It is 2017, and “uncertainty” is the operative word for health care leaders. As we transition from the Obama White House to the Trump White House there is much that has yet to be determined with respect to how healthcare will change. President-Elect Trump has promised to “repeal and replace” the Affordable Care Act better known as Obamacare. With both houses of Congress dominated by Republican majorities it seems likely that change is coming. There has been little talk of exactly what that change will look like, except to say that a full repeal is unlikely because it would be too disruptive to those already on the exchanges who have no other options. It is said that markets hate uncertainty, and the same can be said of healthcare administrators, CEOs and nursing directors. So, what is a healthcare leader to do in order to prepare? As a former V.P. of Clinical Services for skilled, long term, inpatient rehab and home care facilities I recommend the following:
• Review your quality outcomes and develop process improvement plans in any areas that appear deficient
• Develop effective transition of care processes and communication
• Analyze information data sets such as MDS (Minimum Data Set) or IRF-PAE (Inpatient Rehab Facility-Patient Assessment Instrument) to ensure maximum reporting within guidelines
• Review all leadership positions within the organization for maximum effectiveness. Add or delete based upon need to address quality outcomes, education, regulatory compliance and cost containment. (Keep in mind that adding position(s) may lead to long-term cost reduction).
• Review last two years of health survey visit findings and perform audits on any areas with a history of deficient practice
• Perform staff satisfaction survey and develop additional methods to determine staff turnover rates and reasons for turnover then develop definitive plans to reduce turnover, increase recruitment and improve retention
• Perform resident/patient satisfaction survey (if not done within last 2 years) and develop action plan to improve to at least 95%
• Perform risk assessment analysis in areas that impact patient safety, returns to acute care and adverse events. Develop clinical programs that address any deficits.
It is unlikely that value-based purchasing (VBP) will fade. Therefore, a keen eye on quality outcomes is essential. As competition intensifies, this will differentiate your facility from the rest of the pack. Referral sources and patients are shopping for providers with the best results, so ensuring processes are in place which deliver clearly defined clinical programs to prevent readmission is critical to success. Mitigating risk and holding costs down while maximizing referrals is essential. The incoming administration is claiming to be serious about cost efficiency (Boeing learned that lesson before Trump even took office). A well informed, experienced leadership team is a must. Leadership needs to be prepared with a strong staff development program that keeps staff informed, in compliance with regulatory expectations and capable of providing quality customer service skills.
It is likely that legislation will be passed to ensure portability of insurance which will force not only competition between providers, but will also require better communication and cooperation amongst care providers across not only systems (hospitals, insurers, post-acute care providers), but states as well. Transitions of care will be a focus, and those who are prepared will be the clear winners. They will experience the most success, because their patients will reap the whole of the benefits of quality and efficient healthcare and isn’t this what we all want?