Sign up to get full access to all our latest content, research, and network for everything L&D.

New Healthcare Legislation Makes Hospital Training More About Technology

Add bookmark

Lisa Cannata’s healthcare experience spans a decade. She already has one year under her belt as corporate director of learning and organizational development at Orlando Health—a group of not-for-profit hospitals serving central Florida—and she spent seven years at the Florida-based Martin Health System. So she has had ample time to see the writing on the wall.

"We liken it to the newspaper or Kodak," she said. "The newspaper industry has to reinvent itself or it will go out of business. Kodak did not reinvent themselves, so they went out of business."

Cannata isn’t speaking of the music industry or bookstores or the postal service. She’s talking about the state of healthcare in America.

The Affordable Care Act—in theory—will provide healthcare to more Americans at more affordable prices. But it also brings with it a paradigmatic shift to make our healthcare system run more efficiently. The typical fee for service model, which is based on quantity of care, will be replaced by an efficiency model, which focuses instead on quality of care. The change begins with the training of employees, from how procedures are conducted to the very way physicians think.

As part of the streamlining, Obamacare has decreased governmental funding to healthcare institutions where deemed necessary. Orlando Health, where Cannata works, saw a $75 million reduction in Medicaid payments over the past three years. "It has caused us to really stop and look at the work," Cannata said. "That’s driving a lot of the value over fee, rather than fee for service."

More occupied hospital beds and more surgeries have always meant more profits for hospitals. "There’s no longer an appetite for that model," Cannata said. "We have to get people out and healthy and home. Now, it’s just like the floodgates are opened. With January approaching us, I don’t think anyone really knows what’s going to happen. It’s like: What is the new world going to look like?"

A Techno Odyssey

One element is certain: the new world of U.S. healthcare will be one of increased reliance on technology. Rich Kudia, vice president of patient financial services at Loyola University Medical Center in Illinois, knows first hand how technology can streamline patient care. At Loyola, new "Patient Estimator" technology quickens the payment process. "Before a patient arrives, we know what procedure they’re having and we’ll know in advance what their insurance is," Kudia said. "The estimator can spit out a pretty close approximation of what the patient’s self-paid portion will be." Billing and payment discussions are pushed to before procedures even take place. Although the Patient Estimator technology was developed by Loyola internally, Kudia said that the technology will fit in nicely with the ACA as patients begin assessing new insurance plans based on cost. Familiarization with new technologies like "Patient Estimator" must now be integrated into Loyola’s hands-on employee training.

Additionally, Loyola’s computer systems were updated with new internal insurance plan codes as the new Illinois insurance plans have entered the market. It’s yet another technological update relating to the work of several employees. "We’ve set aside some separate spaces, private areas with a computer that’s available to be able to assist the folks when the [ACA’s website] is up," Kudia said.

At Orlando Health, in-patient surgeries are down, shared medical visits are up (a doctor conversing with many patients dealing with the same ailment), and efficiency changes have meant utilizing a risk management company. Deloitte used its unique software to reassess financials in 30 different areas at Orlando Health, and compared them to other similar-sized healthcare institutions. Cannata led the education piece of the puzzle and was charged with finding cost savings in the area of training. "The best way to realize the [financial] goals was to centralize education," she said. The organization had to consolidate and streamline its efforts in order to keep financial pace.

When faced with the unknown, some hospitals opt for the easier way out. Cannata explained that an organization may flee to high dollar pay services like cardiac or oncology to offset decreased funding. Orlando Health is unwilling to do so. They are a "mission-driven" organization, one that takes into account the entire life cycle of a person from birth to death. They will not cut back on procedures—say, baby deliveries—just because it costs the hospital more. "We’ve acquired physician practices...we’ve acquired other hospitals as well," she said. "[We’re] definitely changing the way we deliver and doing more with less resources."

Leaner, Meaner, Medical Culture

Devin Griffith occupies a diverse position at Randolph Hospital, a small community hospital in North Carolina. As vice president of Care Continuum and Support Services, he oversees everything from home care services to human resources and hospital facilities. As Randolph continues to evolve its care in conjunction with the ACA, the hospital is focusing on reducing readmissions and potentially avoidable hospitalizations, increasing quality measures, and ensuring that nursing home patients are cared for properly without needing to come into the hospital. "We’re no longer just responsible for what happens within the four walls," Griffith said. "We are responsible for what happens in terms of the discharge process, the follow-up care, what happens to the patient out in the community setting."

As many hospitals have done over the past several years, Randolph has transitioned nearly all of its paperwork into an electronic medical record. The bolstered efficiency—with illegibility issues eliminated—could not have been achieved without new technological training. Randolph utilized "super users" to jump to the aid of employees who took longer to familiarize themselves with new technology. "Having super users present has helped a whole lot in terms of their comfort levels," Griffith said. "A super user can kind of coach them and guide them through the process." The super users also underwent intensive training.

Additionally, all care plans at Randolph are documented electronically to further comply with ACA expectations—particularly in regards to high-risk patients. With the aid of an electronic medical record, a combination of a few metrics can assess whether a patient is high-risk and assign them a score within the system. A referral is then automatically sent to the appropriate care team.

On the whole, Randolph is focusing more energy on the soft skills side of team-building to cope with the shifts in medical thought. Hospital training at Randolph has taken greater focus on coordination and interdisciplinary team care in addition to the more obvious technical and medical skills. "It’s about making sure you’re providing the right care at the right time to the right patient in the right setting, and bringing that value equation forward," Griffith said. The number of inpatients at Randolph is already on the decline.

Hospitals will not survive in Obamacare’s new landscape without these "leaner" cultures, said Cannata for Orlando Health. Technology advances medical care by making processes speedier, or it can stonewall them altogether. A hospital’s electronic record may not allow physicians to call for more than one medical test for a patient when only one will suffice. "A physician in the emergency department might order five different tests, diagnostics for somebody who has maybe hit their head or fallen," Cannata said. "Do you really need all five tests? Maybe we just do one and see what we get."

It’s a painful adjustment for physicians to be blocked out of certain procedures, effectively being told how they must practice. "But then at the end of the day it’s better for the patient," Cannata said. Insurance providers save money, patients save money, and hospitals make more by working more patients through their system overall.

Kudia from Loyola University Health Medical Center echoed that changes in efficiency are for the benefit of consumers. As did Griffith of Randolph Hospital. " We always ask the question, ‘What is best for the patient?’" he said. "I think that is so important from a quality perspective if we’re going to bring more value to the healthcare system." It’s what the ACA’s overarching goal should be: keeping Americans healthy and keeping our country efficient. One hopes that will make all of the growing pains worthwhile.


RECOMMENDED