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Patient Care: The Conflict Between What Us
Medically Necessary and Economically Feasible
– Richard Markhoff,
M.G.A
Balancing Care: What is Medically necessary
vs. Economically feasible
Richard Markhoff, M.G.A., N.H.A. Earned his
Masters Degree in General Administration from the University of
Maryland, University College. Licensed Nursing Home Administrator
since 1995. Broward Children’s Center, Inc. Administrator since
2000.
President Florida Health Care Association
District XI.
Communication This is the most important item to finding that
balance.
With clear communication and clear goals this balance can more
easily be achieved.
Making the tough choice: Health care worker is always trying to
improve the life of each patient. What is best for the resident
vs. what is covered by payee vs. organization mission. The fight
between the front line workers and the front office. Goals help
them attain the highest practicable level. Not everyone can get
back to the way they were prior to incident. Improve their way of
life in a positive way. Provide the care in a quick and efficient
way. Time is Money some patients require more time than others.
Good care costs less. Extra time spent on care today can lead to
less expense tomorrow. Documentation is proof of care being
delivered.
“Doing the Right things Right”
Getting all of the information necessary to deliver quality care.
Having an admissions team meeting prior to admission. Utilizing
the appropriate assessment forms. Sitting down regularly with
other disciplines (interdisciplinary team meetings). Know your
payer Source Private Insurance Medicare Medicaid Private Pay
Private Insurance What is most cost efficient. Not always what is
the best course of treatment. Need justification as to why your
treatment plan is the best decision.
Pros v. Cons of the treatment plan.
Need to be in constant communication with Case manager. Very
important to always make sure that you are meeting the needs of
the patient. When talking with the admissions/care team to discuss
all treatments prior to admission and as needed. Private insurance
usually pre approves a set period of time or treatments. The
business office needs to be apart of the admission/care team
meeting. They know what is in the contract They need to inform the
team of the financial obligations. Write up a plan/cost of care
spelling out inclusions and exclusions of services. During pre
admission project amount of service time necessary and add into
cost of care. Most interested in cost control. Medicare Justified
by RUG score on MDS. Capitated rate. Medicaid Flat per diem rate
everything included. Must prioritize each need. What are the
immediate medical needs.
Private Pay
The only limit is how much the family is willing to spend for
appropriate care. Must show measurable improvement. If you can’t
get the whole get a piece Use the plan to get to the next level
where a more economical plan can be implemented.
Review as necessary to measure progress and
report to care team/billing as necessary. Communication between
everyone involved is key to a successful treatment program.
Getting to the win-win achieving the balance between patient,
family, staff, payer source and management.
Future Plans for AASHAS and Your Role
– Ronald J, Jordan, Ph.D., CLTC
Only rarely in a professional's career is there
an opportunity for that professional to make a significant mark on
their field. AASHAS presents all of you with such an opportunity.
Among AASHAS missions is to bring academics and practitioners
together with the objective of improving quality education in the
long-term care industry. We hope thereby to help with the supply
of quality workers in the long-term care industry.
AASHAS members who choose to become actively
involved will help to develop training materials, products, and CE
materials which will become the standard for the industry. We are
not just an industry but more importantly we are a profession. It
is necessary for us to recognize that distinction so that
academics and practitioners come together from all allied health
services and administrators charged with the role of education and
training in there respective organizations, AASHAS will assist in
assuring that we provide the continuum of care for the benefit of
the populations we serve. Our training materials will have as one
of their objectives to create the culture that we are all working
toward the good of the patient and not just to protecting our
turf.
Through our training materials, newsletter, CE
materials, AASHAS developed courses, regional and national
conferences, AASHAS will become the national organization to
accomplish the above objectives. It is our hope that eventually
AASHAS will also establish standards for schools and provide
accreditations for the schools that train the workers in the
various allied health services for the future.
We invite you to join us in shaping the future
of the long-term care profession.
The Great Paradigm Shift
- Pauline Broderick, Ph.D.
Outline
Dr. Pauline Broderick discuses the evolution
of the traditional hospital and reviews the changes that have
occurred in the workplace over time. She asses the evolutionary
changes in the healthcare industry and the redesign of principals
and goals that are required to adjust to the evolutionary changes.
She points out the role AASHAS will play in adapting to the rapid
changes in the long-term care industry.
“ “In times of Change Learners inherit the earth while the
learned find themselves beautifully equipped to deal with a world
that no longer exists.” - Eric Hoffer, Disease State
Management
Work Redesign: Creating the workplace of
the future
The great paradigm shift evolution of
traditional hospital problems with current hospital structure
defining with our customers want redesign principals and goals
redesign tools, transition to patient-focused departments.
Assessing an organization for redesign
Physical plant assessment patient services
assessment ancillary and support services assessment technology
assessment leadership and political assessment medical staff
assessment assessing state regulations and licensure issues
The great paradigm shift, paradigm equals set
of rules and regulations, defines boundaries dictates successful
behavior. Paradigm affects equals unable to perceive data outside
of paradigm.
Most influential paradigm shift of twentieth
century Japan’s focus on quality
volution of traditional hospital. The early
1900s, place to group sick people 1940’s-1974 focus on nursing
1974-1983 ancillary services growth 1984 prospective payment 1990s
customer-focused structures.
Problems with current structure Time spent
documenting, scheduling and waiting= 3x time spent on clinical
care 50-60 employees interact with each patient excessive
turn-around times poor customer service duplication fragmented,
task-oriented care requires significant communication goals,
routines and properties revolve around professions/departments,
not customers. Non-productive down time no coordination of care.
edesign principals and goals. Customer defines
quality equivalent to re-tooling a factory one model does not fit
all organize services around customers never document same
information twice, centralize distribution for one-stop shopping
unit-based resources to meet 75 percent of customer demand
minimize number of internal customers minimize customer contacts
with service providers.
Redesign tools, multi-disciplinary patient
record eliminate fifty percent of policies and procedures
cross-training reorganization cost/UOS standards skill mix
conversion ancillary expert consultants
Transition to customer-focused departments
Traditional Hospital includes a profession
teams, clinical standards, manage customers around department’s
routine, task-oriented, call appropriate personal communicated
infrastructure, multiple customers contacts documentation by
profession sand manage processes.
PFU
Customer-focused teams customer-focused teams,
customer satisfaction, priorities, and outcomes manage resources
for customer outcome-oriented do no pass off work you can do,
simplified infrastructure, limited customers contacts,
multi-disciplinary patient record, manage outcomes. Work faster,
work smarter, narrow job scope, broad job scope
Assessing Organization for redesign
Physical plant assessment size of central
station, private versus semi-private rooms, totals beds/station
clean/dirty support space, vertical versus horizontal clumping,
location of radiological facilities
Patient services assessment
Patient demographics, patient diagnosis/LOS,
patient wants and needs, ancillary services/PD i.e. EKGs,
phlebotomy, RT, PT etc.
Ancillary/ Support Assessment
Existing Ancillary FTEs and SW&B i.e. RT, PT,
Phlebotomy, Pharmacy, Medical records, admitting, EKGs etc.
Exsisting environment FTEs and SW&B i.e housekeeping, dietary,
transport, charting. Volume of Ancillary producers by area.
Technology Assessment
Number of EKG machines, number of portable
x-ray machines, oxygen gauges, suction gauges, IVASC’s, Oximerty,
wheelchairs, medication carts, pyxis, scales, silent beepers,
portable ,monitors telemetry.
Leadership/political assessment
-team attitude/turf battles/career goals,
ancillary and support department manager sophistication, corporate
culture, change quotient current /future performance
current/future external environment.
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