Page 59 - 2013 Hospitals/Systems Digest US.NMH.13.02.007
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59
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
HOSPITALS/SYSTEMS DIGEST 2013
LOOKING FORWARD
Even as the Affordable Care Act (ACA) focuses on
provider organization and pay structures, patients
are starting to see new systems that impact not
only how they receive care, but also how they
gather information about specific hospitals.
As the Centers for Medicare and Medicaid
Services (CMS) creates strategies to maximize
financial efficiency and promote healthier
outcomes, it has been gathering data to measure
and compare hospitals’ quality of care. Although
one of the initial uses for the information is to
establish a system for the distribution of financial
incentives and penalties, CMS has made the
data publicly available (
gov/HospitalCompare), enabling patients to use
the information to conduct their own research
and proactively choose a facility based on its
longstanding track record of care.
Among the facility-level measures gathered by
CMS are patient satisfaction, hospital readmissions,
hospital-acquired infections, care for pneumonia
and heart attack patients, and 30-day mortality.
Although the information offers broad insight into
the routine quality of care at various facilities,
some hospitals have voiced concerns about
whether the measures paint an accurate picture.
3
For example, a hospital’s patient demographics
or treatment focus can skew perspective on
certain data, such as comparing an acute-care
community hospital with a facility that maintains
a long-term care or rehabilitation segment.
As the government continues to emphasize
hospital transparency, facilities will have to adjust
to the public’s heightened access to details about
delivery of care, even as hospitals find ways to
coordinate care across expanding networks.
Hospital Transparency Increases Patient Access to Data
LOOKING FORWARD
1
Association of American Medical Colleges. (2012). AAMC Physician Workforce Policy Recommendations. Retrieved from
2
The Physicians Foundation. (2012). A Survey of American Physicians: Practice Patterns and Perspectives. Retrieved from
3
Rau, J. (2012). Experts Question Medicare’s Effort to Rate Hospitals’ Patient Safety Records. Kaiser Health News. Retrieved from
.
kaiserhealthnews.org/stories/2012/february/13/medicare-hospital-patient-safety-records.aspx
Amid increased pressures to control costs and
more efficiently manage patient care, providers
are also charged with addressing the needs of
a growing and aging U.S. population, even as
the total number of physicians is not expected
to maintain pace. In fact, the Association of
American Medical Colleges predicts that by
2020, the shortage of physicians will swell nearly
58%, to 91,500 from 58,000 in 2012.
1
Consequently,
alternative solutions to offset this provider
deficit are gaining popularity, especially in the
patient-centered medical home (PCMH) setting,
where coordination of care is of primary concern.
The PCMH model can accommodate “open
scheduling” using provider pooling, which makes
multiple caregivers available to see patients
either on the same day or within 24 hours of the
requested appointment. This approach to patient
visits relies heavily on the use of electronic health
records for coordination of care and likewise
increases the overall visit capacity. On average,
physicians currently report being able to see 11 to
20 patients daily, a volume that already leads to
long hours for many: 26.1% of surveyed providers
reported working between 51 and 60 hours per
week.
2
Additionally, the use of nonphysician
providers like nurse practitioners and physician
assistants—a tenet of the PCMH model of care—
may soon become crucial to meeting the growing
medical needs of an aging patient population
while limiting the impact on physician workload.
Although open scheduling and diverting patient
care to nonphysician providers may help to offset
the immediate demand on physicians, maintaining
accurate and accessible patient records is key to
any long-term solution for the eventual physician
shortage. As the shortage of providers becomes
more apparent, the core principles of PCMHs
should gain momentum in many circles and move
to the forefront of the health care discussion.
PCMH Model Provides Options as Physician Shortage Looms
