At AORN, Berwick Asks: Does the Future of Healthcare Equal Quality Care?

March 29th, 2012


By , BSN, RN

While attending the Association of periOperative Registered Nurses (AORN) Congress this week I have had the chance to interact with colleagues from around the country and around the world. We talk about what equipment our facilities are using, are we embracing opportunities to green our ORs, and how to more effectively schedule staff and cases. It is all very OR/OR nurse-centric.

One of the guest speakers during the convention is a physician and former government employee who implored us, as healthcare providers, to look outside our small world of perioperative services and take part is the larger demands of our nation for more universal healthcare availability.

“Every system is perfectly designed to achieve exactly the results it gets,” said the speaker as he started the lecture. “States that spend the most have the worst healthcare and reverse is also true, the states that spend the least have the best healthcare. Where are we in healthcare in this country? We are in trouble.”

Dr. Don Berwick is a pediatrician, the former administrator for the Centers for Medicare and Medicaid Services (CMS), and is now the founding chief executive officer (CEO) for the Institute for Healthcare Improvement (IHI). Berwick is also considered one the country’s leading advocates for high-quality health care

”This time is historic,” Berwick said. “We are making healthcare a human right, expanding its availability to 32 million more people.” With that he told the story of his being chosen to lead CMS. Explaining how he came to what he described as an “opportunity to meet the moral test” of his life and work as a physician.

Berwick recalled reading a quote by former vice president, Hubert H. Humphrey, engraved on a wall of a Washington DC building:

”The moral test of government is how it treats those who are in the dawn of life, the children; those who are in the twilight of life, the aged; and those in the shadows of life, the sick, the needy and the handicapped.”

Berwick followed this by saying, “I think it is time in this country to go back and ask, ‘Why do we do the work we do?’” He went on to explain that the job of improving healthcare in this country has become bigger than we ever wanted or expected it to be. He spoke of how coverage for as many people as possible is the key to improving the health of the country and improvement is the key coverage. These are the aims of the Affordable Care Act.

The Affordable Care Act (ACA) is the controversial health care law aiming to improve the current health care system by increasing access to health coverage for Americans and introducing new protections for people who have health insurance. For those with insurance the Act provides steps to stop insurance companies from cancelling coverage if the insured becomes ill. The law will also require insurance plans to cover your out-of-pocket costs for many proven preventive and screening services, like colonoscopies and mammograms.

The ACA offers health plans for people with pre-existing condition and increases access to coverage for people without insurance. The law helps small businesses pay for health insurance for their employees. And it supports programs that will help increase the number of primary care physicians, nurses, physician assistants, and other health care professionals.

”We are all in this together,” Berwick said. “The patient on your OR table is just stopping by on their journey of healthcare.” He went on to explain some of the improvement tools found in the ACA:

  • Transparency – Knowing the quality and cost of health care. Health care transparency provides consumers with the information necessary, and the incentive, to choose health care providers based on value.
  • Payment to support care integration – This is an approach characterized by a high degree of collaboration and communication among health professionals. What makes integrated health care unique is the sharing of information among team members related to patient care and the establishment of a comprehensive treatment plan to address the biological, psychological, and social needs of the patient. The team could include a diverse group of members such as: physicians, psychologists, social workers, and occupational and physical therapists, depending on the needs of the patient.
  • Attaching payment to “quality” metrics – This is the area where providers are not reimbursed if the patient acquires other healthcare problems because of low quality care. These hospital acquired conditions include pressure ulcers, infections and injuries from falls, among others.
  • Investments in innovation.
  • ”Direct” cost pressures – These will include productivity adjustments and Medicare advantage reductions. Private insurers involved in Medicare Advantage often offer extra healthcare that seniors in traditional Medicare don't get, such as vision care or dental, or even gym memberships. Opponents say the private Medicare Advantage plans cost the government 14% more than traditional Medicare.
  • Investments in prevention.

”I think we have a policy in ACA that can work,” Berwick said. “Now it’s time for the professionals, the people who make the care, give the care, to get involved. If we fail to do that the consequences will be severe. It is an intimate relationship and we must embrace it.”

Berwick went on to explain the extreme wastes in healthcare that are drowning the current system in debt. The tests many doctors and nurses think of as routine but may really not be needed, only depending on the actual healthcare problem at hand. Often, orders become just routine, no real thought behind them. “There is stuff we are doing in healthcare that doesn’t help, “ he said. “Let’s take that away.” Berwick concluded by saying we need to find the resources that really do improve care. “We can’t afford poor quality.”

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