Being receptive to coming changes

By Stephen W. Earnhart, MS
CEO
Earnhart & Associates
Houston, TX

Like many, I am frustrated by the Accountable Care Act (ACA) and what it has the potential to do to our healthcare. Most will agree that the path we have been taking prior to the ACA was unsustainable, but, really? Is this the best we can do? Apparently. So, for now, let’s deal with it and move on.

Moving on does, however, pose challenges for all of us. The ACOs (accountable care organizations) that are springing up everywhere essentially are going to be incentivizing the primary care physicians to reduce costs, because reducing costs is at the crux of the ACA. There are many ways this step is going to happen. Some of the more notable include reducing duplicity in diagnostic testing, treatment modalities that have been proven effective, reducing errors, and — this is a big AND — reducing surgery. Well! That is somewhat of a wakeup call to those whose very jobs involve patients having surgery. Necessary, emergency, elective, or unnecessary — it is still how we earn a paycheck.

I suppose if we were in an industry that made, say, rubber automobile tires, and the government said that going forward, it was phasing out rubber tires and only allowing latex tires in the future, we would shift how we did business. We would change our raw material, purchasing contacts, equipment, pricing, research, employee education, marketing, and just about everything else to retool our company to obtain contracts for producing latex tires. Guess what?

Healthcare in the United States has adapted to change with glacial speed in the past because no matter what we changed, well, nothing really changed that affected you and I. Not anymore. I have spent a lot of time researching the changes that are here and tried to forecast how to deal with them now. Regardless of the rhetoric in Washington going on at press time, Obamacare is here to stay. It is actually too late to change it anyway as sweeping changes have been happening behind the scenes for the past couple of years that forbid change. What we have not seen until now is the effects of it all. They are here, and they are monumental to us.

For employment’s sake, the key will be cost control. For personal sake, the key is cash — cash to go to "cash-only" physicians and facilities. Oh, yes, there are coming and starting now. That’s another column. Focusing on the employment, you need to really change the way you do business. If you endorse the concept that ACOs are going to drive the healthcare dollar, then you need to respond to their number one credo: Reduce costs while increasing patient satisfaction and outcomes. There’s not much you and I can do directly about the outcomes issue, but we certainly can reduce our costs in our facilities. Less surgery means fewer staff members. Period! Surgeons are not going to be complaining to you as much if turnaround time gets pushed out a bit because you do not have the staff to flip-flop rooms like you used to do for them. Compressing your surgical schedule from five days a week to three or four is going to become commonplace. Look at what the airlines did to reduce cost when the fuel prices soared: They reduced the number of flights so that only full flights left the gate. Did it affect their staffing? You betcha!

Many larger hospitals have dedicated teams that turn over rooms between cases. How long are you going to pay for those non-clinical employees when your existing clinical staff can do it just as well and save money?

I hear from some large healthcare surgical managers that their staffing plans cannot change, and that they need everyone that they normally use. They say they cannot reduce their staffing. The bottom line is they will, or someone will do it for them. I am always amazed at their resistance to reality. Many of us long-timers in surgery need to face up to the facts and become part of the solution and not hold on to the way it was. We need to be receptive to change and accept what is inevitable. Give the decision-makers in your organization a few months to realize what the financial implications of Obamacare are all about to their bottom line before they start making all of the above mandatory. When they do, they are going to be looking for employees who understand it and are able to see the opportunities and are receptive to the changes required to stay profitable in what is rapidly becoming an unprofitable marketplace. Be one of those who is forward thinking and looking for ways to help your center, hospital, or health system to still be around in the years to come. [Earnhart’s views are not reflective of AHC Media, publisher of Same-Day Surgery. Earnhart & Associates is a consulting firm specializing in all aspects of outpatient surgery development and management. Earnhart & Associates’ address is 238 S. Egret Bay Blvd., Suite 285, Houston, TX 77573-2682. Phone: (512) 297.7575. Fax: (512) 233.2979. E-mail: [email protected]. Web: www.earnhart.com.]