Consumers Have Spoken 1. 1. Job Creation 2. 2. The National Debt 3. 3. Healthcare Costs.
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Transcript of Consumers Have Spoken 1. 1. Job Creation 2. 2. The National Debt 3. 3. Healthcare Costs.
Consumers Have Spoken1. Job Creation2. The National
Debt3. Healthcare Costs
ObjectivesDiscuss the research findings on the major
forces that continue to drive up healthcare cost in the USA.
Discuss the 3 major models for reducing cost.
Discuss the impact on the OR Director as the driver for change.
MONEY
TIME
Medicare Reimbursement- 2012
State Exchanges- Medicare-Commercial- 2013-2014
15-20 %
We pay our doctors, hospitals, and other medical providers in
ways that reward doing more, rather than being efficient
and improving outcomes.
How do you think things will change in 2014 when fee
for value contracts start replacing fee
for service contracts?
#1
We are growing older, sicker, and fatter.What role ( if any ) do you think hospitals and doctors should or could play in reversing the obesity trends? What do you predict
in ACO models?
#2
We want new drugs, technologies, services, and procedures.
How do you think this will change when people begin to request insurance that covers them in an ACO versus a
fee for service contract?
#3
We get tax breaks on buying health insurance…and the cost to patients of seeking care is often low.
What do you think will be the impact of benefit programs moving toward high deductable coverage on your
surgical volume? Is this a good thing or a bad thing in your opinion?
#4
$51,413.00
Dec. 2011Real median household income is 7% lower than it was in Dec. of 2007 and 3% lower than in June of
2009
For families with a $4000-$5000 deductible it may feel to them as if they have no insurance
at all!
We don’t have enough information to make decisions on which medical care is best for
us.Do you think “end of life” interventions will
change much over the next few years under the ACO model?
#5
Our hospitals and other providers are increasingly gaining market share and are better able to demand
high prices.
What type of consolidation is going on in your marketplace? Do you agree or disagree that
allowing near monopolies will drive up prices?
#6
We have supply and demand problems, and legal issues that complicate efforts to slow
spending.
Malpractice premiums and jury awards are part of what drives spending…also some state laws limit the ability of nurse practitioners or other medical professionals to fully
perform…also too many specialist and not enough primary doctors…do you see this changing in ACO’s?
#7
Cost drivers
Incentives….we all make more $$$ in a fee for service world.
We are getting fatter, sicker, and older.
We want the latest technology
End of life care
Legal system
Too big and you can set prices
We lack good tools for decision making.
MONEY
TIME
Medicare Reimbursement- 2012
State Exchanges- Medicare-Commercial- 2013-2014
15-20 %
23
Shopping Carefully for High-Cost Acute Care Services
Walmart Steering Employees to Preferred Providers for Surgical Care
Source: “Walmart Expands Health Benefits to Cover Heart and Spine Surgeries at No Cost to Associates,” Walmart News, October 12, 2012, available at:
http://news.walmart.com; Health Care Advisory Board interviews
and analysis.
Case in Brief: Walmart Centers of Excellence
• Walmart entered into bundled payment agreements with six health systems covering heart, spine, and transplant surgeries• Program launched in January 2013; includes 1.1 million covered lives• Providers selected based on convenience, quality, and potential for cost
savings
Walmart Centers of Excellence Partners
• Cleveland Clinic• Geisinger Medical Center• Mayo Clinic• Mercy Hospital Springfield• Scott & White Memorial
Hospital• Virginia Mason Medical
Center
OR Director’s FocusPartnering with surgeons, anesthesiologist, and
administration to standardize care.Standardizing supplies ( is there clinical evidence
to support carrying 5-6 brands for implants? )Standardizing processes and protocolsReducing waitsDemonstrating superior outcomes at a lower costSet aggressive targets for efficiencyCan it be done with less labor?
