For the last two years, we have been heads down, armor on, swords up and swinging at the air. The enemy we have named COVID-19 is a narcissistic, selfish and ruthless little toad that does not play by the rules, nor even cares about anyone but itself. Isn’t that just like a narcissist?
It cannot stand to have attention or eyes upon anything else but its spiky little projections and its ability to travel where it wants to go, waving at us as it passes by. See what I mean about being selfish? It should have to follow the rules and act like a good citizen. But it doesn’t.
I have always been a rule follower. Something must have happened during my toilet training as a toddler that melted into my brain: Do not break, bend or step out of the lines. Now that is not to say that I have not, or do not, question, challenge or move the lines. Last week, I listened to one of the top healthcare leaders speak about population health, value-based reimbursement and “The Year 2025.”
While we were donning our armor back in 2020, the Centers for Medicare & Medicaid Services announced that the year 2025 would be a special year for Medicare beneficiaries. It is the year of healthcare cost reductions, better outcomes and seismic shifts away from fee-for-service to value-based care and reimbursement finally moving in together. The year of value has been informed by the work seen through the CMS Innovation Center.
Because of the battle we have been fighting, it has been hard to keep up with nuances at CMS. I have included a link providing a quick summary of the work being done through the CMS Innovation Center. A thank you to the Healthcare Transformation Task Force for providing this easy-to-use reference.
Listening to the speaker outline the work healthcare has been doing through ACOs and other models, the shift to home-based care and the call for innovation, I found myself asking a metaphorical question, “Are we trying to color within the wrong lines?”
Population health refers to the health status and health outcomes within a group of people. Notice the word, health, not disease, is used. Yet when we look at the focus of CMS 2025, the thread of disease management is woven into the fabric of the models.
If we truly believe that population health is a viable model to pursue, why then would our focus be on the disease state and not the health state? Expanding the lines to include reimbursement for actions that keep skin, urinary, kidney, cardiac, brain, pulmonary and joints as optimally healthy as possible.
Let me give you an example. I, like you, have worked hard to reduce catheter-associated urinary tract infections (CAUTI). It is logical that we do what we can do to prevent CAUTI. Where the logic fails is the lack of work being done to keep the urinary tract healthy. If we follow the money, we will find that $1.3 billion is spent every year for urinary tract infections, non-catheter related.
What conversations have we had about urinary health and what can be done to impede the probability of a UTI? Do not get me started about skin health and the projected cost of $26.8 billion in cost and treatment for pressure injuries!
To make population health real, we must get real about what it will take to achieve the outcomes we all want for those we love, care for and ourselves. Let’s get real!
Martie L. Moore, MAOM, RN, CPHQ, is the CEO of M2WL Consulting. She has been an executive healthcare leader for more than 20 years. She has served on advisory boards for the National Pressure Injury Advisory Panel and the American Nurses Association, and she currently serves on the Dean’s Advisory Board at the University of Central Florida College of Nursing and Sigma, International Honor Society for Nursing. She was honored by Saint Martin’s University with an honorary doctorate degree for her service and accomplishments in advancing healthcare.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.
