Healthcare

Think back to your last car, truck or SUV purchase. What did you want to know before spending so much money?

More than likely, you wanted to know the price range of the type of car you were considering. You might have wanted to know what features were standard on different makes and models. You might even have identified one or two features that you couldn’t live without, and that helped you narrow your choice. You aIso might have wanted to know where to find the best financing. If you’re tech savvy, you probably found much of the information you needed online—even in a single app or website. In recent years, our collective consumer needs have changed the way we buy cars. In fact, consumer preferences have changed the way we buy most things—even healthcare.

In the previous installment of this two-part series, we considered how the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the game-changer in the transformation of physician payment from fee-for-service to value-based payment. We further contemplated the fact that about 19 in 20 MACRA-affected providers will fall under the Merit-Based Incentive Payment System (MIPS), which consolidates the current Physician Quality Reporting Program (PQRS), Value-Based Payment Modifier (VM), and Meaningful Use (MU) programs into a single Quality Payment Program (QPP). We also pondered critical actions to take today to prepare for MACRA, one of which is identifying preferred MIPS metrics.

Futurists identify hard trends and build prognostications around what will take place. They also use the identification of hard trends to seize opportunities in order to transform businesses. 

As a healthcare consumer, I feel an urgency to do my part to decrease unnecessary cost and improve quality. As a member of HORNE's Healthcare team, I have a greater understanding of why our healthcare system cannot continue in its current state and I've learned that reducing variation and eliminating waste is our “how”; however, since I am not a healthcare provider, my impact is limited in what I can do as a patient as I view my own healthcare, and the care of my loved ones, through a new lens. 

Have you taken a look lately at the statistics that tell the story of the future of health care in the U.S.? It’s sobering. The outdated payment model is just one part of the challenge. Between baby boomers retiring and overloading the system with aging patients that need more care, and the doctor pipeline dwindling, there is a fundamental need to change the delivery model before it crashes. 

Surveys such as the Health Leaders Media survey, Physician Alignment: New Leadership Models for Integration, indicate that physician employment will continue to be a primary integration strategy for many hospitals and health systems. Where saturation of primary care and specialist practice acquisitions and employment has occurred, several markets have moved to a second or third tier, such as urgent care centers and related physician employment. It seems that some markets are only limited by the supply of viable targets.

Physician practices, however, are not created equal, and hospitals and health systems are becoming increasingly savvy in targeting groups for alignment that can demonstrate delivery of high-quality care. As the reimbursement model continues the shift from a volume-based to value-based system, physician participation in meeting quality and cost-saving targets will require a greater nexus to methods of physician compensation. In an increasingly competitive environment, it may be difficult to meet the need for quality care without a carefully selected and motivated physician network.

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.

In earlier days of hospital-based physician coverage, specialties were mostly limited to radiology, pathology, anesthesiology, and emergency medicine. As the hospitalist specialty developed, more hospitals began contracting for inpatient coverage to provide a broader continuum of care. Later, additional specialties, including pediatric hospitalists, intensivists, nocturnists, laborists, surgicalists, and neonatologists, grew in popularity.

Coverage by hospital-based physicians can be based on shifts or hourly or daily coverage, and can extend to multiple facilities and hospital departments. Coverage can include restricted and unrestricted on-call coverage as part of the arrangement. In addition, administrative responsibilities, quality improvement, and program development are often required.

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?

Have you taken a look lately at the statistics that tell the story of the future of health care in the U.S.? It’s sobering. The outdated payment model is just one part of the challenge. Between baby boomers retiring and overloading the system with aging patients that need more care, and the doctor pipeline dwindling, there is a fundamental need to change the delivery model before it crashes. 

A report released last summer from a private foundation that studies health care systems ranked the U.S. last overall among 11 of the wealthiest nations on the planet. Where do we rank first? Cost of care – ours is the most expensive health care system in the world. Unfortunately, a bigger spend does not produce better patient outcomes. The U.S. underperforms in many areas like access, choice, efficiency, and effective care. 

Take a look at the health care stats and trends in our infographic below that tell the story. What’s that great saying about the future? The only way to predict the future is to create it. Knowing the facts can help you prepare for the changes that are coming your way. Knowing the facts can start getting you out of survival mode and into a proactive approach that helps you and your patients thrive in a new and better model. There is no “riding out” the changes. Staying in status quo mode puts your health care facility at risk.