The future of LTC, a puzzle or a mystery?

John O'Connor
John O'Connor

Kaiser Health News provided one of last week's sleeper developments. The organization predicted hospitals will see payment cuts surpassing $500 million in the coming year thanks to escalating readmission penalties.

For those scouring the field in search of clues about the future, this kind of revelation is golden. For it helps fill in missing pieces about the untaken road ahead. And in the case of long-term care facilities, this development clearly has the potential to affect operations in two related but distinct ways.

The first effect will likely be this: Hospitals trying to minimize the damage will seek post-acute operators with the data and track records to be a safe discharge bet.

The possible longer-term effect? Hospitals involved in risk-taking ventures via things like bundled payments and accountable care organizations will need to partner with post-acute facilities that have the size and temperament to make a real commitment.

So in many important ways, puzzle solving — even if it means little more than seeking out the right pieces — will be critical. But it won't be sufficient.

In Malcolm Gladwell's masterful essay about Enron's collapse, he addresses the distinction between puzzles and mysteries. The former relies on the acquisition of key information to clarify matters. Puzzle-solving tends to be a linear exercise. The mystery paradigm, by contrast, accepts a wide realm of possible outcomes, while allowing for many contingencies. Frankly, it's much murkier.

To illustrate the difference, Gladwell points to the way British intelligence helped predict Germany's progress in developing a devastating super weapon during World War II (which would turn out to be the V-1 rocket).

Mystery-solving analysts worked largely by listening to Germany's propaganda broadcasts. It was tedious work requiring many hours of listening with an ear toward inconsistencies, not to mention subtle shifts in emphasis. The analysts did a remarkable job of accurately predicting when the weapon would be unleashed.

How does this apply to the future of long-term care? This way: Both approaches should be put in play.

To be certain, we need to crawl around in the dark as best we can in search of helpful knowledge. That is the puzzle-solving part of the challenge. But why stop there?

If we also treat this sector's future as a mystery, we will be forced to make better use of information as a decision-making tool. This approach will also help us keep a more open mind about the likely twists and turns ahead.

And let's face it: The way things are going, we will all need all the help we can get.

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McKnight's Daily Editors' Notes features commentary on the latest in long-term care news and issues. Entries are written by Editorial Director John O'Connor, Editor James M. Berklan, Senior Editor Elizabeth Newman and Staff Writer Emily Mongan.

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