The Science Journal of the American Association for Respiratory Care

1996 OPEN FORUM Abstracts

Five Things I Learned This Year About Hospital Restructuring

Kevin L. Shrake, MA RRT FACHE Sunday, November 3, 1996

1. WHAT HAS BEEN DONE IS NOT ENOUGH Healthcare expenditures are approaching one trillion dollars per year with approximately 14% of the Gross National Product devoted to healthcare. Insurance premiums are increasing with limited choices being offered to enrollees in regards to physicians and hospital services. Pressures to balance the national budget makes Medicare and Medicaid spending targets for reductions. Although much has already been done to reduce costs through restructuring, market pressures will continue to demand that more radical changes occur.

2. PATIENT FOCUSED CARE WAS A FAD, NOT A TREND Fewer hospitals are looking seriously at extensive patient focused care initiatives and others that have already instituted programs are modifying or even reverting to more traditional models of care. Shortcomings of this type of restructuring includes high costs of training, retraining and equipment duplication, not enough emphasis on utilization of services, and lack of focus on the entire continuum of care.

3. IT'S ALL ABOUT HEALTHCARE RESTRUCTURING, NOT HOSPITAL RESTRUCTURING The acute care hospital is no longer the center of the healthcare universe, but simply a key component in what has become an integrated healthcare delivery system. Home care, subacute care, medical clinics, long term care, hospice care and self care are all part of today's continuum of care. No longer are we simply treating disease, but rather we are managing health, as the financial incentives in our system begin to change. Community education, disease prevention and chronic disease management programs are all part of the changing face of today's integrated healthcare system.

4. PHYSICIAN PARTNERSHIPS ARE KEY Good physician panels attract large numbers of enrollees. Physicians who can function as cost effective gatekeepers are valuable to healthcare systems. RCPs can assist physicians in various aspects of disease management and cost control measures related to utilization of services. It is important to investigate legal incentive plans with physician partnerships that encourage cost controls without compromising quality.

5. THERE WILL BE WINNERS AND LOSERS The change response curve today is very short. Some people lead change, others change slowly, while still others refuse to change. This has created an environment where the leaders of change are demonstrating value to their organizations and are prospering, while others are losing jobs or accepting diminished roles. It is critical to be an active part of the healthcare team and perform demonstration projects that test systems and add value.

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