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HCA, Week 14 notes

by: Loretta Hellmann

HCA, Week 14 notes HCA 340 -002

Loretta Hellmann
GPA 3.75

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last set of notes before the final. week 14
Steven W. Maddox
Class Notes
25 ?





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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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