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Deconstructing the word "Care": Are you ready for the projected patient tsunami?

By Dea Robinson posted 01-31-2013 11:23

  

I would like to propose the year of 2013 be so called "The Year of Repositioning".  No doubt, this year is a gold mine of sorts for any strategic executive innvolved in healthcare.

I was speaking to an acquaintance of mine this week as I noticed on a social media link his title had changed from CEO of a prominent company here in Denver to something like CEO of "X" Healthcare Coop and Creative Stuff.  I couldn't help but hit "reply" and congratulate him giving himself this extraordinary title.  However this is a guy who showed up on the golf course with me last year wearing toe socks...

What makes this litle story noteworthy is he has started a healthcare cooperative and we were talking about the impending changes.  We touch base from time to time as he comes from the broker/payer side and he was wondering if his actuaries had made an error in their numbers with the changes coming by the end of 2013.  I  said I truly believe some of us might be underestimating what the ACA will do to the market.  It is exciting to imagine the majority of previously uninsured patients having coverage.  It is more daunting from the supply side to envision the waves of patients who have not had access or means to care showing up with their shiny, unused proof of insurance in the marketplace and in our waiting rooms.

This brings me to a personal question I have of myself and my colleagues.  I think we are on the brink of a redefintion or at least a deconstruction of the word "care".  Patient who have never experienced regular health"care" will now be regulars at our doorstep.  This concept will either push you professionally to the brink or will bring about a corporate and individual creativity never seen before as our medical communities we manage will need to see more patients with the same number of providers and staff.  (CEO of "Creative Stuff" is sounding much more aligned with my job description...)

The real question will be how all providers (regardless of size and model of practice) reposition to accomodate the mandates of the ACA.  How will this all shake out?  Will we simply see the smaller practices get absorbed into the large healthcare mainstream?  Will those relationships that physicians were trained to cultivate as a means to their production ends matter anymore? 

If you have a moment (ok, a few priceless minutes) take a read at Robert Bellah's compelling article Understanding Care in Contemporary America, where he states "I want to argue that we need to limit market forces as well when they become imperialistic and threaten to dominate our lives. Indeed I would argue that there is such a thing as market totalitarianism that parallels state totalitarianism and is a real threat to us in America today."  I would also add this is a real threat to the healthcare landscape. 

If we apply this to the impending changes (much of which is truly unknown), it is my hope that we can still deliver care with integrity and create relationships that have meaning and point to the only thing that matters: taking care of the patient.  I believe the old strategies of gaining marketshare will be replaced by how to handle the enormity of marketshare. 

And finally...in the words of Mr. Bellah, "that human beings are not auto-nomous atoms, that human beings exist in and through relationships and institutions or they don‘t exist at all."  I think I will have new business cards made.  I am really liking the "creative stuff" idea...

Reference

http://www.robertbellah.com/Understanding_Care_in_Contemporary_America.pdf


Dea Robinson, MA, CMPE, CPC
Administrator
Inpatient Medicine Service PC
MGMA Assembly/Society Steering Committee
dea.robinson@inpatientmedicineservice.com
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Comments

Donald Bryant
02-02-2013 13:45

Think of the addition of new patients as a challenge that you can rise to meet. I think that it will be necessary to add NP's and PA's too. Solving problems as a team and implementing the solutions as a team will go a long way to solve the challenges that are coming.
Let's not forget that the physician and provider version of the CAHPS is just around the corner. Being patient-centered will be necessary in developing solutions to the advent of new patients. PCMH model is a good way to go.

Jane Dodds
02-01-2013 10:26

GREAT post, Dea. I do understand your concerns about a "flood" of patients, but I am not expecting a tsunami at all. The currently uninsured people who will have (newly available) access to health care, will still be required to pay for it in some way. As with any patient population, there will be challenges to educate them about our practices' policies. I suspect most of them will choose high deductible plans, so they'll be on the hook for their initial expenses.
One of the best things that will come from PPACA is that we can expect our patients to take some responsibility for acquiring coverage. People will have to be honest about whether or not they have made the effort. "I can't afford it" will not be an excuse.... there will be systems in place to assure that everyone has access to affordable care. Subsidies will be available if insurance premiums exceed a certain percentage of your income. Now, individual perceptions of what's "affordable" may vary, but we'll have every right to expect that our patients either have insurance, or they're going to be personally responsible.
I'm a big believer in expanding access through midlevel providers. I see a bright future for NPs and PAs. The pendulum is going to swing back away from the "urgent care / doc-in-a-box" model, and patients will seek a "medical home" where they feel the care. We've added a PA and will soon add another midwife, and the competition for those folks is getting stiff. But those are also JOBS, and I think we sometimes forget that nurses, medical assistants, secretaries, billers, and maintenance staff are all JOBS. If we can increase patient throughput by adding a midlevel, with incremental staffing, our businesses can thrive and help the economy thrive too.

Dea Robinson
01-31-2013 12:54

Don-I would say I have reserved optimism; baby steps, if you will. I do believe that the current construct of "caring" for the patient from the clinical and business side will be a transformative process by the end of 2014. We cannot move the mountain of ACA; but we will need to find a way to make it work-somehow.

Donald Knox
01-31-2013 12:38

Good points Dea, my overarching concern is that as caring is continually micro-defined by third parties (government, employers and insurers) the "feel good about helping others" is being replaced by the victimhood of forced caring.
We are taking the once noble art of medicine and turning it into the science of management (not management of a patient but of entire "populations" of patients).
I wish I could share your optimism that the we would be allowed the "creative stuff" to care for this forthcoming wave of patients, instead I see process oriented "quality" measures wholly usurping outcome and patient satisfaction related measures.
Such process measures are moderately helpful in defining the minimum requirements for acceptable patient care (medicine), but do little to nothing to ignite the inherent creativity among our caregivers.
Hopefully you are correct in that we are entering of period of increased creativity in medicine, but sadly I see the future as far less creative and more regimented.

Jerry Golden
01-31-2013 12:19

Enjoyed the blog and i agree. Never a dull moment and now more than ever the demand to get "creative". Take care. jerry

Bill Hughes
01-31-2013 11:40

Great writing Dea! We truly have an opportunity in these changing times to make tremendous strides in our tasks of serving employers and patients alike. Keep up the great writing!