policy nicholas response

In the American healthcare system, hospitals and other facilities face two very interrelated issues that appear to have an inverse relationship. These include the quality of care a patient receives and cost effectiveness of the care provided. As retention and staffing issues have greatly damaged the quality of care and overall patient experience, hospitals and other healthcare facilities have had to think outside of the box from clinical and business perspectives to improve patient outcomes and quality of care all the while maintaining cost effective strategies. Reduction of cost is important to these hospitals when overhead is so high. In the following paragraphs I will lay out a few strategies for hospital improvement, both from a quality perspective and a cost perspective.

           Quality and cost aren’t always inversely related. In some instances, we can improve patient outcomes while reducing the total cost on the healthcare system. For example, in a study completed by Joo and Liu (2017), patients with chronic illnesses such as heart failure, chronic kidney disease and COPD account for 66% of the healthcare costs within the United States (p. 296). In this systematic review, the authors looked at effective case management as an intervention in respect to hospitalization and rehospitalization. They found that case management transitional care services greatly reduced the number of readmissions and emergency department visits (Jiu & Yoo, 2017). In this example, both the cost to the patient and hospital for readmissions and emergency department visits are reduced, and at the same time, less hospitalizations means an improvement in patient outcomes.

           One very exciting and relatively new advent to healthcare is Telehealth. Dickson et al. (2020) explains that “Telehealth may encompass a variety of interactions. For instance, it may involve live videoconferencing between a patient and provider. This “real-time” interaction may substitute for an in-person visit to a clinician and can be used for consultations as well as diagnostic and treatment services” (p. 123). In a study done by Chen et al. (2022), it was also found that on average telehealth users had, more visits per patient per year than those who did not use telehealth (p. 4). Those who criticize telehealth services say that it may increase cost rather than reduce it due to its nature of being an additive service. Though, it can be argued that through increased utilization of primary care via telehealth services, the patients can have more health needs addressed before they become larger, more expensive issues (Chen et al., 2022, p. 4). In addition to potentially improving patient outcomes, I believe utilizing telehealth services will also improve the overall patient experience due to its ease of access in relation to sometimes long wait times in the physician’s office, amount of time it may take to drive to the location, etc.

           Finally, optimization of payment when it comes to billing is imperative to not only the improvement of healthcare outcomes through safe staffing, but also the overall patient experience. For example, Austin and Wetle (2016) point out that retention of healthcare professionals has become a major issue due to burnout (p. 75). They also noted that nursing care is not billed separately, but rather part of the daily fee for hospitals (Austin & Wetle, 2016, p. 75). Burnout often occurs when healthcare professionals and, in this case, the nurses in specific, experience a heavy workload in understaffed healthcare settings. If nursing services were to be billed as a separate entity from the standard hospital services, then it could potentially be an eye-opener to hospitals in terms of the sheer demand for nursing services. In this way, the funds could be allocated differently which could lead to improved staffing levels, less burnout and ultimately better patient outcomes and satisfaction.