In order to successfully prepare for the challenges of impending healthcare reform and address the effects of the extended economic downturn, many hospitals and health systems need to not only improve their operating performance, but also should consider doing so within the context of enhancing clinical integration, service and process coordination, and aligning resource utilization across the care continuum. While considerable uncertainty still exists surrounding the details of healthcare reform, certain consequences of reform are likely that hospitals will need to address.
Most reform proposals being discussed will result in significant reductions in reimbursement per case and an increase in service demand. These proposals will likely lead to further requirements to reduce costs, manage resources, and coordinate services. The table below summarizes the operational components that will require increased attention given the potential results of healthcare reform. Responding successfully to these effects of healthcare reform may well require a new approach to improving hospital operations.
Pressures to better manage costs and more effectively manage resources will most likely continue unabated. Achieving necessary improvements will require gaining efficiencies across the care delivery spectrum. Hospitals will need to develop new approaches to operational processes, structures, and service integration in order to thrive in an environment that requires them to "do more with less" in other words, survive on reimbursements resembling current Medicare rates. Operational improvement initiatives will need to incorporate elements such as clinical integration—that is, the coordination of services, information, and resources across a care continuum. Other elements that need to be included are provider relationship enhancement, fundamental process redesign (including coordination across service delivery components), new accountability and management structures and methods, and revised approaches to utilization of limited resources.
The inclusion of CI components into redesign efforts will be critical to improving operations going forward for a number of reasons:
1. Proposed healthcare reform scenarios include requirements to improve the manner in which clinical care is organized, delivered, and reimbursed across inpatient, outpatient, and ancillary service providers. Hospitals and health systems will need to provide new service models while receiving less revenue per unit.
2. Service performance, quality, and outcomes will increasingly be measured and even rewarded based on a growing standardized set of recognized metrics.
3.Cost pressures in the recent past have led many hospitals and health systems to achieve significant cost improvements in operational areas within their facilities. Additional efficiencies will be derived from improving integration and service utilization across the service delivery system and managing the resultant costs across these components.
4. Increases in the number of individuals with healthcare coverage will lead to amplified service demands (especially from currently decreased levels). This in turn will lead to a number of ripple effects:
5. Hospitals and health systems will need to consider CI requirements when improving service and resource efficiency so that related process, utilization, and organizational enhancements both improve costs and facilitate increased service coordination.
6. In order to realize operational efficiencies that factor in CI components, hospitals and health systems will be required to review their role in the care delivery system and create new models for relationships with providers across the service spectrum.
In order to ensure that CI is sufficiently considered and utilized when conducting an operations enhancement initiative, such efforts should include an evaluation of the level of utilization of key CI components:
Once operational improvement opportunities have been identified, specific enhancements should be planned and implemented with CI in mind so that maximum efficiencies and service advancements can be realized. Feedback from providers and other stakeholders should be used to develop and institute detailed improvement plans which consider:
1. Creation of cross-functional processes that include CI components (e.g., capacity management, communication, critical paths, etc.)