Biology Reference
In-Depth Information
Costs: If all these steps can be successfully tied together - quality outcomes, safety, and
patient satisfaction - the ultimate result should be efficient and lower cost of care. With our
improving results and quality of care, our patient care expenses have been reduced. The
problem with government and bureaucratic unfunded directives is that they have forced
hospitals to behave like regulated businesses always looking at the cost/revenue aspects and
the ability to meet directives. For example, 70% of a hospital's costs are staffing related and if
they must meet certain nursing ratios, the cost of care is driven up. Other examples of
government regulation affecting patient care include time spent entering data in into electronic
medical records and the need to meet building code regulations which makes wards more like
hotels and may not necessarily result in better care. For example a study was done in
California that the top rated hospitals were those where a patient was more likely to die. Why?
One obvious reason was that to improve health a patient needs to get out of bed as soon as
possible and do painful exercises to prevent complications. This is not pleasant and affects so
called HCAPS scores, but if patients are allowed to lie in bed and take it easy and watch TV,
this is a better patient experience but can result in a higher risk of death - despite the greater
comfort. To meet these new directives and patients' expectations, hospitals are spending huge
sums of money and driving up the cost of care.
By comparison, at Shongwe the doctors, including my father, determined what needed to be
done for patient care and then did the best they could, which was excellent and saved many
patient lives for very little cost. American hospitals, administrators are increasingly told what
to do, what the requirements are to get paid by the government, an increasingly larger payer
that will continue increasingly foot the bill, and have payment held back for quality measures
(QPSI). The result is that these administrative requirements and directives are passed down to
doctors who are told how to manage patients, apart from the greater scrutiny of doctor related
costs and productivity performance. The direct costs related to care and the indirect costs
related to building codes, staffing requirements, “quality” metrics, and meeting these directives
rapidly adds up. Thus, this has created a situation where bureaucratic decisions made in
Washington have an undertone of forcing doctors to potentially go down the road to ration
care. The irony is that while Washington has become involved in patient care in the hope of
controlling cost, the opposite has happened, and costs are increasingly driven up by mandates.
It would be difficult to separate out the individual factors, such as new technology, or the
increasing number of baby boomers getting older and needing care (in total 77 million),
mandated costs, medico legal costs and which is the biggest drivers. It cannot be blamed on the
increasing prevalence of disease in the population because cardiovascular disease, one of the
largest expenses and most frequent killers (about a million people a year), is declining.
Currently, about $102 billion per year (2010) is spent on cardiovascular disease, $73 billion
on cancer, and $109 billion (direct and nursing home) although only $11 billion by CMS on
dementia (4.1 million people in USA) but the total cost to society is $210 billion. Nor is it
related to cancer or infectious diseases or trauma such as motor vehicle accidents since these
are stable or also declining nor doctors because their reimbursement is declining. Whether
accountable-care organizations (ACOs) will be able to have any major effect will remain to be
seen.
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