For the past two years, we’ve been headlong, armor, swords up, and swinging in the air. The enemy we named COVID-19 is a narcissistic, selfish, ruthless little toad who doesn’t play by the rules, or even cares about anyone but himself. Isn’t that like a narcissist?
He can’t stand having attention or eyes on anything other than his prickly little projections and his ability to travel where he wants to go, waving at us when he passes. You know what I mean by being selfish? He should follow the rules and act like a good citizen. But this is not the case.
I’ve always been a rule follower. Something must have happened during my potty training as a toddler that melted into my brain: not breaking, bending or getting out of lines. That’s not to say that I haven’t, or haven’t questioned, challenged, or moved the lines. Last week, I listened to one of health care’s greatest leaders talk about population health, value-based reimbursement, and “the year 2025.”
As we put on our armor in 2020, the Centers for Medicare & Medicaid Services announced that 2025 will be a special year for Medicare beneficiaries. This is the year of healthcare cost reductions, better outcomes, and seismic shifts from fee-for-service to value-based care and reimbursement finally coming together. The year of value was informed by the work seen by the CMS Innovation Center.
Due to the battle we fought, it was difficult to follow the nuances at CMS. I’ve included a link providing a quick summary of the work done through the CMS Innovation Center. Thanks to the Healthcare Transformation Task Force for providing this easy-to-use reference.
Listening to the speaker describe the work being done by healthcare through COAs and other models, the shift to home care and the call for innovation, I found myself asking a metaphorical question: “ Are we trying to color the wrong lines? »
Population health refers to the health status and health outcomes among a group of people. Notice the word, healthnot sickness, is used. Yet when we look at the CMS 2025 target, 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, then why would we focus on disease state and not health status? Expand the ranges to include reimbursement for actions that keep the skin, urinary tract, kidneys, heart, brain, lungs and joints as optimal as possible.
Let me give you an example. Like you, I have worked hard to reduce catheter-associated urinary tract infections (CAUTI). It makes sense that we do what we can to prevent CAUTI. Where logic fails is the lack of work done to keep the urinary tract healthy. If we follow the money, we’ll find that $1.3 billion is spent each year on urinary tract infections, not related to catheters.
What conversations have we had about urinary health and what can be done to reduce the likelihood of a UTI? Don’t get me started on skin health and the projected $26.8 billion in pressure injury costs and treatments!
To achieve population health, we must realize what it will take to achieve the results we all want for those we love and care for and for ourselves. Let’s be realistic !
Martie L. Moore, MAOM, RN, CPHQ, is the CEO of M2WL Consulting. She has been a healthcare executive for over 20 years. She has served on advisory boards for the National Pressure Injury Advisory Panel and the American Nurses Association, and currently serves on the Dean’s Advisory Council for 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 for her service and achievements in advancing health care.
The opinions expressed in McKnight Long Term Care News guest submissions are those of the author and not necessarily those of McKnight Long Term Care News or its editors.