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| Vernon Pertelle |
Reflect for a moment about the changes in
healthcare over the past five years. Now think about the transition from
filling the inpatient beds and increasing overall volumes for surgical cases to
reducing the length of stays and performing more procedures in same day centers
or through robotics and minimally invasive methods.
Then consider the
methods and madness surrounding reimbursement for services and products under
the Medicare Part B benefit; and the increased level of scrutiny and vigilance
with utilization of resources relative to medical necessity. No matter
how you are affected, it is plain to see that things have definitely changed.
Some may argue for the better because we are now charged with demonstrating
value by improving health outcomes while reducing costs; while others may say
things have changed too drastically and the patient will suffer as a result of
the shift to value based healthcare.
We have embarked on a
new horizon in which health policy in our country is now focused on the
patient. This is a very good thing because the system just might move away from
a capitalistic and business centric model in which coverage has been the determining factor about using an effective resource; to one that will help improve
healthcare in our country because using a resource that is effective - - is the right thing to do.
The reality is that Centers for Medicare and
Medicaid Services (CMS) has effectively gotten our attention to truly focus on
establishing value for our patients; and will reward us for demonstrating
better outcomes while reducing costs.
We now must quantify data that
clearly shows the use of resources results in better outcomes while reducing costs.1
So, in the words of Michael Porter, management guru from Harvard Business
School (HBS): "Since value depends on results, not inputs, value in health
care is measured by the outcomes achieved, not the volume of services
delivered, and shifting focus from volume to value is a central
challenge."2 So, the question then is how do we deal with the
new normal in which we must demonstrate our value?
Well, it begins with evaluating all of the resources in our armamentarium and critically assessing
each intervention in terms of the value it adds to improving outcomes while
reducing costs. Take for instance patients that are diagnosed with
Chronic Obstructive Pulmonary Disease (COPD); and the typical historic
interventions and resources used to improve outcomes while reducing costs.
Based on the
evidence, we have done a poor job of effectively improving the outcomes of
patients to the extent CMS has now included the diagnosis of COPD in the
Hospital Readmission Reduction Program (HRRP) for FY 2015. We now must address
the need to improve outcomes by considering tangible and effective alternatives
that will help improve the overall care and outcomes.
The resource is a respiratory therapist (RT); specially trained, with
laser sharp focus on the management of patients with COPD. The key is of course
in developing programs and services that are centered on the patient with interventions that improve their engagement with self-management as well as
adherence to their treatment plan.
There are countless
examples in regional and even some national managed care organizations on the
effectiveness of this resource, yet - - by-and-large - - RT's have not been
considered as essential in filling the disease management gaps. That
said more must be done to demonstrate value and in essence establish RTs
through validated clinical studies to once and for all get a better handle on
the management of patients with COPD to improve health outcomes while reducing costs.
1 Michael E. Porter and Elizabeth
Olmsted Teisberg, Redefining Health Care:
Creating Value-Based Competition on Results (Boston: Harvard
Business School Press, 2006), 86-87.
2 Michael E. Porter, “What Is Value in
Health Care?” New England Journal of
Medicine (2010) 363:2477-2481.
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