Healthcare News & Insights

8 rules to navigate new healthcare landscape

467135639Hospital executives have many concerns to address. One of the biggest ones is: How can my facility survive with all the healthcare delivery changes coming down the pipeline?

One way is by focusing on evidence-based best practices.

Paul Keckley, managing director at the Navigant Center for Healthcare Research and Policy Analysis, wrote an article for the American Hospital Association’s Hospitals & Health Networks magazine outlining some new rules hospital executives should keep in mind when it comes to all the recent healthcare changes.

Keys to remember

Keckley challenges hospital executives to think beyond what they know as the norm and start considering what they need to do so their facilities can adapt to the new environment. The rules are:

  1. Health care doesn’t have to be local. Previously, almost all healthcare delivery took place within close proximity to the patient, unless there were extenuating circumstances. But insurance networks are changing to the point where it may be more beneficial for patients to seek care farther away from their homes, whether it’s to save money or get more comprehensive care. Hospital executives should examine their market and patient mix to find out who’s leaving to get treated elsewhere and why.
  2. Physicians are business partners. It’s important for executives to treat doctors as equal partners when it comes to patient care. And it’s equally crucial to hire physicians that will best help your facility reach its goals, both in terms of finances and meeting quality benchmarks. Doctors should have just as much at stake in the risks and rewards of healthcare delivery as the top brass.
  3. Employers are activists. Before the Affordable Care Act (ACA) became the law of the land, employers were fairly passive when it came to the health of workers who participated in their health insurance plans. But since they have a bigger financial burden now, they’re more concerned with their employees’ health care and how it’s administered, especially when it comes to their company’s share of the cost.
  4. Insurers are partners. Hospitals and other healthcare providers are working closely with payors under various shared-risk arrangements, where both entities share in any cost savings achieved by providing high-quality patient care. This also means that each party assumes equal responsibility for any issues that arise. These types of collaborations are gradually becoming the rule, not the exception.
  5. Risk is now about unnecessary care, not just fraud. In the past, the only thing hospitals had to worry about was that they weren’t intentionally billing for services they never gave to patients. Now, all treatments patients receive are being closely examined for medical necessity. And even if hospitals provided the services, they won’t be reimbursed if they’re deemed unnecessary – or if they were administered because of a hospital’s carelessness, negligence or even a simple error.
  6. The business is all about health. Instead of providing patients with health care when they’re ill, now healthcare delivery is all about preventing them from getting sick in the first place. So creating partnerships with primary care providers, mental health specialists and other community organizations may be the best bet moving forward. That way, you can easily direct patients to resources to keep them well.
  7. Consumers (patients) are customers. Patients never used to question their health care. Whatever a doctor or specialist told them to do, they did. Now many patients have more information available to them about their health, and they pay a larger portion of their healthcare costs out of pocket. So they view health care as more of a business decision, and it’s crucial for hospitals to get them to see the value of their treatment. This may mean treating them more like consumers instead of patients when it comes to marketing and other outreach efforts.
  8. Funding is capped. Medicare and Medicaid have already announced that they’re only going to reimburse hospitals a set amount for certain procedures, regardless of any complications that arise. Other payors will likely follow suit. And due to the recent expansion of insurance coverage under the ACA, hospitals are getting less money from the feds for charity care. So there are financial constraints all around. Survival means looking into alternate resources for funding, as well as considering non-traditional sources to generate revenue.

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