4/8/2015 Increasing health care costs at an unsustainable rate - PDF document

4/8/2015 � Increasing health care costs at an unsustainable rate � Lack of access to health care � Payment based on fee-for-service vs. quality ◦ Potential overuse or misuse of spending � Ordering unnecessary tests Darci Becker, PhD, CCC-SLP, BCS-S � Varying rates charged for procedures Assistant Professor, MSLP program, St. Ambrose University � Patients admitted to hospitals could be managed as beckerdarcil@sau.edu outpatients or not discharged as soon as medically Speech-Language Pathologist, Genesis Medical Center beckerd@genesishealth.com stable ◦ Widely varying treatment patterns � March 2010: Patient Protection and Affordable Care Act (ACA) & Health Care Education and ◦ “Triple “Triple Aim of “Triple “Triple Aim of Reform” Aim of Aim of Reform” Reform” Reform” Reconciliation Act (HERA) signed into law � Vision ◦ Reductions in payments Improve Improve the patient Improve Improve the patient experience of care the patient the patient � � Much of the change occurring in acute care � Quality Quality Quality Quality ◦ Penalties � Satisfaction Satisfaction Satisfaction Satisfaction � Hospital-acquired infections Improve the health Improve Improve Improve the health of populations the health the health � � Readmissions Reduce Reduce the per capita cost Reduce Reduce the per capita cost the per capita cost the per capita cost of health care � � Wrong procedures � Means ◦ Incentives � Move from fee-for-service model to pay-for-performance � Outcomes � More changes with each passing year � Good intentions to improve patient care and � There is enormous opportunity to eliminate waste in US There is enormous opportunity to eliminate waste in US There is enormous opportunity to eliminate waste in US There is enormous opportunity to eliminate waste in US health health c care are health health c c are are reduce healthcare costs with ACA regulations ◦ Potential sources of waste include � Because of growing, critical shortfall of � Failures of the Care Delivery healthcare professionals: Lack of adoption of best care processes best care processes best care processes best care processes � � Failure of Care Coordination Care Coordination � Increased patient wait times Care Coordination Care Coordination “Patients fall through the slats of fragmented care” � � Shortened patient time with caregivers ◦ Overtreatment � Decreased patient satisfaction � “Subjecting patients to care that according to sound science and the � Increased workloads and documentation demands Increased workloads and documentation demands Increased workloads and documentation demands for Increased workloads and documentation demands patients’ own preferences, cannot possibly help them” employees E.g. Excessive antibiotics, intensive care at end of life � � Increased patient acuity Increased patient acuity Increased patient acuity Increased patient acuity for employees E.g. Dementia patients and holding food; rehabilitative model is not � beneficial � Reduced staff due to necessary layoffs ◦ Administrative Complexity � Greater employee stress, dissatisfaction and burnout Greater employee stress, dissatisfaction and burnout Greater employee stress, dissatisfaction and burnout Greater employee stress, dissatisfaction and burnout � When government, accrediting bodies, payers etc. create inefficient and � Increased potential for safety events Increased potential for safety events Increased potential for safety events Increased potential for safety events misguided rules � Ethical dilemmas Ethical dilemmas between employees “following their moral Ethical dilemmas Ethical dilemmas ◦ Pricing Failures conscience and obeying potentially immoral orders of their � Prices exceed actual costs and fair profit superiors” ◦ Fraud and Abuse 1

4/8/2015 � “…health care, and especially the economics economics economics economics Allowable Allowable Allowable Allowable ”nonproductive time” reduced of health care, will be undergoing of health care, will be undergoing a dramatic of health care, will be undergoing of health care, will be undergoing a dramatic a dramatic a dramatic Time Time before patients transitioned to Time Time change over the next several years. Although change change change next level of care decreased decreased decreased decreased momentum for these changes has been developing over the past decade, concrete changes in health care delivery and payment changes in health care delivery and payment changes in health care delivery and payment changes in health care delivery and payment are imminent are imminent.” are imminent are imminent Documentation demands Documentation demands Documentation demands Documentation demands increased increased increased increased Amount of time required to sift time required to sift time required to sift time required to sift through all the evidence through all the evidence through all the evidence has increased through all the evidence increased increased increased � Ad Hoc Committee formed � Recommendations focused efforts on five areas: ◦ Met throughout 2013 ◦ Re Re- Re Re - -framing/re - framing/re framing/re framing/re- - -branding the profession - branding the profession branding the profession branding the profession ◦ Produced a 21 page report in December 2013 ◦ Reconsideration/expansion of the clinical paradigm � http://www.asha.org/uploadedFiles/Reframing-the- ◦ Quality and outcomes measures and management Professions-Report.pdf#search=%22reframing%22 needs ◦ Professional preparation ◦ Member education and widespread dissemination of information IMPROVE DOCUMENTATION � Information CARE � Strategies COORDINATION � Overall Overall Overall Overall Aim Aim Aim of Reframing the Professions Aim BEST CARE PRACTICES ◦ Provide value value to individuals with communication and/or value value feeding/swallowing disorders � “deliver services that improve functional outcomes improve functional outcomes improve functional outcomes improve functional outcomes that FUNCTIONAL matter to clients’ everyday lives…with a high degree of high degree of high degree of high degree of GOALS patient/family satisfaction and is cost effective”… patient/family satisfaction and is cost effective patient/family satisfaction and is cost effective patient/family satisfaction and is cost effective COST- EFFECTIVENESS BETTER OUTCOMES 2

4/8/2015 � “Evidence based decision making involves the use of best evidence best evidence best evidence best evidence, best clinical judgment best clinical judgment and the ethical imperative to select best clinical judgment best clinical judgment ethical imperative to select ethical imperative to select ethical imperative to select interventions (using best evidence and judgment) that conform with interventions interventions interventions that conform with that conform with that conform with the patient's values and expectation the patient's values and expectations, and to collaborate the patient's values and expectation the patient's values and expectation collaborate collaborate with the collaborate patient in selecting the most appropriate intervention. ” Cheers, James L. Coyle James James James L. Coyle L. Coyle L. Coyle, Ph.D., CCC-SLP; BRS-S Assistant Professor, Communication Science and Disorders Level I Evidence from one well-conducted randomized Level I randomized Level I Level I randomized randomized ◦ Recognize that’s the case Recognize that’s the case Recognize that’s the case Recognize that’s the case clinical trial ◦ Form a theory theory or working hypothesis theory theory Level II- Level II Level II Level II - -1 - 1 1 1 Evidence from one well-conducted study with controls but without randomization Level II- Level II Level II Level II -2 - - 2 2 Evidence from one well-designed cohort or 2 case-control study preferably from independent researchers Level II- Level II -3 3 Evidence from multiple time-series single- Level II Level II - - 3 3 subject investigations or dramatic results from non- controlled experiments Level III Level III Opinions of authorities, Level III Level III Opinions of authorities, Opinions of authorities, Opinions of authorities, descriptive studies, case studies, reports of expert committees Section 1 Task Force of the Division of Clinical Psychology of the American Psychological Association Task Force (1998) � Takes EFFORT! � 1. Spend a little time reading the literature 1. Spend a little time reading the literature 1. Spend a little time reading the literature 1. Spend a little time reading the literature regularly regularly regularly regularly � Takes TIME! ◦ SIG 13 community forum � Little to NO time during the typical work day in many healthcare settings � Be a critical consumer of this information � Save relevant posts � Categorize by topic � Reference manager software options available � Perspectives � Current and clinically relevant summaries of the literature � CEUs ($5, 2.5-4 hours) 3