Affordable healthcare was supposed to be the American dream, yet the entangled bureaucracy to achieve it has made it a nightmare.
Long before the Affordable Care Act became law, major changes came to the U.S. healthcare system. An aging population, growing advances in technology and research, mounting healthcare costs and an epidemic of chronic illness have forced all of us in the healthcare industry to step back and re-evaluate everything we have been doing.
With major academic centers forced to rebalance their organizations and lay off workers, and small community hospitals declaring bankruptcy, we must find more cost-effective ways of delivering quality care while improving the health of our patients. Providing affordable healthcare has now added to the unemployed workforce. It would be fatal for our nation to overlook the urgency of this vital moment.
Martin Luther King’s famous “I have a dream” speech can easily be applied to our healthcare travesty today.
“I say to you today, my friends, so even though we face the difficulties of today and tomorrow, I still have a dream. It is a dream deeply rooted in the American dream.”
I too have a dream: affordable healthcare in the communities in which we live. We all need it, and we dream regularly about our own well-being; but is it now becoming out of reach? The ACA made healthcare accessible for all, but the costs to provide that care are becoming increasingly unsustainable.
The nightmare
Healthcare has become so complex to navigate that many healthcare workers and patients describe it as a nightmare. Many clinicians are leaving healthcare with early retirements, leaving the bedside to pursue other healthcare avenues, or worse, changing their major in college and leaving medicine altogether.
The World Health Organization defines health as such: Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity.
The "nightmare" in the U.S. healthcare system is not just wasted time waiting for clinical attention. The nightmare in the U.S. healthcare system is not just the bureaucracy that beats up and burns out our clinicians. The reality is, despite all the literature that clearly depicted where we had room to improve and what we needed to do to get there, we failed to execute.
The real nightmare in the U.S. healthcare system is that we continue to place more attention on acute care, when every human being who shows up for medical care should have more attention paid to factors that determine health and that will keep them healthy.
The dream
The Robert Wood Johnson Foundation has developed a weighted impact of various “health factors” based on reviews of health data for every U.S. county. Its research has discovered that “clinical care” accounts for 20% of a person's health.
However, the U.S. healthcare system focuses on clinical care that is inefficient for today’s growing epidemic of chronic diseases. We cannot stand by silently and watch our community hospitals perish. Affordable healthcare that is within reach both geographically and financially is the American dream.
The reality
David Houle, a futurist, and Jonathan Fleece, a healthcare attorney, predict in their book, “The New Health Age: The Future of Health Care in America,” that one-third of all hospitals will close by 2020 because healthcare is shifting out of the acute care arena into alternate settings. Only acutely ill patients will occupy hospital beds in the future. Healthcare is moving more toward providing care management and coordination. We as a nation must move away from task-oriented care and into a focus on care coordination to maintain health and wellness.
As we watch the number of acute-care beds shrink, facilities offering alternative services such as rehabilitation, subacute and acute long-term care, assisted living and hospice are expanding. This rise in acuity and complexity in the post-acute care environment is squeezing out the community hospitals in our neighborhoods. Community hospitals must develop a strategic position and adopt the changes that need to happen.
It is imperative that every healthcare provider realizes the healthcare landscape has completely changed. Clinical skills and services alone will not see us through this new paradigm. We must focus on improving the health outcomes, and the distribution of such outcomes, through quality improvement, improved workflows and systems of care within the communities we serve.
Communities must reach out to their local legislature and ask how they can get involved. Let’s not continue to wake up to this nightmare every day, but take a proactive, unified approach in our neighborhoods so that affordable healthcare within our communities is not a dream or nightmare, but rather, a reality.
Darlene A. Cunha, MMHC, BSN, RN, ACHE, is an accomplished senior healthcare executive whose focus is leading change for clinical, quality and operational excellence.