Healthcare

If I had to pinpoint the key to healthcare reform, I would use one word – quality. If I had to identify the focus of our efforts, it would be patients. And if I had to construct a timeline for action, it would begin today. We have no time to waste in creating a sustainable model for delivering high-quality care.

Quality care involves providing appropriate care in the appropriate setting so that we can improve the health of entire communities using available resources. We must develop an economically sustainable healthcare model.

If you are hoping that you can survive the changes in the healthcare industry by maintaining your current business model and waiting for the rules to change, you may regret your delay. Status quo simply is NOT an option. You need to start taking action now in order to remain viable in the future.

My advice is to abandon survival mode and begin to design and implement proactive strategies to help your stakeholders thrive in the new environment. 

Ordinarily lists made in the New Year are predictions for the next 12 months. Predictions aside, I’d like to share with you six things that you can count on in healthcare during 2015.

#1 The Affordable Care Act is not going away.

Although skirmishes between Congress and the White House seem certain this year, neither repeal of the ACA nor withdrawal of its funding is likely in 2015. Additionally, repeal of the law will not fix the underlying problems the ACA was designed to correct. As the year progresses, your best response is to abandon survival mode by designing and implementing a proactive approach to help you and your patients thrive in the new environment.

Whether you are a healthcare provider or a patient, it can be challenging to be away from family and friends at such a celebratory time of the year. But the lengths that hospitals and other healthcare facilities will go to spread holiday cheer for patients and staff is truly inspiring. We reached out to some area hospitals and asked them to share their stories.
 

As health care evolves from fee-for-service to shared-savings model, accountable care organizations are a key component in driving this evolution. ACOs can be broadly defined as: "a group of health care providers who accept shared accountability for the cost and quality of care delivered to a population of patients." This concept places the financial risk of each patient's care on the group of providers.

There have been many obstacles blocking the success of implementing the ACO model nationwide. At a recent summit, I attended a session about why ACOs have not been successful, and many challenges were discussed, such as:

Join our own Thomas Prewitt, M.D., director of the HORNE Healthcare Delivery Institute, for plain talk about how we’ve reached critical mass in health care by buying into unnecessary care. Dr. Prewitt walks us through memorable examples of how unnecessary tests and procedures put patients at risk and drive up costs.

• The challenges physicians face to stop “over-treating” patients
• What we as patients need to do to take ownership of our personal health care
• How our healthcare focus needs to shift from rescue-care to overall patient health

To see Dr. Prewitt’s TEDx event talk, click here:

Getting your patients actively involved in their health care keeps them healthy. Simple. This very important learning comes from a recent Robert Wood Johnson Foundation's Quality Field Notes brief about patient engagement¹.

And, according to other research², in order for changes to the healthcare system to be successful in reducing expenses and improving quality, the patient must be consistently "engaged" for everything to work.

The concept of patient engagement has been in existence for more than a decade. But, what is patient engagement?

Leaders in the hospital field are already pursuing integration to improve patient outcomes and reduce the ballooning cost of health care. The Centers of Medicare and Medicaid Services' quality initiatives, and now the Affordable Care Act, demand a new health care model that brings hospitals and physicians together to coordinate the continuum of care for improved patient care. One emerging trend to enhance care coordination is clinically integrated networks, or CIN.

Earlier this month, the Journal of Accountancy published a detailed article about the shared-responsibility provisions of Section 4980H of the Affordable Care Act. The 3200-word article, titled "The Sec. 4980H assessable payment for large employers," demonstrates how time-consuming and complex traversing the provision can be, and time is running out for employers to determine if they are "applicable large employers" and, more importantly, put the necessary payroll systems in place to comply with the provision.

In this spotlight series we will explore changes to care delivery driven by the Affordable Care Act (ACA) and the increasing sophistication of patients who want health care that is affordable, transparent, and accessible. 

Today the spotlight is on retail medicine. 

Retail medicine is increasing its presence in the U.S. and a variety of health care organizations and analysts are taking notice. First the stats: 

Team-Based Care – Part III

For health care organizations to successfully implement any type of team-based approach to patient care there are some things to consider. The culture will have to change to encourage adoption of this new approach and patients, just as physicians, will need to change.

In a field where every position already feels they are working as hard as they can, being passionate about new responsibilities can be difficult.

Team-based Care – Part I 

Are we facing a health care disaster due to an increase in demand for primary care and a decrease in availability of providers?  Should we be concerned that statistics from the Association of American Medical Colleges predict we will lack more than 60,000 physicians nationwide by 2015?  It is definitely true that the number of insured individuals is increasing due to the Accountable Care Act (ACA); baby boomers are aging and will require more medical attention; and the number of primary care physicians is decreasing.  But the prognosis isn’t necessarily grim as this imbalance of supply and demand creates opportunities for new health care delivery systems. 

Cutting administrative costs has traditionally been the first strategy hospitals use to make up a budget deficit. But in today’s health care environment, it will take more than reducing personnel and operational expenses to make up the shortfall that is on its way, if not already here. There are a variety of reasons why cutting administrative spending won’t balance the budget – but in a nutshell, it’s not enough and it does not drive better patient care. 

Many hospitals already lose money on Medicare and Medicaid and those reimbursement amounts continue to drop. It is also anticipated that private payers will reduce their rates in proportion to the federally funded programs.  Medicare Fee-for-Service (FFS) reimbursement models are on their way out. Physicians and health care systems will be forced to adapt to changing models in order to stay in business.