Moving Health Care to the Home

Re: “IHI Lays Out 10 Ways to Radically Transform Health Care” by Marty Stempniak in H&HN Daily, Oct. 7

Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement, is clearly a visionary and health care thought leader. IHI is one of the most influential leaders in shaping the new health care system. I applaud her presentation, but believe that there needs to be an acknowledgement of a shift that needs to happen and will inevitably occur: the shift from hospital- or health system-centric care to health care at home.

Given the aging of the population, the increased numbers of people needing health care, quality challenges and cost from traditional models that are not sustainable, there needs to be/will be a shift to the least costly option. The goal must be to provide services in settings that are equal to or better than existing services.

Thanks to new treatment protocol (chemotherapy to cumin checks), new clinical insights (risk assessment protocols, hospitalization reduction protocols) and, of course, new clinical technologies (telehealth, online education and monitoring), the home is steadily becoming the far better, far less costly option.

The challenge now is to not simply move to health care at home, it needs to be done in a manner that responds to the reality that many of the procedures that are shifting to the home have historically been revenue generators for an already fragile hospital/health system bottom line. Ensuring the financial stability of many, albeit not all, hospitals/health systems throughout the country is not only essential, it is required.

Thoughtful yet aggressive transition to providing services in the inevitable location of the vast majority of clients, health care at home is a must. So, too, is the need to acknowledge that this move must be at the heart of the evolution to the new Triple Aim health care reality. For any wise and strategic hospital or health care system, this reality needs to be at the forefront of their planning. It also needs to be at the forefront in any national or international discussion on the transformation of our health system.

— Bob Fazzi, Ed.D.
Managing partner
Fazzi Associates

Patients Must Take Responsibility

Re: “IHI Lays Out 10 Ways to Radically Transform Health Care”

I believe in these ideas. The underlying challenge that is implied but not directly addressed here is that patients and their families are the primary providers of good health care. Our culture has developed an underlying belief that the doctor, pharmaceuticals (pills), hospitals and insurance programs are the responsible parties for our health. Until patient attitude transforms to self-responsibility, creating a personalized healthy lifestyle and thereby minimizing lifestyle-related diseases, we will always be fighting a losing battle.

Bruce Bainbridge, R.N.

The ROI on RNs

Re: “The Five Key Elements to a Hospital’s Value Proposition” by Kenneth Kaufman in H&HN Daily, Oct. 22

Most consumers see the PRIMARY purpose of hospitals as RN care. For serious conditions, there is no substitute for RN assessments (critical thinking), observations (not just monitoring) and interventions (real time), and working with capable MDs (local and remote).

Most consumers hope to avoid ALL hospitalizations but, if needed, want qualified, caring RNs using best practices/IT that keep us safe — don't infect, harm or kill with med errors — and optimize recovery and transition of care. Why have an exam, test or wellness program in a hospital at 200–400 percent cost of the same service elsewhere?

In the frenzy to redefine themselves and propose new revenue sources, hospitals miss the boat on their core competency and value proposition — top consumer goal — of providing safe and effective life-critical services that cannot be provided elsewhere or by care extenders and IT. Demand for high-touch, high-tech RN care of high-acuity, co-morbid patients will increase with aging boomers, even if more non-acute care is provided outside the hospital, augmented by lesser trained personnel.

In the fee-for-service model, hospitals often lay off RNs as first-line margin management. RNs fail to present compelling data on return on investment for their services. With rare exception, RN services are bundled in room/bed charges, with housekeeping, rendering them as expenses in “corporate thin.” With value-based payment, even if not billable, RN care can be tied to the top line for the first time. RNs should be treated like the valuable, marketable assets they are. Wake up, hospitals!

— Ann Farrell

Hello, Health Plan?

Re: “Open Enrollment Season is Upon Us. What’s Your Hospital Doing to Help Those in Need?” by Marty Stempniak in H&HN Daily, Oct. 23

The enrollment resources provided by hospitals and retail pharmacies can improve consumers’ understanding of health plan basics like costs, subsidies and application processes. As health plans also seek to differentiate their services with value-added services like health and wellness programs and personalized customer care, consumers should consider contacting health plans directly as part of their research.

— David Rauch

Payer offering lead

Xerox Health