Hospitals Facing Three Changes from Healthcare Reform

What Health Care Reform will certainly bring:  It’s difficult to predict the specifics of what health care reform will bring, but it is clear that it won’t be business as usual. We believe that three things will be certain results of the current public debate.

First, reimbursement changes are going to increase the importance of managing the cost of delivering services. Hospitals will need to pursue operational efficiencies with a vigor that has not been widespread. Labor costs, work processes, duplication reduction, and reducing unnecessary utilization will be critical for preserving the bottom line.

Second, coordinating care will become more important. The public debate has highlighted the lack of coordination of care providers. For example, the debate on readmissions has blamed the problem, in part, on poor follow-up after hospital discharge. Post hospitalization care is a responsibility shared among hospitals, physicians, nursing homes and home health care providers. Yet, no one seems to “own” coordinating care. Regardless of the structure of reimbursement changes, someone is going to get blamed (and penalized) for letting patients fall through the cracks. This requires rethinking the health system’s business design, from being a collection of provider assets to a unified, single provider that cares for a patient.

The third major change will be increased accountability for failure to ensure patient safety (as measured by results, not processes) and treatment plans consistent with best practices and evidence-based medicine. Oversights will not be tolerated. While much can be learned from investigating undesirable events, there will be much more emphasis on error prevention. After an event, staff may be motivated to prevent a recurrence and willing to make changes, but preventing an occurrence will require changing current practices when the staff may not appreciate the degree of risk.

Many hospitals will struggle with this cultural challenge. Case management should be an important part of achieving these goals. Many hospitals fear implementing an effective case management program because they perceive that case management is similar to insurance company authorization process. This is a misconception. Health system based case management should be built to optimize multiple care process outcomes (financial, quality, and patient experience). Case managers collaborate with other care providers; they don’t evaluate them. When operating properly, case managers are valued by patients, physicians and hospital staff. Case management can multiply the effectiveness of other initiatives. Smart hospitals are not waiting for new legislation. Their leaders see the writing on the wall and are steering their organizations to make changes now!

Filed Under: Featured Articles • Hospital Leadership