"I am excited about the future of healthcare. We are poised for things to be better than they have ever been," says Oak Hill Hospital’s CEO Mickey Smith as he welcomes an attentive group of healthcare professionals to the symposium.

Understanding healthcare reform can be overwhelming to large medical facilities with personnel specifically trained for changes in paperwork and accountability. Smaller business entities — such as home health, hospice or medical transport — have a greater challenge to continue to provide excellent care while also following new healthcare regulations. Oak Hill Hospital wants to be "ahead of the game" by facilitating collaboration and information sharing between providers so everyone involved with patient care is well-informed and connected, resulting in the highest level of continual care and appropriate compensation for all medical professionals.

To that end, Smith contacted LarsonAllen, one of the nation’s top 20 accounting and consulting firms with a specific interest and experience in healthcare reform. "LarsonAllen responded by sending not one, but three people — this is their ‘A-Team’ for the healthcare industry," says Smith. "These people understand accountable healthcare and they are not just talking about it; they are doing it." Nancy E. Rehkamp, Principal; Sue Ann Bunevich, CPA, CFE, Principal and Gregory M. Hawthorne, CPA, CHFP, Principal provided a comprehensive overview along with specific examples of impending reform and how other healthcare professionals and businesses are responding.

According to symposium speakers, one way for this area to provide the highest quality medical care is for agencies, both large and small, to form a cooperative, effective and efficient chain of information — which adheres to all patient privacy laws — but allows for the sharing of information from one medical entity to another so that when a patient leaves the hospital there is a continuum of care to reduce the chances for another acute medical incident. This means when a patients are discharged that a professional patient care coordinator stays connected to ensure services by the appropriate providers are in place (such as skilled nursing or assisted living facilities) and that the patients do their parts to follow the doctor’s orders (prescriptions are filled and follow-up appointments met).

This will provide a significant improvement in the delivery of medical service and the resulting reduction of cost, which will be of paramount importance with the incoming changes in "bundled payments" for services covered under Medicare. The key message is that Hernando and surrounding counties are in a position to do something innovative and forward-thinking in the healthcare field for the residents of the Nature Coast. For example, just because there is a nationwide shortage of trained nursing staff doesn’t mean this area has a shortage. "We actually have a waiting list of nurses for certain units who want to work here in Hernando County. We are — and can continue to be — the innovative ones and people look forward to working here in our area," adds Smith.

The History and Future of Healthcare

Payment for services during acute care has undergone significant incentive change since 1965 when Medicare provided funding for healthcare for people 65 or over. Originally Medicare was a "cost-based reimbursement incentive system," but as medical costs rose in the early 1980s Medicare moved toward a "prospective fixed payment system." Now Medicare is moving toward a "value-based purchasing system" that focuses not on medical providers getting paid for what they do, but for what gets done: for results. According to Smith, unfortunately these previous systems of payment lead to some instances of mediocre patient outcomes and duplicate medical services. "In the past, Medicare paid for healthcare whether needed or not and whether quality or not," he explains.

Smith and the LarsonAllen presenters further explained that changes are needed to improve medical services by focusing on a continuum of care so that agencies do not repeat services (such as medical tests) and that subsequent agencies understand what has been provided and should continue as the patient enters the care of the next medical agency. Changes to medical necessity criteria will reduce the volume of unneeded care and reduce cost. Medicare has announced that it will not pay until a prepayment review is completed to see that medical necessity is documented for 20 conditions. Medical providers are encouraged to build collaborative systems for information sharing because claims will be paid for the "bundle" of services provided. If a medical test or procedure is repeated unnecessarily, the second provider will have to absorb that cost because Medicare will no longer pay as it did in the past. The presenters also noted that private pay insurance companies will follow the lead of Medicare in restricting payment for duplicate or unnecessary services or avoidable re-admissions to hospitals.

It was also noted that another important outcome of the new transparency in healthcare  is use of the data collected. Because "hospital acquired conditions" statistics must now be reported and are available to the public, many medical facilities responded proactively to reduce the cases of hospital acquired Methicillin - resistant Staphylococcus aureus (MRSA), an antibiotic-resistant staph bacteria. The result is a safer environment and reduced costs billed to Medicare (or private pay insurance) for an avoidable infection. Now when anyone walks into a healthcare facility, it is commonplace to see a hand-sanitizing station at the entry, by the elevator, in waiting areas, and inside every patient’s room — along with multiple signs encouraging use of these simple precautions.

Smith reported that Oak Hill Hospital had no hospital acquired conditions for two months due to the formation of its "HAC (Hospital Acquired Condition) Attack Team." He is also quick to point out that this kind of attention and commitment also applies to other medical errors, such as wrong-site surgery, sepsis or prescription mix-ups. Changes in healthcare reform are redefining what an acceptable level of risk is for patients and thereby improving accountability, which advances the quality of medical care while also reducing cost. Medical care facilities and providers who long ago may have been hesitant about public access to statistics are now seeing that facilities that truly care deeply about the patients they serve pay attention to data — and even use this information to encourage patients and families to choose a facility or provider because of an excellent healthcare rating or positive data accumulated. "With all the medical care choices available to people, somehow we as providers must be motivated to work together to make healthcare reform a success for the people we serve and for our own continued existence," says Smith.

Data from 2010 Census	Hernando	Citrus	Pasco	State of Florida
Population in 2010	172,778	141,236	464,697	18,801.310
Population increase from 2000-2010	32.1 percent	19.6 percent	34.8 percent	17.6 percent
Population 65 or older	25.8 percent	31.9 percent	20.7 percent	17.3 percent
Veterans 2005-2009	22,239	23,787	54,271	1,685,421

Source: U.S. Census Bureau quickfacts.census.gov Accessed 1/7/2012

"Information sharing, collaboration and a combined focus on excellence in the continuum of care is the future of healthcare reform," explains Mickey Smith, CEO of Oak Hill Hospital.

"Providers like all of you who care enough about your community and your businesses to be here today will be in the best position to be ready for the impending changes in healthcare reform for post-acute care," says Nancy E. Rehkamp, LarsonAllen. "Oak Hill sets a very high standard for themselves and for those who partner with them."

"Due to the rising older demographic and medical costs, our future has greater financial risk for medical service providers. Change is imminent and those businesses and professionals — from doctors’ offices to hospitals to home health and assisted living — that survive healthcare reform will be those with the greatest operational efficiency, the best patient outcomes, and the strongest collaborative connections," says Sue Ann Bunevich of LarsonAllen.

"Professionals are collaborating to get ready for healthcare reform. Initial focus is on integration of hospital and physicians, but pro-active post-acute providers are developing innovative programs and a range of options — even Skype and video contact between provider and patient," states Gregory  Hawthorne.

Discussion

blog comments powered by Disqus