Healthcare out of focus, time to adjust the lens.
Third party payers such as Medicare and Medicaid as well as privately based insurers need to refocus their attention on what is in the best interest of the patient. In an attempt to force industry change payers have restricted their reimbursement rates, increased premium costs for patients and employers, and developed lists of medical conditions that they [payers] feel are avoidable and thus will not provide any remuneration for. The consequences of such actions have created significant fiscal hardship for small businesses, healthcare organizations, providers, and patients. The high cost of healthcare is forcing the healthcare industry to care more about their own bottom lines than about the patients.
Mounting bad debt from medical indigence and poor reimbursement rates are forcing many hospitals to cut back on services, lay off staff, and in some instances completely close their doors. Payers fearful of their narrowing profit margins are withholding reimbursements and jacking up the price of policies. Millions of people continue to be either under insured or uninsured. Primary care providers are dumping their practices due to the high cost of maintaining them and entering hospitalist programs. Patients are left hanging in the breeze much of the time forced to find a new primary care provider which can take many many months, and then obtaining access to providers in a reasonable amount of time has become a luxury only for the rich who can afford the high out of pocket expenses associated with concierge medical care.
The blanket policies that affect healthcare today need to be revisited and rescinded. Reimbursement rates need to be increased to ensure healthcare organizational stability and ensure the needed resources are there to provide high quality care. Individual organizations that have established poor patient outcomes, low quality standards of care, are not utilizing evidenced based practices in the delivery of care should be fiscally punished with lower reimbursement rates, not those institutions and practices that have well established high quality programs and excellent patient outcomes.
If insurance companies feel the need to fiscally punish healthcare organizations let them do so on an individual basis and not on a macro scale. Healthcare organizations that are focused on providing high quality patient care and have clear definable patient outcomes that are favorable should be rewarded with higher reimbursement rates.
Furthermore despite the best attempts from healthcare organizations to mitigate preventable harm to patients it is unlikely that any hospital will completely remove medical error and iatrogenic complications from the acute care setting. Humans are fallible, and always will be. The best we can hope for are institutions that have low complication rates for procedures and minor infractions regarding patient safety. Clearly there should be no patient safety violations that would cause serious harm to any patient, however in today’s world it is unrealistic I think that healthcare is going to be able to eradicate iatrogenic complications. Even under the best conditions most industries do not have a perfect sustainable record of perfection.
In order to solve the high cost of healthcare in this country it is likely that some form of Federal regulation will need to be implemented. Investor interests need to be replaced with patient interests, greed must be replaced with moderation and satisfaction, patient disregard needs to be replaced with patient accountability and responsibility, and individualism needs to be replaced with collaboration.
All of us will use the healthcare system in our lifetimes. It is imperative that we as a society unite to improve the overall functioning of our system. Healthcare is a basic need of all, it should not be viewed as a means of financial security through litigation or a means of fiscal independence at the expense of the injured and infirmed, it should be more about taking care of people.
About the Author
Mike Pringle is the author of Healthcare Today where he offers commentary and insight regarding today’s healthcare issues. Additionally he provides regular commentary for Red Scrubs and editorial content for Future Healthcare. He has over 20 years of nursing experience working both domestically and internationally. Mike has a Bachelor’s Degree in Nursing and a Masters Degree in Public Administration with a Healthcare emphasis. He specializes in both Emergency and Critical Care Nursing. He currently works at Falmouth Hospital as a Shift Manager for the emergency department.
