Presently, there are many factors involved when it comes to health care and many of the changes are industry-driven as the health care model moves into the future.
Newman Regional Health is an in-between hospital. It’s not as big as a metro hospital but not as small as a rural hospital. This delicate mix brings unique challenges to health care in Emporia. The patient mix has an impact on the hospital, said Terry Lambert, chief executive officer of Newman.
“We’re not a big hospital which has a more favorable mix (of insured patients),” Lambert said. “We do try to provide as many services as possible. We do try to take care of our patients and respond to the physicians.”
Lambert said the desire is to keep patients in Emporia, however there isn’t always a specialty physician to make that possible.
“It’s a balancing act,” Lambert said. “There has to be enough business to keep a specialist here.”
There not only has to be enough business for a specialist physician, there has to be enough support from the medical community to keep the specialist. If the medical community doesn’t support the specialist and send him patients, he won’t stick around.
“There might be plenty of business for a cardiologist but everybody has to support that person,” Lambert said.
Cuts in reimbursement by insurance companies and Medicare and Medicaid are some struggles hospitals are up against. Lambert said the cuts are affecting every provider out there. It also effects how long a patient is in the hospital and what criteria the patients are admitted under. Lambert said if the hospital doesn’t comply with the insurance standards, it doesn’t get reimbursed for that patient.
“A patient has to be quite ill to be in the hospital,” said Paula Taylor, assistant administrator of clinical services at Newman.
Lambert explained further.
“People don’t understand if they don’t meet the medical necessity criteria, then the insurance companies won’t pay for it,” he said.
This misunderstanding often leads to complaints from patients of family members claiming they were released from the hospital soon. There also are standards written out that state the average length of stay in patients with a certain diagnosis.
The reimbursement rate is different for hospitals and physicians, Lambert said. The hospital gets one payment no matter how long the patient is in the hospital. The physicians bill on a daily basis.
“They’re on a different reimbursement schedule,” Lambert said.
Provider write-offs are increasing as well, Lambert said. The provider charges a fee and the insurance agrees to pay a certain amount. Any losses in that reimbursement are written off by the provider — they do not get payment for those write-offs.
Federal mandates are changing the current face of health care as well. The mandate to institute electronic medical records is one example. The mandate states that all hospitals have to move to electronic medical records by 2016.
“That creates a lot of change,” Lambert said.
Electronic medical records will increase patient safety as well. Medical staff can make chart notes on the computer instead of jotting them in a paper chart. This means fewer handwriting mistakes and fewer mistakes when it comes to dictation. When notes are dictated there’s extra potential for errors.
“If the physicians are entering their own orders, that eliminates that extra layer of risk,” Taylor said.
Taylor said many of the mandates are unfunded — meaning the hospitals and medical facilities must pay for the changes out of pocket.
Hospitals are expected to enforce federal mandates.
“It puts us in the role of watchdog or sheriff,” said Nancy LeClear, Newman director of marketing.
Not only does the hospital have to keep up with federal mandates, there are different rules and regulations broken down by state mandates, insurance companies, Medicare and Medicaid.
“There are so many rules and regulations being made by different organizations,” LeClear said.
There’s a lot more paper work these days as well.
“It can become very, very difficult,” LeClear said.
With the paperwork and communication with physicians, it’s an all-day balancing act.
“We have to communicate with the providers all day,” Lambert said. “The hospital can only do what the physician orders.”
Technology has driven changes in everything from the way patients are taken care of to how people communicate.
“So many of us have become dependent on electronic communication,” LeClear said.
Electronic communication has its drawbacks, LeClear said. Many times it’s assumed that once that send button is pushed, the communication has been made but there’s no way of knowing how long it will take the person on the other end to get to that message. Also, non-verbal communication such as voice intonations can’t be read through e-mail.
“There’s less face to face,” LeClear said. “... There’s just so much information coming at you.”
However, electronic communication can be beneficial. Newman is trying to make things easier on physicians and staff by streamlining the way the hospital does things, such as using a system that requires one password instead of a different password for every program. Electronic signatures are on the horizon for Newman as well.
Technology is a recruiting tool as well. It’s another balancing act that hospitals face.
“You don’t want to come out of medical school and come into the dark ages,” Taylor said, adding that newer physicians are coming out of medical school used to the latest technological advances.
Patient safety is a priority at Newman, Holly French, chief financial officer at Newman said. French said bedside electronic medication verification is one of the technologies that Newman has instituted. Patients wear a bracelet that is scanned before medication is administered. The medication is scanned as well and the information is electronically stored. Blood units are done the same way. Taylor said this system does take longer, but the medical staff sleeps better at night knowing they have the extra layer of patient safety.
The hospital voluntarily participates in many national initiatives promoting patient safety. However this, too, poses some challenges.
“All of the health care providers are pulled in different directions,” said Kathie Butcher, assistant administrator for quality service for Newman Regional Health. “Sometimes all the initiatives are not in line with all the health care providers.”
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Posted by create (anonymous) on May 7, 2008 at 4:41 p.m. (Suggest removal)
Are insurance write-offs tax deductible for providers? Just wondering.
Why does Newman's have to have a Director of Marketing if they are the only game in town?
I would think physicians would prefer electronic medical records. It certainly takes less time to type than to write something out in longhand. In my doctor's office, they've been electronic for years now. Isn't the hospital?
It is good to know that there is now a bedside electronic medication verification system. That is where many errors were made in the past.
As far as paperwork is concerned, join the club because it is in almost every profession. As a recently retired teacher, how well I remember being buried in paperwork every single day. In fact, "it’s an all-day balancing act" and all part of the picture of doing business with the government.
Posted by eiggohp (anonymous) on May 7, 2008 at 6:27 p.m. (Suggest removal)
I am very glad that my doctor uses electronic medical records. Can you image a druggist tying to read all of those "difficult" doctor's handwritings when filling a prescription? Mistakes are made far less with electronic medication orders.
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