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Economic pressures increasing for patients
Efficiency, collaboration are important
As the economy worsens and the rolls of the unemployed and uninsured increase, hospitals can expect some hard times, as well, an expert says.
Hospitals' economic pressures will result from several directions:
1. Patients will be sicker with more comorbidities. "People with chronic illnesses or generally poor health will wait until they have an economic crisis to seek help," says Lanis Hicks, PhD, a professor in the department of health management and informatics at the University of Missouri in Columbia, MO.
Sicker patients are less able to handle their comorbid conditions when they're discharged, Hicks notes.
"As we try to get patients out of the hospital and into different step-down levels, we're going to need somebody to help coordinate all of these services that are needed and work with providers and patients," she explains. "We need to accommodate the patient and also increase efficiency."
Discharge planners will be a crucial part of this process, and their work could extend to the home environment.
Without DPs or case managers, how will health care providers know whether patients have the basics needed in their home environment in which to maintain their health, Hicks asks.
2. States will cut Medicaid. "Their condition won't be easy to take care of, and at the same time states are cutting Medicaid payments and are cutting eligibility and cutting the amount they pay per patient," Hicks says. "So at a time when the demand is increasing on hospitals, they're getting paid less."
This puts economic pressure on cutting services that are not reimbursed, including preventive services, Hicks says.
But this would be a long-term mistake.
Discharge planning, which can help prevent future medical crises, should be expanded under these conditions - not cut.
"As we start focusing on the management of chronic conditions rather than delivery of acute, episodic care, then this type of activity is going to increase," Hicks says. "We have people coming in with multiple conditions, so how do we ensure as we treat them for a single condition that we don't let the other conditions worsen?"
3. Insurers will delay payments. The economic pressure also means that insurance companies, which now have a declined financial status, are dragging out how long it takes them to pay a bill, and hospitals will have a more difficult time getting loans to meet their payrolls, Hicks adds.
This scenario is frightening and painful, she acknowledges.
"But there are also ways we can do things to be more efficient and more effective," Hicks says.
The key is for hospitals not to view the recession as a short-term problem, where if they just hang on, things will get better next month or the month after, Hick advises.
"It will be painful in the short term, but I think we can use this as an opportunity to look at it and say, 'Maybe we don't need all of this technology, the newest and fastest all the time,'" Hicks says. "Does it really provide us with benefits equal to its costs?"
If hospitals do some soul searching and cut costs where it's less necessary, then they could come out of the recession as a stronger system, Hicks adds.
Hospitals also can improve collaboration and cooperation among different providers, Hicks says.
This is a process that is helped by a strong discharge planning team.
"As hospitals are trying to discharge patients, they need to work with either home health agencies or nursing homes to admit patients," Hicks says. "They can't take the attitude of 'This is no longer our problem.'"
The discharge planning process must focus on making sure the next provider receives all of the patient's medical information, including medication prescriptions, she adds.
Communication will be key, and this is where an electronic medical record could make the discharge process more efficient and safe.
"It would certainly help if everyone was electronic," Hicks says. "But it also has to have a standard platform, a system where when I enter information the next person down the line can read that information."
Many facilities do not even have standard electronic communication within their own systems, she notes.
"Doing this would require government grants and maybe national requirements," Hicks adds.
Or private industry could make this standardization happen through a monopolistic approach, similar to what Microsoft did with personal computers.
"It would have to be someone who has enough market power to say, 'Yes, this is what we're going to do,'" Hicks says.
Despite the economic crisis, Hicks remains optimistic: "We hear a lot of doom and gloom reactions right now, and I think definitely we are facing in the health care industry a lot harder times than we've had in the past," she says.
But the key is to see these economic pressures as an opportunity to review processes and find ways to improve both quality and efficiency, Hicks adds.
For more information, contact:
Lanis Hicks, PhD, Professor, Department of Health Management and Informatics, University of Missouri, Columbia, MO. Telephone: (573) 882-7423. Email: hicksL@health.missouri.edu.