HCA, Week 14 notes
HCA, Week 14 notes HCA 340 -002
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This 5 page Class Notes was uploaded by Loretta Hellmann on Wednesday May 4, 2016. The Class Notes belongs to HCA 340 -002 at Western Kentucky University taught by Steven W. Maddox in Spring 2016. Since its upload, it has received 18 views.
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Date Created: 05/04/16
Week 14 Tuesday, May 03, 2016 9:36 AM Future of Health Care Paradox of US Health Care Policies of six decades yielded Medical advances World-wide scientific and clinical acclaim Investments in the NIH (nation institute of health) and NSF (national science foundations) for university basic and applied research Investments in academic health centers, hospitals and technology Medical, other professional proliferation and specialization Successes contrast with failures to recognize a social mission beyond meeting individual needs of those available to access services: Inequitable access, variable quality, controlled costs ACA symbolic of discontent with system that: Cannot cover basic services for 16% of citizens Provides services of doubtful necessity and benefits Is fraught with controlled costs, errors, waste Continuing Challenges Facing Health Care in the Reform Era Sluggish federal, state economies, rising health care costs cause drops in insurance State government budget deficits affecting all services Employers discouraged by double- digit premium increases; predictions that more may forgo benefits under the ACA, leaving 7M workers without employer coverage Demand for Greater Fiscal and Clinical Accountability Persistent resistance to change among major stakeholder groups detterd system-wide reforms despite overwhelming evidence, e.g. IOM report on medical errors and failures to meet 5 year targets Failures are system leaderships', not individual practitioners Hopeful signs: AHRQ morbidity and mortality rounds on the wed stimulates anonymous provider input and discussion and errors DHHS hospital Quality Information Initiative provides public access to hospital quality of care data CMS reimbursement incentives and incentives on hospital medical error rates "never events" ACO's care coordination imperatives Growth of Home, Outpatient and Ambulatory Care Emphasis on community-based care, aging demographics will result in continued home care growth; since 200, agencies increased by 1000 to 12,000 in 20120 Outpatient medical and surgical procedures will continue growth fueled by technology advances, high provider and consumer satisfaction Technology MRIs: coercive power of glamorous, expensive technology over cost-benefits; extensive research demonstrates no patient benefits in therapeutic choice or outcomes Technology's mixed blessings: imposes barriers between consumers and practitioners; technology investments contribute nothing to solutions for access barriers, health disparities, other major health determinants Changing Population Composition Older population size and diversity increasing and surviving to very old age Intact families to care for older adults decreases with divorce, single-parenthood, adult child out-migration Changing racial and ethnic composition w/minority groups, especially Hispanics Inadequate of culturally competent providers at all levels in acute and long-term care for home and institutional care; difficult to recruit and retain; most long-term care facilities now propriety with uneven quality track records Systems chronic care focuses on acute interventions w/little attraction to "maintenance" services that will be requires Effective chronic illness care will require major shifts in health services priorities; more geriatrics services in an acute care system is not a solution Health professional must change entrenched acute care mindsets, values, clinical behaviors ACOs' care continuums may help, but widespread movement from fee-for-service to holistic approach will not come easily or quickly Changing Professional Labor Supply Institutional employment practices disrupted by hospital size and service reductions; inpatient to outpatient shifts; needs for new classifications of workers Employment will grow in home care, practitioners' offices, nursing and residential care facilities Aging workforce will contribute to many job openings through retirement ACA will present many challenges w/30M+ newly insured and realignment from volume to value-driven services NHCWC (National healthcare workforce commission) if empowered, will evaluate and recommend new approaches to professional training and education, efficient work force, deployment, compensation, coordination Physician Supply and Distribution and other primary care practitioners Managed care principles made primarily MD roles paramount, increased demand for services; shortage gaps filled with NPs and Pas Predicted shortages New physician roles Hospitals will continue to proliferate throughout the system Physicians entering roles in management and administration in pharmaceutical companies managed care organizations Nurses At 3M, largest component of health professions and best positioned for reformed system's roles Nurse training in behavioral and preventive realms, coordinating care with multiple disciplines and lesser-trained colleagues aligns well with goals of reformed system Future of Employer- Sponsored Health Insurance For 5 decades, employer sponsored health insurance protected workers Industry predominant role in ACA parameters reaffirmed influential policy role Under ACA, may opt to drop health coverage and endure penalties Significant, uncertain speculations on employer decisions as market changes and reform proceeds Changing Composition of the Delivery System: hospitals No long system "hubs acute care hospitals will become combinations of high-level intensive care units and full0service facilities for more serious conditions, the uninsured and indigent Almost all will become part of for-profit or not-for-profit corporate networks Outpatient Facilities Privately owned ambulatory surgery centers, urgent and immediate care facilities, diagnostic facilities, specialty hospitals will continue growth trajectory fueled by entrepreneurial opportunities, technology advances, provider, consumer, payer preferences and demands Health Information Technology Ideal future: provider and health plans will replace voluminous, disorganized medical records with standardized, reliable, clinically relevant electronically delivery information Obstacles and solutions Complex confidentiality, compatibility, transferability, organization culture issues and complexities of patient service receipt at multiple sites Academic medical researchers and developers with private HIT corporations will combine resources to build workable infrastructures to create a new era of HIT Summary of Predictions and Future Challenges Public's prevailing belief in privately supplied US health care as a "good" despite high costs, redundancies, access and quality problems countered by belief in scientific, technological superiority Solutions envisioned by the ACA Change from only coordinating service delivery to actively managing quality of process and outcome Add serious commitment to resolving community and public health issues
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