Department of Health and (specifically) in Connecting for Health, to promote improvements to the systems and software associated with Choose and Book”.

So it is not his problem; in his view, it seems to be the problem of the Department of Health, NHS Connecting for Health and the software manufacturers. Evidently, choose and book has nothing to do with the Appointments Line and everything to do with everybody else.

I would not want the Minister to think that, because I started with a case from 2007, he can respond by saying, “Yes, there were some initial teething difficulties, but everything is fine nowadays.” It is no better now. Calls still go unanswered, appointments are still unavailable and infuriating reminder letters are still sent. Unanswered calls are a problem for my constituents.

Last November, my hon. Friend the Member for North Norfolk (Norman Lamb) asked a parliamentary question and received a briefing in the Minister’s reply saying that last October, 338,000 callers tried to access the Appointments Line. According to the figures in the reply, 27,000 were not answered. One must read the small print carefully to find out that 17,000 callers found the line engaged and 10,000 found it playing Vivaldi. One in 16 calls made to the Appointments Line is unsuccessful. That is from the Minister’s own figures for last October, which show 27,000 calls not answered last October. That works out at 324,000 missed calls a year. A third of a million calls, according to his own figures, fail to get through to the Appointments Line.

The astonishing thing is that the Appointments Line met all its key performance indicators. I do not know whether any other call centre in the country, commercial or public, would meet all its key performance indicators if it left out a third of a million callers a year. If so, I hope that the Minister will brief us on which one it is. I suggest to him that the key performance indicators for the Appointments Line are not sufficiently rigorous. He is not getting his money’s worth.

The second big problem is that appointments are not available when people do get through. There are two causes for that. Well, there may be more than two causes—the BMA report suggests quite a range of them—but I will focus on just two. The first, and perhaps the one that the Minister could most easily do something about, is the 18-week waiting period, which creates a black hole beyond 18 weeks when appointments are not taken. If appointments cannot be booked more than 18 weeks ahead, when a particular clinic or consultant is fully booked, they are taken off the list of appointments available. They do not even appear. Of course, at the call centre, they cannot say, “Well, that’s because they’re booked up for the first 18 weeks”; what they say is, “They’re not on the system.” They disappear into a black hole.

New program from Saskatchewan Health Quality Council aims to help clinics, specialists improve access to services

International expert to serve as adviser

SASKATOON, March 6 /CNW/ - Lengthy waiting lists, patient no-shows, and frantic workdays could become a thing of the past for health care providers in Saskatchewan, thanks to a new program being offered by the Health Quality Council, in conjunction with an international expert in improving access.

Clinical Practice Redesign (CPR) is a method proven to decrease wait times and missed appointments as well as improve patient/provider satisfaction and efficiency. The approach has been used successfully by some providers in Saskatchewan and other provinces, as well as in the United States. The Health Quality Council is offering CPR School, a hands-on training program for anyone interested in learning the method - clinicians, office managers, and medical assistants.

Catherine Tantau, an internationally recognized authority on access, efficiency, and patient flow through health care systems, is the expert adviser to the program. Ms. Tantau led the creation and implementation of the Clinical Practice Redesign model. She has worked with hundreds of health care organizations in the U.S. and Europe on improving access and efficiency, including the National Health Service of Great Britain and Kaiser Permanente in California.

The Clinical Practice Redesign method applies to any appointment or referral based system. The tools and techniques help practices understand their supply (available appointments) and demand (requests for appointments) and find ways of better matching supply and demand.

"When you have a waiting list that's two or three months long, it might seem like you don't have enough people or appointment slots to meet the demand," says Bonnie Brossart, CEO of Health Quality Council. "Practices are often surprised to discover that they have enough capacity; clinical practice
redesign is about helping providers and office staff understand their system and use their capacity more effectively. It takes some work, but the end result is a more efficient office that allows patients to be seen in a timely manner and providers to spend more time with their patients."

The Saskatchewan Medical Association (SMA) and the Ministry of Health are supporting this initiative by sponsoring spots in the program for ten physician practices.

CPR School will begin its first training sessions in April 2008. There are a limited number of spots available to interested participants. More information is available on the Health Quality Council web site: www.hqc.sk.ca/cpr or by calling (306)668-8810, ext. 104.