Disaster Contact a disaster preparedness person at either a local hospital, or local city or county emergency services agency. NORTHEAST OHIO 1. Blackout 2003 2. Chardon Highschool shooting 2012 3. Great blizzard 1978 Interview your contact, asking the following questions: 1) "What do you consider to be the top three disasters for which you prepare?" 2) "What would you say are your top three lessons learned about managing a disaster?" What Would the Best Future for Health Care Look Like? Introduction The one thing the debate over reforming health care taught us all is that there are as many opinions as there are interested groups, and all of them differ in meaningful ways. To look at the views on improving the systems of care delivery, it is important to note where they have points of agreement and where they differ. They are all driven by the values and principles of the constituencies and what they hope to achieve from changes in the delivery system. This module will explore points of agreement and differences between important groups that will influence the direction health care will go in the next decade. Patients It is an interesting point that all constituencies, in their public statements, emphasize that a strong health care system should focus on getting the best outcomes for patients. What would that be, from the perspective of patients? Typically, patients relate that they want top quality in their care and the latest technology, along with immediate and unrestricted access to care, at the lowest possible cost. This triad has become the stumbling block of change initiatives, since to date, no one has figured out how to deliver all three. However, when patients' views are explored and probed, some interesting facts emerge. When patients say they want top quality care, in general, they tend to define that as achieving a cure or return to health. They certainly do not want to leave the system feeling worse than when they came in. Patients have been heavily lobbied in the media by pharmaceutical and medical technology companies to convince them that the latest (and most expensive) technology will deliver the desired outcomes. However, very little real research on the true effectiveness of treatments and technology makes its way to most patients, and patients in general do not shop for their medical care as carefully as they would if they were purchasing new cars, for example. The language of research and medicine is difficult for patients to understand and is frequently not well-explained by providers. So, the nuances of top quality care in terms of being able to deliver a cure or return to health are not well understood by the constituency with the most at risk. What patients do understand is whether they feel better or see improvement in their health and whether care was rendered without errors and in a compassionate way. The best health care system, from a patient's point of view, is one that can consistently deliver the good.

1. Disaster
Contact a disaster preparedness person at either a local hospital,
or local city or county emergency services agency.
NORTHEAST OHIO
1. Blackout 2003
2. Chardon Highschool shooting 2012
3. Great blizzard 1978
Interview your contact, asking the following questions:
1) "What do you consider to be the top three disasters for which
you prepare?"
2) "What would you say are your top three lessons learned about
managing a disaster?"
What Would the Best Future for Health Care Look Like?
Introduction
The one thing the debate over reforming health care taught us
all is that there are as many opinions as there are interested
groups, and all of them differ in meaningful ways. To look at
the views on improving the systems of care delivery, it is
important to note where they have points of agreement and
where they differ. They are all driven by the values and
principles of the constituencies and what they hope to achieve
from changes in the delivery system. This module will explore
points of agreement and differences between important groups
that will influence the direction health care will go in the next
decade.
Patients
It is an interesting point that all constituencies, in their public
statements, emphasize that a strong health care system should
focus on getting the best outcomes for patients. What would that
be, from the perspective of patients? Typically, patients relate
that they want top quality in their care and the latest
technology, along with immediate and unrestricted access to
care, at the lowest possible cost. This triad has become the
stumbling block of change initiatives, since to date, no one has

2. figured out how to deliver all three. However, when patients'
views are explored and probed, some interesting facts emerge.
When patients say they want top quality care, in general, they
tend to define that as achieving a cure or return to health. They
certainly do not want to leave the system feeling worse than
when they came in. Patients have been heavily lobbied in the
media by pharmaceutical and medical technology companies to
convince them that the latest (and most expensive) technology
will deliver the desired outcomes. However, very little real
research on the true effectiveness of treatments and technology
makes its way to most patients, and patients in general do not
shop for their medical care as carefully as they would if they
were purchasing new cars, for example. The language of
research and medicine is difficult for patients to understand and
is frequently not well-explained by providers.
So, the nuances of top quality care in terms of being able to
deliver a cure or return to health are not well understood by the
constituency with the most at risk. What patients do understand
is whether they feel better or see improvement in their health
and whether care was rendered without errors and in a
compassionate way. The best health care system, from a
patient's point of view, is one that can consistently deliver the
goods in terms of a cure and a return to health, in a way that is
safe for the patient and does not hit them with unexpected or
heavy costs, from providers they trust to have their best
interests at heart.
Physicians
Physicians, in general, strongly believe that they are the most
informed providers of care and are best placed to make the
needed decisions about what care is best for the patient. They
may or may not be interested in new research results,
innovations in care, new drugs or technologies, or new systems
of care. Physicians believe that medicine is an art as much as a
science, and many of them develop entrenched patterns of
providing care that can be resistant to changes unless and until
those changes are proven over time. Since physicians believe

3. they are the best primary decision makers on care alternatives,
they may strongly resent restrictions on utilization, selections
of drugs and treatments, or the requirements to preauthorize
care, which are placed by insurance companies. Many
physicians see these requirements as bureaucratic waste built
into the system to cut costs, without regard for patient benefit.
They also struggle with the need to contract with insurance
companies for what physicians see as low-value reimbursement
and feel helpless to negotiate better rates of pay overall. Their
idea of an ideal delivery system is one where they have the
freedom to practice medicine without regulatory or utilization
restraints, without fears of malpractice claims when patients do
not get the outcomes they want, and without worry about being
paid appropriately for what they do. Their ideal system would
not include any form of micromanagement by insurance
companies but instead offers fair and reasonable (by the
physician's definition) payment for services immediately upon
receipt of the physician's bill. In the physician's ideal world,
nothing stands between the patient and his/her physician in
determining and carrying out care.
Hospitals
Hospitals also tend to remember the days when they provided
the services ordered by the physician to patients, submitted
their bills, and were paid as requested in a timely manner. The
current reality is that increasingly hospitals are being paid a flat
fee, or case rate, for an episode of care. This leads hospitals to
focus on procedures, which pay better, and to conduct their own
utilization management in order to keep their costs down. This
may also extend to the physician, who may be told that she/he
cannot give a certain drug to a patient due to its high cost or
must limit the choice of a hip implant to one or two vendors
with which the hospital has contracts. Hospitals and physicians
thus enter into a complicated relationship, where they both need
each other but also continue to push against each other: the
physician striving for more autonomy in providing care and
services to the patients, and the hospital attempting to reduce

4. costs below the case rate in order to avoid financial losses.
Hospitals are extremely regulated by laws, rules, and
regulations, which change frequently. One of the newest
departments in hospitals is the compliance department, which
did not exist in many hospitals decades ago. The constant
monitoring of compliance to all the laws, rules, and regulations
that apply to health care providers has added considerable cost
to the system, of which most patients and many physicians are
unaware. The ideal hospital delivery system would focus on
providing top quality care in terms of using whatever was
needed to get patients to their desired outcomes; would have
much less regulatory load with which to comply; would have a
steady and reliable payment source for all patients treated in the
hospital; and, under tort reform, would have less malpractice
liability.
Payors
Insurance companies and government payors also struggle in the
current system. Their focus has been to contain costs, given the
steady rise in expense during the last several decades. They
attempt to reduce the costs of physician care by enabling more
care to be done by less expensive midlevel providers, pushing
physicians to agree to contracted rates of payment, and in some
cases, establishing rates unilaterally on a "take it or leave it"
basis, as done by Medicare and Medicaid. The payors are
leaders in utilization review, case management, and pushing the
shift from expensive inpatient care toward less costly care on an
outpatient basis where feasible. They are in a continuous
struggle with patients and employers, who do not want to see a
rise in premiums; and with hospitals and physicians, who do not
want to see payment rates decrease. In a payer's dream system,
the focus would be on efficient achievement of medical and
health outcomes, with payment only when outcomes are
achieved. They also would have stringent controls over
unnecessary utilization of services by a simple refusal to pay
for those services without preauthorization for the necessity.
Standard protocols of care for particular conditions would be

5. the norm, and these would be grounded in evidence-based
research. Payments to hospitals and physicians would be global
in nature, with one payment made to the joint entity, leaving the
hospital and physicians to divvy it up. Above all, for the
business side of insurance, there would be healthy profit
margins for the payer to return to its stockholders.
The Community
The larger community looks at the current system of health care
delivery, scratches its collective head, and wonders what is
going on. It sees inefficiencies, competing interests, ballooning
costs, errors and near-misses, unequal access to care, financial
impacts, and controversy about who controls what and how care
is delivered. In the community's ideal system, there would be
universal access to health care at an affordable cost, no waste or
inefficiency in the system, care would be delivered based on
patient needs and expected outcomes, health would be achieved
and maintained through prevention activities, and there would
be a method of managing the financial aspects of care in a
sustainable way, so that all parties are made financially whole,
but no one becomes obscenely rich. The cost of care is matched
to the community's available resources and does not exceed
them.
Conclusion
As one can see, the various stakeholders in the current system
have many overlapping desires and needs, along with some that
are directly competing. Anyone who is planning to tackle health
care reform and the design of a new and innovative system of
care needs to be sure that they have a thorough understanding of
the needs, desires, and wishes of all the constituencies. The
search for a compromise position that meets some of everyone's
shared needs, without overloading on meeting competing
desires, is the Holy Grail of health care system design.
READING
Explore the Preparedness for Healthcare Facilities sections of
the Centers for Disease Control and Prevention's website.
https://www.cdc.gov/phpr/readiness/healthcare/planning.htm

6. READING
Managing Security and Safety During Disasters
Read "Managing Security and Safety During Disasters" by
Huser, from Briefings on Hospital Safety (2015).
https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com
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live&scope=site#.Wq1RZxCK9pk.gmail
MUST HAVE REFERENCE