Hospital Reinventing

This topic encompasses the various changes that hospitals have undergone or will possibly make as a result of managed health care. The topic includes changes that are consciously made (perhaps to cut costs) and changes that were not willingly made by hospitals (such as relationships with payers and providers becoming stronger or weaker). The following "bookmarks" relate either directly or indirectly to this general topic

Documents

Cutting Care
This page discusses how managed care/competition does not really save costs and how it decreases the care that patients actually receive. This page specifically discusses the Massachusetts hospital financing bill and how it gives health insurance companies the right to negotiate unlimited discounts with hospitals to aid with managed competition. There are examples of patients who had to switch hospitals several times because their HMO kept switching hospitals that they contracted with. The page also descibes how hospitals in Massacchusetts and California have been forced to cut their costs by getting rid of skilled personnel, such as nurses, and replacing them with lesser skilled personnel, such as technicians and aides. They say that patients receive less and inferior care from institutions in these 2 states.
This page appears to be appealing to nurses and patients across the country to inform them of the dangers of getting rid of experienced workers(especially nurses). The pupose of this page seems to be to get nurses and consumers to lobby against such changes in their own state's hospitals. The information here is definitely one-sided, but they do have some figures supporting ther argument. I would give this page 3 1/2 stars.
Hospitals Show Trend Toward Sicker Patients, Shorter Stays
This page briefly discusses how hospitals in Washington state have decreased inpatient days and associated charges even though there has been an increase in sickness. The authors allude to the fact that this was accomplished due to the presence of managed care and its probable grater presence in the future.
The authors of this page say that the improvement in efficiency is due to insurance companies changing their reimbursement schemes and due to greater efficiency of inpatient care. They say that the insurance companies pay a set fee per diagnosis related grouping , regardless of patient length of stay and services received. This led hospitals to decrease patient days per year even though illness in Washington State has increased by 4% in the recent past. These hospitals are treating patients in less time for less money.
The targeted audience would most likely be insurance companies and hospital administators. I would rate this page as 3 1/2 stars. It gives a satisfactory overview of what has occurred in Washington state, but it has not explored any of the details involved in how the above was accomplished.
Managed Care and Long-Term Services
This article discusses the possibility of states using managed care for long term care, such as mental health care. This aricle does not directly discuss hospitals , but many of the ideas and concerns pertain to hospitals (especially since hospitals are trying to get into long term care). This page discusses the good points of using managed care for these services, such as states being able to design their own managed care system to better suit its population. This article also discusses the possible bad points to managed care, such as managed care companies/systems determining that many types of long term care patients are a financial burden and drastically cutting services and care. The authors seem to be in favor of managed care, discussing the benefits of a well designed system, such as: flexibility and improved services. They just want to warn consumers of the potential problem of focusing only on cost savings and not on patient care. The authors say that a properly designed system could improve communication between different services and improve the continuity of care. This page seems to be intended for the interested, intelligent consumer and all of the various interest groups. The ideas presented are important, but they are not detailed at all. I would give this page 2 1/2 stars.
Managed Care Does Not Reduce The Growth Of Health Care Expenses
This page descibes how HMO's save money by virtue of their large size , which forces hospitals and physicians to accept lower payments. They give Medicare SELECT as an example of how discounting arangements are responsible for any cost savings, and that these savings are not due to active care management or the efficiency of SELECT networks. The page describes how discounts are one-time only and are only a short term solution. The page talks about how hospitals in the St. Paul-Minneapolis area, which has one of the greatest participation rates in HMO's in the country, were forced to form 3 hospital chains. This greatly decreased hospital competition and patient choice. A similar situation is discussed about Iowa. Iowa supposedly now has only 2 healthcare delivery networks in the entire state.
The audience of this page would be the concerned consumer and healthcare administrators. Its purpose is to warn how managed care does not save health care costs and could actually increase costs. This page is once again decidedly one-sided against managed care, and some of its evidence is only anecdotal. I would give this page 2 stars.
WHAT IS THE IMPACT OF MANAGED CARE ON PATIENTS IN HOSPITALS?
This page has 2 small articles that try to answer the question posed by its title. The first article discusses how managed care is many times being used today as a cost-cutting measure only ,and not considering quality and continuum of care for the patient. The article then talks about how "slashing RNs" has become a quick fix for many hospitals today. They say that this could lead to greater complications increased mortality rates and higher costs with lesser skilled personnel. The second article discusses how managed care is of two types. The first type trying to coordinate patient care and educate patients. The second type is only trying to cut costs with bulk services and not worrying about coordinating services. This article calls for all health care "links" ,including hospitals, to stress the first approach to managed care.
The audience for this page is the general public. It is intended to inform the public of the potential dangers , if managed care is not approached properly by healthcare institutions. I would give this page 3 stars.

Sites

American Medical Specialty Organization, Inc. Home Page
This site covers managed care topics such as ethics and cost savings. There are different areas on the main menu that you can choose from. Then you get inyo the "room" or page for that particular issue. The site is easy to use, but the available information is very limited. Users may respond to ideas/opinions on the various pages. This site is probably intended for the interested consumer. I was disappointed with its lack of pertinent information. I would give this site 2 stars.
Managed Medical Care
This site was accessed via a "newspage" site. It has a relatively small list of articles about managed care and insurance. The articles are about various states and some of the articles include changes that hospitals are making with insurance carriers. This site has a limited amount of information available compared to other sites, but the available information that it does have seems to be quality. This site is targeted toward administrators and interested, intelligent consumers.
The site is easy to use, but it was somewhat difficult to find this managed medical care site from the original newspage site. I would give this site 3 1/2 stars.
Medscape
This is a site that gives access to many diffferent interest sites related to the medical and health care environment. Managed care is one of the areas of interest. The managed care site gives you access to feature stories such as, hospitals using pharmacoeconomics to make decisions on what drugs to carry in their formularies. Another article was about shortened hospital maternity stays. The managed care site also has regular features, such as: recent trends and newsbriefs.
This site seems to have access to much valuable information. The various article summaries are somewhat technical , so I believe that this site is primarily geared toward health care professionals. The menu seems to be easy to use. The service is free , but you do have to register your name and e-mail address in order to use the service. This could scare some people away. Overall I would give this site 4 stars.
WNET Managed Care Disscussion
This site is sponsored by Channel 13 Netstation. It is a sight where individuals anywhere on the web can "discuss" issues pertaining to America's managed care revolution. Some of the issues that people can comment on include: does managed care really save money, is quality of healthh care effected by managed care, and what is the impact of managed care on patients in the hospital. You can enter the different discussion areas and read what other people have said ,and/or you can leave your own messages for others to read. This is not a "live" conversation. It is a "bulletiin board" type of discussion.
Some of the comments in the various areas touch on how hospital changes, such as discharging patients quicker than before, have or could lead to compromised care. Overall the information here is anecdotal, but it is a discussion site.
This site is very easy to use and clearly organized. Its targeted audience would be consumers of health care. It could have information exchange purposes, but it seems to be mainly used as a release for individuals who do not like managed care. I would give this site 2 1/2 stars.
Your Money & Your Life
This site is entirely about areas of interest related to managed care. It is sponsored by PBS and was inspired by its documentary of the same name. There are different areas on the menu that lead to different types and forms of information. One menu choice is called Overview and is an overview of how HMO's and other managed care org.'s work. There is a selection called Real Life Stories , and a selection called Viewpoints that has articles that try to answer fairly specific questions about managed care. Several of these questions relate to hospitals, for example one subject was managed care's impact on hospital patients.
The target audience would be intelligent, curious members of the general public who want more information about issues in managed care. This site is very easy to use . I would give this site 4 stars.

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