Healthcare’s Horizon With or Without Supreme Court Decisions
The next generation of healthcare provider is already in business, and may be in your neighborhood. Healthcare is changing rapidly, and you don’t need to read the trade press or other industry specific news to read about it. The presidential election of 2008 made health and healthcare a hot topic of debate. Front page stories and op-ed pieces address health and healthcare on a daily basis.
David Ignatius writes op-ed pieces for the Washington Post Writers Group. Writing about the Affordable Care Act and the Supreme Court Ignatius opines that “the current debate is over financing and access to care, not healthcare delivery—that the train has already left the building.” No matter the ruling of the Supreme Court, healthcare, and the care we deliver in people’s homes is changing and will continue its rapid evolution over the coming few years.
Ignatius cites the following significant changes in healthcare that give us a glimpse of the future for homecare. I have added a question specific to home health after each of his points.
- Hospitals are consolidating, 60% of all hospitals are part of consolidated systems, which will continue merging to enhance efficiencies. The same process has occurred in banking, book retail, and across industries. Ignatius indicates care may be less local, less personal, but it will be cheaper. Question – Will predictions of similar consolidations for the home health industry hold true? If this trend has occurred in other businesses why would home health be any different?
- Doctors are becoming salaried, with 60% of physicians today being hired by health systems, and that number is expected to increase to 70% over the next decade. This changes the economic incentives of MDs who sometimes make decisions that often don’t make sense for patients or impact their outcomes. A shortage of primary care doctors and will continue to drive care to physicians assistants and nurse practitioners. Question – How will physicians’ employment by hospital systems change home health agencies’ approach to referral sources? Can nurse practitioners play a more active role in the next generation of homecare?
- Health records are going electronic, a must in an outcome oriented health system. The cost for implementation is significant, with Cleveland Clinic having paid $300 million over the past 10 years, but Ignatius writes that the return on investment will result in “huge dividends in terms of cheap and better care.” Question – Has my home health agency engaged in the ongoing journey of adapting to electronic health records? How has it impacted our decision making processes?
- Government data on health outcomes are quickly leading to national standards for care. We know the benchmarks that have been used in homecare around length of stay, therapy utilization, average HHRG scores, etc. While we too often think of these measures in terms of abuse or waste, these data will lead to greater effectiveness and higher quality care. Does having better data change my vision and strategy for the future?
Ignatius closes by saying our overhaul of healthcare “is happening whatever the Supreme Court decides.”
Care at home is critical to the next evolution of healthcare. Chronic care management currently accounts for over 80% of all healthcare costs, and this is the area in which we excel. Whether we are part of this next evolution, whether individual agencies adapt to work with or become part of whatever models come out of the Supreme Court’s ruling or some other post Affordable Care Act innovations is up to us. No matter what moniker they go by, Accountable Care Organizations, Patient Centered Medical Homes, Independence at Home providers, and other new innovations in care models are the wave of the future.
I hope this spurs you and your staff to ask other questions. Maybe those are different from the ones that are most important to you. But the one question we must all ask at this critical point in time is this: will you and your agency be part of the next generation of homecare? Take care.
Warren Hebert
HomeCare Association of Louisiana
