Journal of Gerontological Nursing

Guest Editorial 

Where is the Patient?

Sue Morgan, PhD, RN, C, GNP

Abstract

In our scramble to focus on PPOs, HMOs, MCOs, DSMs, home health, hospice, HCFA, balanced budgets, Medicare, Medicaid, chronic care, care caps, LTC, JCAHO, anti-fraud, cost accounting, case management, primary care, and IPAs, where is the patient? We seem to be getting farther and farther away from the "true" focus of caring. Have we lost the patient in the www.patientgone.com? Are we delivering services or bar graphs to demonstrate our effectiveness? Have our "show me the money" attitudes superceded patient needs? Are we still having territorial discussions about where patient care is delivered? It seems as if we have lost the focus of people and how we can meet their needs.

Put yourself in the "hot seat" for a change - You need a form of health care. Do you want to feel as if you were a number on a conveyor belt, wondering if someone would help, hoping you had the right cards to get you access to the right rooms and people, and that you could make it past "Go" with the right $200 to get help?

The fact is 97% oí all people managing a chronic disease do so from home, not within acute care, office, or outpatient settings (Lee, 1 998). We must go where the patients are and ensure they receive cost-effective, quality care at the most appropriate level of care to meet their needs. According to Lisa Remington (1998) in her Publisher's Message entitled "Unwarranted Fears Cause a Decline in Home Care Referrals from Physicians," physicians may have overreacted concerning the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997 that set civil penalties for doctors who falsify patient certification for home care. Remington went on to advocate continuing our efforts to

educate and communicate with physicians to dispel any false information that is arbitrary and get back to the business of the common goal between the home care industry and physicians: taking care of patients (Remington, 1998, p. 1).

I recently heard a surgeon lament that in the past if a surgeon needed an extra pair of hands in the operating room a colleague gladly would step in to help without charting, recognition, or reimbursement, but now that extra pair of hands (if you can get anyone to help) will complete a huge write up to bill the patient. This same surgeon said doctors were practicing insurance instead of medicine, which is just another perspective on the disastrous health care system that has evolved as we have lost sight of our reasons for being - patients and caring.…

In our scramble to focus on PPOs, HMOs, MCOs, DSMs, home health, hospice, HCFA, balanced budgets, Medicare, Medicaid, chronic care, care caps, LTC, JCAHO, anti-fraud, cost accounting, case management, primary care, and IPAs, where is the patient? We seem to be getting farther and farther away from the "true" focus of caring. Have we lost the patient in the www.patientgone.com? Are we delivering services or bar graphs to demonstrate our effectiveness? Have our "show me the money" attitudes superceded patient needs? Are we still having territorial discussions about where patient care is delivered? It seems as if we have lost the focus of people and how we can meet their needs.

Put yourself in the "hot seat" for a change - You need a form of health care. Do you want to feel as if you were a number on a conveyor belt, wondering if someone would help, hoping you had the right cards to get you access to the right rooms and people, and that you could make it past "Go" with the right $200 to get help?

The fact is 97% oí all people managing a chronic disease do so from home, not within acute care, office, or outpatient settings (Lee, 1 998). We must go where the patients are and ensure they receive cost-effective, quality care at the most appropriate level of care to meet their needs. According to Lisa Remington (1998) in her Publisher's Message entitled "Unwarranted Fears Cause a Decline in Home Care Referrals from Physicians," physicians may have overreacted concerning the Health Insurance Portability and Accountability Act of 1996 and the Balanced Budget Act of 1997 that set civil penalties for doctors who falsify patient certification for home care. Remington went on to advocate continuing our efforts to

educate and communicate with physicians to dispel any false information that is arbitrary and get back to the business of the common goal between the home care industry and physicians: taking care of patients (Remington, 1998, p. 1).

I recently heard a surgeon lament that in the past if a surgeon needed an extra pair of hands in the operating room a colleague gladly would step in to help without charting, recognition, or reimbursement, but now that extra pair of hands (if you can get anyone to help) will complete a huge write up to bill the patient. This same surgeon said doctors were practicing insurance instead of medicine, which is just another perspective on the disastrous health care system that has evolved as we have lost sight of our reasons for being - patients and caring.

REFERENCES

  • Lee, S. (1998). The good the bad and the opportunities. The Remington Report, 6(4), 9-13.
  • Remington, L. (1998). Publisher's message: Unwarranted Fears Cause a Decline in Home Care Referrals from Physicians. The Remington Report, 6(6), 1.

10.3928/0098-9134-19990401-03

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