Perhaps more than ever, hospitals and health systems are closely examining their pocketbooks and ways to reduce spending. Trends to keep an eye on are consolidation, more efforts to cut readmissions, focus on outcomes, care coordination, and communication, according to a Kaiser Health News article yesterday.
Mergers and consolidations
At an all-time high of healthcare mergers and acquisitions in dollar value, hospitals and physicians are no doubt integrating. Robert Blendon, professor of health policy and political analysis, Harvard School of Public Health, said in the Kaiser article, that it's likely that 10 years from now, there will be only three main players in Massachusetts to negotiate and affiliate with.
"So at one side, we're doing experiments with the (accountable care organizations) paying primary care physicians, but at the other there is this very visible sign of concentration among providers, which they argue will lead to less expensive care, but economists argue will lead to monopoly," he said.
Tied to reimbursements, readmission rates are the target of hospitals to reduce the number of repeat patients for the same condition. Previous studies have found that a number of things can help reduce readmissions, such as home health use after hospitalization, patient engagement, and nurses.
"The most interesting conversation going on right now is in Rochester, N.Y., where they are indeed focused on reducing [hospital] readmissions and unnecessary admissions for conditions that probably would not have led to an admission if the person had gotten proper primary care," said Len Nichols, director of the Center for Health Policy Research and Ethics at George Mason University.
Comparative effectiveness research
As leading institutions continue to look at evidence-based medicine and patient outcomes, new research is being developed about what is most effective.
"The most hopeful trend that is occurring is in places like Geisinger (Health System in Pennsylvania) and Kaiser (Permanente), where they are really looking in detail at examining what doctors actually do and what the results are in terms of outcomes and then feeding it back into the system," said Stuart Butler, director of the Center for Policy Innovation, Heritage Foundation.
With initiatives already in motion for accountable care organizations (ACOs) and patient-centered medical homes, more attention will focus on outcomes from care coordination, according to Blue Cross and Blue Shield Association Senior Vice President Alissa Fox.
"We're reimbursing doctors and hospitals to pay outcomes instead of just paying for more care. We would like Medicare to start paying for outcomes because that's (an approach) we think is most successful," she said.
With ever-growing requirements for compliance, hospitals and providers will need to collaborate in their communication efforts, according to Federation of American Hospitals President and CEO Chip Kahn.
"... I think hospitals and doctors and other kinds of providers are going to have to find new ways to work together ... I think there will be just more lines of communication. In some, the expansion of health information technology will lead to virtual connections between them," he said.