Wednesday, April 27, 2011

Prior Predicition Appear as Today's Realities

Two articles pasted by my computer this week which caused me to recollect blogs that I have published over the last several year, making predictions that now appear are becoming today's realities in  health care delivery.
The first article stated that "As technologies empower patients to control their health care journeys, hospitals may downsize to the point where they will povide only advanced trauma and critical care. Declining inpatient and increasing outpatient business are signals of the impending change". In previous blogs I gave numerous reasons why hospitals and healthcare systems should be moving to increase their services lines in the non-acute programs, including home care, hospice, palliative care, and even retail services, along with the more traditional outpatient offerings. Some of the reasons for these changes included:
       >The increasing development and use of non-invasive technologies
       >The increasing safety of anesthesia and surgical techniques exploding the use of ambulatory surgical centers doing procedures now not even requiring a one night stay
       >The expanding use of outpatient cancer treatments because of the decreasing toxiciiy of the drug therapies
       >The ability of many invasive cardiac procedures to be delivered in an outpatient setting
       >Trauma becoming the leading cause of death in people 57 years and younger and moving higher. As I indicated before, trauma was the leading cause of death in children 7 years and younger when I trained, the significant rise casued by our abilities now to identify and treat diseases which killed many people in the past at a much younger age.

All these reasons are still valid, and cause one to suggest that all leaders of healthcare today should ask two important questions:
       1. Are we creating the hospital of the future rather than supporting the hospital of the past?
       2. Are we allocating a sufficent portion of our capital to developing and implementing non-acute service lines?

I strongly believe that both of these questions must be answered in the affirmative if a sustainable healthcare delivery system is to be achieved which can providethe high quality, low cost care which is imperative for future sucess.

The second article stated that "cat scans are used 30% more in Pediatric Emergency Rooms where they are readily available with no proof that the treatment outcomes are better". As you have read in numerous of my previous blogs, I have reitierated that the high cost of healthcare in the United States is due to overuse of equipment and studes, and not misuse or underuse. I also have written that many studies get done because we can do them, not because we should do them. They get done, as is the case in these pediatrics ERs, because the equipment is available. Oh we know that some parents demand that the studies be done, and physicians say that they need to do them to minimize their exposure. But this probably accounts for only 5% of the overuse. What about the other 95%? Could it be due to the need for us to maximize our revenues?  Over 30 years ago in the Emergency Dept. at the Geisinger Medical Center we proved that skull xrays did not alter the treatment plan or medical outcome in children who had mild head injuries with no physical skull deformity and no history of being unconscious. So we stopped doing them! Changing the present trends will not be easy, but the answer is clear. Treatment plans must be driven by evidenced -based protocols which drive high quality and low costs which are aligned with the best reimbursement for both hospitals and physicians!

It is clear, by studying the past and the present, some future predicitions can be made, that can become the reality quickly. Will you be ready?

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