Hotspotting to improve care, lower costs

Sandberg: A lot of academic centers are providing charity care for populations in need and hot spotting is a way to get at these patients and provide them with better care that, hopefully, also lowers costs. I’m Shana Sandberg, and I’m a researcher and writer at the Association of American Medical Colleges, Center for Workforce Studies. 

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Interviewer: We’re talking about hot spotting today. What is hot spotting, first of all? 

Sandberg: Hot Spotting is the identification of patients who spend a lot of time in the hospital, either in emergency rooms or in hospital admissions, and helping these patients get better care. 

Interviewer: Who are these patients? 

Sandberg: A lot of times, these are patients with multiple chronic conditions. They may have other barriers to accessing care, such as transportation problems. They may be homeless or in and out of shelters. They may not be able to afford regular medical care and not have a primary care provider. And so, because of things that could have been prevented, they end up being hospitalized over and over. 

Interviewer: So you’ve targeted medical students and residents with your hot spotting guide. Why them? 

Sandberg: The Association of American Medical Colleges is really committing to ensuring that the next generation of physicians is trained in ways that can provide patients with better care and provide better health outcomes. We would like to get medical students involved in some of the transformations that are taking place in healthcare at different hospitals across the country and get them excited about new ways to provide care for patients. 

Interviewer: Tell me about how you came up with the concept of hot spotting, and then how you transferred it into a guide for medical students. 

Sandberg: Well, we were very inspired by an article in "The New Yorker," actually, by Atul Gawande where he talked about this process of hot spotting. He talked about the great work of Dr. Jeffrey Brenner, who’s speaking at this conference, and some other physicians who are involved in really focusing intensive care on these high-utilizing patients. 

We thought that this guide would be a great way first to spread the idea about hot spotting, but also to get the next generation involved so that they can start participating in some of these newer models that look at the population as a whole, look at those patients who might not be coming in for regular doctor’s visits, but might end up in the hospital. 

And, of course, underlying this is also the issue of cost. These patients do end up costing the system some amount of money. It’s expensive for them if they need to pay for their care if they’re uninsured. Hospitals are bearing some of that cost. So it’s a nice way to help patients get better care, to involve students in the process, and also to, hopefully, create a more sustainable healthcare system.

Interviewer: AAMC President Darrell Kirch has talked about the change imperative. Hot Spotting, it seems, fits into that imperative really well because it’s both targeted at students and targeted at improving patient care, and lowering costs, part of that triple aim it sounds like, in some ways. What do you hope to accomplish with the hot spotting initiative? 

Sandberg: We hope that students, through reading this guide or taking a look at our website, AAMC.org/hot spotter, can easily follow these 10 steps to find one patient who’s been admitted several times recently to the hospital and just starting with that one patient, to get to know that patient a little bit better, to maybe ask permission to visit them at home and talk to some family members. Find out what are some of the barriers that this patient faces. Do they not have a refrigerator and they are unable to keep their medicines at the right temperature? Really think through a new intervention to help this patient get better care. 

Interviewer: Everything that they would need to access the guide is available at the website? 

Sandberg: That’s right. The website has the 10 steps, as well as sources where they can learn more about the concept of hot spotting, and a toolkit to really help them with the interview questions and their talking to the patient. We really hope that all healthcare providers, from students through practicing physicians and faculty will take an interest in this program and help us transform the health care system.

Interviewer: Why did we come up with a guide? Isn’t this already happening in hospitals? 

Sandberg: Unfortunately, not to the extent that we would hope. I think, up until very recently, we’ve thought of healthcare in terms of what can you provide the patient in a doctor’s office or in a hospital . . . 

Interviewer: Episodes of care. 

Sandberg: . . . and more recently . . . Episodes of care, exactly. And more recently, we’ve been thinking about the population as a whole, and people in their homes and what do they need there and what kind of barriers prevent them from getting better care. 

Interviewer: It’s taking people away from viewing every visit to the hospital independently, but looking at the continuum and saying, “This person keeps coming back. How can we engage to help improve this person’s healthcare, improve their health, and keep them out of the hospital?” 

Sandberg: Exactly. Until recently, we weren’t thinking about collecting data in terms of how many times has this patient been to the hospital before. And now, as systems change, to be able to look at those kinds of things, you can identify real gaps in care. 

I think academic medicine’s impossible problem is the unsustainable growth rate in cost of care. A lot of academic centers are providing charity care for populations in need and hot spotting is a way to get at these patients and provide them with better care that, hopefully, also lowers costs. 

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