As part of the new healthcare overhaul, efficiency and improved patient care
are important goals. As part of healthcare reform, Medicare has proposed to pay
doctors and hospitals based on patient health and effectiveness of care, giving
an incentive for medical practitioners and medical facilities to keep track of
patients and their health. This personal interest, though motivated by financial
gain, is nevertheless intended to improve the relations of patients with
healthcare providers and lead to a healthier America.
Many healthcare groups are trying to get ahead of healthcare overhaul by
establishing accountable care organizations. These can be either physician-run
or hospital-physician partnerships. They manage patient care in an effective
way, and are rewarded for cost saving measures. Many programs seek to address
the problem of waste in Medicare, and various experiments are being run all
across the country that should improve care and reduce wasteful spending.
Dr. Gerard Anderson, director of Johns Hopkins University's Center for Hospital
Finance and Management discussed an initiative set to start in 2012. "One of the
major initiatives that will start in 2012 are the accountable care
organizations, which hospitals and managed-care organizations and insurers are
all trying to figure out how to do," said Anderson. "That's a fundamental change
in how Medicare works and nobody knows how it's going to play out. Even the
preliminary regulations haven't been written."
All over the country, unique solutions to these problems are being sought
through various programs and other initiatives. One health insurer Humana, based
in St. Petersburg, Flori., operates a program called Humana Cares, a national
call center that connects nurses and social workers with Medicare Advantage
patients with chronic illnesses. Another pilot program called "medical home,"
run by Metcare and SeniorBridge, is a primary-care program in which doctors
coordinate patient care with the help of non-medical staff.
Metcare's medical home project, launched in August, is a primary-care program in
which doctors coordinate patient care with the help of non-medical staff. This
program also saves Medicare money and improves the health of seniors, because
many elderly health issues can be adequately addressed in their own homes, but
without house calls available, they must visit a hospital.
The New England Journal of Medicine recently published findings that demonstrate
that one in five seniors is rehospitalized within 30 days of being discharged
from a hospital. Metcare wants to prevent this rehospitalization by giving
enrolled patients weekly visits from a nurse or social worker, and the ability
to contact an on-call nurse 24 hours a day. Johns Hopkins analyzed similar
programs and found that for each nurse hired, the program saved $75,000, and
hospitalizations became two-thirds less frequent.
House call nurses in the program drive to patients' homes and chat with them
over coffee while giving health exams and listening to their problems. If their
problem is serious, nurses pick up patients and drive them to the doctor's
office. If they're having a bad reaction to medication, nurses rushe to attend
the problem. If they are having trouble reaching a pharmacy, nurses makes those
calls for them.
This particular program focuses on Medicare patients who do not have relatives
nearby, who have chronic conditions requiring frequent doctors' visits, and who
have confusing medications to keep track of. The pilot program is being run in
the areas of Daytona Beach, New Smyrna, and Ormond Beach. When totally up and
running, the program expects to include 100 patients.
Daytona nurses in the program have already demonstrably prevented several
unnecessary emergency-room visits. For example, one patient with chronic
obstructive pulmonary disease (COPD) called a home health nurse complaining of
shortness of breath, and the nurse drove 20 minutes to his house, only to find
him having a panic attack. The nurse have him his anti-anxiety medication, and
sat with him as he calmed down. Once the panic attack had passed, his
primary-care doctor was called and filled in on the situation.
Doctors and patients alike appreciate the fact that the program allows patients
to have real human connection with medical caregivers, rather than just a
handful of minutes in rushed doctors appointments. "I see patients in the office
for 15 or 20 minutes, maybe 30 at the most," said Dr. Jose Guethon of Metcare.
"But someone who is able to follow them at home can get a much broader picture
of what's going on from a social, economic, physical, nutritional perspective ?
all of which affect their care."
In fact, all too frequently, patients' needs are not medical, but social or
practical. Some just need transportation to doctor's appointments, others
require help sorting their medical bills, and some are merely lonely.
"A lot of the needs of these clients are social," said Patricia Canney, director
of clinical operations for the care management division. "What do you do if you
have a senior who doesn't have any food in the house? If we can assist in
getting funds or going to urban ministries and picking up groceries, then we do
that. Those are social needs, not medical needs, but sometimes the social needs
are just as important."