A new day is coming to the already rambling, shambling, expensive, labyrinthine American healthcare system. U.S. healthcare is twice as expensive as the next most expensive system in the world (Germany’s) while delivering worse outcomes than in most industrialized countries. Now, a seed planted by the Affordable Care Act is beginning to germinate into a new way of life inside the healthcare workplace.
The Affordable Care Act mandated that Medicaid and Medicare, which now cover roughly 38% of Americans, provide reimbursement based on a new set of standards starting in 2015. Rather than flat reimbursement for procedures, the new system scores service based on outcomes, efficiency, patient experience, and clinical processes.
The new reimbursement formula is just beginning to take hold and will soon infect private and other payers as well, says Dr. Audrey McCrary-Quarles, Associate Professor in the Health Science Department at South Carolina State University. Dr. McCrary-Quarles teaches graduate courses such as Quality Management and Healthcare Organizational Behavior as part of the Healthcare Management Concentration in South Carolina State’s MBA program, which offers classes at the Lowcountry Graduate Center.
Everyone from managers to janitorial staff are affected on the job by the new reimbursement formula.
Managers now have to focus on the quality of care delivered by their staff, says Dr. McCrary-Quarles. Their job will increasingly revolve around inspiring employees, to ensure adequate training and focus more on customer service and patient satisfaction.
For high-level caregivers, like physicians, nurses, and therapists, there will be a new emphasis on customer service. That will put added weight on their ability to communicate with patients and with other staff and to recognize that they are part of a team. RNs especially will be more accountable for the quality of care they deliver and the documentation of that care. “Everything they do from the time a patient enters the hospital until the time they exit will affect the reimbursement score,” Dr. McCrary-Quarles said.
The new reimbursement system will even affect ancillary employees, like those in custodial and food service. If patients complain about a dirty room or their food not coming on time, that will influence the patient experience score – and the reimbursement.
The new reimbursement system was a long time coming, says Dr. McCrary-Quarles. “Manufacturing has been doing this for a while,” she said. “If you do not improve quality and reduce errors, the profits are going to decline. Healthcare facilities have always assumed the (customers) were just going to come.”
This shift in focus of the healthcare business is going to require years to fully take hold, Dr. McCrary-Quarles says, but its most significant impact will be how healthcare management interacts with staff.
“When I was in the healthcare business, upper management simply told people what to do, like a dictatorship,” she said. Today, top brass’s foremost concern is finding the proper staffing mix and preparing staff to work in the new environment.
Dr. McCrary-Quarles’s graduate courses teach students who enter as junior healthcare managers how to understand employees and the organizational environment. “You’re not just on an island by yourself,” she said. “You have to work with others as a team.”