Transcript L. Pickler - Center for Global Health Affairs

THE ENVIRONMENT OF ACUTE CARE
IN THE UNITED STATES AND A
COMPARISON WITH JAPAN
Osaka March 1, 2014
Tokyo March 2, 2014
Lee Pickler, DBA
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ACUTE CARE IN THE UNITED STATES
ROLE OF LTAC’s
• CURRENT HIGHLIGHTS OF HEALTHCARE TODAY
– UNTIL 2013 HEALTHCARE COSTS HAVE INCREASED
EITHER ALARMINGLY OR AT LEAST SIGNIFICANTLY
– FORTY-SEVEN MILLION AMERICANS EITHER UNDERINSURED OR UNINSURED
– THE DEMOGRAPHICS WILL NOT IMPROVE THE
SITUATION—ONLY WORSEN IT
– THE PRIVATE SECTOR HAS NOT BEEN ABLE TO
ADDRESS THE PROBLEM
– THE AFFORDABLE CARE ACT IS THE GOVERNMENT’S
RESPONSE TO THE PROBLEM
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THE ENVIRONMENT
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•
•
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DEMOGRAPHICS
MACRO ECONOMICS
HEALTHCARE RESOURCES
PUBLIC SECTOR
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Japan United States
Demographic Comparisons
2012 Population
Japan
127,515,000
U.S.
313,914,000
2013 Elderly (65+) %tage of Population
Japan
23.7%
U.S.
13.9%
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Projection of Population over 80 Years
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Notes on Japan -- LTC
• Japan public spending on long-term care is
projected to more than double from 1.4% in
2007, and could even reach 4.4% of GDP in
2050. Japan’s real public LTC spending is
expected to grow at a faster rate between
2006 and 2025.
– Highlights from Help Wanted? Providing and
Paying for Long- Term Care, OECD Publishing,
2011.
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Japan United States
Macro Economic Comparisons
2010 Health Expense Per Capita
Japan
$3,958
U.S.
$8,233
Health Cost %tage covered by the public (2011)
Japan
80.0%
U.S.
45.9%
http://www.oecd.org
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Japan United States
Macro Economic Comparisons
• 2012 GDP Per Capita (in U.S. Dollars):
• Japan US$46,720
• U.S.
US$49,965
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RESOURCES
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•
•
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Acute Care Beds Density per 1000 (2011)
Japan – 8 (Avg length of stay 17.9)
U.S. -- 2.6 (Ave length of stay 4.8)
Physician Density per 1000 (2010)
Japan – 2.23
U.S. -- 2.44
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FIND A NEED AND FIX IT
• GOVERNMENT POSITION—REGULATE AND
PRICE FIX. RESULT WILL BE ADJUSTMENTS
MADE BY THE PRIVATE SECTOR TO ADDRESS
THE PROBLEM.
• PRIVATE SECTOR CHANGED ACORDING TO
WHO HAD THE POWER.
• PHYSICIAN POWER, INSUROR POWER
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THE RESULT
• NO INCREASE IN PATIENT ACCESS
• INCREASED COST OF CARE
– DUE TO THIRD PARTY PAYORS
– TECHNOLOGY
– SERVING THE UNDER-SERVED
• NOTHING FIXED SO THEREFORE:
• OBAMA CARE (THE AFFORDABLE CARE ACT)
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TWO CHALLENGES
• ACCESS TO CARE FOR EVERYONE
– IMPROVE COVERAGE
• DRIVE COST OUT
– SOME METHODS:
•
•
•
•
REGULATE INSURORS
CONTROL/DECREASE REIMBURSEMENT
BEGIN TO BUNDLE PRICING
DON’T PAY FOR MISTAKES
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DELIVERING CARE IN THIS
ENVIRONMENT
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•
•
•
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SHORT TERM ACUTE CARE
LONG TERM ACUTE CARE
INPATIENT REHABILITATION
SKILLED NURSING FACILITY
HOME CARE
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A Comparison of Facilities
Long-Term Acute
Care Hospital
Rehab Hospital
Skilled Nursing
Facility
License
Acute hospital
Rehabilitation hospital
Skilled nursing facility
Medicare
Certification
Acute hospital
Rehabilitation hospital
Skilled nursing facility
Meets acute criteria
60% falls into case mix
groups for rehab
Meets chronic
care criteria
Admitting
Criteria
Length
of Stay
Physician
Involvement
Minimum 25 days
ALOS for Medicare;
no requirements for
non-Medicare
typically 12-18 days
Daily visits by internists
with multiple medical sub
specialities; consultation.
care directed by
physical medicine physician
Typically: Medicare
35-40 days
HMO 10-15 days
Physician visits weekly/monthly
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LTACH DEFINITION
• LONG TERM ACUTE CARE HOSPITALS PROVIDE
SPECIALIZED ACUTE CARE FOR MEDICALLY
COMPLEX PATIENTS WHO ARE CRITICALLY ILL
WITH MULTI-SYSTEM COMPLICATIONS AND
REQUIRE LONG HOSPITALIZATIONS.
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