Term Paper on "Leadership & Management, Health Care"

Term Paper 9 pages (2758 words) Sources: 1+

[EXCERPT] . . . .

States, however, control Medicaid payments, not the federal government alone. Thus, several states have begun implementing alternative services such as home-health care, to contain Medicaid costs. This has given birth in those states especially to an expanded sector of health care services that are professional without being housed within a monolithic facility such as a nursing home. In such cases, for example, benefits may be "individually tailored to each qualified person using state and federal long-term care funds. For instance, an elderly woman living alone in her own home may require minor nursing care and help with household tasks at a cost of roughly $900 a month" (Fox-Grage & Shaw 2000, 30), which is significantly better for the stakeholders than $51,000 a year, and open up new roles and responsibilities for health care managers as well.

There is also a government impact on the environment for health care for the aged. IN the summer of 1998, a General Accounting Office report exposed gaps in nursing home regulation enforcement. The President (Clinton) promised to crack down, Congress expressed outrage, and state agencies vowed to get tough. Some of this was related to the pressure to do more with less; it is difficult, however, to improve quality of care without increased operating costs as quality is often related to staffing with more and better qualified (that is, more expensive) staff (Hovey 2000, 43).

However, federal nursing home regulation has little effect on whether a nursing home can open for business or remain in business; its major effect is on participation in Medicaid and Medicare (Hovey 2000, 43).

However, this leaves open a double bind for managers, with the need for income provided by Medicaid and Medicare, and the need to provide the beds required by the community.

Federal requirements under the Omnibus Budget Reconciliation Act of 1987 (OBRA 1987) required nursing homes to adhere to new standards for quality of care, facility practices, resident rights, resident assessment, and quality of life, as well as improving standards for nursing assistants and conducting outcome-oriented surveys. Also instituted were intermediate sanctions for noncompliance. (Hovey 2000, 43)

Who are the stakeholders?

The idea of 'stakeholders,' or everyone who has an interest in a particular company's product or service, has been gaining ground since the 1980s. A study by Kumar & Subramanian (1998) tried to throw some "empirical light" on stakeholder management through a survey asking hospital executives to rank the importance they attached to a variety of goals relating to stakeholders. (Kumar & Subramanian 1998, 31+)

The stakeholders in the case of health care for the aged are the aged themselves, and their families, but also their doctors and the health care facility itself. The federal government and state governments, as well as insurance companies, can also be considered stakeholders. Problematical in this regard is that only 10 to 20% of older Americans can afford premiums on long-term care insurance, which range fro $900 to $2,400 a year, according to a study by the U.S. General Accounting Office (Fox-Grage & Shaw 2000, 30). Because of this, the federal and state governments become, by default, the biggest stakeholders, and therefore of primary concern to health care managers. Moreover, they have to power to impose demands that the relatively powerless consumer of this form of care cannot impose or effectively demand. This adds to the roles and responsibilities of the manager. In addition, "Each of these stakeholder groups has its own expectations, and if the hospital executives are to gain their acceptance, they must set their performance goals to address the specific concerns of each group" (Kumar & Subramanian 1998, 31+).

It is also wise (if not always accurate) to consider that the government may represent the interests of the consumer stakeholder vis-a-vis care for the aged:

Government regulators of nursing home care face an even more difficult than usual task in balancing cost and quality concerns, because unlike most areas of health care in the United States, government payers (primarily Medicaid) fund nearly three-fourths of all nursing home care in the U.S. (Hovey 2000, 43)

Noting the huge numbers of people who will require long-term care, and the relative beginnings of alternatives to facility-based care, there is likely to be a cost-quality tradeoff mandated at least in the short and medium terms (Hovey 2000, 43).

Possible outcomes

One method to serve all the stakeholders would be to expand home and community-based services to "rebalance the system, which is too heavily weighted toward nursing homes" (Fox-Grage & Shaw 2000, 30).

Oregon, in 2000, was the leader in that thrust. That year, the state spent more on community-based services than on facility-based care. Nearly 80% of Medicaid patients who needed long-term care was getting help in their homes in the community, with only 20% in nursing homes.

Another scenario assumes cost-containment factors are instituted in facilities, altering (Kahl & Clark 1986, 17+).

What roles and responsibilities of the health-care manager in the current care environment?

The key drives affecting management in health care are:

An aging population with increasing life expectancy

Relative lack of private coverage for long-term care expenses

Ability to perform procedures on the elderly not possible previously, extending life but often requiring care

Need to serve a variety of 'stakeholders,' from consumer to family to physician to insurance company to government regulator

Increased government regulation

Shift of payment from individuals to government agencies

Search for alternatives, including home health care services

The key to providing good care lies in trained staff, especially competent nurses' aides.

In 2000, 1 million aides and paraprofessionals provided up to 90% of hands-on care in facilities and in private homes (Fox-Grage & Shaw 2000, 30). Because many states' plans for Medicaid reimbursement are tied to extra pay for nights, weekend and holidays, as well as home-health workers' travel time, managers will need to be able to properly manage the finances to allow for this, within the funding available, and with an eye toward satisfying all the stakeholders (Fox-Grage & Shaw 2000, 30).

Results of the Kumar and Subramanian study mentioned above showed that "hospital executives have generally focused their attention quite well on managing the demands and concerns of diverse stakeholders, with the possible exception of customers" (1998, 31+).

In view of all the demands in the bulleted list, above, these are the qualities required in a manager working in health care/aged services today and increasingly for the next 15 years. The manager must:

Be able to influence behavior

Conduct and settle negotiations (wage and other)

Facilitate improvement

Resolve conflicts

Be politically savvy

Think in terms of the needs of multiple stakeholders

Be an effective communicator

Have a clear vision to communicate (Froeschle & Donahue 1998, 60)

Conclusion

The most salient features of the current and future health-care/aged care scenario are the increasing elderly population and the shift from private to government forms of payment; long-term care insurance is affordable to relatively few. At the same time, with fewer people contributing to paying the bills, cost containment will be a factor. On the other hand, so will providing excellent care because the industry will be increasingly monitored. The roles and responsibilities of the manager therefore must encompass financial management, customer service, and regulatory compliance. Moreover, attracting and keeping high-caliber staff, especially in traditionally low-paid areas, will also be necessary. It will be essential for health care managers to achieve the highest level of professional competencies in half a dozen areas ranging from line supervision to global vision.

References

Fox-Grage, W., & Shaw, T. (2000, April). The crisis ahead… READ MORE

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