Considering Cost and Quality
President and CEO
Holy Family Memorial
Holy Family Memorial is deeply committed to process improvement methodologies. When we decide that we need to change processes to accommodate new operating realities, our extensive use of process improvement takes into consideration that the change will add value for customers, including safety and quality, as opposed to detracting from them.
Continuing changes in payment methodologies do, however, impact on patient access and quality, and providers' efforts to ensure continuity and safety are challenged.
What frequently happens is that patients think that Medicare or their insurer is going to cover something expensive—for example, a month of their stay in the nursing home—and later learn that they are not covered.
In the nursing home example, Medicare frequently points out that they were not an official inpatient at the hospital for three nights—possibly, they left the hospital before midnight or were marked as being under observation. This affects the willingness of the patient to be admitted to the skilled nursing facility—for many of these patients, if their stay is not covered, they're going home. Some patients forgo necessary tests or treatments for similar reasons, too—and high-deductible plans are a cause of this as well.