1997 OPEN FORUM Abstracts
Patient-Driven Protocols To Help Control Utilization
Kevin L. Shrake, MA, RRT, FACHE, Sunday, December 7, 1997.
There are numerous mixed financial incentives that occur in our present day health care delivery system. These various payment incentives include the Medicare DRG system, commercial fee for service insurance, per diem rates, and capitation. Even though there are a variety of ways in which healthcare organizations receive reimbursement, utilization control is the key cost containment measure that cuts across all payment systems. Patient driven protocols are effective in improving the overall appropriateness of utilization, improving communication, lowering costs and, in some instances, improving quality. When planning for the development of patient driven protocols, a task force should be selected for the development of protocols based on the AARC Clinical Practice Guidelines. Solicitation of medical director review and approval is an important aspect of program development. Once the protocols have been completed, the selection of a pilot unit to implement the protocols on a small scale is the usual technique. The early successes that a pilot project provides can be used as incentive to expand the scope of the project hospital-wide. Patient driven protocols decrease costs through choosing not to treat various patients, limiting utilization of treatment, tapering of therapeutic treatment regimes, and switching to less costly modalities. Keys to success of protocol development include easing fears of practitioners during the change process. This includes communicating effectively with physicians regarding their fears about loss of control of a patient, lack of information on care plans, how will they be contacted if their patient's condition worsens, and how will protocols affect pulmonary consults and resident education. Collection of data is extremely important in measuring the effectiveness of protocols, as well as providing incentives to apply the protocols across a wider scope of practice. Some of the data elements that could be considered for collection include: number of patients on protocols, number of physicians participating in the protocol process, percent agreement with the established care plan, and the percent of patient's that are tapered, discontinued or placed on their home regime prior to discharge. Once appropriate data elements have been obtained, it is important to document the financial savings that occur due to the protocol process. Once these savings can be documented, it is an effective technique to tell your success story in appropriate hospital meetings such as executive management, department manager meetings, nursing unit based counsels, and quality improvement committee meetings.
AARC 50th Anniversary, December 6 - 9, 1997, New Orleans, Louisiana.