What's on horizon in health care?

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A changing health care system will require a changed health care workforce.

The question is: What kind of change? What skills will be needed? And where do we find workers with those skills?

Those were among the topics at a day-long meeting of experts from across the U.S. at the Jewish Healthcare Foundation training center, Downtown, on Thursday. The gathering was jointly sponsored by the foundation and the National Association of Workforce Boards.

The first major components of the federal Patient Protection and Affordable Care Act are slightly more than a year away from implementation, when an estimated 32 million more people will have health insurance, half of them through Medicaid.

But there is still a lot of uncertainty about what that means for those working in the health care industry.

"This could all happen very quickly, but it sometimes takes a while for behaviors to change," said Karen Wolk Feinstein, president and CEO of the Jewish Healthcare Foundation and Health Careers Futures. "I think most people feel this will be a decade with a lot of unpredictability."

What is known is that health care workers will be caring for a patient population that is older, with more -- as well as more complex -- health problems.

At the same time, Ms. Feinstein said there will be greater emphasis on controlling health care costs. Currently, she said, 40 cents of every health care dollar spent is wasted on preventable complications, unnecessary treatment, errors and general inefficiencies. The Institute of Medicine has estimated the total waste amounts to $765 billion yearly.

"We have a system that sadly underperforms," she said.

While errors cannot be eliminated, the savings from reducing errors and addressing waste would mean more money for needed health care services.

"What can we take out of the system so we can afford what we need to put into the system?" she asked, later adding that we "take money out responsibly. Take it out of useless activities. But don't cut staff and don't cut salaries."

A 2009 Reuters report said by far the single biggest area of waste is unnecessary testing, which Ms. Feinstein said can also harm rather than help because of the added radiation exposure from X-rays, or the unanticipated side effects of a medication.

While some of that extra testing may be due to physicians practicing defensive medicine so they don't get sued, she said a large portion is due to a payment system that traditionally has carried financial rewards for each additional test and procedure.

Another major cost is the expense of caring for the most acutely ill. One Kaiser Family Foundation report found that the 5 percent of patients who require the most care account for nearly half of all health care spending.

Ms. Feinstein said doctors and nurses need to find some way "to break the cycle."

Sometimes the solution is simply training physicians how to have an honest conversation with their patients about their prognosis.

Bringing those costs down, she said, "is not going to be popular but, Democrat or Republican, I don't see how you're going to avoid it."

businessnews - health

Steve Twedt: stwedt@post-gazette.com or 412-263-1963.


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