Healthcare Reform: What Might it Look Like?

I showed this photo to an acquaintance who happens to be an ER nurse. The turkey vulture in the image was sitting on a tree next to the freeway, and the title of the photo was Waiting for Roadkill. That nurse said, “hey, that’s how we feel about ourselves working in the ER!”

There is that certain irony in healthcare in that we get into it because we want to help. But perversely we need people to get sick or injured in order for us to help, to have jobs, to get paid, and fulfill our personal mission to do good. One person’s worst day of their life can be our chance to make a difference, or to have an adrenaline rush or an intellectual challenge.

The same irony applies to healthcare organizations: the unhealthier the population we serve, the more likely that the organization can fulfill its mission, especially if that population has a payment source.

What about the future mission of healthcare organizations? The mission will probably not change, but:  Can we continue to sit like the vulture and keep our beds full and our outpatient departments busy, or is something new headed our way? Below I’ve listed some of the changes that we can expect as part of healthcare reform. And if you are thinking that the Supreme Court is going to strike it all down and we will return to the good ol’ days, think again: The current system is simply unsustainable. These are the good ol’ days! Reform itself will change, but there will be reform of some sort.

Moving From
Paid to take care of sick people. The more procedures and episodes of care, the better the revenue stream.
Moving Towards
Paid to keep populations healthy; the less that high cost care is provided, the better the bottom line. Encourage use of seat belts, obeying speed limits, eating healthy, ambulatory services and so forth.

Moving From
Set our prices and make up for losses on charity and government-paid services through profits on commercial insurance (cost shifting).
Moving Towards
The expectation that all payors will gravitate towards the level of payment made by Medicare. There will be nowhere to cost-shift to.

Moving From
We write things down, scan it, and then we file it away. A box of paper costs $10. Pens are ten cents.
Moving Towards
We document electronically, communicate the information through all levels of care, and assemble the collective data in novel and useful ways to guide our decisions. The patients’ records follow them wherever they go. A comprehensive EMR costs millions of dollars.

Moving From
Do our best and charge for our efforts, even if sometimes we have to re-admit or do-over.
Moving Towards
Payments will be at risk based on measures of quality and patient satisfaction. We will have to absorb the costs of our errors.

Moving From
We do our thing, doctors do their thing.
Moving Towards
Alignment of physicians and hospitals into some version of coordinated care organizations.

Moving From
We do our thing, nursing homes, home health agencies, outpatient providers do theirs.
Moving Towards
Single payment per episode of care, and other “bundled payment” schemes

It will be a challenging time. You’ve probably heard the old saying that “no money, no mission.” Some organizations will likely not survive the changes. I’m confident that the organization that I work for can survive and possibly even thrive in the “going to” future world, but that period of transition will be incredibly challenging because the incentives and payments now and in the future are polar opposites.

Here is what I know rehab providers can do to prepare that is within our control:
1. Reduce costs through control of expenses.
2. Learn how to optimize and most effectively use services. (For an example, in outpatient PT will 3 visits per week be more effective than 2 visits per week? Challenge the conventional wisdom and go with identified best practices.)
3. Where ever possible, measure quality and strive to be the best.
4. If we have an established way of doing things, do it that way always. Variation is costly and leads to errors and uncontrolled processes.
5. Challenge the way we do things, but remember that in a complex system each thing we do is tied to many things that others do; any proposed change needs to be carefully evaluated to avoid unintended consequences.
6. Focus on the mission, and have fun.

Many people get anxious when they face change. I see it differently: It’s an opportunity to become an agent of change, to make a difference in how we do things for years to come. This is a time when we all need to engage in adapting and molding our work to the new future.

New Video on the RVMC Inpatient Rehab Web Page

Check out the the video on this page!  It takes about 6 minutes and gives a pretty good overview of the facility and what patients and families can expect on the unit.

A New Milestone

Last night's therapy staff holiday party was very well attended, and a lot of fun.  Here's the newsflash:  In front of the entire assembled mass of about 40 or so staff and significant others, one of our very own PTs was proposed for marriage.  It was a surprise to everyone in the room.  I'll leave it at that, and hopefully photos will soon follow.  The object of the proposal tells me that she answered "yes" to the question!

We've had a lot of great stuff happen within our departments over the years, but this is Super-Great!   How will we top this at next year's gathering?

Inpatient Rehabilitation Center Refresher

This week we've engaged staff and leadership of the IRC in refresher courses in FIM scoring as well as rehabilitation nursing competencies.  The consultants also reviewed work processes and operational details to provide suggestions for improvement.  (Prior to arriving they'd sampled some of our charts for compliance to regulations and indications of quality.)  I'm expecting a full report in the near future, but my own observations are that we have an extremely solid foundation of staff and skills, that those who attended the training (nearly everybody did!) were very engaged in the learning, and the information provided will be a stimulus to allow us to move to the next level of excellence.

Thanks go out to Angie Phillips and Pat Heimann for the great job they did in providing consulation and education for our unit.

Inpatient Rehab Center Staff

During our recent all-staff training I had an opportunity to get group photos from the two sessions.  These will eventually appear on our website, but in the meantime these are too great to not display.

We have a wonderful team and fabulous individuals that I'm privileged to work with.

Time Flies!

 

What you see above is a Weber Grill, 27000 btu of grilling power!  Why am I showing this to you?  Well, it's because that grill arrived at my door a few weeks ago, one of those splendid awards that Asante provides their employees upon a multiple-of-5-year anniversary.  Mine happens to be 35 years as of today.  I can say in all honesty that it's gone very quickly.  

Last week a barrista asked me where I worked and if I liked my job, and it came out of me without pause or thought:  "Yes, I love my job."  I love the challenges, and I love the people I'm privileged to work with.

A few things have changed, of course.  When I arrived to start work on night shift at Rogue Valley Memorial Hospital, the reputation of our across-the-town competitor was better than ours.  They were known as the high-touch place, we were known as the high-tech place.  Of course, people were choosing where to go based on the "touch" thing unless their condition dictated that they absolutely had to have the technology.  We've long since turned around that perception, and we are now both high-tech and high touch.  The government outcome data regarding patient satisfaction supports that statement.  And I know also from conversations around town with people that I meet that there is earned pride in working for Asante.  In fact, that same barrista replied, "Well, that's the hospital that I would go to if I needed to, for sure."

The hospital has afforded me the chance to grow and accept new challenges.  From night shift staff respiratory therapist, I advanced to supervisor, then to my current Director of Rehabilitation Services position.  That job morphed into a regional director job, and along the way I became a nursing home administrator to manage the Transitional Care Unit which was our first venture into an inpatient rehabilitation unit.  That unit only lasted a few years until the reimbursement methodology for skilled nursing facilities changed, but it was a sort of a precursor to our Inpatient Rehabilitation Center which is now approaching its fourth anniversary.  I'm now privileged to act as Program Manager for that unit, in addition to my broader duties as Director of Rehabilitation Services.

It was a different world when I started.  In fact, 1976--the year that I started at RVMH--is the year that Apple Computer was incorporated and Microsoft was one year old.  Telephones had wires, and many people still used rotary dials.  New studies indicated that fluorocarbons from aerosols were depleting the ozone layer, exposing people to increased risk of skin cancers.  Home video technologies of VHS and Betamax were intensifying their competition for the best way to view movies at home.  There were serious questions as to whether or not theaters would survive.

Medford did not have a mall;  we often traveled to Eugene to do "real" shopping.  The area west of Providence Hospital was bean fields up to Biddle Road.  There was a "Big Y" intersection and store roughly across from the current mall where Hwy 99, Hwy 62, and Front street intersect.  That store was one of the big shopping venues, similar in concept to Fred Meyer but locally owned (and now defunct).  The area around our current RVMC was relatively unpopulated.

The economy was on the ropes in 1976.  Inflation was 5-6% and seemingly continuing to rise.  Unemployment was approaching 8%, but southern Oregon was still prospering with the timber industry dominating the economy.  The decline had begun, however, and timber harvests have fallen steadily since that year.  Meanwhile, Intel built its first plant in the Portland area and the focus on computer technology as a basis for economic development took hold.

A postage stamp cost 13 cents, and you had to lick it.  Jimmy Carter was elected president.  The Concorde flew the Atlantic 3-1/5 hours faster than any prior commercial jet.  Roots was published.

Statistics:  35 years equals 1,829 weeks.  Subtracting vacations and so forth, that's 8,374 work days.  That translates into about 21,000 cups of coffee on work days, at my rate of consumption.

During this time staff have started their careers with us, and stayed on for decades.  Many, many students have passed through our departments.  We've lost some employees to illness, many more have married.  Children have been born, and in some cases the children have come to work for us, too.  We've had marriages physically in our departments, and at least one baptism (of a quadriplegic) in our pool.  Too many holiday parties to count, and many, many acts of selfless giving.  It feels like a huge, connected family.

Within a couple of months of starting work here, while getting off duty one morning around 7 a.m., I walked out the door into a bitter cold.  In those days the airport would seed the fog clouds to open the airspace for take-offs.  So it appeared to be snowing, and the ground was covered with a layer of frozen white.  The night xray tech was walking out the door with me.  I had moved here from Arizona and this was a new experience for me.  I blurted out, "We've been flocked!"

Her reply stuck with me:  "Was it good for you, too?"

Yes, it was, and it still is.

I cannot think of a better way to spend my time.  Looking back, I can feel the accomplishments and the good we've done for individuals and the community.  I'm incredibly grateful for where I live, and where I work.  

Onward!

Annual Rehab BBQ

Last Thursday we successfully held our annual lunchtime BBQ for the Rehab Departments.  And we again joined forces with our neighboring Asante Work Health buddies to make this twice as enjoyable.  Even within our own Rehab departments its often hard to get to know one another, so this was a welcome opportunity to sit next to someone we barely know and make friends.  Personally, I got some instruction in gluten-free eating and photography tips.

The weather was perfect, the food was fabulous, and attendence was great.  We cooked about 15 veggie burgers (grilled by yours truly), and around 80 beef burgers (grilled by the out-of-dress-code Mike M.), along with some excellent desserts, salads, dips, and so on.  Our CEO Kent Brown attended and joined our collection of happy staff from both inpatient and outpatient areas.

Our little after-lunch review concluded that we'd finally hit the mark on how to put this all together.  We're already making plans for next year.

Special thanks to Angela K and Carrie W for doing all the legwork to make this come off without a hitch.  Angela also reports that our leftover burgers were donated to Asante's Angel Team, and will be given to needy employee families.  Approximately 20 of our burgers have eased some stress for our own extended family of employees!

For those who asked, here's the recipe for my wife's Korean carrot salad:

This recipe is from the Sunset Oriental Cookbook. You can use the dressing over any appropriate cooked or raw vegetable. I use it for carrot salad.

This amount of dressing is for one serving of vegetables (1 serving = one carrot) :

1 Tablespoon sesame seeds
1 T. soy sauce (I use the low salt variety by Kikkomon)
2 teaspoons sesame oil
1 t. sugar
1t. vinegar (I use apple cider vinegar. You might try using rice wine vinegar that can be purchased at an Asian food store.)
1/16 to 1/8 t. ground red pepper (cayenne)
One green onion (scallion) for every serving of vegetables you make.

Grate the carrot. Chop the onion. Mix everything together and serve. Enjoy!

RVMC Staff at the Senior Health Fair

Hilary talked about our Speech/Language Pathology services, and Michaela was there on behalf of our neuro programs.



Fred was representing the Central Point PT office.



And thanks to the other staff who also did a fine job of showing off our programs!

- Posted using BlogPress from my iPhone