Healthcare administrators are the overseers of hospitals and similar facilities and are tasked with making sure all aspects of the system are running smoothly and are at, or under, budget. While that may seem pretty clear cut, in fact administrators must also project future needs and issues that may arise so the problems can be addressed and minimized before they even begin to affect the facility.
By taking a look at recent issues administrators have faced, or are facing, you can get a grasp of the range of problems and solutions healthcare administrators face each year as they strive to provide the best care possible for each patient their facility encounters.
There is a shortage of healthcare workers nationwide, and at the same time the healthcare industry is expanding rapidly. Employment for registered nurses alone is expected to climb by 12% over the next decade, and licensed practical nurse positions will grow almost as fast at 11%. In addition, the Association of American Medical Colleges projects a doctor shortage of up to 121,300 by the year 2030. A full 43% of administrators report their nursing shortages are worse this year than last, and they when combined with labor costs that makes staffing shortages a top issue for administrators.
What is the solution? Because nursing is a high burnout profession, savvy administrators are focusing on retention rather than new staff. Wellness programs, flexible schedules, and similar incentives are being used to retain current staff, which in turn reduces labor costs because there is less hiring and fewer training hours involved. Many hospitals are also partnering with nursing schools to encourage trainees to return as new hires upon graduation, hopefully filling the gap to keep facilities fully staffed.
Many hospitals and clinics have unintentionally fueled the opioid crisis by prescribing opioids for extended periods to surgery patients, causing addiction during the healing process. Once the initial medical issue has been addressed, doctors have run into issues when they try to wean patients off their addictive medication and the patient enters the cycle of drug addiction and spirals downward. Another aspect of addiction is patients who are self injuring in order to obtain opioid prescriptions in emergency treatment rooms, or hospital hopping in order to obtain multiple prescriptions.
Not all doctors are educated in both pain and addiction, and this is a key factor administrators can focus on for improvement. Specific training can be offered to help patients taper of their opioid use successfully, and larger facilities can consider detox services as part of their patient care. Physicians can receive training in the use and prescribing of buprenorphine, which is a treatment for opioid use disorder, in order to prevent addiction in the first place. For ER patients who may be seeking opioids, administrators can network with community services, which provide evidence-based care in order to coordinate a plan to treat patients while refusing to provide them with their drugs of choice.
Worsening Patient Outcomes
Although we have one of the most advanced healthcare systems in the world, it is also one of the most costly, and with the aging Baby Boomer generation sliding into their retirement years this issue could easily snowball if not addressed. Many are entering the hospital with one issue and leaving with two or three, and while hospital staff has discovered the additional issues rather than caused them, the patient outcome is still worse than expected.
Much of the finger pointing is at the US healthcare system as a whole but pointing fingers does not resolve the problem. Administrators need to stay on top of the issue by promoting more efficient care and encourage staff to be more aware of the overall health of each patient rather than focusing on the initial illness alone. Stressing preventative care to patients is another option, as educating a patient on their condition can encourage them to become proactive in their overall health.
IT Issues with Security and EMR/EHR Changes
First the secret codes: IT is information technology, EMR is short for Electronic Medical Records, and EHR refers to an Electronic Health Record. IT has concerns about EMR/EHR for several reasons. First of all, the software used for medical records is expensive, as is the training to use the software properly. In addition, the facility may need a new IT system in order to use the programming. Both office staff and physicians must be trained to use the program, which costs both time and money. In addition, healthcare has used paper records for the entirety of its existence, so the management process must also adjust to the difference in recordkeeping. Finally, an administrator is charged with the security of the patient records even though the IT department may be the only ones knowledgeable about the ins and outs of electronic record security.
One solution is to hire an EMR consultant to implement the computer system and software as well as oversee employee training. While this may seem costly at the onset, a consultant can usually compile a presentation to stockholders and/or CEOs to show both the value and the process of hiring them to implement a new system. On the other hand, you may have one or more board member or IT staff who is fluent with the new programming and can give advice on switching to the new system. Administrators also must comply with patient information protection laws, meaning the EMR software must be secure from hackers. This is best accomplished by utilizing a professional computer security firm as a protection from lawsuits if the health records are compromised.
Rising Healthcare Costs
America has the most expensive healthcare system in the world, and it’s only getting more costly rather than less. Insurance premiums, pharmaceuticals, and healthcare spending are all rising, yet administrators are still expected to meet their budget and profit margins. In addition, the population over the age of 60 is projected to grow to a high of 110 million within the next five years, meaning the healthcare industry will be even more stressed by volume and cost. The coding and billing system used by medical providers is complicated, and changing, meaning administrators must oversee accounts receivable over an extended time frame as patient fees go through the billing and insurance cycle before actual payment is received. Administrative costs such as these make up approximately 34% of total healthcare costs, roughly twice the amount spent by the Canadian healthcare system.
Administrators can’t do much about the cost of care other than stress to staff the importance of prescribing generic drugs instead of brand names, encourage lower co-pays, and work within the system to lower the cost of pharmaceuticals and the structuring of drug benefits. They can also ensure all staff has proper training in order to reduce errors in medical billing before the cost is passed to the patient.
Shifting Reimbursement Models
Some facilities are shifting their reimbursement models from the standard fee-for-service to one based on outcome. In the typical model, patients often wait too long before scheduling an appointment, meaning they are usually much sicker by the time they see a doctor. Providers get paid by the patient regardless of outcome, giving them little incentive to ensure a positive clinical outcome. By shifting to a value-based reimbursement system, payments are based on both cost and quality of care, so staff is more vested in a positive patient outcome. Some systems use a graded value to measure patient health after treatment, which encourages staff to meet specific criteria in patient care.
To shift to this system, administrators must redesign services to a team model so that all staff is proactive in the patient’s health. The object is for medical providers to earn more for a positive patient outcome than a negative outcome, giving them incentive to provide exceptional care.
In order to meet the demands of these payment reforms, practices must redesign the delivery of services to a team-based system that provides proactive care to prepared patients. Care must evolve to enable increasing coordination between practitioners within the healthcare system and connect patients to community-based resources and supports. Providers will need to maintain increased vigilance and communication with patients, even when they are not physically in the office. Increasing care coordination will force providers to adopt new technologies for communication and monitoring. The concept of a longitudinal relationship between a patient and provider over time that addresses the patient’s individual needs and coordinates care across the continuum of a multidisciplinary team is an important foundation for successful population management. The best way for an administrator to switch their facility to this model is to personally train in the new system, then ensure all staff members do the same.
Executive Order on Healthcare Transparency
The Executive Order on Improving Price and Quality Transparency in American Healthcare takes historic steps to empower patients, provide transparency in drug pricing, and increase competitive pricing among group health plans, insurance providers, and hospitals. Hospitals are also required to provide clear information and standard fees to enable patients to shop for the best deal in healthcare.
While the executive order doesn’t go into effect until 2021, administrators must act now to draft new rules and processes in order to smoothly integrate changes into the current billing system. Before that can be done, various agencies must formulate and publish rule proposals, accumulate feedback, implement information gathered, and issue new policies and rules. Administrators must stay on top of these developments in order to determine the effect they will have on the overall cost of their facility’s service.