How will reform changes impact your clinicians?

There has been a lot of talk about how healthcare reform will impact facilities, but how will the way physicians, nurses, and other providers care for patients on a day-to-day basis be impacted? Expect more of a team-centered approach to care, says Jane Kusler-Jensen, BSN, MBA, CNOR, specialist master, service operations/healthcare providers/strategy and operations, Deloitte in Chicago. Kusler-Jensen gave a presentation on this topic at the Association of perioperative Registered Nurses (AORN) Leadership Conference in July.

Kusler-Jensen points to the Innovation Center within the Centers for Medicare and Medicaid Services as a setting to test innovative payment and service delivery models. "These new models will certainly be piloting additional ways to manage care throughout the medical disciplines in a more team-centered mode," she says. "This, combined with the formation of accountable care organizations, ... will only further drive team-based approaches."

Consider these other impacts predicted by Kusler-Jensen:

• More alignment among providers.

Expect additional alignment and tighter integration with healthcare systems as well as accelerated consolidation. "One change that will need to occur is working with physicians as health systems' partners, not their customers," Kusler-Jensen says.

Providers and systems will introduce pay-for-performance collaboration with Medicare Advantage patients, she says. "This will create a whole new working relationship, one that surgery centers owned by physicians are familiar with," Kusler-Jensen says.

Multiple factors will impact where surgical cases are performed, she says. "These include in-network healthcare insurance coverage, alignment of physicians with specific healthcare systems, patient preference of location, and perhaps, the requirement to disclose financial relationships between health entities, including physicians, hospitals, pharmacists, other providers, and manufacturers and distributors of covered drugs, devices, biological, and medical supplies."

• You might receive more information electronically.

Prepare for the possibility of receiving information from integrated electronic health records, Kusler-Jensen says.

"If the center is aligned with the larger healthcare system where the information is maintained, it should not be an issue," she says. "However, if the center is independent, procurement of this information may be difficult and may require IT security clearance or requesting the information in a timely manner to obtain the necessary information prior to surgery."

• An increased emphasis on education.

Healthcare reform puts a heavier emphasis on keeping patients well, which presents a challenge for outpatient surgery providers who have a limited amount of time to interact with patients.

"Providers must become more active educators, helping patients see the benefits and tradeoffs of lower-cost, higher quality care, as a whole throughout the healthcare system," Kusler-Jensen says.

In an ideal world, education should begin when the surgery is scheduled, she says. "Utilization of web portals to access preoperative health care information and expectations for the postoperative course can provide a patient with 24/7 access to information," she says. "This information can be personalized for the patient by the locations where one receives care, the physician performing the procedure, as well as the type of procedure being performed.