I don’t feel well. What do I do now?

Where should I go for my care? That is a loaded question. Do you have a choice?

• Don’t have a choice – Trauma, Medicaid, where your physician has privileges
• Have a choice – How do you find out where to go

Yep – super user friendly.

Using Hospital Compare from the CMS website, users can compare hospitals against a number of variables. This tool is also available for nursing homes

I am a nurse. If someone…anyone in my family gets sick, I get a phone call, an email or a text. What should I do? Where should I go? Do you know anyone at (insert hospital name here)? For the most part, I do know what to do. I do not have all of the medical answers, for sure, but I can do a quick enough triage to know whether I have enough information to make a decision. Go to the emergency room. Make an appointment. Get a referral for a specialist. I agree with your doctor.

What if you don’t have a nurse or other medical professional in the family? How do you know where to go? How do you even know if you have a choice? These are questions asked every day by people who are likely already stressed out by some health concern.

Luckily, if you have access to the internet, there is a wealth of information at your fingertips….if you know where to look.

The first question to ask is, “Do I have a choice of where to get my care?” That is a tricky question. It is best to check with your insurer to see which facilities are considered in-network. That will help keep your costs down for elective procedures. If you have a Primary Care Physician (PCP), ask where they “have privileges” to practice. This means they can be your primary doctor while you are in the hospital. Some PCPs do not practice in the hospital and leave the job of in-hospital care to a group of “Hospitalists.”

Urgent and Emergent Care is another whole can of worms and perhaps the topic of another blog. Suffice it to say that The Affordable Care Act of 2009 requires that insurers cover emergent care regardless of location or whether the provider in a location is in or out of network. If you need to go to the Emergency Room, call 911 or go to the nearest one!

Let’s get back to finding the best place for an elective procedure or hospital stay due for a non-urgent issue. Head to the Medicare website, “Hospital Compare” and follow along. After entering your zip code, you can see, at a glance, how many hospitals there are in a 25 mile radius, a list of those hospitals and a few key data points. Select the button to add up to 3 hospitals to your comparison list. I have my 3. Do you? Yes? Ok, now select . Across the top of the page, you will see seven tabs with different topics. Here are my tips for viewing this section.

1. You will not notice much variation in any of the Acute Care Hospitals’ General Information. Skip it!
2. The next tab is “Survey of Patients’ Experiences.”
   1. These are results of the “Hospital Consumer Assessment of Healthcare Providers and Systems” surveys.
   2. The results are much like when you go to the car dealership and they ask you for a 5 out of 5 rating. The same thing is true here. Notice words like “Always,” “Strongly Agree” and “Definitely.”
   3. If you want to see a little bit more information, select the “View More Details” button.
   4. What you will likely notice is that all of the major hospital systems are pretty close together as far as their patient experience scores go.
   5. The take home message in patient experience – There will be good things and bad things no matter where you go.
3. The subsequent 5 tabs. Here is where you can go to see more specific information about topics like surgical site infections, outcomes and payment information on hip and knee replacements, readmission rates (like I got discharged from the hospital too soon and had to go back), and the like.
   1. I get a little nervous when I’m looking at something and the information says something like “sample too small.” What this says to me is that the facility isn’t doing a whole lot of this procedure and maybe it’s a good idea to find a place that is.

If you are looking for a rehabilitation hospital or skilled nursing facility, Medicare.gov also has “Nursing Home Compare” This is a great place to start looking for a longer term care facility if needed. In this comparison, you can see health inspections, fire safety information and quality of care.

It’s probably a good idea to still call that family nurse or doctor friend. We’ll wonder what’s wrong if you don’t!

Resources

“Find And Compare Information About Hospitals | Hospital Compare”. 2019. Medicare.Gov. https://www.medicare.gov/hospitalcompare/search.html?.

“Affordable Care Act Implementation FAQs – Set 1 – Centers For Medicare & Medicaid Services”. 2019. cms.gov. https://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs.html#Out-Of-Network%20Emergency%20Services

Rachel K. Rogers, Assistant Director Healthcare Management, Assistant Teaching Professor, University of Denver – University College

Rachel previously worked in direct patient care, nursing education and leadership, and clinical informatics. She holds a Certificate in Clinical Informatics and was adjunct faculty with the Community College of Aurora and University College. Her most recent work centered around the implementation and adoption of technology in ambulatory care.

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By Dr. Bobbie Kite, University of Denver & Bobby Balke, University of Denver

The emergence of Digital Health technologies (Telehealth, Telemedicine, Virtual Health and Wearable Devices) in the U.S. is becoming rapidly prevalent to serve population health. Digital Health’s inherent ability to accommodate generational norms and values is its key.  As people become more mobile, its important telemedicine becomes entrenched so that healthcare delivery and health systems alike can:

• accurately track the needs of the patient,
• provide timely responses which many times are critical and
• serve the greater good by providing data which informs new innovations and more efficient processes.

As a next step large scale participation will be the key to providing adequate sample sizes for more accurate data and to realize new innovations.  To accomplish this, we must first explore whether it’s likely that each generation will buy into these technologies.

Generation Z’ers

First, let’s begin with the Gen Z’ers (those born 1995 – 2015) inclination for being “wired,” have largely never known a world without electronic devices that provide seemingly infinite access to information.  Smartphones, Wi-Fi and Google are what older generations may consider innovations, but for a population which makes up 24.3% of the collective U.S. population, these have always been part of their life (Grace et al., 2017; U.S. Census, 2016).  Digital Health comes naturally to Z’ers, its helps to manage their lives and minimize trips to their physicians.  For instance, when a Gen Z’er does need medical advice, they are much more likely to seek attention from a provider virtually.

Millennials

Moving on, we turn to Millennials (those born 1981 – 1996). Similar to Gen Z’ers and projected to become the largest generation in 2019, they also embrace a life prevalent with technologies a generation that has championed the retail clinic for basic medical needs is also in the technological “sweet spot” we know today.  While Millennials weren’t necessarily born into the smartphone revolution, they still were at a perfect age to adapt and develop an affinity for the advances which made their lives not only easier, but innovations that didn’t disrupt their day-to-day break necking pace.  Pennic (2019) illustrates:

Nearly one-third (29 percent) of respondents have used some form of virtual care — up from 21 percent in 2017 — and almost half (47 percent) have used a walk-in/retail clinic. Further, consumers would prefer non-traditional methods over traditional ones for certain basic medical needs, including cold/virus treatment (65 percent vs. 48 percent), flu shots (62 percent vs. 54 percent) and checking vitals (59 percent vs. 54 percent).

Given that Millennials are projected to become the largest generation, coupled with the 24.3%t Gen Z population, a major challenge in institutionalizing telemedicine across generations is complete.  In turn, as the health industry conversation surrounding social determinants gains momentum, biometric data sent from these wearable devices to data warehouses and/or physicians monitoring patients provides information on not only who may or may not need care in a given moment but also with population health trends.  In fact, according to HIT Consultant (2019) who published Accenture Survey: Millennials and Gen Z Embracing Virtual Care Models (2019) state, “Half (51 percent) of all respondents said they use a wearable or mobile app to manage their lifestyle and healthcare conditions and more than half (53 percent) use virtual nurses to monitor health conditions, medications, and vital signs.”  But what’s in it for those Gen X’ers and Baby Boomers and are they likely to conform?

Generation X’ers

Gen X’ers (those born 1965 – 1980) sometimes called the “middle child” of generations, turns out to be a perfect label in this vein because they are incredibly adaptable.  For those of us who are middle children or parents of them, we likely understand how adaptable and resilient they must be for their survival.  Gen X’ers were young professionals at the inception of Personal Digital Assistants (PDA’s).  This generation’s need for convenience combined with their ability to adapt are both compelling for the emergence and prevalence of virtual care.  However, the “middle child” generation, or at least those who reside on the side of an old-fashioned need for human interaction, may or may not be as welcoming to seeing a doctor on the smartphones.  Let’s split the difference and for those are opposed to interfacing with doctor on a digital device and/or virtual doctor, would still likely find it convenient to don a wearable device since this is minimal hassle.

Baby Boomers

Last and perhaps the toughest sell for telemedicine are the Baby Boomers (those born 1946 – 1964).  It’s reasonable to assume this generation likely has the largest number of people that maybe will struggle with technology.  However, let’s remember that at least for the purposes of the topic surrounding telemedicine/virtual health, we really are only focusing on the capabilities of wearable devices which do not require a ton of technical savvy.  According to Ryback (2016), “Baby Boomers grew up making phone calls and writing letters, solidifying strong interpersonal skills. Yet as they got older, they actually became fluent in technology and now use cell phones and tablets.”  Additionally, let’s also remember that either the Gen X’ers, Millenials or even the Gen Z’ers will be charged as primary caregivers as the Baby Boomers get older requiring more care.  If a Baby Boomer would prefer to remain as independent for as long as possible by not being forced into geriatric care, Digital Health may be a critical key.  For instance, if a Baby Boomer is unable to drive but needs immediate care, it could either be triggered by a wearable device which transmits the need for care to a nurse who then dispatches medical professionals to the patient.

As with most things, there are always pros and cons depending on how we choose to steer our perspectives.  When it comes to these ground-breaking Digital Health innovations, it seems there is enormous potential to serve a large number of people across generations.  The generational characteristics may in some ways be generalizations, but that doesn’t mean they are not well-founded.  We would venture that even through this short argument it is conceivable the Digital Health benefits has potential across generational populations and a high likelihood of continued adoption and innovation.

Follow up questions to think about?

• Did your generation summary resonate with you?
• Are there ways you might want to engage more with Digital Health after reading this?
• Do you see the potential for new ways to use Digital Health?

With these answers in mind, think about possible cost and time savings.

References

Facts and Trends. LifeWay. (2018, October 31). 10 Traits of Generation Z. Retrieved from https://factsandtrends.net/2017/09/29/10-traits-of-generation-z/

Pennic, J. (2019, February 15). Accenture Survey: Millennials and Gen Z Embracing Virtual Care Models.

Retrieved from https://hitconsultant.net/2019/02/12/accenture-survey-millennials-gen-z-virtual-care/#.XRx6OExFxpx

Ryback, R. (2016, February 22). From Baby Boomers to Generation Z. Retrieved from

https://www.psychologytoday.com/us/blog/the-truisms-wellness/201602/baby-boomers-generation-z