While most patients definitely prefer a quiet room to a noisy one, or an attentive nurse to a flighty one, these smaller aspects of patient experience pale in comparison to the overall quality of treatment, a new study finds. It’s an aspect of patient care found largely at bigger hospitals, and one that smaller hospitals seldom offer.

Published in Risk Management and Insurance Review, the study built upon prior research into what makes one hospital “better” than another, utilizing a methodology called PRIDIT, a tool commonly used in detecting health care fraud. The researchers compiled multiyear data sets on U.S. hospitals and analyzed the different quality variables and outcomes to find out which type of facilities yielded the best overall rating. Even though large hospitals were worse at satisfying patients, their ability to deliver top-notch surgery and treatment options eclipsed the comforts of smaller hospitals.

“Patients who have chronic conditions like heart failure should go to large hospitals that treat a lot of other patients with heart failure,” Robert D. Lieberthal, Ph.D., the study’s lead author and assistant professor in the Jefferson School of Population Health, told Science Daily.

Lieberthal has worked with PRIDIT extensively in the past, and in his current study examines not only the intrinsic benefits of hospitals offering better care, but also the ways in which the hospitals’ reimbursement rates are determined based on that care.

The method has a number of benefits in the current medical landscape. Hospitals care because as programs like Medicare and the Patient Protection Affordable Care Act, otherwise known as Obamacare, slide into the foreground, insurance companies must evaluate appropriate terms of compensation. Over a number of years, erratic measures of hospital quality could cause the rates to become volatile, despite large, complex hospitals remaining relatively unchanged year to year.

Consumers also have skin in the game, especially as more Americans gain access to health insurance and must decide among the best hospitals available to them.

“There is a lot of information patients can use to select a hospital,” Lieberthal said. “However, this is usually a laundry list of indicators that may not mean much for the lay person or that they may be unaware even exists. Our method compares hospitals directly, so that a patient choosing between two or three hospitals can easily compare them and choose the highest quality facility.”

Lieberthal’s method employs a raft of variables, each receiving a specific weight, in order to evaluate what constitutes the “best” type of hospital. If a place has more beds, for instance, then that typically means it offers more care, which weighs favorably on the hospital’s overall score. More overt signs of success are also measured, such as patient mortality and staff size.

The team’s findings highlight what may come as an obvious point — how the hospital’s food tastes is meaningless if you don’t survive the surgery — but the depth of the research signals areas for improvement, particularly among the larger hospitals that have more working parts. Greater attention to the smaller details still improves a hospital’s overall score, even if the primary roles — getting sick people well — are satisfied first.

In the meantime, the information obtained through the PRIDIT method should be useful for consumers, Lieberthal noted.

“Based on this study,” he said, “the hospitals that have the best survival outcomes are not doing the best job of satisfying patients.”

Source: medicaldaily.com

Bukittinggi, Padek– Rencana Pemko Bukittinggi membangun se­buah Rumah Sakit Umum Dae­rah (RSUD) mulai diwu­jud­kan.

Hal itu diungkapkan Wali Kota Bukittinggi Ismet Amzis dalam sidang paripurna Ran­cangan Peraturan Daerah (Ran­perda) tentang Pembentukan Dana Cadangan Pembangunan Rumah Sakit Umum Daerah (RSUD) Kota Bukittinggi Senin (30/9).

Sidang dipimpin oleh Wakil Ketua DPRD Bukittinggi, H. Darwin. Hadir Muspida, SKPD, camat dan lurah se-Bukittinggi. Wali kota menjelaskan, menga­cu kepada Permendagri no 21 tahun 2011 tentang pedoman keuangan daerah, kepada pem­da diberikan kesempatan dalam mengelola anggaran untuk mem­bentuk dana cadangan.

Berangkat dari latar bela­kang tersebut, Pemko Bukit­tinggi untuk pertama kalinya pada APBD Perubahan 2013 membentuk dana cadangan, sebagai upaya memenuhi kebu­tuhan pendanaan.

“Pembangunan RSUD yang semestinya kita miliki, dalam rangka memenuhi kewajiban dasar kepada masyarakat kota, sesuai empat pilar prioritas pembangunan kota yang telah dirumuskan dalam Rencana Pembangunan Jangka Me­nengah Daerah (RPJMD) ta­hun 2011 s/d 2015,” kata Ismet.

Menurut Ismet, pem­ba­ngun­­an sebuah rumah sakit, tentu membutuhkan dana yang cukup besar, disamping me­nyediakan lahan, pemba­ngunan fisik serta sarana pra­sarana dan pe­ralatan medis. “Secara jujur, ha­rus diakui pembagunan RS­UD ini 100 persen dibebankan kepa­da APBD. Tentu kita tidak akan mampu mengingat keter­bata­san sumber ke­uangan,” ujarnya.

Pembentukan dana ca­dang­an ini merupakan langkah awal mewujudkan cita-cita pem­bangunan RSUD tersebut. “Un­tuk itu, secara bersama kita bertekad melakukan langkah konkret mecarikan sumber pembiayaan lain di luar APBD seperti APBN dan hibah ser­ta donatur resmi sesuai ke­ten­tuan yang berlaku,” ungkap Ismet.

Langkah awal pembentukan dana cadangan pembangunan RSUD tersebut akan berlang­sung dalam kurun waktu selama tiga tahun, yakni 2013, 2014, 2015, dengan harapan tahun 2015 mendatang telah terhim­pun dana sebesar Rp70 miliar untuk bisa terealisasi.

“Ini merupakan tanggung jawab kita bersama dan komit­men yang tegas untuk diwujud­kan ke dalam Perda dengan ha­ra­pan pembangunan RSUD dapat direalisasikan demi kepen­­tingan warga kota khu­susnya dan masyarakat umum­nya,” harap Ismet.

Wakil Ketua DPRD Bukit­tinggi Darwin sangat mendu­kung realisasi pembentukan dana cadangan pembangunan RSUD tersebut dengan meng­anggarkan dana setiap tahunnya melalui APBD serta dituangkan dalam Perda.

Hal itu sebagai langkah per­wujudan pembangunan RSUD tersebut. “Rasanya sudah sepan­tasnya Bukittinggi yang terbilang kota kesehatan mem­punyai RSUD, sebagai ma­nifes­tasi pelayanan terhadap warga kota,” sebut Darwin.

Darwin menyebutkan, sebe­tulnya rencana pembangunan RSUD merupakan wacana dari DPRD bersama Pemko Bukit­tinggi. Hanya saja dalam pem­bangunan RSUD merupakan ranah dari eksekutif untuk me­realisasikannya.

“Sesuai dengan fungsinya, dewan pada lintas fraksi me­nyetujui rencana pembangunan RSUD tersebut dengan pem­bentukan dana cadangan secara bertahap. Total pembiayaan sebesar Rp70 miliar yang akan diwujudkan tahun 2016 men­datang,”jelasnya.

Sumber: padangekspres.co.id

Metrotvnews.com, Ternate: Dokter dan paramedis Rumah Sakit Umum Daerah (RSUD) Chasan Busoirie (RSUDCB) Ternate, Maluku Utara, mogok kerja, Selasa (1/10), menuntut RS membayar tunggakan jasa pelayanan selama 14 bulan.

Para dokter dan paramadis itu juga membawa poster yang bertuliskan tuntutan mereka sambil berorasi di halaman RS tersebut. “Kami hanya menuntut hak kami. Sudah 14 bulan hak-hak kami tidak diperhatikan. Kami juga manusia. Bukan robot,” kata salah satu paramedis saat berorasi.

Aksi itu mengakibatkan pelayanan di sejumlan poliklinik terganggu. Ratusan pasien yang datang untuk berobat mengeluhkan dampak aksi tersebut, karena mereka tidak dilayani.

“Saya datang dari jam 08.00 WIT, sakarang sudah jam 10.30 belum ada pelayanan. Dokter dan perawat memilih demo. Kalau begini terus, kami bagaiaman? Siapa yang bertanggung jawab,” kata Saleh Ibrahim, salah seorang pasien penyakit dalam kepada Media Indonesia di depan poliklinik penyakit dalam.

Pelayanan baru berjalan setelah Wakil Direktur RS, Musriono Nabiu, menemui pengunjuk rasa dan meminta mereka agar melakukan aktivitas seperti biasa. Namun pelayanan hanya dilakukan oleh sebagian dokter dan paramedis, karena sebagian lainnya melakukan pertemuan tertutup dengan Direktur RS, Tutha Nurany Nachrawie untuk memastikan pembayaran hak mereka.

“Pertemuan itu untuk memastikan apakah hak-hak kami akan diselesaikan atau tidak. Kalau masih tidak jelas lagi, kami akan melakukan mogok kerja secara besar-besaran,” kata kordinator aksi, Ifan Husni.

Sumber: metrotvnews.com

Semarapura (Bali Post) – Pelayanan mengecewakan yang dirasakan pasien di RSUD Klungkung, sampai akhirnya seorang pasien meninggal disikapi serius kalangan legislatif. Sejumlah anggota dewan lintas komisi langsung mendatangi RSUD Klungkung, Senin (30/9) kemarin. Mereka meminta pihak RSUD Klungkung harus mengevaluasi pelayanannya dan mengedepankan sentuhan kemanusiaan.

“Jangan baru tidak mau dirujuk, lantas didiamkan. Kalau memang pasien tidak mau karena takut kena biaya-biaya lain, pihak rumah sakit harus mampu meyakinkan keluarga pasien agar mau dirujuk ke rumah sakit lainnya yang bisa memberikan pelayanan sesuai dengan kebutuhan pasien,” kata anggota dewan, Komang Gede Ludra. Ludra mengingatkan kasus yang menimpa pasien stroke dengan pelayanan JKBM, Ngakan Nyoman Rai asal Banjar Pekandelan Kaler, Semarapura Tengah, Klungkung, ke depan tidak boleh terulang. Sehingga dia meminta insiden ini menjadi bahan evaluasi pihak rumah sakit. Sebab, masalah pelayanan di rumah sakit sangat berkaitan dengan hal-hal prinsip yang menyangkut nyawa seseorang. Kondisinya harus mendapat penanganan segera dari pihak rumah sakit.

Hal serupa disampaikan anggota dewan lainnya, A.A. Gede Bagus. Usai menanyakan langsung kepada pihak rumah sakit, Legislator PDI-P ini menekankan tidak ada sinkronisasi antara keluarga pasien dengan pihak rumah sakit. Pihak rumah sakit mengatakan pasien Ngakan Nyoman Rai setelah mendapatkan pemeriksaan awal oleh dokter dikatakan menderita stroke dengan kesadaran menurun, sehingga perlu dirujuk ke rumah sakit lain agar mendapat pelayanan sesuai dengan kelas rumah sakit. Sebab, kata dia, RSUD Klungkung merupakan rumah sakit tipe C yang hanya melayani penderita stroke dengan kesadaran baik. Kondisi itu juga dibenarkan Kabid pelayanan RSUD Klungkung, Dr. I Wayan Swatama, M.Kes, yang menerima anggota dewan di ruang UGD RSUD Klungkung.

“Kalau stroke dengan kesadaran baik, rumah sakit kami bisa menangani. Namun, saat itu, stroke pasien dengan kesadaran menurun. Apalagi saat yang bersamaan, satu-satunya dokter neurologi (saraf) kami sedang cuti ke luar negeri mengikuti seminar,” terangnya. Anggota dewan lainnya, seperti Tjokorda Istri Raka, Wayan Sugati, Ketut Suastika juga mengatakan sepintas kasus ini tampak tidak manusiawi dan tidak dapat diterima oleh keluarga pasien. Karena itu, kasus semacam ini ke depan mesti diantisipasi. Sebab, jika kondisi serupa terjadi dan sikap pihak rumah sakit juga sama ketika pasien tidak mau dirujuk, maka sangat disayangkan jika pasien lainnya juga sampai meninggal.

Atas masukan tersebut, Wayan Swatama mengatakan bakal berusaha terus berbenah dan mengingatkan kembali setiap perawat dan dokternya melakukan komunikasi yang baik dengan pasien, agar antara pasien dan pelayanan rumah sakit sinkron sebagaimana diminta A.A. Gede Bagus. Pasien Ngakan Nyoman Rai akhirnya meninggal setelah sebelumnya telantar di ruang UGD RSUD Klungkung. Dia meninggal keesokan harinya akibat pecahnya pembuluh darah di bagian otak akibat tekanan darah tinggi.

Sumber: balipost.co.id

Infections picked up in hospitals, nursing homes and doctor’s offices affect more than 1 million patients and are linked to nearly 100,000 deaths a year.

It’s a simple enough request, but for patients and families who feel vulnerable, scared or uncomfortable in a hospital room, the subject can be too intimidating to even bring up with a doctor or nurse: Have you washed your hands?

Hospitals are encouraging patients to be more assertive, amid growing concern about infections that are resistant to antibiotics.

Strict hand hygiene measures are the gold standard for reducing infections associated with health care. Acquired primarily in hospitals but also in nursing homes, outpatient surgery centers and even doctor’s offices, they affect more than one million patients and are linked to nearly 100,000 deaths a year, according to the Centers for Disease Control and Prevention.

Yet despite years of efforts to educate both clinicians and patients, studies show hospital staff on average comply with hand-washing protocols, including cleansing with soap and water or alcohol-based gels, only about 50% of the time. Two new studies show patients aren’t much more comfortable today than a decade ago with the idea of asking doctors and medical staff to lather up.

Hospitals have reduced certain infections over the past four years with measures such as removing unnecessary catheters and washing a patient’s skin before surgery with antibacterial soap. Some have lifted hygiene compliance to nearly 100% with strict “wash in, wash out” protocols, and some have designated unidentified staffers to secretly monitor co-workers. Some hospitals link merit increases to compliance and temporarily suspend clinical privileges of doctors who ignore the rules, says Gina Pugliese, vice president of the Safety Institute at hospital purchasing alliance Premier Inc. According to a 2010 study, a disciplinary program at the University of Kentucky Medical Center in Lexington that included suspending doctors’ privileges led to improved compliance rates.

More hospitals have turned to electronic sensors, thermal imaging and video cameras to monitor hand hygiene, and some are issuing badges that wirelessly record staffers’ use of hand hygiene stations before entering a patient room. Some monitoring systems emphasize patient engagement and sound an electronic alert to remind patients to speak up when a staffer enters the room.

The CDC has provided 16,000 copies of a video, titled “Hand Hygiene Saves Lives,” to be shown to patients at admission. In one scenario, a doctor comes into a room and the patient’s wife says, “Doctor, I’m embarrassed to even ask you this, but would you mind cleansing your hands before you begin?” The doctor replies, “Oh, I washed them right before I came in the room.” The wife says, “If you wouldn’t mind, I’d like you to do it again, in front of me.”

After patients at 17 hospitals run by Cincinnati-based Catholic Health Partners watched the video, there was a rise in both the proportion of patients asking staffers to wash their hands, and physicians and nurses reporting that they were asked, according to a 2010 study. “Hand hygiene is probably the most important thing health-care workers can do to protect their patients from infection,” says John Jernigan, director of the CDC’s hospital infection-prevention efforts who appears in the video. When patients speak up, it helps create “a culture of safety,” he says.

The nonprofit Association for Professionals in Infection Control and Epidemiology is kicking off a campaign this month including posters mailed to 15,000 hospitals with tips on how patients can take an active role. It suggests asking staff about hand hygiene and requesting that hospital rooms be cleaned if they appear dirty.

“We’ve been focusing on intensive interventions to improve hand hygiene among health-care workers for decades, yet we’ve really shown very little progress,” says Carol McLay, a Lexington, Ky., infection prevention consultant and chair of the committee that designed the campaign. “We are trying to empower patients and families to speak up and understand their role.”

At some hospitals, posters, bedside placards and buttons for staffers say, “Ask me if I’ve washed my hands.” Susan Coffin, a pediatric infectious disease physician at the Children’s Hospital of Philadelphia, says while many efforts are made in good faith, they are “insufficient to overcome some of these barriers.” She is co-author of a study, published in June in the American Journal of Infection Control, which found that 84% of parents were aware of infection risk yet only 67% would remind a health-care worker to wash their hands, most often because of concern about appearing rude or undermining authority. Yet 92% of parents said if a health-care worker invited reminders, they would be more likely to do so. The hospital is “trying to make it a more active conversation,” Dr. Coffin says. Admission packets offer detailed information on hand hygiene and nurses tell families that staffers welcome questions about hand washing.

In a study published in September in the journal Infection Control and Hospital Epidemiology, one-third of patients surveyed at the University of Pittsburgh Medical Center said they observed doctors failing to wash their hands, but nearly two-thirds said nothing to their doctor about hand hygiene. Most didn’t believe it was their role to do so and said they felt embarrassed or awkward and worried about reprisal.

Patients are more likely to ask nurses about hand hygiene, says Gregory Bump, associate professor of medicine. “There is something about the white-coat barrier that makes them reluctant to challenge doctors.” Physicians may resist assertive patients and seem unreceptive or even hostile to a question about hand washing, he says.

Patients, instead of receiving information about infections and hand washing, would prefer having staffers wear a button or light to indicate whether his or her hands had been washed, the study also found. UPMC is developing a system to measure and track hand-washing compliance, as well as computerized verbal reminders to patients to ask the employee to clean their hands when they enter the room.

Michael Gettes, 50, has been hospitalized several times and says he has never had to remind Dr. Bump, his primary physician, to wash his hands. He has asked other hospital staffers to do so. One doctor reacted negatively. “It put our relationship on a bad footing,” Mr. Gettes says. “Yes, you run the risk of upsetting someone who has been taking care of you. But it is my life. If they make a mistake I am impacted or I die.”

Gail Ulager, a 72-year-old kidney transplant recipient at UPMC, says she worries about the possibility of infection because she is taking drugs that suppress her immune system to prevent rejection of her new organ. She found a way to give the message to doctors, nurses and even her dentist without seeming disrespectful. “I always tell them that the transplant center insists that everyone washes their hands” she says.

Source: online.wsj.com

Liputan6.com, Jakarta : Mencuatnya kasus dokter asing yang berpraktik di RSU Tangerang Selatan belum lama ini, ternyata cukup mengkhawatirkan. Bahkan Ketua Umum IDI (Ikatan Dokter Indonesia), Dr. Zaenal Abidin menyebutkan dokter asing yang berpraktik di RSU Tangsel ilegal.

Bagaimana tidak, menurut Zaenal, status dokter asing seperti tertera di UU Rumah sakit baru pada tahap alih teknologi. Maksudnya, ada proses pendidikan dan teknologi yang dialihkan dan semestinya dilakukan di RS pendidikan bukan di RS daerah.

“Kesalahannya adalah dokter ini ilegal karena tidak ada izin praktik. Masalahnya, turis di Indonesia banyak yang bekerja. Padahal kita saja tidak boleh bekerja di negara asing jika visanya turis. Mungkin di Indonesia penegakan hukumnya belum kuat,” kata Zaenal.

Zaenal menegaskan, sebagai warga negara Indonesia, kita justru jangan mengajak dokter asing melanggar hukum negeri kita sendiri.

“Semua mengenai dokter asing sudah jelas ada di UU rumah sakit, UU praktik kedokteran, dan UU kesehatan. Semuanya menyebutkan bahwa dokter asing harus ada izin praktik. Jika tidak ditaati, akan ada sanksi pidana, kurungan bahkan denda. Sanksi ini berlaku bukan hanya pada rumah sakitnya tapi juga pimpinannya,” tambahnya.

Sumber: liputan6.com

Mangupura, Pos Bali- Nengah Wijana warga Abian Base kecewa dengan pelayanan RSUD Kapal Badung, karena lambatnya penanganan terhadap vaksin rabies yang digadang-gadang gratis oleh pemerintah.

Hal ini terjadi sekitar 3 minggu yang lalu ketika cucunya Agusta Nugraha (6 tahun) digigit monyet saat berenang di kolam renang Tirta Bayu Abian Base.

Agusta yang digigit monyet pada bagian leher, ketika itu telah diberikan pertolongan pertama dengan pemberian obat merah saja. Nengah Wijaya yang khawatir cucunya terkena rabies, langsung melarikannya ke RSUD Kapal Badung.

Namun kenyataanya berbeda dengan plang yang tertera di seputaran Badung mengenai rabies. Sampai di RSUD Badung, tepatnya di UGD Nengah Wijana dengan cucunya Agusta Nugraha tidak mendapatkan pelayanan dengan baik.

Menurutnya, pelayanan RSUD Kapal sangat tidak bersahabat. “Kata pegawai di UGD ketika itu, vaksin rabies sudah habis,”ujarnya agak kesal.

Penjelasan yang berbelit membuat Nengah Wijana kesal, pasalnya vaksin rabies habis dan Nengah Wijana disarankan untuk membeli vaksin dengan harga Rp300.000.00. “Kata pegawainya, vaksin yang gratis sudah habis, kalau mau hanya ada vaksin rabies dengan harga Rp300.000 sekali suntik,”ujarnya dengan ekspresi kaget saat itu.

Bayangkan saja, jika sekali suntik seharga Rp 300.000.00 berarti 2 kali suntik vaksin membayar Rp 600.000.00 karena suntik vaksin rabies di kedua lengan kanan dan kiri.

Sementara suntik rabies maksimal dilakukan 3 kali pada periode beberapa minggu sekali. Jika ditotal mungkin mencapai Rp1.800.000.00. Melihat mahalnya biaya vaksin rabies yang seharusnya gratis, Nengah Wijana menanyakan alternatif untuk mengobati cucunya. “Pihak RSUD Kapal Badung menyarankan agar kami langsung ke RS Sanglah saja,”tandasnya kebingungan.

Mendengar alternatif tersebut, Nengah Wijana langsung menanyakan contact person yang bisa dihubungi di RS. Sanglah. Namun pihak RSUD Kapal, ngeles (pura-pura gak tahu-red) dengan menyatakan tidak tahu contact person di RS. Sanglah yang bisa dihubungi. “Setelah itu alasan kedua adalah, telepon mereka rusak,”katanya mempertanyakan fasilitas dan pelayanan RSUD Kapal yang merupakan RSUD pemerintah Badung.

Melihat pelayanan yang berbelit-belit dan terkesan dipersulit, Nengah Wijana langsung mengajak cucunya menuju Sanglah. Pelayanan di RS Sanglah, sangat berbeda di RSUD Kapal Badung. “Setelah sampai di RS. Sanglah, kami langsung ditangani dengan sigap,”ujarnya puas dengan pelayanan RS. Sanglah. Cucunya langsung di suntik vaksin rabies, dan itupun gratis tanpa embel-embel.

Melihat hal ini, Nengah Wijana melontarkan kritik bagaimana dengan program pemerintah Badung khususnya di bidang pelayanan kesehatan masyarakat. Nampaknya belum maksimal terlaksana dengan baik, entah pihak RSUD yang nakal atau memang SDM disana kurang sigap.

Khususnya pada penanganan kasus gawat darurat seperti vaksin rabies, “Bagaiman SDM seperti itu jika menghadapi pasien UGD lainnya,”ujarnya mempertanyakan.

Sumber: posbali.com

BLOOMINGTON — Health care systems are evolving from a focus on treating sick people in the hospital to managing peoples’ health.

It’s not just the right thing to do. They are following the money.

Under the Affordable Care Act, health care providers may be rewarded if they demonstrate better health outcomes at lower costs.

OSF HealthCare, Advocate Health Care, and Hospital Sisters Health System (HSHS) have been transitioning to the new model for several years.

“Long before the law was passed (and before incentives to coordinate care), we’ve been active in changing how care is delivered,” said Tim Eckels, an HSHS vice president. HSHS includes St. Mary’s Hospital in Decatur, St. Anthony’s in Effingham and St. John’s in Springfield.

“The key to keeping patients out of the hospital is a good thing,” he said.

“We’ve been working on the Affordable Care Act goals with our partners,” said Colleen Kannaday, president of Advocate BroMenn Medical Center in Normal and Advocate Eureka Hospital in Eureka.

“When the act passed in 2010, we didn’t wait,” she said. “Our perspective was, ‘We’re going to embrace this and create a model.’”

A step in that direction by Advocate has been creating an Accountable Care Organization (ACO) in partnership with Blue Cross.

OSF’s Pioneer ACO has been in cooperation with the Centers for Medicare & Medicaid Services. Goals are to provide more coordinated care for Medicare beneficiaries.

OSF reported recently that — after the first year of its ACO — care for patients with chronic medical conditions included in the ACO had improved while costs decreased 1 percent.

“As we have more success, we will have a healthier population,” said Ken Natzke, CEO for OSF’s Bloomington-based Eastern Region.

“In the old world, doctors and hospitals were paid more if they did more,” said Kannaday. In the new model, doctors and hospitals that demonstrate they are providing quality care at a lower cost are rewarded financially, she said.

Health care systems are operating in both worlds.

Advocate Physician Partners — which includes Advocate Medical Group doctors and some independent physicians — have joined Advocate hospitals in initiatives focused on keeping people healthy. Included are: reserving some physician appointment times for same-day appointments; expanding hours for doctors’ offices; encouraging doctors to prescribe generic medicines; and adding case managers in some larger offices who stay in contact with patients with multiple diagnoses to ensure they are on top of their health and another in the BroMenn emergency department who helps coordinate care for patients who need special help after being discharged.

OSF also has initiatives — such as flexible scheduling — to improve access to primary care physicians, Natzke said.

Results have been improved health and more cost-efficient health care, administrators said.

“If you can reduce emergency department visits, admissions and re-admissions, you can reduce the cost of providing care,” Kannaday said. “We have demonstrated that for the last three years.”

Acute care in hospitals won’t go away. But as the focus continues to shift to outpatient services, so too will health care systems’ employment base.

“We built at the right time,” Kannaday said of Advocate BroMenn’s addition that opened in 2012. “Going forward, we will see less investment nationwide in the inpatient setting.”

However, Advocate Eureka is planning to replace its two operating rooms and to provide private rooms for all inpatients, she said.

Marketplace impact

Decatur Memorial Hospital isn’t expecting major immediate changes as the Health Insurance Marketplace opens on Tuesday and coverage under the exchange and expanded Medicaid begins Jan. 1, said CEO and President Ken Smithmier.

The hospital, which has about 2,000 employees, has cut about 300 positions in recent years, but Smithmier isn’t anticipating more staff reductions.

Kannaday and Eckels also aren’t expecting significant changes for their hospitals in 2014, but gradual change over the next few years.

Natzke estimated OSFSt.JosephMedicalCenter will experience a 10 percent ($1 million) decline in charity care and bad debt with more patients on Medicaid and the exchanges. The hospital’s yearly operating budget is about $300 million.

“But the big unknown is what will happen Jan. 1 when people wake up with insurance for the first time,” Natzke said. “I don’t think we’ll see any massive change in peoples’ (health care) behavior overnight. People are getting health care now, whether it’s paid for or not.”

“We’re not expecting a huge rush,” Eckels agreed. “There will be a lot of confusion for a while. We think enrollment will be fairly gradual, allowing us to manage as it happens.”

Natzke said, “As we get more embedded in population management, we anticipate a lower demand on the emergency department. Hopefully, most of our newly covered individuals will get lined up with good primary care coverage.”

Eckels also anticipates fewer people using the emergency department as more people get health care before their illnesses become acute.

At Decatur Memorial, Smithmier isn’t expecting a decline in emergency department visits, saying, “I don’t see that changing.”

Advocate and OSF medical groups’ offices accept patients on Medicaid and, with the Affordable Care Act, the number of people on Medicaid will increase. Advocate, OSF and HSHS Physician Group have been adding primary care physicians.

People will turn more to doctors’ offices and clinics, putting more pressure on those services, Eckels said.

“It’s something we’ll have to manage,” he said.

“Patients have been getting care,” Kannaday said. “Our hope is that more of them will find a medical home and their care will be better managed.”

“The health care system clearly was not sustainable,” she added. “By partnering with physicians and hospitals and payers, we can create a health care system to propel us the right way into the future.”

Source: pantagraph.com

University of Wisconsin Hospital and Clinics is contributing $2 million to United Way of Dane County to create a program that will pay for the cost of insurance premiums for plans bought on the marketplace set up through the Affordable Care Act.

The program, HealthConnect, will help about 7,300 adults in Dane County who have household incomes between 100% and 133% of the federal poverty threshold — or $11,490 to $15,281 a year for one person.

Uninsured people in this income group would have been covered by BadgerCare Plus if Wisconsin had agreed to accept the federal money available under the law. Those with children under 19 now are covered by the program.

Under the plan put in place by the Walker administration, they now will get subsidized coverage from private health plans sold on the marketplaces but will have to pay, on average, 2% of the cost of the premium and some out-of-pocket costs, such as deductibles.

Adults with incomes below 100% will be eligible for coverage through the BadgerCare Plus program under the Walker administration’s plan.

HealthConnect will pay the premium for the benchmark health plan sold in the silver tier on the marketplace.

“UW Health made this commitment because it will make a difference for thousands of people in our community,” Donna Katen-Bahensky, president and chief executive officer of UW Hospital and Clinics said in a statement. “This is the right thing to do to make high-quality health care accessible to the most vulnerable among us. There’s an incredible potential to have an impact in this area through HealthConnect.”

The program will be overseen by the United Way of Dane County.

“We see every day, in our practice of medicine, the negative consequences of care delayed. Successful enrollment in health exchanges can do much to allow early and ongoing access to health care, said Jeffrey Grossman, a physician and president and chief executive of University of Wisconsin Medical Foundation.

To enroll in the program, individuals should first visit the Health Insurance Marketplace at healthcare.gov or call (800) 318-2596 and purchase any silver-level coverage plan. They should then call United Way 2-1-1 or visit unitedwaydanecounty.org/healthconnect and submit a short application form.

Source: jsonline.com

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Rumah Sakit, UHC dan Agenda Minggu ini Salah satu kunci sukses implementasi Universal Health Coverage di seluruh dunia adalah sistem rujukan yang berjalan dengan baik dan benar. Ada dokter keluarga, primary health centers – dan di Indonesia ada RS pratama – yang akan berperan sebagai gate keepers. Saat para gate keepers belum berperan optimal, maka RS akan dipenuhi pasien sampai melebihi kapasitas – seperti yang terjadi di DKI ketika mengimplementasikan KJS. Pada kondisi ini, sulit mengharapkan mutu pelayanan yang baik dari RS. Peningkatan peran gate keepers inilah yang menjadi fokus perhatian Task Force Health Care WG, The Netherlands saat berkunjung ke FK UGM pada 23-25 September yang lalu. Bersama dengan tim dari FK UGM, tim ini akan membenahi sistem rujukan dengan berbagai aspek pendukungnya, sehingga RS dapat dikembalikan pada posisinya semula, yaitu sebagai pusat rujukan. Silahkan untuk mengikuti reportasenya. Sementara itu, rumah sakit juga masih menghadapi isu “perang tarif”. Sebagian RS menganggap tarif INA-CBGs sudah cukup baik, yang dibutuhkan hanyalah ketelitian RS saat menggunakan coding diagnosa yang tepat. Sebagian lagi mengganggap tarif ini masih terlalu rendah sehingga mendesak pemerintah untuk merevisinya. Sebagian yang lain bahkan belum menerapkan tarif INA-CBGs dan masih merasa nyaman dengan tarif lokal. Pemda DIY berencana menerapkan tarif INA-CBGs di seluruh RS di provinsi ini per 1 Oktober 2013 sebagai upaya menerapkan BPJS secara bertahap. Di daerah lain, penerapan ini dilakukan secara sporadis. Agar bisa optimal RS harus pula mengembangkan dan menerapkan clinical pathway yang sama sekali tidak mudah. Agenda Minggu ini: Pekerjaan rumah masih banyak, sementara waktu terus berjalan, membuat topik terkait UHC ini semakin ramai dibahas. Di Yogyakarta saja setidaknya ada dua pertemuan besar pada minggu ini yaitu:  Health Level Forum to Informal Sector yang berlangsung di Hotel Ambarukmo pada tanggal 30 September – 2 Oktober 2013 dan Symposium on Health Equity and Financial Protection in Asia yang berlangsung di Hotel Tentrem pada 2 – 4 Oktober. Untuk kawasan NTT, Program Performance Management & Leadership dan Sister Hospital akan mengadakan pertemuan pada tanggal 1 Oktober 2013 di Surabaya untuk membahas progress kegiatan sampai dengan pertengahan tahun ini dan exit strategy untuk kesinambungan program. Salah satu isu besarnya adalah bagaimana sumber pendanaan bagi RSUD di NTT agar upaya pencapaian MDGs dapat terus berlanjut dan RSUD di NTT juga tetap dapat menikmati fasilitas BPJS karena telah mampu memenuhi persyaratan yang ditetapkan. + Arsip Pengantar Minggu Lalu
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