Changes in healthcare are moving at lightning speed. There are 4 trends that should have your focused attention regardless of where you sit as a stakeholder in the system.
If you’re concerned about your employees, patients, and workplace, these trends should keep you up at night.
- Increasing utilization of a hospitalist system to manage inpatients
- More ER visits and observation stays
- Companies not fully leveraging programs and services they already have
- A rising number of caregivers
Hospitalist system challenges
The first trend that should keep you up at night is the increasing utilization of a hospitalist system to manage inpatients. Hospitals are embracing the hospitalist system for quality of care and efficient management of admitted patients. However, the early promise of that care delivery model does not appear to be living up to its potential.
The goal is to provide efficient and high-quality care by (1) coordinating and providing continuity of care during an inpatient stay, (2) coordinating with a patient’s primary care physician at the time of admission and discharge, (3) improving the patient experience and also achieving greater physician satisfaction. While the potential benefits are numerous, they’re often not being manifest.
Many/most hospitalist systems do indeed deliver on one goal of the hospitalist movement. That’s a schedule with regular hours for the physicians who deliver care. However, the scheduling process leaves much to be desired for both patients and physicians. Often, it involves assignments in cycles of care as short as two days or rotating among several hospitals in a multi-hospital system.
Patients who have extended hospital stays are often the most complex cases and most ill. However, the system instantly fails the continuity of care test and is heavily dependent on a hand-offs approach which is often less than optimal. Having a parade of doctors often means:
- added stress on the patient and family
- often having to constantly explain to the hospitalist “du jour” what’s going on from the hospital bed or bedside
- disparate and competing perspectives on a work-up and treatment plan
- inefficiencies in moving through a work-up
- a specialist having the most complete picture of the arc of the patient’s stay
- a reduced likelihood of any feeling of relationship with the hospitalist to help reduce the likelihood of litigation if things go awry
- a constantly changing “slide show” of patients for the hospitalist and little opportunity to follow a patient from admission to discharge which translates to a more stressful and less satisfying experience for the hospitalist, who is always in “getting to know you” mode
- an even greater dependence on (an already strapped) nursing and aide staff for the safety of the patient and the quality of the service experience
Emergency Room visits are up
Rising ER visits and observation stays are the second concerning trend.
With changing rules and reimbursement guidelines, there is a significant rise in observation stays for patients who visit an ER. In addition, there’s an increase in the length of that observation stay. There has also been an increase in the number and costs of ER visits, which serve as “feeders” to observation stay status.
In fact, findings by the Health Care Institute show ER visits increased 31-percent between 2012 and 2016. Plus, spending costs per person are growing at faster rates than in prior years.
- Patients are in limbo. They are not fully in the ER and not admitted either. Sometimes, the patient is on a gurney in the hallway for hours in a crowded ER which may be filled with patients with potentially contagious illnesses.
- From a clinical and patient perspective, a reduction in 30-day readmission rates that may not be as significant as reported. For example, a patient who returns to the hospital after being held as an observation stay does not count as a 30-day readmission. For the patient, a return to the ER (not infrequently designated once again as an observation stay) and having to go back to the hospital means going back to the hospital no matter what moniker is used.
- A patient with a higher bill relative to out-of-pocket expenses for the care that was received due to the rules of observation stays vs. admissions.
Are you leveraging what you already have?
Third, often employers, medical groups, and health systems don’t leverage what they already have.
Many employers and most health plans offer a plethora of benefits, programs, and resources, which can be dizzying and confusing for the employee/member. This buffet of opportunities often reflects:
- a lack of integration among the various offerings
- an inadequate communications strategy
- a communication frequency that may be ineffective
- the difficulty of communicating in-the-moment a resource which may be of greatest interest and most benefit
- multiple vendors who provide a patchwork of programs and services
What may be more helpful? Getting the most out of what is already in place before adding more. Take actions which include:
- Focusing on an integration plan to provide a less complex and more seamless experience for the employee/member/patient.
- Requiring an integration plan from each program partner in a situation where multiple vendors provide programs and services.
- Convening a “vendor summit” at least annually to ensure each program partner is aware of other offerings. This also helps identify integration opportunities which may lead to better outcomes for each individual vendor. Plus, an experience which is more satisfying for the end-user.
Helping caregivers find work-life balance
Truer words were never spoken, especially when you consider the numbers. There were 5.7 million people suffering from Alzheimer’s in 2018 in the U.S. alone. 34 million Americans provide unpaid care to a loved one. It will take more than a village to face the reality of an aging population and a heavy chronic disease burden.
Fourth, the rising number of caregivers is a trend that should keep you up at night.
It will take all of us to address the needs of caregivers and to help support their health and well-being, especially since almost all of us will find ourselves in a caregiver role at some point in our lives.
The impact on the health and well-being of caregivers due to both the realities of caregiving and the inevitable stress is immense and well-documented. And depression often follows as an unwelcome companion.
Anyone who is a family caregiver can attest to how quickly healthy eating habits, regular physical activity, and sufficient, quality sleep go flying out the window. This is especially true during episodes of acute events like hospitalization and in situations which involve caregiving of long duration.
Most caregivers understand the importance of maintaining focus on their own health and well-being. However, it’s often challenging to “walk the talk,” even though it is in these exact situations when self-care is more important than ever.
With an increasingly female workforce, an aging population, and a tight job market, the support of caregivers should be considered a talent management issue according to the new report, The Caring Company: How Employers Can Cut Costs and Boost Productivity by Helping Employees Manage Caregiving Needs, by Harvard Business School’s Joseph Fuller and Manjari Raman.
Benefits programs to help caregivers
So what can employers do to help address the problem?
- Learn how and “Why Business Should Support Employees Who Are Caregivers,” in Harvard Business School’s Working Knowledge article. The piece points out almost three-quarters of employees care for a child, parent, or friend which means they’re looking for ways to balance work and home life. One suggestion is to create a “care culture.”
- Become familiar with how to measure the costs of caregiving, which include productivity impacts and turnover costs. Childcare and elder care needs are frequently linked to turnover, and the cost is highest among those in senior levels of the organization.
- Follow the lead of companies like Deloitte and rethink your leave program by creating a pooled benefit that can be used for all types of caregiving. Deloitte offers 16 weeks of fully paid family leave. Employees can use it for any type of caregiving. For example, it can be used for the arrival of a new child, support of aging parents, care of a spouse/life partner, etc. rather than a siloed allocation strategy for life events like maternity and paternity leave. Those leaves may prove to be of no benefit whatsoever to employees who are at a different stage in their life cycle.
- Recognizing the manner and degree of support an employer provides for caregivers can also serve as a competitive advantage.
The healthcare landscape continues to be increasingly complex, volatile, and ever-changing. The challenges inexorably march on. It appears this state is the “new normal.” So, there is no time like the present to address the trends above and bring an end to tossing, turning, and insomnia.
Gail F Levy says
I really liked your selection of the 4 HC trends (hospitalist; ER visits, observation stays; leveraging programs & services and caregivers). The impact these problems/issues have throughout the entire HC system is huge. You did a great job pin pointing the key issues with the trends and in noting where to begin the correction, turn- around process. Thanks!
Gail, so glad you found the article helpful and on point!