I am intrigued by the new operational and practice models that will emerge this year. As the industry faces the general "do more for less" edict, words of fear are coming from those who aren't sure if what they do is valuable enough to ensure their survival.
In the fee-for-service world, we all performed our functions; mostly oblivious to the resources consumed. We were less than efficient in analyzing the true costs or benefit of the services we provided, and usually took minimal steps to manage costs. As we developed care plans and goals, delivered services, and discharged patients, the care received by patients was heavily influenced by caregiver or agency experiences, treatment philosophies, and reimbursement sources. Now, payors are demanding more accountability for the products we sell, and we are recognizing we don't have a standardized description of what it is we sell.
We have not standardized what home care is because we have yet to discover what is the best practice based on costs and outcomes. We must ask ourselves:
When is home care better than care in other settings?
What types of patients and services are best cared for and provided in the home?
How is home care best provided?
Who should provide the care?
"We" (healthcare folk!) too often feel that the "thing" we do (read: heal the world) should be above the controls and constraints present in the "business world" (read: selling Pokemon Cards, Lincoln Navigators, and Web site development). While it's true that these other commercial endeavors do not usually have life and death implications, they are clearly defined products and services that consumers willingly pay for, with an expectation of what they will receive in return. I see the goal of the new millennium as defining home care's product.
What can we offer that consumers are willing to pay for?
What is the mutually agreed-upon expectation of what consumers will receive in return?
Healthcare has been on a pedestal, and we have been allowed to absolve ourselves from accepting responsibility for outcomes. "I'm sorry Mr. Jones, I know I've been treating you for 9 weeks and you're out over $3,000 and still have the same pain you came in with...but this is healthcare." The concept of healthcare providers accepting financial risk associated with the outcomes they can deliver was not a comfortable transition for hospitals, hospices, or skilled nursing facilities. Home care will be no different.
I predict a change in industry players. We will lose those who see healthcare as an obscure and fickle phenomenon that can be helped but not controlled. We will gain business-focused leaders who see the opportunity to make and legitimately keep a profit in home care. This new breed will come from many sectors; those where general business principles of supply, demand, added-value, profitability, and customer service are ways of life. These leaders will not tolerate cries of "It's not fair," "I don't know how many visits I'll have to make to reach these outcomes," and "I know the benefits have run out, but the patient needs me!"
Clinicians will need to understand the issues and speak thoughtfully, intelligently, and objectively as the industry accepts accountability for care delivered and resources consumed. A complement of competent business and clinical focus will be required to identify best practices in home care. This combined focus will also allow us to effectively fight for necessary reforms through the gathering, analysis, and presentation of objective data that represents the real impacts of our interventions on our newly-defined home care product.
Our general statements of, "home care is the most cost effective way to deliver care...and that's where the patient wants to be," aren't good enough anymore. We should look at what we can do best and acknowledge that there may be types of patient or services that are more costly, or have poorer outcomes, when delivered in the home.