An underlying theme present in the healthcare professionals’ response to the topic of care reform is the resistance to any significant change in how we do what we do. Administrators and physicians often express skepticism to the idea that the current level of quality care they manage, develop, or deliver can be improved for future patients. They cite quality outcomes, patient satisfaction results, care volume and cost reductions as real-time metrics of their advanced care, and they are right. Care production and delivery has reached levels of efficiency and quality previously unseen in modern healthcare; no one wants the programming of the past reprised in today’s market.
Some element of this standard response is the effect of human nature and the general resistance to the change process itself. Successful Providers and clinicians are intimately connected to their craft; they traditionally have entered a healthcare profession to care for others, and connect viscerally with work experiences that reinforce that decision. Despite the ongoing trends based on progress in society that affect our everyday lives, particularly in the areas of Information Technology (IT), we find ourselves reluctant to embrace the same types of advances in the healthcare workplace. As we cling to the routine, pace and value of what we do to deliver care to our patient population, we often fail to envision what could become the care delivery of the future.
Post-acute Providers have seen the evolution of the care continuum deliver patients to their door, as the reform effort that was the Prospective Payment System began to regulate the care programs delivered through acute hospital admissions. When Medicare was developed in the 60s, hospitals were the only care Providers; there were no outpatient clinic, SNF, or Home Health programming available to deliver healthcare of any form. The introduction of PPS to regulate hospital admission volumes marked a new day for healthcare; acute programs were now being managed through capitated payments designed to focus Providers and clinicians. Patients began to be discharged sooner from hospital admissions, and the evolution of post-acute care, in terms of sub-acute rehab (SNF) and community care delivery (Home Health), had begun.
Over the next 30 years, hospitals decreased their utilization by greater than 75% as DRG-control dictated care content and length of stay statistics. Care migrated to the post-acute sites, and Home Health grew to today’s level (20+ billion/year). The changes have literally reinvented the acute episode experience, and patient attitudes have changed in like fashion. Virtually no one wants to be in the hospital any longer than necessary, and an ever-increasing amount of care is delivered on either an outpatient basis or in the home environment.
So as patients and the healthcare industry in general embrace the ongoing pace of change, it is imperative that Providers and clinicians don’t fall behind. Most healthcare professionals desire the best for their patients, and are eager to deliver quality care programs. But the actual process of re-wiring or evolving care is often a stress-laden experience that conflicts with our self-image as caring and quality caregivers. Reform efforts that focus on the current structure or pace of how we produce or deliver care speak to the daily routine of our professional lives, and contribute further to our stressful working environments. Challenged by caseloads and regulatory pressures, healthcare practitioners often perceive any change as “the last straw”.
Current healthcare reform targets waste and un-necessary spending in an effort to reduce entitlement costs while freeing funds to expand healthcare coverage to the un-insured. This approach provides a carrot to the industry while asking for care evolution; reforms that result in increased coverage for the currently un-insured will ultimately deliver additional patients (and work) to post-acute healthcare Providers and professionals. The current care models being touted by the latest reform efforts, ACOs, Care Transitions, Population Health, and Post-Acute Bundling, all center on the de-emphasis of acute inpatient treatment. Focusing on pre and post-acute care, these reforms feed right into the recent evolution of post-acute care, and the vendors who deliver that type of care (SNF and Home Health).
So don’t be left behind by these changes; our patients and their care needs are not going anywhere. Attempt to develop an open mind to hear the essence of any proposed reforms or changes, and use your skill and experience to find ways to care for your patients in a changing care landscape. Quality Providers and clinicians will respond to the care challenges that lie ahead, and as a result, will continue on the care path of the future.
Arnie Cisneros, P.T., President of Home Health Strategic Management, is the most progressive speaker in homecare today. He provides coaching and consulting services to providers on a national basis (see www.homehealthstrategicmanagement.com) regarding S.U.R.C.H. and other clinical management protocols for quality outcomes.