4/8/2015 1
Darci Becker, PhD, CCC-SLP, BCS-S Assistant Professor, MSLP program, St. Ambrose University beckerdarcil@sau.edu Speech-Language Pathologist, Genesis Medical Center beckerd@genesishealth.com
Increasing health care costs at an
unsustainable rate
Lack of access to health care Payment based on fee-for-service vs. quality
- Potential overuse or misuse of spending
Ordering unnecessary tests Varying rates charged for procedures Patients admitted to hospitals could be managed as
- utpatients or not discharged as soon as medically
stable
- Widely varying treatment patterns
March 2010: Patient Protection and Affordable
Care Act (ACA) & Health Care Education and Reconciliation Act (HERA) signed into law
- Reductions in payments
Much of the change occurring in acute care
- Penalties
Hospital-acquired infections Readmissions Wrong procedures
- Incentives
Outcomes
More changes with each passing year
- “Triple
“Triple “Triple “Triple Aim of Aim of Aim of Aim of Reform” Reform” Reform” Reform”
Vision
- Improve
Improve Improve Improve the patient the patient the patient the patient experience of care Quality Quality Quality Quality Satisfaction Satisfaction Satisfaction Satisfaction
- Improve
Improve Improve Improve the health the health the health the health of populations
- Reduce
Reduce Reduce Reduce the per capita cost the per capita cost the per capita cost the per capita cost of health care
Means
Move from fee-for-service model to pay-for-performance
There is enormous opportunity to eliminate waste in US
There is enormous opportunity to eliminate waste in US There is enormous opportunity to eliminate waste in US There is enormous opportunity to eliminate waste in US health health health health c c c care are are are
- Potential sources of waste include
Failures of the Care Delivery
- Lack of adoption of best care processes
best care processes best care processes best care processes Failure of Care Coordination Care Coordination Care Coordination Care Coordination
- “Patients fall through the slats of fragmented care”
- Overtreatment
“Subjecting patients to care that according to sound science and the patients’ own preferences, cannot possibly help them”
- E.g. Excessive antibiotics, intensive care at end of life
- E.g. Dementia patients and holding food; rehabilitative model is not
beneficial
- Administrative Complexity
When government, accrediting bodies, payers etc. create inefficient and misguided rules
- Pricing Failures
Prices exceed actual costs and fair profit
- Fraud and Abuse
Good intentions to improve patient care and
reduce healthcare costs with ACA regulations
Because of growing, critical shortfall of
healthcare professionals:
Increased patient wait times Shortened patient time with caregivers Decreased patient satisfaction Increased workloads and documentation demands Increased workloads and documentation demands Increased workloads and documentation demands Increased workloads and documentation demands for employees Increased patient acuity Increased patient acuity Increased patient acuity Increased patient acuity for employees Reduced staff due to necessary layoffs Greater employee stress, dissatisfaction and burnout Greater employee stress, dissatisfaction and burnout Greater employee stress, dissatisfaction and burnout Greater employee stress, dissatisfaction and burnout Increased potential for safety events Increased potential for safety events Increased potential for safety events Increased potential for safety events Ethical dilemmas Ethical dilemmas Ethical dilemmas Ethical dilemmas between employees “following their moral conscience and obeying potentially immoral orders of their superiors”