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What a difference a year makes! I am amazed how mindsets are changing in an industry that typically takes its sweet time to make any changes of significance.
In a sense, the whole debate around healthcare reform — both before and after it was enacted — shocked those who were not happy with the proposed models into starting their own initiatives around new models of care. We have entered a new era of collaborative care and provider transformation and, whether you believe in state-sponsored health insurance exchanges and ACO’s or not, one fact holds true: the lines between payer and provider are becoming blurred. Take the recent controlling interest that Pittsburgh insurer Highmark Inc. took in West Penn Allegheny Health System as an example. Hospitals, which are the core of this new wave of accountable, integrated care, are moving to models where they will take on more risk, and they are in dire need of new expertise and tools to help them manage populations rather than care episodes. This is something that payers have done for over 50 years, and they are now jumping in to help hospitals get there.
This week’s guest post comes from Martin Brown, M.D., FACEP, chairman of the Department of Emergency Medicine at Inova Alexandria Hospital in Alexandria, Va.. A key player in MEDS-ED Link, a grant funded project recently instituted by the Northern Virginia Regional Health Information Organization (NoVaRHIO), Dr. Brown discusses the impact of health information technology on patients in his facility.
We’re all aware that the evolution of healthcare technology is ultimately driven by a desire and need to improve patient care and operational efficiencies. However, many hospitals and clinicians today feel like they’re swimming in a sea of regulations, deadlines, implementations and go-lives. The plus side is that more and more frequently, we’re able to derive some improvements, motivation and gratification from the instances where access and sharing of clinical data across a healthcare community clearly makes an immediate difference in a patient’s treatment.
This week’s guest post comes from Justin Chang, M.D., chief of emergency services, Kaiser Permanente, Colorado, and medical director, Exempla St. Joseph Hospital Emergency Department. A proponent of collaboration and enhanced coordination of care, Dr. Chang makes the case for a new model of healthcare delivery as defined March 31 by the Centers for Medicare & Medicaid Services (CMS) in its proposed ruling on Accountable Care Organizations (ACOs).
I think we can all agree — physician, payer, provider, patient, etc. — that the ultimate goal of regulations and reform should be to improve the delivery of healthcare, lowering costs and ultimately, making patients healthier and more satisfied. Coupled with driving toward the results defined by CMS, this requires some fairly significant changes in how healthcare providers operate — changes which may rightfully make some providers uneasy. But what many of us may not realize is that hospitals, physicians and payers across the country are already becoming advocates for the types of changes ACOs will require, supporting a shift away from the fee-for-service and silo-type models, even before the regulations go into effect.
I commented several months ago about how the hurried healthcare reform bill became so imperfect that there was no way it would not add to already escalating costs. But in accordance with the rule of unintended consequences, all the debate around the bill, along with the fear that some of its most onerous provisions like large cuts in Medicare for hospitals, has spurned a tidal wave in thinking and planning about new models of care that will be more efficient. We now hear the words “accountable care organization,” or ACO, more often than you heard “web strategy” during the dot.com boom. ACO is a technical term originated by the Brookings think-tank and adopted by CMS to cover the rules around ACO eligibility and qualification. However, the term “Sustainable Health Communities” (SHC) is a more descriptive term with the obvious connotation that left to our present course, the current system is unsustainable, and the addition of “community” extends all the way into all the pre- and post-acute care entities.
This week we’re excited to introduce Sharon Giarrizzo-Wilson MS RN, CNOR, Informatics Nurse Specialist with the Association of periOperative Registered Nurses (AORN) as our guest blogger.
Not since Florence Nightingale has nursing been viewed as a key agent in changing the delivery of healthcare. The landmark report recently released by the Institute of Medicine (IOM), in collaboration with the Robert Woods Johnson Foundation (RWJF), The Future of Nursing: Leading Change, Advancing Health, urges strategic nursing opportunities to transform the healthcare in the United States. The report from this joint partnership made several recommendations based on the challenges the nursing workforce faces as contributors in national healthcare reform and public health access. The collective recommendations call for a stronger nursing voice in redesigning the healthcare system.
It’s not news to most that with increasing regulations, an aging population, rising healthcare costs and dwindling numbers of nurses and certain medical specialists, U.S. hospitals are finding themselves scrambling to do more with less. Most hospitals today are focused on trying to meet Meaningful Use requirements, to avoid penalties and secure financial incentives. But many are missing the bigger, longer term picture of this country’s financial situation: how half a trillion (or more) in Medicare cuts over the next 10 years will impact the industry.
Those of you who read my previous posts on health care reform know where I stand – that while its creators had the best of intentions, the bill ultimately failed to accomplish two key goals: increase quality and decrease costs. The most critical pieces that legislators missed include tort reform, competitive insurance across state lines and much more aggressive pay-for-performance measures and disease management-based incentives. With these additions, health care reform would have been viewed as much more cost-conscious and quality-focused. Instead, we’re now left with a “Frankenstein” system that was cobbled together with, in many ways, the best of the worst – one that’s expensive to maintain and challenging for physicians, providers and ultimately patients.
At this year’s Picis Exchange meeting in Miami, FL, I had a chance to sit down with Tommy G. Thompson, whose resume will take up half of this blog post – former secretary of Health & Human Services, four-term governor of Wisconsin, member of Picis’ board of directors and a personal friend and resource – to talk about where today’s healthcare system is headed.
The most compelling part of our discussion was his take on President Obama’s approach to healthcare reform and his direct advice on next steps.
Let us know if you agree or disagree with his advice – and what yours might be? And stay tuned for more from our discussion in the weeks ahead!
- Todd Cozzens
I don’t know about you, but I was thrilled to hear about today’s launch of MEDS-ED Link, a project of the Northern Virginia Regional Health Information Organization (NoVaRHIO) in conjunction with Inova Health System and GE Healthcare.
In a move that caught many by surprise, the recently-installed coalition government of Britain has proposed a radical reorganization of the National Health Service (NHS). The goals of the reorganization are to decentralize the control of the NHS budget, dismantle layers of bureaucracy, empower patients, and realize some £20 billion in savings through increased efficiency. All of this is set against a backdrop that calls for doing more with less – improving outcomes, ensuring high quality care and patient safety and giving providers and hospitals more autonomy while requiring more accountability. The UK, like much of Europe, is looking at ways to restructure budgets and social programs, in an attempt to reduce deficit spending and overall debt. And while the original goals of healthcare reform in the US included cost control, we on this side of the Atlantic did not take the courageous steps necessary to “bend the curve” on health care costs.
