After spending the last two weeks traveling in Europe on business, it feels really good to be home again. Watching the US elections play out on international television while in a time zone 9 hours ahead of home was a particularly memorable part of the trip.
So now with the reelection of President Obama, the Patient Protection and Affordable Care Act of 2010 is pretty much etched in stone, and the American healthcare system must come to grips with lots of change over the next few years. Personally, I do feel a bit more protected by Obamacare. However, the “affordable” part still escapes me. All I see is American corporations passing on more and more costs directly to their employees while the cost to both employees and employers continues to escalate. Having just priced equivalent high-deductible health insurance coverage for my wife and I should I leave my current job, I find it would easily cost $1500 to $2000 a month. What’s “affordable” about that!
The Patient Protection and Affordable Care Act places plenty of burden on hospitals too. They are charged with increasing care quality, providing more access to more people, and doing so at a lower cost. Most healthcare executives I meet say they are being asked to do more with less. While that is true, I would prefer to look at it another way. The secrete to surviving under the auspices of the Affordable Care Act will be to do more, by doing new with less. Here are a few examples of the things that need to be done. And yes, part of the solution is prudent use of new information communication technologies (ICT).
Measure. Whether it is comparing outcomes for a particular surgical procedure, or analyzing patient satisfaction, you cannot improve what you can’t measure. The most progressive and cost effective health organizations today are constantly measuring what they do and comparing their results with best practices from other leading organizations. This drives continuous quality improvement., standardization, improved efficiencies, and lower costs.
Eliminate Waste. If you look closely at hospital design and operations, you’ll likely find lots of waste. For example, how much space do you allocate for patient “waiting rooms”? Why do you even have waiting rooms? High performing healthcare organizations have taken a lesson from lean manufacturing. The waiting room not only wastes valuable space, it points to wasted time. Wasted time for your patients, and wasted through-put for their treatment in your facility. By measuring time and carefully analyzing work-flow (often with real time location services or RTLS technology) lean organizations have been able to increase patient through-put without increasing staff or space, and this lowers costs per unit of volume.
Virtualize. If hospital revenue really shifts from volume-based care to value-based care (outcomes), then it makes sense to virtualize as many of your services as possible. Banks and retail centers did this long ago. Some of the best-known, staff model health maintenance organizations in America have already been able to virtualize 20 to 25 percent of their primary care volumes. If you can meet a patient’s need for information with an e-mail instead of a personal visit; if you can provide a quick postop check with a video chat; if you can help manage a chronic disease with an app on a patient’s Smartphone (and you get paid based on outcomes and value, not volume) then virtualization is a very good thing. Imagine freeing up your space and staff just for those patients who really need to be there in person.
Put Patients First. Healthcare has traditionally been designed to meet the convenience and needs of its providers. A new era is dawning in which the patient is now being placed at the center of care. Organizations that put patients first, will benefit from higher levels of patient satisfaction. Higher patient satisfaction scores (a measurement required as part of stage 2 meaningful use reporting) will result in higher payments from government payors. Healthcare organizations that strive to organize everything they do around meeting the needs of the patients, will please their patients more and receive higher revenues for what they do.
I suppose another idea would be to take a lesson from government itself on how to increase revenues—perhaps selling lottery tickets or even pot (now that voters have made it legal in Washington and Colorado). You might even be in a great position to make the case that marijuana sold on your premises was for “medical” purposes only. OK, I’m totally kidding on that one. But for sure, healthcare organizations will need to fundamentally change the way they do business in the years ahead if they hope to survive. The appropriate and creative use of ICT can be applied in each of the areas I’ve outlined above to help take you where you need to go. Let us show you how to do more by doing new with less.
Bill Crounse, MD Senior Director, Worldwide Health Microsoft