Managed care or not, staff work harder, faster

There aren’t many managed care contracts yet at Valley View Hospital in Glenwood Springs, CO, where Linn Kight, BSN, RN, is clinical path coordinator. "But even so," she says, "the health care environment is such that we have to work harder and more efficiently than ever before. That’s true of a facility whether or not it is heavily affected by managed care."

Insurance companies follow the example of Medicare and Medicaid, and those dollars are shrinking, so reimbursement is lower in any case. "There is no hospital in the country that has not been impacted," she says. "No one is exempt from tightening the belt and working at appropriate utilization of services, not just within the clinical setting but in all the support departments as well. But it’s harder for some hospitals than others, depending on their payer mix."

Kight sees an advantage to HMOs having copies of a facility’s pathways and patients being on pathways. "If a company knows a patient is on a pathway, case managers have to answer very few questions from the company," she says. "The people from the company know what’s on the pathway and know what time frames to look at for length of stay. That makes it easier and less time-consuming for the case managers." When a patient is not on a pathway, she says, private insurers as well as managed care companies ask more questions and need more information. "Then they ask, Why is the patient still here? He doesn’t need that intensity of service. You need to look at getting him discharged,’" Kight says.

For more information, contact Linn Kight, BSN, RN, Clinical Path Coordinator, Valley View Hospital, Glenwood Springs, CO. Telephone: (970) 945-6535, ext. 3312.