The plan was as simple as it was ambitious: Find “no-brainer,” perhaps nonsensical, regulations and practices that should be eradicated from nursing home routines. In doing so, save everyone money and improve quality of care.
Consider step one a rousing success, says the plan’s architect.
“It was beyond expectations, really amazing,” John Whitman told me Tuesday.
Whitman is the former nursing home administrator and Wharton School of Business professor who convened a cross-section of LTC stakeholders Friday in Philadelphia to drill into wasteful practices. They were identified by providers and others across the country, partially in response to earlier McKnight’s articles on the subject.
Of the approximate 100 submissions received, about nine were slotted for discussion. In the end, a handful were dug into and a “big three” emerged as the ultimate no-brainers, with plenty of immediate savings and quality improvement potential.
1) Telemedicine not being used systemwide (projected for “at least” $1.3 billion of lost or wasted money each year)
2) Blood transfusions that are mandated by the Medicaid program only (not also Medicare) to be performed only in a hospital setting $400 million), and
3) End-of-life care that is ill-advisedly transferred to a hospital setting ($1.8 billion)
“That’s $3.5 billion a year that we are wasting with just these three,” Whitman noted. “Even if those numbers are over-exaggerated, if it’s half that, that’s a significant number. As an industry, we have an obligation to look at this.”
The 38 stakeholders at the summit who debated program merits and parsed projected savings included health economists, so the numbers above are not just plucked from thin air. Just as importantly, the list included geriatricians, administrators — from big chains and smaller players, pharmacists, managed care representatives and others, including from the staff of the U.S. Special Committee on Aging.
More government reps expressed interest, but Whitman said it’s almost immaterial whether or not they embrace the effort right now. Momentum is building for an end-run if necessary. By going to third-party payers, such as the Pennsylvania managed care players who attended, the hope is to exhibit the merit of recommended improvements so that Uncle Sam has no choice but to join the cost- and quality-improvement bandwagon.
The key is to move on the big three as soon as possible said Whitman, whose nonprofit TRECS Institute is working in concert with the University of Pennsylvania’s Leonard Davis Institute of Health Economics, to administer the initiative.
He expects to finish a report for summit members in about three weeks. Then, the full effort to leverage changes will take place. They include lobbying the Centers for Medicare & Medicaid Services to create an expedited review process to approve obvious win-win scenarios. Such as the no-brainers.
If the creaky wheels of the federal government aren’t lubricated enough to move on these, then perhaps booming managed care players will. The appeal would be to at least improve THEIR bottom lines and start instituting new money-saving ideas. Whitman and colleagues held special meetings with the manage care reps, who said they were interested but generally have been overwhelmed with trying to keep up with day-to-day regulatory affairs. Thus, Whitman’s creativity and education drive could be a godsend — to them and the system.
“In the next two to three years, any nursing home that doesn’t adopt telemedicine will not be competitive and economically will lose opportunities,” Whitcomb said. “For the blood transfusions, the nursing homes we checked on were sending one or two per month to the the hospital.
“The nursing homes we checked were sending two, three or four patients a month near the end of life to the hospital, but they didn’t have to,” he added. “There was no additional medical value.” He blamed nervous or out-of-state relatives arriving on the scene as the biggest reason residents were moved to a hospital room for their final few days.
“Really, the big goal is to go after those who provide managed care, ACOs and all third party players to make the case. They’re not restricted like CMS and could make changes right now and offer shared savings opportunities,” Whitman explained.
After that? There’s a second tier of no-brainers, which includes tort reform and survey redesign, which some see as “politically untouchable” and thus require more planning.
There is no question, however, that it’s time to design a new survey process. The big problem, as Whitman sees it, is surveyors are no longer helpful to facilities. Nobody denies there’s a need to evaluate the quality of a process. But now surveyors are so authoritative, “if they cite you for something, they can’t give you advice.”
If you want somebody to improve some aspect of themselves or their business, it seems only natural to make education and coaching part of the solution. That’s a no-brainer if ever there were one.
Follow Editor James M. Berklan @JimBerklan.