A day after her father had gone to the hospital to get the bulge in his aortic artery repaired, Neeci Packard said the 90-year-old was sent home.
“He was feeling fine, because the anesthesia hadn’t worn off,” Packard said. “They called me and said he wants to go home, he’s feeling better. I was very unhappy about that decision. Nobody explained to him what happens when anesthesia wears off and how much pain he was going to be in.”
If you think there ought to be a law against that sort of thing, there is.
The Patient Protection and Affordable Care Act, nicknamed Obamacare, calls for the health care system to improve care. At the same time, it needs to keep a lid on prices.
While the headlines have focused on health insurance, that’s just part of the legislation. A major portion is dedicated to how patients will benefit from having that coverage. The bill calls for improving the quality and efficiency of all levels of care, and points on several occasions to hospitals.
It calls on them to perform in several areas, such as reducing readmissions and making sure they don’t cause patients to get sicker. But the law doesn’t spell out how they’re supposed to do that.
“That’s the piece you have to figure out and build it yourself,” said Dr. Bridgette Wiefling, senior vice president and executive medical director of Rochester General Medical Group.
Because money will be tied to their results, hospitals have a good reason to get it right.
Once they do, patients are likely to see their care better coordinated among all their doctors and to get more coaching to help them manage a chronic condition or avoid it in the first place. The Affordable Care Act has spurred consolidation, and patients will be more likely to get their various needs met in one system than they do now. They also may get more information about price and results.
More than 111,000 patients were discharged from Monroe County’s five acute-care hospitals in 2011, according to the most recent full-year data available from the state Department of Health.
“The idea is we will improve,” said Wiefling, who also is vice president of clinical innovation for the Rochester General Health System. “Will it ever be a perfect system for any community, for any hospital system? No. I think we have headed in the right direction.”
Quality rules
When the Affordable Care Act talks about payment, it means Medicare reimbursement. Because private insurers often follow the government’s lead, the changes are worth studying because eventually they may affect everyone else. A form of this already is underway in Rochester. The University of Rochester Medical Center and Rochester General Health System each have their own agreement with Excellus BlueCross BlueShield where payment is tied to results.
Under the Affordable Care Act, instead of getting paid for every service they provide, hospitals will get reimbursed on how well they’ve done their job. For example, if patients with certain conditions are hospitalized again within 30 days or patients pick up an infection during their stay, the hospital forfeits some of its total reimbursement.
On the other hand, if patients who respond to the federal Hospital Consumer Assessment of Healthcare Providers and Systems survey report high quality care and high satisfaction, the hospital earns a bonus. The survey is administered to a random sample of adult patients, not necessarily Medicare beneficiaries, and given between 48 hours and six weeks after discharge.
“Certainly there is an element that measures the perception of the environment that the patients have,” said Dr. Michael Rotondo, chief executive officer of the University of Rochester Medical Faculty Group.
He said patients basically want three things. “Help me, heal me, don’t hurt me. When I look at that data, for patients who come through the facility, are we satisfying those three conditions.”
Running start
Some quality and patient experience initiatives started before President Barack Obama signed the health care reform legislation on March 23, 2010, said Stewart Putnam, president of the health care services division of Unity Health System.
The law added a sense of urgency. “All these things are encouraging the kind of performance we strive for all the time,” he said.
Packard declined to say where her father was treated, or where her daughter was readmitted after treatment for a sinus infection. Considering each situation, the idea that payment would be tied to results appealed to her. “That would be a good thing.”
She also suggested a hospital first consider how it meets an individual patient’s needs.
“The patient’s age, whether they live alone, and explain what’s going to happen,” said Packard, who lives in Irondequoit and works in human services. “It seems like they just don’t prepare people.”
Under the business-as-usual model, Wiefling said doctors weren’t trained or paid to understand fully what a patient needs. Care was handled in episodes without looking at the big picture. “We’re skilled tradesmen,” she said, adding “there’s nothing wrong with that.”
The Affordable Care Act is broadening the focus. One way is through development of the patient centered medical home, where the primary care doctor acts like a quarterback. When the patient goes into or is discharged from a hospital and a handoff needs to be made, that doctor makes sure the ball isn’t dropped.
“We recognize that it’s time to get better,” she said. “It’s time to change the way we look at the patient.”
The pace of change may be happening quickly. In three-plus years, the Affordable Care Act has touched almost all facets of health care. It’s likely to take consumers and providers several years to adjust.
“What any of us would like to see, as patients and physicians, is an easily accessible system that’s easily understood, with transparency around care that’s being rendered at affordable prices,” said Rotondo.
At the same time, officials are trying to educate consumers.
Rochester General Health System will be training staff to help patients figure out New York’s health insurance exchange, nystateofhealth.ny.gov. John Midolo, vice president of finance has noodled around on the site.
“For people who don’t work with insurance, it’s confusing. I don’t think there are enough people to help those who need help. We want to be available when they come to us for advice.”
Source: democratandchronicle.com