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As the weekend approaches, here is an interesting exercise to undertake.  Imagine yourself as a hospital CEO in a board meeting and the trustees pose this question:

Describe a new healthcare system that will result in lower costs, higher quality care, and improved patient safety.

What will you say? 

I am not looking for a plan that is essentially the status quo with less regulatory interference and more money from CMS and the commercial payers.  Nor am I looking for solutions built around “drop kicking” the problem to a public, tax-supported entity, such as EMS, for example.  That would be too easy.  Besides, that isn’t going to happen.  I am talking about a healthcare model that is dramatically different from the one we operate today.  The Affordable Care Act and other healthcare reform initiatives—plus deficit reduction efforts—will likely push the nation to a decade of government austerity in an effort to avoid a Greek-styled near death fiscal crisis.  This will dramatically impact healthcare.  So this is more than just a little hypothetical exercise.  It is entirely probable that we will be forced to do this—for real.  

Here are some questions to help get the process started. 

  • What does population health management mean to you, and how will that impact a hospital’s business over the next three to ten years?  What new resources will you need to develop?  What type of facilities will you build, what will your manpower needs be?  Same for management information systems?  How will you deploy your clinicians in the market to maximize effectiveness and revenue — physicians, nurse practitioners, techs, pharmacists, etc
  • How will you handle inpatient services in terms of facility design, manpower and technology — large medical centers focusing on critical patients, or smaller specialty disease-focused facilities?  Will your health system be more, or less, reliant on inpatient services
  • What role will home care/visiting nurses play?  How will you integrate pre-hospital care/emergency medical services, sub-acute and long-term care?  It is not fair to assume that fire department EMS services, a highly inefficient public safety model, will do anything more than they are doing now — transporting “emergent” patients to emergency departments even though studies show that EMS agencies that have pre-hospital care programs dramatically reduce the number of chronic “frequent flyer” patients who are frequently medically indigent, and millions of dollars in emergency department spending
  • What regulations will need to be eliminated or modified to permit innovative, patient/physician-centered relationships that incorporate incentives that will reward high quality, and safe healthcare at a lower cost 

© 2012 John Gregory Self