News pundits claim this is a time of breathless anticipation.
They’re talking about the Supreme Court‘s decision, due tomorrow, on the constitutionality of the Affordable Care Act. The ruling could transform the landscape of health care.
Regardless of what the chief justices decide, industry changes that underscore the federal law already reflect the coming of the new age of big cuts and revised reimbursement formulas.
While the wait for the Supreme Court decision enters its final hours, Poudre Valley Hospital and Medical Center of the Rockies — like most hospitals in the U.S. — continue on a course set when congress approved the reform legislation in March 2010. No one is waiting around to see if the law will be revised or struck down.
PVH, MCR and the Colorado Health Medical Group (formerly Poudre Valley Medical Group), embarked on a road more than a year ago to provide patients with world-class health care regardless of what health care reform brings about.
Within the health care industry, there’s little doubt that the future business model must include more efficiency, more savings and an improved way of doing things. The movement is prompted by health care reform, but also, significantly, by the market place. The net outcome is that most hospitals are developing strategies to follow now and in the future.
The driving force behind many strategies is a part of health care reform that changes the way hospitals are paid for treating patients. Hospitals have traditionally sought out more patients, since federal reimbursements generally are determined according to the number of patients.
The incoming model, however, provides for a set payment, a fixed amount, to take care of all patients within a community. That will require hospitals and health systems to be more efficient.
If a patient is treated and then readmitted for the same ailment, then the hospital will receive less money. This means a hospital might ultimately become responsible for how patients conform to treatment plans once they leave the hospital setting.
Hospitals that historically relied on sick patients for revenue are now searching for opportunities to keep the general population healthy. Wellness initiatives that encourage people at certain ages to receive diagnostic tests — like colonoscopies and mammograms — improve the chance patients won’t be as sick if and when they use hospital services.
This is a potential win-win for patients and hospitals. Disease is caught earlier, patients receive treatment earlier, and the hospital provides medical intervention before care gets more expensive.
At PVH and MCR, University of Colorado Health’s northern Colorado hospitals, one of the major strategies is to pursue a Lean philosophy and projects that can enhance patient care, standardize processes and protocols, eliminate waste and focus on areas where hospitals add value for patients and the organization.
And like other measures, those projects will continue regardless of what the Supreme Court says about health care reform.
