Problems_in_U.S_Health_Care_System

Problems in U.S. Health Care System Staci Berry MHA614: Policy Formation & Leadership in Health Organizations (NDD13310A) Instructor: Judy Roberts April 14, 2013 Problems in U.S. Health Care System In this paper we will discuss some of the major problems facing the U.S. health care system. This paper will talk about how these problems are affecting individuals in society today. In this paper we will discuss these two problems facing the U.S. health care system, the lack of coordination of care as well as the duplications of efforts. We will research each of these problems and explore strategic options as well as specific recommendations for change. There are many problems facing the U.S. healthcare system. These problems include issues with managed care, access to care, issues with long term care, as well as quality patient care. There are so many issues within our healthcare system that it is in need of makeover. Politics plays a huge role in what policies are implemented and which ones are not. Many times politics creates so much red tape that has to be gone through that many policies to improve health care are never heard or seen by those of importance. There have been many attempts at trying to fix the problems with the health care system. “The country has been on the verge of national health reform many times before. In the early 1900s, smaller proposals began to pave the way. In 1912, Theodore Roosevelt’s Bull Moose Party campaigned on a platform calling for health insurance for industry; and as early as 1915, Progressive reformers ineffectively campaigned in eight states for a state-based system of compulsory health insurance” (kff.org). Many of the efforts that have been attempted have resulted in nothing but failure. The costs of health care coverage is continuing to rise which is making it more and more difficult for Americans to be able to afford any type of health care coverage. With the economy in the mess that it has been in there are many individuals that have lost their jobs resulting in them also losing their health care coverage. Many individuals do not have any type of health care coverage and are not able to get the medical treatments that they may be in need of.  Not having health care coverage can lead to a person not getting preventive care as well as not getting treatment when they are sick. Many times when an uninsured person gets sick and is not able to go to the doctor they wait until they are so ill that they have no choice but to go to the emergency room. This often times leads to extended hospital stays that the patients cannot afford as well.  Quality patient care is another area where there are problems. Research has shown that in many cases patients are not getting good quality care. “Over 90,000 Americans with conditions such as high blood pressure, diabetes, and heart disease die each year because they don’t receive the type of care that research has shown to work best for their condition. For details, see The essential guide to health care quality and State of health care quality 2004 by the National Committee for Quality Assurance”(OEBB). Unfortunately, there are many medical mistakes that are being made that can and do cause serious injury to patients.  “Historians debate the many reasons why National health insurance (NHI) proposals have failed, including the complexity of the issues, ideological differences, the lobbying strength of special interest groups, a weakened Presidency, and the decentralization of Congressional power. While short of NHI, major health reforms have been enacted in the past fifty years that have proved to be broadly popular and effective in improving access to health care for millions through Medicare, Medicaid and the Children’s Health Insurance Program. Important lessons can be gleaned from how these major reforms were accomplished, as well as the attempts to achieve NHI—lessons that may lead to new health reform paths while steering us away from previous mistakes” (kff.org).  The first problem that we will discuss is lack of coordination of care. The reason that this is a problem is “because the systems have been set to benefit physicians” (Toussaint, 2012). These systems need to be set up to benefit patients and to ensure that they are receiving quality patient care. “Doctors are busy people. They tell themselves that they must organize their patients for maximum efficiency in order to get everything done.  If that means visiting a hospitalized patient before dawn, when the patient is too groggy to communicate effectively so be it. If an important surgery needs to wait a week until the doctor is doing three other similar surgeries — that is business as usual” (Toussaint, 2012). Physicians are busy people but without the patient they would not be. When dealing with a hospitalized patient it may be more convenient for the doctor to see this patient at very early hours however by doing this the patient may not completely understand what is being said to them. It is important for the patients to be able to understand what is going on with them as well as any treatment suggestions that physicians may have. In some instances it may be more beneficial to the patient and the physician if they speak with the patient later on in the day. Another way that could possibly help with this situation is by employing Medical Home. What is Medical Home' Patient Centered Medical Home helps to get patients involved in their own healthcare. Patient Centered Medical Home is currently being implemented by many health care organizations. In a physicians office there will usually be a Patient Care Coordinator that is there to talk with patients. These individuals are there to help patients better understand their illness as well as their treatment options. The patient care coordinator is there also to help teach patients that have been newly diagnosed with things like diabetes give themselves their insulin injections. They also provide information regarding things that the patient should and should not be eating with this particular disease. By utilizing patient medical home it ensures that patients that are in need of care do not fall through the cracks and helps to ensure that patients take part in their own health care. When discussing Patient Medical Home with individuals for the first time they may wonder where the facility is, the facilities hours as well as services offered. Patient Medical Home is not a hospital, building of any sort or a home health agency. “The Patient Centered Medical Home is a health care setting that facilitates partnerships between individual patients, and their personal physicians, and when appropriate, the patient’s family. Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner” (NCQA, 2011). By having a patient care coordinator in the physicians office this makes it easier to ensure that the patient understands the illness and is fully capable to be able to administer any medication that they may need on a daily basis. Patient care coordinators also follow up with patients to make sure that they are taking their medications as well going to follow up appointments. Patient care coordinators also follow up on patients that may have recently been in the hospital to ensure that they have scheduled a hospital follow up appointment with their primary care physician. They are also there to answer any questions that the patient may have after they have left the doctor’s office and had time to think about what is going on with them. If a patient misses a scheduled appointment the patient care coordinator will do a follow up call to check on the patient to make sure that everything is ok. With Patient Centered Medical Home “the objective is to have a centralized setting that facilitates partnerships between individuals patients, and their personal physicians, and when necessary and appropriate, the patient’s family” (ACP, 2013). “Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where the need and want it in a culturally and linguistically appropriate manner” (ACP, 2013). Another problem facing the U.S. health care system would be health information exchange. Health Information Exchange is “electronic sharing of health related information among organizations” (HealthIT.gov). Why is HEI important to health care organizations' HEI provides “the ability to exchange health information electronically is the foundation of efforts to improve health care quality and safety. HIE can provide: the connecting point for an organized, standardized process of data exchange across statewide, regional, and local initiatives, the means to reduce duplication of services (resulting in lower health care costs), the means to reduce operational costs by automating many administrative tasks, governance and management of the data exchange process” (HealthIT.gov). What are some of the benefits of the Health Information Exchange' HEI helps to improve quality patient care as well as help to improve patient safety. “Health Information Exchange (HIE) refers to the process of reliable and interoperable electronic health-related information sharing conducted in a manner that protects the confidentiality, privacy, and security of the information. The development of widespread HIEs is quickly becoming a reality. Health Information Organizations (HIOs) are the organizations that oversee HIE. For HIOs to function, they must have the capability to employ nationally recognized standards to enable interoperability, security and confidentiality, and to ensure authorization of those who access the information” (AHiMA). “The HIE implementation challenge will be to create a standardized interoperable model that is patient centric, trusted, longitudinal, scalable, sustainable, and reliable. HIM principles will be critical to the success of HIEs and the nationwide health information network. HIEs, enabled by technology, are expected to improve the quality of care and patient safety and reduce healthcare costs” (AHiMA). Many health care organizations have the opportunity for improvement in the area of health information exchange (HIE) for patients as well as improved information sharing of patient health records between the hospital and physicians Many health care organization’s efforts are fragmented at best. By closing gaps in technology and communication, several organizational behaviors will be affected. These include customer service, employee satisfaction, employee stress levels, and duplication of efforts by employees and physicians, connectivity with physicians, over utilization of tests and services (resource utilization), safety, and quality patient care issues. For instance, if a patient was seen in the emergency department (ED) yesterday and then sees a specialist two days later, the specialist has no concrete way of knowing what tests were run on the patient while in the ED. The specialist, not having access to the previous tests, may reorder them, thereby causing duplication. This costs more and can also lead to safety issues for the patient, such as multiple exposures to radiation. If this patient has multiple health issues that require him to see more than one specialist, the potential exists to have multiple plans of care that may or may not agree. With physicians on board and working from a team of care approach, using evidence based medicine and clinical pathways, outcomes for the patient will be better and will more likely cost less. Another example would be a patient referral made by a physician to a program such as cardiopulmonary rehabilitation (cardiac rehab). The patient, knowing her physician said he would send a referral to cardiac rehab, shows up for class; however, cardiac rehab has not received the referral form yet and cannot allow her to take the class. Disappointed, the patient is turned away and has a negative experience driving to the health care facility from her home, which may be far away. Her first experience with the health care facility was a bad one, which colors her overall impression of the organization from the beginning. If information can be shared real-time between physicians and the hospital, time can be saved and employees as well as physicians can be more productive. Information can more efficiently be shared, for example, between the hospitalist and the primary care physician. Prescribing medications and sending results to those who need to know could be instantaneous. Being more productive often leads to greater financial rewards. Patient satisfaction would also go up because patients would not be asked to fill out the same information every time they go to a healthcare provider. They could keep up with their medications electronically and know what tests they were given, when, and what the results were. There would be less of a chance for dangerous medication interactions, which increases patient safety. Patients could have better outcomes, providers could more effectively take care of their patients, and ultimately relationships between the hospital and medical staff could be strengthened. While not all parts of healthcare reform are ideal to everyone, many of the issues touch on getting fraud, duplication, and unnecessary expenses out of the picture to create a more efficient system of healthcare. By exploring in more detail strategic options related to HIE, health care facilities will be offered a concrete recommendation that will help create a culture of care that improves patient safety and satisfaction while reducing expenses and improving productivity. The development of a secure HIE between health care providers is a nationwide initiative and has been labeled as a high priority in order to improve the overall continuity and quality of care for patients. According to a study conducted by researchers with the Center for Information Technology Leadership, a fully functional health information exchange could yield a net value of $77.8 billion per year nationally (Walker, 2005). Additionally, a successful HIE enables access and exchange of actionable health information when and where it is needed. There are many lessons to be learned from early adopters who have already implemented HIE systems. It is important for health care organizations to study these examples and learn from their successes in order to pattern behavior in a similar manner. Health care organizations have an opportunity for improvement in the area of information sharing of patient health records between the hospital and the surrounding health care community. The recommended solution to this problem is the implementation of a fully integrated health information exchange (HIE). According to the eHealth Initiative’s sixth annual survey, the primary drivers of HIE efforts are improving the quality of health care and patient safety, reducing inefficiencies experienced by providers, and lowering health care costs (Migrating Toward Meaningful Use). The successful implementation of an HIE system will benefit health care organizations in these areas as well as lead to improvements in productivity, efficiency, and satisfaction for patients, employees, and physicians. HIE offers communities and healthcare providers the opportunity to improve the quality and safety of health care, but these benefits do not come without the possibility of risks. It is important to identify and create strategies to mitigate these risks when considering implementation of an HIE system. Health care organizations must consider strategic, political, medical, regulatory or legal, and financial risks. Political risks must also be considered. Care must be taken not to alienate organizations that do not participate. Additionally, efforts must be made to properly manage the relationship and interactions of those who do participate. Small practices or those who opt not to participate due to lack of needed infrastructure may feel left out and become reluctant to refer patients to specialist or facilities participating in the HIE, impacting patient care and revenue. Health care organizations must be careful not to drive a wedge between participants and non-participants to ensure the medical community stays intact and patient care is first and foremost. It is important to keep any and all possible and current stakeholders informed and encourage their participation in the decision making process. In this paper we have talked about the many problems facing the U.S. health care system. We have talked about some of the failed attempts when trying to correct these problems. This paper has talked about how these problems are and have affected individuals in society today. In this paper we have discussed two problems facing the U.S. health care system. One of problem being the lack of coordination of care and the other being the duplications of efforts. We have researched each of these problems as well as explored strategic options and specific recommendations for change. Reference Health Information Exchange retrieved April 14, 2013 from http://www.ahima.org/resources/hie.aspx Health Information Exchange retrieved April 14, 2013 from http://www.healthit.gov/providers-professionals/health-information-exchange Health Tip Sheets for OEBB Members “Serving our members and their families” retrieved April 14, 2013 from http://www.oregon.gov/oha/OEBB/healthinfo/docs/2010/ oebb1awhat_is_quality.pdf Lack of health care coordination benefits physicians John Toussaint, MD. April, 2012 r retrieved April 14, 2013 from http://www.kevinmd.com/blog/2012/04/lack health- care-coordination-benefits-physicians.html Migrating toward Meaningful Use: The State of Health Information Exchange retrieved April 14, 2013 from http://www.sftvision.com/2009SurveyReportFINAL.pdf National Health Insurance—a Brief History of reform efforts in the u.s.2009 retrieved April 14, 2013 from http://www.kff.org/healthreform/upload/7871.pdf Patient-Centered Medical Home retrieved April 14, 2013 from http://www.ncqa.org/Programs/Recognition/PatientCenteredMedicalHomePCMH.aspx Walker, J., Pan, E., Johnston, D., Adler-Milstein, J., Bates, D., & Middleton, B. (2005). The value of health care information exchange and interoperability. Health Affairs, 24(10-18). Doi:10.1377/hlthaff.W5.10. retrieved April 14, 2013 from http://www.ncbi.nlm.nih.gov/pubmed/15659453 What is the Patient-Centered Medical Home' Retrieved April 14, 2013 from http://www.acponline.org/running_practice/delivery_and_payment_models/pcmh/ understanding/what.htm