Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Key Issues to Consider When Evaluating Healthcare Reform Models While the quality movement in healthcare has been evolving rapidly, it is important to keep in mind that quality improvement has long been a part of hospitals’ day-to-day operations. It is a cornerstone of every hospital’s mission, and they stake their reputations on their ability to provide quality care. Hospitals and all other stakeholders operate within a healthcare system that balances the need for high quality care against access and cost considerations. And although quality improvement initiatives are sometimes considered an extra expense, oftentimes these initiatives actually generate savings by avoiding additional costs down the road. In fact, this is a strong component of the rationale behind pay for performance. The increased public attention to quality assessment and improvement is not expected to abate any time soon. As healthcare reform proposals are debated and politicians explore which models might be replicated on a national scale, any plan should be scrutinized based on its ability to achieve the ideal balance of cost, access and quality. Using this cost, access, quality framework, The Center for Health Affairs has developed a series of Policy Snapshots that explores each of these three key facets in detail. In the coming weeks, we will be releasing an Issue Brief that ties these concepts together to explore which existing models most successfully address all three dimensions while minimizing potential unintended consequences. The Distinction Between Quality of Care & Health Status Critical reviews of the U.S. healthcare system sometimes make the mistake of pointing to the population’s poor health status as an indicator that there must be a problem with the quality of care. However, in order to most effectively develop strategies for improving the U.S. healthcare system, it’s important to distinguish between the quality of care provided by our healthcare practitioners and the overall effectiveness of system, which encompasses health status, public health initiatives, research, preventive care, our financing structure and a whole host of components in addition to the quality of hospital and physician services. Data from the Organisation for Economic Co-operation and sidered in any healthcare system, and they exist in ss Access, Cost & Quality: in Perfect Harmony stool; they are the three elements that must be con- ce Accrediting bodies, healthcare providers, payers and business groups each have spearheaded a vast array of quality measurement initiatives. While they all look a bit different, they share some basic characteristics: an emphasis on the use of treatment guidelines for particular illnesses or conditions, the measurement of treatment outcomes, and the reporting of data. Most recently, payers have begun tying reimbursement to progress on quality measures, and this trend is expected to continue. Cost, access and quality are like the three legs of a Ac Q uality is one of the buzzwords in healthcare today. With healthcare spending on the rise, everyone from consumers to payers to employers wants more information about the return they are getting on their healthcare investment. Policy Snapshot st Part 3: Quality Co org et. November 2008 an a balance. An ideal system could be defined as one with completely unfettered access, where people could have on-demand care for their every Quality health need great and small; one with perfect quality, with the best, most-advanced procedures and technologies and flawless quality control systems; and one that is able to do all of this at bargain prices. Clearly, compromise is unavoidable, and any existing health system or proposal for reform must weigh these three elements and make choices regarding cost, access and quality to create an approach that is best suited to those being served. Development’s 2007 Health at a Glance help to demonstrate the difference between health status and quality of care. For example, while the U.S. is a world leader when it comes to the percentage of the population that would be categorized as obese, an indicator of health status, it is also a leader in breast cancer survival, an indicator of quality of care. The distinction is important because to be effective, a healthcare system has to be good at not just treating illness, but preventing it as well, and this is where the other resources described above, such as research and public health, are especially important. What are the Crucial Components of Quality? Ensuring quality is a complex endeavor. Below are some of the key issues related to quality that should be considered when developing or evaluating healthcare reform models. Recommended Treatment Guidelines A large part of the quality movement has been focused on ensuring that all healthcare providers are aware of and consistently follow recommended treatment guidelines that are based on the best medical knowledge available. For example, research has shown that the use of drugs called beta-blockers reduces heart attack mortality in the first week by 13 percent and long-term mortality by 23 percent1. Given the clear clinical science supporting the use of beta-blockers for heart attack patients, many payers and accrediting bodies now measure their usage. Providers support the use of recommended treatment guidelines that are based on clear clinical science and they have played a key role in collaborating with various organizations to improve the quality of care provided to patients. At the national level, through the Hospital Quality Alliance hospitals have partnered with consumer representatives, physician and nurse organizations, employers and payers, oversight organizations and government agencies to make meaningful, relevant, and easily understood information about hospital performance accessible to the public and to inform and encourage efforts to improve quality. f www. ch Yet as the quality movement has gained traction, providers increasingly are being inundated with requests for data from insurers, employer groups, accrediting bodies and government agencies. As healthcare reform models continue to take shape, streamlining the number of places and ways in which providers must submit quality data will reduce confusion for both providers and consumers. Furthermore, attention should be paid to ensuring that the information consumers receive and that is sometimes used to determine provider reimbursement is based on solid data and good measures. Health Information Technology The rise of information technology holds great promise for improving the quality of healthcare. Already the healthcare field, and ultimately patients, have benefited from the implementation of countless medical technologies, from using bar coding to provide increased medication safety to utilizing magnetic resonance imaging (MRI) to help doctors make more definitive diagnoses. Electronic medical records (EMRs), which facilitate access to comprehensive medical information by a patient’s care providers, One study put the have been touted as a way to not only cumulative cost for 90 improve patient safety but also make processes faster and more efficient, percent of hospitals leading to cost savings. Encouraging to adopt an electronic the adoption of EMRs is a positive step toward improving quality of care, health record system yet there are multiple issues that must at $98 billion if 20 be considered. Patient confidentiality percent of hospitals concerns must be addressed and the up-front cost of these technologies now have such a cannot be overlooked. The standard3 system. ization of technology is another significant challenge to overcome.2 Eliminating Disparities in Care Central to ensuring that a healthcare system is functioning well is ensuring that it is functioning well for people of all races and ethnicities. Yet research has shown that despite efforts by providers to extend equal care to patients regardless of race or ethnicity, disparities in care exist. Many experts believe that a complex host of factors influence the existence of disparities. These can range from systemic problems, such as financing, geographic location and access to care, to factors arising from the provider-patient interaction. To reduce disparities, the healthcare community is working hard on increasing their collective level of cultural competency. Progress has been made in developing language access services that effectively target hospital resources at patients with limited English proficiency and lead to improved communication between clinician and patient. Staff training programs are increasingly incorporating cultural competency components to ensure effective communication with all patients who seek care at our hospitals. The U.S. is expected to become more, not less, diverse in the future. As policymakers work on developing healthcare reform models, supporting providers’ efforts to reduce disparities while continuing to track healthcare outcomes for different subsets of the population will remain important. Eliminating Workforce Shortages A well-trained and adequate supply of healthcare professionals is also essential to the provision of high-quality healthcare. In recent years, the growing nursing workforce shortage has garnered attention. The national shortage of registered nurses (RNs) is expected to hit roughly 1 million by 2020, while Ohio is projecting a 12 percent shortage of RNs by 2010. Locally, Northeast Ohio is anticipating that an additional 3,887 nurses will be needed by 2010.4 1226 Huron Road E., Cleveland Ohio 44115 800.362.2628 www.chanet.org Workforce shortages aren’t just affecting the nursing profession. Shortages of primary care physicians also exist, as do shortages of certain allied health professionals, which are healthcare practitioners with formal education and clinical training who are credentialed through certification, registration or licensure. As the population ages, healthcare workforce needs are only expected to grow. While workforce shortages can impact quality of care, they can also hamper access to care. With quality of care so closely linked to the workforce, any long-term strategy for the healthcare system should also address issues of workforce supply. Changing Course While the economy has moved front and center in the minds of Americans, healthcare still remains a key issue for voters across the country. Eight in 10 Americans believe the U.S. healthcare system needs to be fundamentally changed or completely rebuilt according to a recent poll, and 90 percent of respondents said they thought it was important for presidential candidates to have reform proposals that would improve the quality of care.5 Barring serious healthcare reform efforts, problems associated with the current healthcare system are likely to worsen. Yet the current trajectory can be altered by implementing the right healthcare reform policies. As the dust clears from this most recent election, we hope that the national discussion crystallizes around how to most effectively achieve real change within the healthcare system that will bring harmony to the goals of increasing access to healthcare, upholding the highest quality of care, and making the most out of opportunities to create efficiency within the system and save costs. In the end, individuals ought to be able to receive the highest quality of care, when they need it. Wrapping up our series on Cost, Quality & Access and their role in health reform will be an Issue Brief that will be published in the coming weeks. The brief will explore health reform models based on systems in place in a few of the U.S. states as well as some other countries. Previous installments in this series, as well as all of our Policy Snapshots and Issue Briefs, can be found online at www.chanet.org. Endnotes 1. Hennekens, C., et al. “Adjunctive Drug Therapy of Acute Myocardial Infarction – Evidence from Clinical Trials.” New England Journal of Medicine, 1996; 335(22), 1660-1667. 2. American Hospital Association. “Improving Quality and Patient Safety.” http://www.aha.org/aha/content/2008/pdf/08-issue-quality.pdf 3. Hillestad, R., et al. “Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, and Costs.” Health Affairs. September/October 2005. Vol. 24, No. 5, pp. 1103-1117. 4 Northeast Ohio Nursing Initiative, The Center for Health Affairs. “Local, State and Federal Solutions to the Nursing Shortage Problem.” June 2006. http:// chanet.org/NR/rdonlyres/DA757BF5-AA7E-4B7A-8948-033282748F29/192/ policy_solutions.pdf 5. How, S. K. H., et al. “Public Views on U.S. Health System Organization: A Call for New Directions.” The Commonwealth Fund, August 2008. http://www.commonwealthfund.org/usr_doc/How_Public_Views_8-4-08. pdf?section=4039 The Center for Health Affairs is a hospital trade association representing 35 hospitals in Northeast Ohio and serving those organizations and others through a variety of advocacy and business management services.