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“What health care needs is more pit crews, not cowboys.”
When Ben Spedding, DHA, faculty chair for Health Leadership and Innovation at Capella University, says those words, he is referring to the tendency for doctors and surgeons and other highly trained health care professionals to rely on their own experience and expertise rather than lean on a broader team of providers to strategize on care delivery.
But why does it matter? Why can’t we have lone rangers in health care who are excellent at what they do, and just let them do their thing on their own?
Here’s why. Consider these two scenarios:
Scenario 1: A patient needs a knee replacement. Medicare, which covers the patient, pays for the cost of the procedure and follow-up care. Although the total package of care is estimated to cost $50,000 (an estimate for illustrative purposes only), there is no set limit for what Medicare will pay and how long the procedure and recovery will take. As long as the care delivery team believes treatment is needed, Medicare will continue to pay. Therefore, the total cost could be much higher than originally estimated.
Scenario 2: That same patient needs the same knee replacement. Medicare again estimates the total cost of the procedure to be $50,000. In this scenario, however, Medicare sets a ceiling for the total amount it will pay and limits the time frame to provide the care to 90 days. After that time has passed and the $50,000 is spent, that’s it. No more reimbursement will be provided to the hospital or health care facility providing the treatment. Any additional care required will need to be covered by the care provider. Suddenly, the incentive to provide that care in a highly coordinated, efficient manner takes on new importance.
That new scenario, often referred to as bundled payments, is being ramped up by Medicare, and increasingly private insurers are following suit. This represents a sea change in health care and its payment structure. According to Spedding, under this new reality, unless health care professionals up their games and come together as one highly coordinated, collaborative, efficient machine, the health care organizations they work for could be at serious financial risk.
“Health care payers are increasingly dropping their fee-for-service payments, and instead paying only a lump sum,” Spedding says. “One of the critical ways health care providers can respond to this is to put renewed focus on communications – between doctor and patient, between doctor and nurse, between physical therapists and care coordinators. Everyone. They all need to talk about expectations. They need to talk about next steps. They need to talk about potential complications. It’s critical that everyone understands the game plan.”
Spedding provides a simple example of how health care organizations can operate in a much more coordinated fashion – checklists. In other industries, the use of checklists is commonplace if not mandatory. Think of pilots and their pre-flight checklists. However, according to Spedding, the use of checklists in operating rooms, for example, is far from universal. He argues it should be.
“A checklist can be fairly basic and straightforward, but it can also be incredibly powerful in aligning everyone on a health care delivery team to the game plan and avoid simple but often life-threatening mistakes,” Spedding says. “Simply verifying that the team has all the equipment they need, that everyone is there who needs to be, that they are ready and have no questions before you begin, can be huge.”
The amount of information that health care professionals now know about their patients can be staggering. Electronic health records can provide a detailed view of not only patients’ health history and care received, but, more importantly, what their behavioral characteristics look like. Are they self-starters who take control of their rehabilitation plans? Are they forgetful about taking their medications? Do they come to every appointment religiously or do they skip every other one? In other words, those records can tell us who is likely to be successful following treatment plans and who needs more help. When a health care team uses and shares that data and develops a coordinated care plan that takes those factors into account, the results can be powerful in terms of successful outcomes – and also in cost savings.
“Not only does the health care organization save money when data and technology are leveraged by the whole team, but also patients don’t receive extraneous care,” Spedding explains. “It’s truly a win-win. But it only happens when everyone on the team takes a coordinated approach to data. Let data inform the team about what they need to do, how they need to do it, and, importantly, what they don’t need to do. The days of one-size-fits-all health care need to be over.”
“All of these cowboys in health care, no matter what their level of skill, need to embrace the idea of being more open to a team mentality where we share all of the data and knowledge at our fingertips,” Spedding concludes. “They need to care about what others have to offer: their opinions, their ideas, their concerns. We all need to be more inquisitive and let go of the belief that any one of us can know it all or go it alone. We can’t. Those days are gone.”
Explore the critical issues facing the health care industry with an online degree in health administration from Capella University.