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THE ENVIRONMENT OF ACUTE CARE IN THE UNITED STATES AND A COMPARISON WITH JAPAN Osaka March 1, 2014 Tokyo March 2, 2014 Lee Pickler, DBA 1 ACUTE CARE IN THE UNITED STATES ROLE OF LTAC’s • CURRENT HIGHLIGHTS OF HEALTHCARE TODAY – UNTIL 2013 HEALTHCARE COSTS HAVE INCREASED EITHER ALARMINGLY OR AT LEAST SIGNIFICANTLY – FORTY-SEVEN MILLION AMERICANS EITHER UNDERINSURED OR UNINSURED – THE DEMOGRAPHICS WILL NOT IMPROVE THE SITUATION—ONLY WORSEN IT – THE PRIVATE SECTOR HAS NOT BEEN ABLE TO ADDRESS THE PROBLEM – THE AFFORDABLE CARE ACT IS THE GOVERNMENT’S RESPONSE TO THE PROBLEM 2 THE ENVIRONMENT • • • • DEMOGRAPHICS MACRO ECONOMICS HEALTHCARE RESOURCES PUBLIC SECTOR 3 Japan United States Demographic Comparisons 2012 Population Japan 127,515,000 U.S. 313,914,000 2013 Elderly (65+) %tage of Population Japan 23.7% U.S. 13.9% 4 Projection of Population over 80 Years 5 Notes on Japan -- LTC • Japan public spending on long-term care is projected to more than double from 1.4% in 2007, and could even reach 4.4% of GDP in 2050. Japan’s real public LTC spending is expected to grow at a faster rate between 2006 and 2025. – Highlights from Help Wanted? Providing and Paying for Long- Term Care, OECD Publishing, 2011. 6 Japan United States Macro Economic Comparisons 2010 Health Expense Per Capita Japan $3,958 U.S. $8,233 Health Cost %tage covered by the public (2011) Japan 80.0% U.S. 45.9% http://www.oecd.org 7 Japan United States Macro Economic Comparisons • 2012 GDP Per Capita (in U.S. Dollars): • Japan US$46,720 • U.S. US$49,965 8 RESOURCES • • • • • • Acute Care Beds Density per 1000 (2011) Japan – 8 (Avg length of stay 17.9) U.S. -- 2.6 (Ave length of stay 4.8) Physician Density per 1000 (2010) Japan – 2.23 U.S. -- 2.44 9 FIND A NEED AND FIX IT • GOVERNMENT POSITION—REGULATE AND PRICE FIX. RESULT WILL BE ADJUSTMENTS MADE BY THE PRIVATE SECTOR TO ADDRESS THE PROBLEM. • PRIVATE SECTOR CHANGED ACORDING TO WHO HAD THE POWER. • PHYSICIAN POWER, INSUROR POWER 10 THE RESULT • NO INCREASE IN PATIENT ACCESS • INCREASED COST OF CARE – DUE TO THIRD PARTY PAYORS – TECHNOLOGY – SERVING THE UNDER-SERVED • NOTHING FIXED SO THEREFORE: • OBAMA CARE (THE AFFORDABLE CARE ACT) 11 TWO CHALLENGES • ACCESS TO CARE FOR EVERYONE – IMPROVE COVERAGE • DRIVE COST OUT – SOME METHODS: • • • • REGULATE INSURORS CONTROL/DECREASE REIMBURSEMENT BEGIN TO BUNDLE PRICING DON’T PAY FOR MISTAKES 12 DELIVERING CARE IN THIS ENVIRONMENT • • • • • SHORT TERM ACUTE CARE LONG TERM ACUTE CARE INPATIENT REHABILITATION SKILLED NURSING FACILITY HOME CARE 13 A Comparison of Facilities Long-Term Acute Care Hospital Rehab Hospital Skilled Nursing Facility License Acute hospital Rehabilitation hospital Skilled nursing facility Medicare Certification Acute hospital Rehabilitation hospital Skilled nursing facility Meets acute criteria 60% falls into case mix groups for rehab Meets chronic care criteria Admitting Criteria Length of Stay Physician Involvement Minimum 25 days ALOS for Medicare; no requirements for non-Medicare typically 12-18 days Daily visits by internists with multiple medical sub specialities; consultation. care directed by physical medicine physician Typically: Medicare 35-40 days HMO 10-15 days Physician visits weekly/monthly 14 LTACH DEFINITION • LONG TERM ACUTE CARE HOSPITALS PROVIDE SPECIALIZED ACUTE CARE FOR MEDICALLY COMPLEX PATIENTS WHO ARE CRITICALLY ILL WITH MULTI-SYSTEM COMPLICATIONS AND REQUIRE LONG HOSPITALIZATIONS. 15