The July 2012 Issue

Game On

By Peter DeHaan, publisher

Peter DeHaan, publisher and editorI was quite skeptical when I first heard about “gamification,” the use of gaming concepts to motivate desirable behavior among customers (or employees).

I reasoned that while expecting customers to “play games” might result in a short-term increase in brand involvement or purchases, I doubted if it was sustainable. However, I am rethinking my initial assessment.

As a Netflix customer, I was likely involved in a basic gamification effort. As I posted movie reviews on their site, I was given a “reviewer rank.” As I posted more reviews, my rank would improve. At one point I had worked my way to the neighborhood of 5,000 out of several million reviewers. Bettering my reviewer rank became a game for me. Yes, I enjoyed watching the movies and yes, I found it rewarding to share my input with other Netflix customers, but the validation of my efforts came through watching my reviewer rank improve.

However, if it was a “game,” the problem was I didn’t know the rules. I assumed that more reviews were good, more readers of my reviews were beneficial, and more people flagging my reviews as “helpful” in comparison to “not helpful” were a factor. But this could not be verified, as everything I did was in competition with what others did. I could do something to improve my reviewer rank, but if others did even more to improve theirs, my rank would actually decrease.

I reviewed 71 movies and then abruptly stopped when I realized I no longer enjoyed doing so. It seems gamification may work after all — at least for a while.

While I’m yet to envision a viable gamification application for call center callers, I do see it as having value for call center agents: to improve their metrics, learn new skills, increase first call resolution, and enhance caller satisfaction. Plus, as covered later in this issue, gamification is also being used to improve employee health and reduce costs. Game on!

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Nurses Learn, Share Best Practices at AAACN Annual Conference

American Academy of Ambulatory Care Nursing celebrates record-breaking conference attendance, gives awards

An outstanding education program drew more than 750 nurses to the American Academy of Ambulatory Care Nursing (AAACN) 37th Annual Conference, May 2-5, 2012, which was the highest attendance ever.

The nurses convened in Orlando, Florida, to strengthen their skills and explore the latest clinical, management, and leadership trends in ambulatory care and telehealth nursing. Topics focused on advancing practice and leadership and included enhancing quality and safety, the many settings and multiple roles of ambulatory care nurses, medical home models, and telephone triage.

Healthcare reform and its impact on the ambulatory care nurse was a hot topic throughout the conference and was the subject of both a general session and the Town Hall meeting. The Town Hall offered attendees the opportunity to share best practices and question an expert panel about the Patient Protection and Affordable Care Act (PPACA) and other topics.

The pre- and post-conference workshops and educational opportunities were also record-breaking in attendance. Nurses learned to identify legal pitfalls and safeguard their practice, prepared for certification with the Ambulatory Care Nursing Certification Review Course, and polished their telehealth skills with the Telehealth Nursing Practice Core Course (TNPCC).

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New Survey Shows More Doctors Can’t Afford to Take Medicaid, Medicare

Majority of some specialists unable to take new patients

While at least 13 million Americans may soon join the Medicaid rolls, a majority of physicians in many specialties say they can no longer afford to accept new Medicaid patients due to declining reimbursements, according to a new national survey of physicians by Jackson Healthcare.

According to the survey, 36 percent of physicians said they are no longer accepting new Medicaid patients. Currently, 26 percent of doctors don’t see Medicaid patients.

However, 66 percent of dermatologists, 64 percent of endocrinologists, 58 percent of internists, 57 percent of physical medicine and rehabilitation doctors, and 53 of adult psychiatrists said they can’t take on more Medicaid patients.

Other specialties also report an inclination to limit the number of Medicaid patients they can treat because of the low reimbursement: orthopedic surgeons (50 percent), family practitioners (45 percent), gastroenterologists (47 percent), neurologists (43 percent), cardiologists (39 percent) and urologists (35 percent).

Under the Patient Protection and Affordable Care Act, many of the uninsured will gain health insurance coverage through Medicaid beginning in 2014. An estimated 13 million or more are expected to sign up for Medicaid the first year, and that number is expected to grow as high as 26 million by 2020.

“This is creating the perfect storm that will make it very difficult for the poor and elderly to access a doctor,” said Richard L. Jackson, chairman and CEO of Jackson Healthcare. “Physicians say they just can’t afford to be part of a system that generates so many patients for so little compensation.”

Meanwhile, the same trends are emerging for baby boomers and the elderly who are insured by Medicare, according to the survey. Seventeen percent of physicians said they could no longer afford to see new Medicare patients. Ten percent of doctors report they do not see Medicare patients at all.

Doctors reporting they can no longer take new Medicare patients include 43 percent of adult psychiatrists, 27 percent of internists and generalists, 25 percent of family practitioners and 24 percent of ob-gyns.

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Games Improve Employee Health and Well-Being, May Reduce Costs

Games that promote health can improve the well-being of employees, saving employers direct and indirect healthcare costs. Employers can more readily reap these benefits by offering game-based services that educate their employees about health and wellness and improve physical and psychological fitness, according to an editorial in Games for Health Journal, a peer-reviewed publication from Mary Ann Liebert, Inc.

“Wellness programs using health games have the potential to significantly impact human well-being and the costs, pain, and suffering of preventable illnesses and conditions,” said Games for Health Journal editor-in-chief Bill Ferguson, PhD, in the editorial entitled “Games for Wellness—Impacting the Lives of Employees and the Profits of Employers.”

Dr. Ferguson highlighted the key factors that will drive increased market acceptance of health games and wellness initiatives among employers. The editorial describes the characteristics of health games for improving wellness and shows how videogaming can help engage people in their own health, supplement traditional forms of exercise, promote healthy living, and improve patient care.

“The most successful wellness programs incorporate video games that present themselves as in the service of the player,” states Dr. Ferguson. “These activities enable individuals to engage in things they have personally desired but were unable to prioritize and accomplish before wellness games. The result is healthier, happier, and more productive employees – a win-win for employers and their people.”

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Physician Income Growth Slows in 2011

Physician compensation growth stagnated in 2011, according to a recent survey of physicians and healthcare providers conducted by The Medicus Firm, a national physician-recruiting firm. Conversely, nurse practitioners and physician assistants reported increased incomes in 2011 as compared to 2010.

Conducted in April and May of 2012, this was the ninth annual physician compensation survey released by The Medicus Firm. Over 2,500 physicians from eighteen specialties participated.

“This year, physicians reported the lowest year-over-year income growth we have seen in the history of our physician survey,” said Jim Stone, president. The average net change in physician compensation from 2010 to 2011 was a decrease of 1.70 percent. This is the second consecutive year that average incomes have declined, but this year’s figures represented a greater decline than the previous year’s average net change of -0.14 percent from 2009 to 2010.

Even when specialties reported income growth, it was moderate. Specialties reporting growth include anesthesiology, hospitalists, neurosurgery, pulmonary medicine, and pediatrics.

Specialties reporting income declines include cardiology, gastroenterology, obstetrics/ gynecology, and general surgery. “As physicians’ income growth slows, it’s not surprising that their dissatisfaction with their pay grows,” Stone added.

Only 3 percent of physicians indicated that their income exceeded their expectations. Thirty-two percent reported feeling “satisfied” with their income for the amount of work completed, down from 35 percent the previous year. Meanwhile, 63 percent of respondents were dissatisfied to some extent with their 2011 income, including 8.1 percent who report feeling significantly disappointed and unsure of their future.

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Are Generics as Effective as Brand-Name Drugs?

In a recent issue of the Harvard Health Letter, editor-in-chief Dr. Anthony L. Komaroff answered a question that’s on a lot of people’s minds these days: Is atorvastatin, the generic version of the cholesterol-lowering drug Lipitor, as good as the brand-name drug? Generic atorvastatin became available for the first time in November 2011 after Lipitor lost its patent protection.

In his answer Dr. Komaroff noted that the FDA is legally required to make sure that generics are “bioequivalent” to brand-name drugs, which means they produce similar blood concentrations of the same chemicals. “Many independent researchers have also compared generics with brand-name drugs, and the vast majority of them have concluded that generics are just as safe and effective,” Dr. Komaroff said in the Health Letter, citing research by his Harvard colleague, Dr. Aaron Kesselheim, and others.

Generics are produced in other countries, and overseas manufacturers do make mistakes, Dr. Komaroff noted. “But that’s also true of US-based manufacturers,” he continued. “The FDA does regulate the manufacture of all drugs sold in the United States, which is reassuring, but I also believe the FDA hasn’t been given the budget it needs to adequately carry out its responsibilities. So I can’t give you an absolute guarantee that generic atorvastatin will be equal to brand-name Lipitor.

“But I can tell you this: I take Lipitor, and I’ll be switching to generic atorvastatin, so I will be following my own advice (something my wife has suggested that I should do more often).”

Read the full-length article: “Ask the Doctor: Are Generics as Good as Brand-Name Drugs?

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Physicians Give Health Law a “D”

Health law has a negative impact on patient/physician relationship

A new survey by Jackson Healthcare finds that a “D” is the mean grade physicians give the health law, despite its primary intention to reduce the cost of healthcare and provide coverage for the uninsured. Physicians who said they were very knowledgeable about the law were even more negative.

In addition, 68 percent of American physicians disagree that the Affordable Care Act (ACA) will have a positive impact on the physician/patient relationship. Only 12 percent of physicians said the law provides needed healthcare reform. A majority of physicians said the ACA would not improve healthcare’s quality, rising costs, or patients’ control over their own healthcare. They also said it would lessen the amount of control physicians have over their practice decisions.

The only positive rating physicians gave the ACA was related to access. Fifty-four percent of respondents said the new law will increase patients’ access to care. The health law is estimated to generate 13 million new Medicaid enrollees beginning in 2014.

“Physician opinions are important since they are a primary driver of healthcare decisions and costs,” said Richard L. Jackson, chairman and CEO of Jackson Healthcare, a national healthcare staffing company. “Overall, they believe the law does not meet its intended objectives, negatively impacts the patient/physician relationship, and hinders their ability to control the treatment of their patients.”

One important provision in the law set to take effect next year is the Independent Payment Advisory Board, charged with finding savings in Medicare. Sixty-four percent of physicians said it would have a negative impact on patient care.

Among other key survey findings:

  • 70 percent said ACA would not stem rising healthcare costs
  • 66 percent said ACA would give physicians less control over their practice decisions
  • 61 percent said ACA would not improve the quality of healthcare
  • 55 percent said Congress should scrap ACA and start over
  • 49 percent said ACA would give patients less control over their healthcare
  • 35 percent said ACA did nothing to reform healthcare
  • 31 percent said ACA didn’t go far enough and a single-payer system is needed
  • 22 percent said ACA went too far and impedes a physician’s ability to practice medicine