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The question has never been whether health care will change. Its evolution is continual, and predictions about its future often are about as accurate as 1930s science fiction. Even so, several trends already have emerged that some experts claim provide an interesting glimpse of what’s to come — both in case management and in the industry at large.
Two of the largest trends seem to be on a collision course: The aging of the so-called "baby-boom" generation, and the worsening nursing shortage. Aging boomers very well could reverse the current trend of decreased patient days at a time when there are fewer nurses to care for them.
"[There will be] more than 1 million [baby boomers] turning 65 each year for the next 20 years, and they will be consumers with high expectations. Patient satisfaction is going to be a big deal," predicts health care futurist Russell C. Coile, MBA, vice president and national strategy advisor for Superior Consultant Co. in Plano, TX.
Coile’s recent book, Futurescan 2001: A Millen-nium Forecast of Healthcare Trends 2001-2005, published in cooperation with the Society for Healthcare Strategy and Market Development (SHSMD) in Chicago, makes several specific predictions for the health care landscape over the next five years. He and his team surveyed the 4,000-plus membership of SHSMD, as well as the 30,000 members of the American College of Healthcare Executives, also in Chicago, to create a panel of about 500 respondents.
The book covers seven themes: the health care consumer, technology, cost and clinical performance, managed care, health policy, human resources, and integration. Many of these indicators will have a great impact on hospital case management, Coile notes.
"[One] thing is a predicted increase in patient days, which is counter to the trends, or at least the past trends. There’s a message here for case managers about older and sicker patients: They’re going to need more time, and they’re going to cost more money," he explains. "Length of stay [LOS] might need to increase, and your job is to moderate the rate of increase, rather than [ask] how much lower can we go?’" Coile points out.
On the other hand, Judy Homa-Lowry, RN, MS, CPHQ, president of Homa-Lowry Healthcare Consulting in Canton, MI, is optimistic that the future might hold fewer inpatient days. "I guess you can look at it both ways," she says. "With the advances in technology, and depending on the direction health care plans and reimbursement will take, we might see more of a link between prevention and services. . . . I think health plans may try to incentivize people to get prevention in place and identify issues early so that they may be managed more effectively and so that there won’t be as big a need for [inpatient] services down the road."
Homa-Lowry points out some present-day examples that suggest preventive action will be stressed more in the future.
"You’re starting to see higher premiums if you’re a smoker," for instance. And there was a surge in colonoscopies after recent national publicity efforts created new awareness of the preventive action’s effectiveness. Encouraging these measures is especially appropriate for the aging baby-boom population, she adds.
One of the goals for acute care case managers can be to help usher in that era of preventive care through the establishment of community case management programs. (For more information about community case management, see Hospital Case Management, March 2001 and December 2000.)
Coile’s prediction is that, one way or another, LOS is going to be an important indicator. His survey shows that in the future, hospital rankings are going to be watched carefully both by consumers and providers. "The data are going to be public, and competing on these rankings is going to be a big deal. Case managers, your indicators, particularly LOS, will be among the important national ratings that will be compared among the best of the best," he says. "The numbers matter."
The numbers also will matter in the areas of cost and clinical performance, Coile and his colleagues predict. "The good news is that hospital finances will improve, not so much based on cost performance as on revenues," due to the easing of Medicare payment cuts in the Balanced Budget Act, better fee schedules from managed care plans, and increases in volume, Coile explains. "The challenge, of course, will be to keep costs down while you’ve got these increases, so you can actually make money off operations," he points out. "There certainly will be pressure to improve operational profits."
One way to do that is with intensive, on-site, integrated care management. "The focus is clinical. The . . . first priority in care management has to be error reduction. I think every hospital is going to be doing this. It’s not going to be just a case management system; it’s really a care management system," Coile says.
Case managers, of course, play a big role in that initiative as the communicative link among the different segments of health care. "I agree with the prediction and believe this is great news," says Jackie Birmingham, RN, MS, vice president of clinical design for CuraSpan, in Needham, MA, and a consulting associate for the Center for Case Management in South Natick, MA.
"Refocusing on [clinical needs], particularly as the variety of treatment modalities grows daily, will strengthen the contribution of case management in the delivery of health care. The very need for case management services in hospitals occurs when the clinical resources need to be directed to the patient," she explains.
Homa-Lowry also hopes for a front-end piece of the care management puzzle to come into play. "Case managers need to have a bigger role in physician offices. With all the requirements and what payers are paying for visits, it would be nice to have someone really coordinate the care so that the patient understands [his or her] responsibility, how to move into the continuum, and maybe prevent that visit to the emergency room," she says. "It’s no secret that in certain types of capitated environments, physicians don’t have time to do the teaching and follow-up."
There are several other components to Coile’s health care prediction for 2005. Among them:
• Electronic medical records will become universal. "We won’t be paperless, and it may not happen tomorrow afternoon, but within the next five years is the theory," Coile says. The survey also found that the era of telemedicine finally may be arriving. The increasing use of the Internet by physicians and other health care professionals indicates that in the near future, health plans as well as federal programs will have to consider ways to pay for telemedicine visits.
• Congress will remain divided. "A closely divided Congress is likely to spend more time arguing than legislating in the next two years," Coile says. The panel of survey respondents, he explains, "is sure this will be a food fight right out of Animal House,’ and very little will get done."
Coile says he is only moderately more optimistic but hopeful that things like the Patient’s Bill of Rights and more money in the children’s health program will be accomplished. "The other big set of regulations is HIPAA [the Health Insurance Portability and Accountability Act]," Coile says. "And case managers are very active users of the medical record, so [HIPAA] might make their lives modestly more complicated."
Birmingham adds that although the HIPAA regulations are back on the drawing board as of press time, with the privacy section on hold and sent to a committee for review at the request of Health and Human Services Secretary Tommy Thompson, the privacy standard should survive in some format. "It will complicate the lives of case managers on a daily basis since they will need to use a method of transferring information that is considered secure. The use of the Internet for secure transmission will become the standard of communication, and faxes and e-mail will be used simply for notification of information and not for transmission of personal health information," she predicts.
• The trend toward integrated health systems soon may be over. Futurescan reports that some of the largest integrated delivery systems are downsizing. "The prediction is that larger systems will get smaller, and some will break up altogether," Coile says, explaining that in the last 10 years, the larger health systems haven’t necessarily proven that being large is the best way to manage patients.
[Editor’s note: Copies of Futurescan 2001 are available for purchase, at $25 for members of the Society for Healthcare Strategy and Market Development or the AHA; $50 for nonmembers. To order, call (800) AHA-2626, fax your order to (312) 422-4505, or order on-line at www.ahaonlinestore.org.
For more information, contact:
• Russell C. Coile, MBA, Vice President and National Strategy Advisor, Superior Consultant Co., 101 E. Park Blvd., Suite 413, Plano, TX 75074. Telephone: (972) 403-1945.
• Judy Homa-Lowry, RN, MS, CPHQ, President, Homa-Lowry Consulting, Canton, MI. Telephone: (734) 459-9333.
• Jackie Birmingham, RN, MS, Vice President for Clinical Design, CuraSpan Inc., 368 Hillside Ave., Needham, MA 02494. Telephone: (860) 668-7575.]