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Change and Health Care

Change and Health Care. Stephen Foreman, PhD, JD, MPA Associate Professor Robert Morris University School of Nursing and Health Science. Overview. Current trends are not long run sustainable Pressures to cut costs Patient safety and publicity Health care reform

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Change and Health Care

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  1. Change and Health Care Stephen Foreman, PhD, JD, MPA Associate Professor Robert Morris University School of Nursing and Health Science

  2. Overview • Current trends are not long run sustainable • Pressures to cut costs • Patient safety and publicity • Health care reform • Quality, safety, efficiency • Change and bedside care • Organized nursing • Collecting and disseminating information • The future

  3. Spending Trends • Federal –Medicare / Medicaid / SCHIP • State spending • Private commercial health insurance • Out of pocket

  4. Private Commercial Health Insurance Premiums pmpm

  5. US Health Care Demand by Age Group

  6. Medicare Part A • The Hospital Insurance (HI) Trust Fund will pay out more in hospital benefits and other expenditures this year than it receives in taxes and other dedicated revenues. • The difference will be made up by redeeming trust fund assets. • Growing annual deficits are projected to exhaust HI reserves in 2017. • After 2017 the percentage of scheduled benefits payable from tax income will decline from 81% in 2017 to about 50% in 2035 and 30% in 2080.

  7. Medicare Funding • The difference between Medicare’s total outlays and its “dedicated financing sources” is estimated to reach 45 % in fiscal year 2014. • Trustees are required to issue a determination of projected “excess general revenue Medicare funding” • This is the third consecutive such finding, it triggers a statutory “Medicare funding warning”.

  8. Non-sustainable trends • Need to change costs • Policy makers see “silver bullet” in • Efficiency • Quality • Safety • Also publicity and public perception • “Free money”

  9. Health Reform • Funds comparative effectiveness research … to identify research priorities and conduct research that compares the clinical effectiveness of medical treatments. • Hospital value-based purchasing program … to pay hospitals based on performance on quality measures. • Implement value-based purchasing programs for skilled nursing facilities, home health agencies, and ambulatory surgical centers.

  10. Health Reform • Develop a national quality improvement strategy … improve the delivery of health care services, patient health outcomes, and population health. • Independent Payment Advisory Board .. recommendations to reduce the per capita rate of growth in Medicare spending if spending exceeds a target growth rate. January 2018, submit recommendations if Medicare per capita spending exceeds GDP per capita plus one percent. • Medicare penalties for central line infections, falls

  11. State Level Reforms • Prescription for Pennsylvania

  12. Quality, Safety, Efficiency • Lots of attention • Cost savings • For its own sake

  13. The Bedside Nurse • Change will come • Best position to advance changes that make sense • Need “voice”

  14. Organized Nursing • Can help provide voice • Best position to provide solutions that make sense • Attention to quality, safety and efficiency builds credibility for negotiations

  15. Information and Change • Effective change requires good information • Paperwork vs information • Collection of information / data can amplify voice • Data collection that is used for quality, safety and efficiency information is gold • Important future role for the bedside nurse

  16. The Future • The future will bring change • These changes will be substantial, may not be incremental • The greater the voice of organized nursing the more relevant the change • An opportunity for all

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