Hospitals that rely on a government subsidy for uncompensated or under-compensated care now face a cut to that subsidy that may make it necessary to cut back on certain services, like cancer care. The subsidy cut is hardest hitting to hospitals in states that opted out of a Medicaid expansion. Read the story
The subsidy, which for years has helped defray the cost of uncompensated and undercompensated care, was cut substantially on the assumption that the hospitals would replace much of the lost income with payments for patients newly covered by Medicaid or private insurance. But now the hospitals in states like Georgia will get neither the new Medicaid patients nor most of the old subsidies, which many say are crucial to the mission of care for the poor.
Participants at Kindred’s Fifth Annual Clinical Impact Symposium – from senior leadership to the clinicians on the front lines of patient care – say you should not only remember it, but you should use it often!
A big takeaway from the three days of discussions: Communication. Is. Key.
And it doesn’t require fancy devices to communicate effectively; it can be as easy as picking up the phone. Call the next care setting. Or the previous care setting. Talk about the patient. Gather important information. And let it inform great care across the continuum.
Pick up the phone!
In the last presentation of the 2013 Kindred Clinical Impact Symposium, Ronald Leopold, MD, MBA, MPH, Senior Vice President, National Practice Leader, Health and Productivity for Wells Fargo Insurance Services, talked about the business value of a healthy workforce.
People are remaining in the workforce longer than ever before, and perhaps longer than they had planned, Leopold said.
“Your ability to earn a living is your biggest financial asset,” he said.
And companies, in turn, are well-served to encourage a healthy workforce.
“It’s in [companies’] best interest to get their workforces healthier and more importantly, it’s in your own best interest,” Leopold said.
How can individuals do that? First, they can pick realistic goals and stick with them. Have a healthy lifestyle – move around, eat well, consider behavior changes – what are you doing that you shouldn’t be doing and vice versa?
As the Fifth Annual Kindred Clinical Impact Symposium wraps up, participants came together to make some recommendations for further care of our fictitious patient, Jack, who has many co-morbid conditions and ended up in the post-acute care continuum after being hit by a car while riding his bike, requiring surgery for a broken femur.
After his initial discharge from the acute care hospital, Jack went to a skilled nursing facility, back to the acute care hospital, then to a transitional care hospital and ultimately he was transitioned to home health care. At the current moment, Jack’s home health providers are concerned about his agitated state and resistance to taking medications and exercising.
As Jack continues his journey in the post-acute continuum, CIS participants had some common recommendations for his care:
Kim Warchol has been an Occupational Therapist specializing in dementia for more than 24 years. One minute of listening to her talk about her field and you can hear the years of experience and passion in every word. But she readily admits that she wasn’t prepared to deal with cognitive impairment when she first started practicing.
Her “aha!” moment came through the work of Claudia Kay Allen, MA, OTR/L, FAOTA, which completely changed her perspective from focusing on the limitations of patients with cognitive impairment to focusing on uncovering what they could do. She hasn’t looked back since and, she says, she is no longer “leaving these vulnerable individuals to fend for themselves.”
Would you get on a flight if there were a 1 in 100 chance of the plane crashing? Healthcare is at a one percent rate of adverse events. It used to be 6 to 18 percent, so we’re making progress.
What are three things we can we do to keep people safe? Create and use checklists and standardize processes and products.
What is efficiency in care? Delivering the right amount of care in the right place at the right time.
How did one Massachusetts hospital significantly reduce the mortality rate from ruptured aortic aneuryisms? By setting up systems where everyone is trained in the treatment and knows where things are, so staff and clinicians are ready to go at a moment’s notice.
What does “post-acute paradigm shift” mean?
What’s wrong with the U.S. healthcare system?
“A lot goes in and very little seems to be coming out the other side in terms of welfare and satisfaction and extended life”
- Jack Wennberg, founder, Dartmouth Institute for Health Policy
What are care management’s best practices at this early stage in its existence? This question was answered by William Mills, MD, Chief Medical Officer for Kindred at Home and Vice President of Medical Affairs for Kindred’s new Division of Care Management, during a break-out session at Kindred’s Fifth Annual Clinical Impact Symposium.
There’s no doubt that readmissions to acute care hospitals are costing the healthcare system a lot of money, and the patients who cost the system the most might fit a profile like this:
Patients like this typically see anywhere from two to ten doctors regularly. They have no home support, so when a crisis arises, 911 is called and the patient is taken to the emergency room, which leads to a hospital stay eight out of ten times, Dr. Mills said. Rehabilitation and a long-term care stay follow, then home care and then the cycle recurs.
For patients like this, wouldn’t it make more sense to deliver care in the home setting?
Although the posters at Kindred’s Clinical Impact Symposium came from different Kindred facilities and covered different topics, the one thing each had in common was the passion and enthusiasm of the people presenting the projects and information.
While the posters were filled with technical terms and acronyms, the patient was never forgotten and there were often pictures of patients surrounded by their care teams, many having defied the odds for a successful outcome. While it wasn’t possible to cover all of the presentations, we had a chance to talk to the people behind three of them.
Our fictitious patient, Jack, has developed severe diarrhea and is being treated with metronidazole. He is in a skilled nursing facility for wound care and rehabilitation. The diarrhea is not improving and oral vancomycin is started for suspected C. Diff infection. Stool cultures have been sent out.
The stool culture comes back positive for CRE, or Carbapenem Resistant Enterobacteriaceae.
Ruth Carrico, PhD, RN, Associate Professor, Division of Infectious Diseases, Department of Medicine, University of Louisville School of Medicine, led participants at the Fifth Annual Clinical Impact Symposium through the next steps of infection control for our patient, Jack.
Carrico first questioned participants about whether, given his situation, Jack should be isolated. The answer? Yes.
“We must assume that a body fluid out of control is caused by something transmissible until proven otherwise,” she said.
Effective, efficient movement of patients through the post-acute continuum of care is Kindred’s goal. But infectious diseases are unwelcome visitors that also like to make the post-acute continuum of care their home, starting in the acute care hospital and settling in at the various levels of post-acute care settings.
Addressing issues related to infectious diseases today at Kindred’s Fifth Annual Clinical Impact Symposium was Alice Kim, MD, Director of Infectious Disease/Control at Kindred’s Cleveland Fairhill Hospital.
Dr. Kim, who came to Kindred from the Cleveland Clinic with the mission of implementing acute-hospital devised infectious disease plans in the post-acute setting, described the challenges related to infectious diseases in both acute and post-acute care.
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