It Has Been An Interesting Year

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Bruce KnepperBy Bruce Knepper AIA

It has been an interesting year for healthcare.

As December draws to a close I would like to take a moment, look back, and see just what on Earth happened!

We have a new form of healthcare payment; remember Medicare and Medicaid have been around for some time so taxpayer-funded healthcare is not new.

We have a hard push for hospitals to follow the essence of the Hippocratic Oath, “First do no harm,” and be accountable (pay for) problems that arise on their account.

We have rankings and ratings and patient opinions that indicate how well hospitals are performing.

We are dropping medical service lines that are no longer financially viable.

The community hospital is most often affiliated or owned by someone other than the community.

I think it is official . . . Healthcare is now a business.

I have seen many changes over my 35 years in this profession. The current market changes offer a chance to improve OUR healthcare.  Never forget we will all someday be the patient!

We are deep in the information age.  I can easily access rankings, ratings and even costs.  I can find fantastic information about my health.  It is only a matter of time until an outfit like Angie’s List has this information.  We will personally, for the first time, be required to be serious about the cost.  The out-of-pocket cost for the average consumer is escalating and is now a significant item in every family’s budget.  We as a society have more or less followed our physicians’ instructions and facility choice.  This new cost awareness will change that model and we will, more than ever before, follow the dollar.

The hospital of the future will have significantly fewer acute care beds and have a predominance of critical care beds.   The cost model is a push to limit inpatient acute care as much as possible. We have seen this with the CMS observation status changes.  My mother believes she was an inpatient because she stayed overnight; that is no longer the case, is it?  Technology and homecare nursing will allow many of us to go home early or not be admitted at all.   Maybe the house call is back?

I have recently heard that we should bring back the three-bed ward.  Before you jump off the roof, think about the travel time for the nurses between two rooms vs. six or the cost to build six rooms vs. two.  With the nurse in your room more, would your perceived care improve?  With cost being a driver and margins being so tight, this might be something to consider.  It is a tradeoff between privacy and cost – it might just be our future to join the rest of the world- placing a premium cost on the private room while staying in a ward is a part of your basic insurance plan.

Large employers are striking deals with healthcare providers to entice employees.  These deals create reduced costs for the employer and often the copays are eliminated for the employee.

We need to seriously improve the efficiency of our hospitals and clinics, meaning we have to provide the care for fewer dollars.   NASA has adopted the “Faster Better Cheaper” mantra with some success.  It might be the catch phrase for Healthcare 2014.   I think by now every hospital is embracing some form of the Lean Process and many have had success.  If not, this is the year to do so!

Will our new providers be Walgreens and Wal-Mart?

I believe in 2014 we not only need to think outside the box, but we need to throw the box out and find innovative solutions to providing the finest healthcare in the world – at an affordable cost.   Some suggestions:

Retail healthcare locations – Ross Park Mall Medical Associates, anyone?

Internet medicine (telemedicine, but at home). Can we use technology to keep us healthy?

Bring back the patient ward (did I really say this again?).

Eliminate the insurance barriers to a free market for everyone. Remove the employer from the mix and purchase the plan as you do car insurance.

Enable PAs and LPNs to do more.

Educate the public that they are responsible for their own health (put down the biggie fries and go for a walk!).

Provide transparency of cost and quality metrics to the public.

We will finally learn to wash our hands.  Thanks mom!

Being the best will include; quality and cost somehow balanced with the patient experience.    Transparency will be the buzz word.

I am sure that 2014 will prove to be a defining year and just as interesting as 2013.

Bruce Knepper is a registered architect and Vice President of Healthcare East at Stantec. Bruce works out of the Butler, Pennsylvania Office and can be reached at bruce.knepper@stantec.com.