Thursday, July 10, 2014

Changing Roles for Hospital

Our hospitals have been, traditionally and intentionally, places that fix people who have health problems.  As a reward for the fix, hospitals were paid very well by insurance providers.  In the early days, many hospitals were paid 100 percent of what they billed.

Then Medicare came along and started paying based on what were called Diagnostic Related Groups (DRGs).  Procedures were carefully coded by the hospital to get maximum reimbursement for as many DRGs as could possibly fit the patient and the treatment.

Today, Medicare wants to pay hospitals based on the performance of the hospital, its success in treating a patient. If too many patients are readmitted to the hospital within thirty days of discharge, the hospital is penalized in  reimbursement for services rendered. Hospital are also penalized if their infection rates were above a certain level for infections from catheters and from central lines, such as intravenous tubes.

Tomorrow, hospitals will be reimbursed based also on the health status of the community, based on how long and how well people live as well as on obesity, smoking, and other health factors in the population.

Some hospitals have made this transition by being a part of an Accountable Care Organization (ACO). Other hospitals are doing what they can to make the transition.

Hospitals are not meant to take on the burden of community health status on their own.  They are a part of a team, including public health organizations, municipalities, major industries and businesses, schools, universities, restaurants, grocery stores, banks, and other organizations in the community.

For too long, hospitals and physicians have been the upfront players in health care.  They will still be on the stage, but need to have many supporting actors to improve health status, reduce obesity, and get smoking eliminated altogether.

Some see this as a "social" agenda or even as a "socialist" agenda.  It is simply people helping other people in their community to live long, healthy lives.

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