Integrating health care
Hospitals will evolve to reflect ongoing changes in the way health care is delivered and paid for. That's why, with the exception of maternity and pediatric services, hospitals are becoming more like intensive care units, treating trauma and emergency patients, and those requiring major surgery and other highly skilled, advanced care. Unfortunately, it's common for those nearing the end of life to spend their final days or weeks in a hospital. While hospice and home care is certainly preferred, it's often not an option for those without an adequate support system in place.
Most health care leaders understand the care continuum is constantly shifting, and like many health systems, Northwell has spent years investing in different parts of a delivery system that is far less fragmented and siloed than years ago, with primary care, ambulatory care, hospital care, home care, rehabilitation and long-term care all playing integral parts in meeting the needs of patients of all ages.
Interestingly, the movement of clinical services out of the hospital and investments in ambulatory expansion into communities where health systems previously did not have a presence can actually lead to increases in hospital admissions. As health systems enlarge their outpatient footprint, they come into contact with an entirely new patient base, some of whom will require integrated care that can only be provided in a hospital setting.
As all health care administrators know, much of the patient movement out of the hospital has been driven by CMS, which has also raised the stakes on penalties for hospital readmissions. These statistics can sometimes be a helpful indicator of care quality, but using readmission rates as a primary metric to gauge the caliber of a hospital is dangerously simplistic. While policymakers seem to think patients can be treated with assembly-line efficiency, restoring people back to good health is far more complicated than building a car.
No two patients are alike, and while most of us have standardized care as much as possible to treat a range of illnesses and diseases, the unique nature of each individual means some people may have to be readmitted after they leave the hospital. This is not necessarily a reflection of poor care, only that a patient requires additional time with their care team.