It’s a new year and a new Congress. A Congress that has seen a change in leadership from Republican control of the house to now Democratic control, while the Senate has gained in Republican strength.

The Democrats rode to their election victory on anxieties over the “repeal” of the Affordable Care Act and the potential loss of coverage for pre-existing illnesses. Already, the new Governor of California is calling for a “state-run single-payer health system.”

Healthcare has always been political and now in 2019, it has become even more so. Change is in the air as there will be major battles ahead as the Democrats push towards more “government control” of healthcare through single payer or Medicare for all and Republicans push back on greater government involvement. The wild card in all of this is what a populist President feels he needs to do as he faces re-election.

Change is in the air, but change is an extremely difficult thing for healthcare providers.

Meetings, conferences and internal programs highlight the need for innovation, new delivery models, new approaches to care, and the need to put the patient first. The call is for change!

But at the end of the day, the provider industry has not changed much in the past 50 years. Yes, we provide more care on an outpatient/ambulatory basis and we use more technology to image and treat patients than ever before. We have substantially reduced deaths from heart disease and cancer and life expectancy has risen substantially.

We spend two times more per capita on healthcare than comparable countries for no better outcomes. Are we wasting money? Do we spend too much on routine care? On specialty care? On pharmaceuticals? The answer, of course, is yes.

We have just spent well in excess of $200 Billion on the implementation of electronic health records across US Hospitals. Did that expenditure lead to lower costs? To better outcomes? Clearly not lower costs and you can be the judge if outcomes are substantially better.

We just keep doing more of the same in a more expensive manner.

We are reluctant to change and examine any new approach that could substantially reduce costs or change work-flow. Reluctance to change has become institutionalized in a culture of postponement….”let’s just wait until Epic has that module!” Or “Cerner has announced that it is developing that so let’s wait and see.” Or even better, “we don’t have any money to invest in new technology since we have to upgrade our existing EHR to the next release!”.

Hospitals may face a Medicare for all payment environment with commercial rates being set at Medicare rates. Cross subsidies of commercial patients go away. That means that true cost reduction has to occur in a major way.

We have been examining patient clinical flow information. And the waits, lack of time specific responses and the just utter lack of parallel care adds thousands of dollars of costs to every patient encounter.

As an example, when a physician decides on the morning of discharge that another consult is required prior to discharge…that means that the patient will not be discharged until late afternoon rather than before noon. Why wasn’t that consult ordered the night before? Who knows? And why does the patient have to pay for the physician and hospital’s failure to perform?

Or patient delayed for days while waiting for a nursing home placement…every patient admitted to the hospital will leave the hospital at some time. Discharge disposition should be arranged before the patient is admitted…not determined near the end of the stay. Simple concept but hard to put in place because it has not been done that way before.

Repp can track anything that moves in a hospital, equipment, staff, and patients. Hospitals have between $75,000 and $100,000 per bed of moveable equipment. Yet there is very little tracking of the equipment utilization and relating costs associated with delivering care.

Staff costs are over 50% of operating costs of a typical hospital, there is no measurement on an on-going basis of staff utilization, much less even locating staff in real time.

Patients wait, be it for care, for procedures, and for treatments, yet there is no measurement of the patient wait or even where patients are located in real time. Current hospital systems use time stamped data from the EHR to try and identify patient flow, but the data are unreliable at best.

If you don’t measure it, you can’t control it. If you don’t control it, you cannot reduce costs and eliminate waste.

The healthcare political environment of 2019 is changing rapidly. Are we going to see Medicare for all in 2019? Not likely, but will there be rate compression over the next several years? Undoubtedly. Can the current environment of delivering care in the same fashion as the last 50 years continue, no way! Change has to occur.

Repp is looking for those leading organizations that see the future and want to act now, begin to substantially improve operations by understanding the flow of patients, staff, and equipment. We are committed to be your partner. Let’s connect and make a difference in how care is delivered…eliminate the wait, reduce the cost and improve the satisfaction!

Michael A. Sachs

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