Health Care System in the USA - Coursework Example

Health Care System in USA: Oncology services at Midwestern Regional Medical Center in Zion, Illinois. Name Institution Executive Summary Objective: This report examines cancer care services at Midwestern Regional Medical Center’s (MRMC’s) in light of the concepts of effectiveness, efficiency, and equity. Description of cancer care services at MRMC MRMC provides some advanced treatments like radiation therapies such as Intraoperative Radiation Therapy (IORT). It also provides vascularized lymph node transfer surgery and breast-sparing surgery, such as breast reconstruction alternatives like reconstructive microsurgery. Findings from critical evaluation: To a great extent, MRMC provides efficient and effective cancer care services. However, it does not provide an equitable cancer care service. Efficiency: MRMC provides an efficient cancer care services in ADV communities than in DIS communities in Chicago, although they still have more significant outcomes DIS in terms of reducing mortality rates. MRMC has an efficient workforce that offers a favorable practitioner: patient ratio. However, there are sometimes delays in attending to patients due to “preauthorisation.” Additionally, the growing demand for cancer care as a result of improved access to healthcare due to ACA 2010 and an aging workforce coupled with a declined interest in private practice careers overwhelm its existing workforce. Equity: MRMC does not provide an equitable cancer care service to its target population in Chicago. Because of its location in Zion city and the high cost of cancer treatment charges at MRMC.A high number of MRMC’s oncologist specialists are also concentrated in urban places. Effectiveness: Adoption of information systems has increased the effectiveness of cancer care services at MRMC. By examining the four curative effects that reflect the clinical terminal quality of Midwestern Regional Medical Center such as “cured, improved, uncured, and death,” the hospital appears to provide effective care. However, cases of surgical procedure infections have been noted. Recommendations MRMC should encourage all its cancer patients to procure health insurance. It should come up with new and updated evidence-based guidelines or recommendations. It should also engage policymakers in improving the payment reforms. MRMC should also adopt advanced health information technology to reduce the cost of operation and reduce the cost of drugs. It should also come up with structural transformations to reduce administrative burdens and avoid taking up patients’ time and resources. Table of Contents Executive Summary 2 Table of Contents 4 1. Introduction 5 2. Description of oncology/cancer care services at MRMC 5 3. Critical evaluation 7 3.1 Efficiency 8 3.1.1 Cancer treatment 8 3.1.2 Payment models 10 3.1.3 Staff ratio 12 3.2 Equity 14 3.3 Effectiveness 16 3.3.1 Comparative operating efficiency 16 3.3.2 Clinical terminal quality 16 3.3.3 Patients’ satisfaction 17 Conclusion 17 Recommendations 18 References 20 1. Introduction The health care system in the United States has set itself apart from that of other advanced industrialized economies like Germany, Australia, and the United Kingdom. Unlike the health system of its counterparts, that of the U.S. lacks a universal health care coverage and uniform health system. In fact, it is only in 2010 that the U.S. Congress passed a law that currently mandates health care coverage for nearly each American. In oncology practice, the current cancer care service delivery shows a mixed picture effectiveness, efficiency, and equity. This appears to be the case for Cancer Treatment Centers of America (CTCA) at its Midwestern Regional Medical Center (MRMC) facility in Zion, Illinois. There is an indication that this is attributable to a decline in mortality rates from cancer on the one hand and increased costs and a growing population of the elderly that increase the demand for cancer care services on the other hand (Department for Professional Employees, 2016). Such complexity rationalizes a need to examine cancer care services at MRMC in light of the concepts of effectiveness, efficiency, and equity. 2. Description of oncology/cancer care services at MRMC Midwestern Regional Medical Center (MRMC) provides some advanced treatments like radiation therapies such as Intraoperative Radiation Therapy (IORT). It also provides vascularized lymph node transfer surgery and breast-sparing surgery, such as breast reconstruction alternatives like reconstructive microsurgery. It has a bed capacity of 72 (Gerlach, 2017). Despite targeting the population of Illinois, it attracts patients from across the country. A survey by U.S. News (2017) indicates that in 2016, it received1303 patients in its emergency room, and had a sum of 2099 admissions. The hospital’s oncology specialists catered to 1949 outpatient and 1075 inpatients surgeries. MRMC adheres to an integrative approach to ontology care that applies conventional approaches such as chemotherapy, surgery, immunotherapy, and radiation in treating cancer. At the same time, it provides integrative therapies for side-effect management, such as depression, fatigue, nausea, anxiety, lymphedema, and pain. MRMC is a wholly patient-centered institution, whereby its business model does not independently rely on doctors to refer patients to the hospital (Cancer Treatment Centers of America, 2012). The organization seeks to ensure there is transparency in accessing a complete range of cancer diagnosis and treatment resources. It has one of the best nurse-to-patient ratios in the United States of 1:6. It is also exposed to 1,500 doctors and clinical professionals employed by CTCA (Cancer Treatment Centers of America, 2012). MRMC takes up measures to provide advanced cancer care service at its center in Zion, Illinois. This is in line with the idea that cancer care services in the United States are currently undergoing evolution to advance the quality of services to a wider population at fairer costs (CTCA, 2012). An increased demand for cancer services, increased costs of care, inconsistent healthcare delivery systems for cancer patients continue to create reservations regarding MRMC’s capacity to provide quality care to all cancer patients at fairer costs. This rationalizes a need to look at MRMC in light of the concepts of effectiveness, efficiency, and equity. Significant economic pressures, changing market dynamics, in addition to a change in payment policies have collectively placed existing MRMC in jeopardy. Such changing trajectories along with a gradually more limited workforce have raised concerns regarding the capacity of the organization to act in response to an anticipated increase in demand for cancer care in future (Department for Professional Employees, 2016). 3. Critical evaluation Health programs should effectively reach their objectives in ways that ensure efficient utilization of resources. Also, the benefits need to be equitably distributed to the targeted patients (Hinrichs-Krapels & Grant, 2016). The concept of effectiveness, efficiency, and equity, also known as the 3e’s can serve as approach for evaluating a health service in general, its performance or health system performance. The first basic concern for health service is effectiveness, which refers to the degree or amount of benefits attained. The second measure is linked to efficiency, which refers to the magnitude of scarce resources required to generate benefits. The last measure relates to equity, which is concerned with distributing benefits fairly among the target population on account of individual needs (Begley et al., 2013). The objectives of the 3e’s are usually considered jointly, as though they are mutually reinforcing (See table 1). Table 1. Defining the 3e's In the case of the Midwestern Regional Medical Center, while a narrowly targeted oncology service may be efficient, its benefits may only become accessible to few individuals. This is because distributing the benefits is only achievable when marginal costs are increased, which may make an effective program less efficient. 3.1 Efficiency 3.1.1 Cancer treatment For purposes of evaluation, cancer care services can be characterized depending on intermediate outputs achieved (OP), such as coverage of the service, inputs required (IP), often in terms of cost, and outcome (OC). Example of outcome may be reduced deaths or mortality rates (Reinke, 1994). In Chicago, Illinois, a relatively privileged community (ADV) may be considered where it is supposed that 19 percent of whites die from breast cancer. Breast cancer care can be attained for $1,000 per patient per month (Thometz, 2017). The second is a disadvantaged community (DIS) is made up of minorities in Chicago who are disadvantaged, whereby 38% of women die from breast cancer, and providing supplementary outreach service to achieve community support contributed to an added cost of $1000 per cancer treatment case (Shelton, 2010; Thometz , 2017). Cost-effectiveness is related to services coverage and resources needed. Hence, in a Community ADV, 100 cancer treatments can be attained per $100,000, while only 50 cancer treatments can be achieved with the same resources in DIS community. To this end, the Midwestern Regional Medical Center only gets to use resources in a cost-effective manner in ADV communities in Illinois. In a related case of cost-effectiveness, the outcome (OC) can as well be measured to input (IP), whereby cost per death averted (IP/OC) is examined. Using an example of cancer service for colon cancer surgery, Midwestern Regional Medical Center can avert 20 deaths per $1000 a month, compared to only 10 in DIS communities in Chicago per $1000 a month (Shelton, 2010). This indicates that colon cancer surgeries in ADV communities in Illinois are more cost-effective, although the advantage may not be obvious as in the OP/IP evaluation. As the basic interest is focused on the outcome, the OC/IP measure is considered. The measure can be divided into two. They include OC / IP= OP /IP × OC / OP. Here, the first term to the right represents the traditional outcome of efficiency, as it is concerned with output to input. The second term represents the outcome per unit of service. These translate to “Cost - Effectiveness = Efficiency × Impact” (Reinke, 1994). Table 2. Cancer treatment efficiency Community Target Population (000) Cost per breast cancer surgery ($) Case fatality Rate (%) Avoidable deaths Efficiency Impact Cost-Effect Surgery per $100,000 (OP/IP) Deaths per $10,000 (OC/OP) Deaths Averted per $10,000 (OC/IP) ADV 5 1,000 19 100 100 50 100 DIS 10 2,000 38 200 50 60 80 In the table above, it is established that the cancer care service is provided efficiently in ADV communities in Chicago, although they still have more significant outcomes DIS in terms of reducing mortality rates. 3.1.2 Payment models Cancer care services at MRMC are highly efficient, as a result of payment models that are convenient to patients. Due to an increased demand to control costs of care at MRMC and other cancer hospitals industry-wide, payers are today in pursuit of new care delivery and payment models capable of lowering spending while maintaining quality (Vose, 2016). Indicators of improved efficiency at MRMC include a greater level of financial flexibility, due to consistency to repayments of cancer services through Medicare. A momentous advancement for the United States healthcare sector happened in April 2015 after a resolution by US Congress to revoke the sustainable growth rate (SGR) opinion. The resolution, a component of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), managed to reverse the requisite payment cuts successfully and substituted the SGR with an arrangement that would restore consistency to repayments of physician services through Medicare (Kirkwoord, 2016). MACRA provides CTCA with incentives to take part in new payment models with a capacity to offer a greater number of flexible alternatives to repaying physician services in return for greater accountability in the delivery of high-quality cancer care (Department for Professional Employees, 2016). Quality measurements are at the core of nearly all payment reform models that were proposed in 2017. For instance, Medicare and Medicaid, both of which make up the largest payers for health services in the country, demand that healthcare providers and oncology practices should show their devotion to enhancing the quality of care (ASCO 2017). However, there are sometimes delays in attending to patients. A study by Citrin et al. (2012) showed that some breast cancer patients felt that physicians at MRMC are bossy, and may deliberately delay treatment. There is a growing concern regarding the time that healthcare service provides spend attending to matters with insurance firms as this limits the time that can be committed to patient care (ASCO, 2017). This is particularly so when it comes to “preauthorization,” which refers to a necessity for healthcare providers to obtain an authorization from patients' insurance providers in advance, before making orders for some tests or administration of some treatments. Preauthorization is a major drawback to quality and efficient cancer care at CTCA. A 2014 survey by ASCO revealed that affiliate firms often find preauthorization requirements as an impediment to efficient services, as it increases demands on workforce time. It also causes delays or interruptions to patient care and delays decision-making. High administrative burdens also weaken the efficiency of cancer care services At CTCA, as it adds to high overhead costs. Administrative burdens also take up resources from patients, as money that would have been spent on medical equipment is spent on office equipment (Cisco Systems 2008). A similar trend has been observed in the entire sector. On account of an increased number of cancer patients, a 2017study established that cancer services currently face an increase in some practice burdens, which take up patients’ time and resources (ASCO 2017). The study identified ever increasing overhead costs and costs of administration as being the major impediments to oncology practices, as they take up patients’ time and resources. Indeed, in 2016, the total expenditure for oncology practices from regular medical was near US$15.4 billion. The time taken up by the patient for each oncologist included an average of 785 hours to fulfill requirements for reporting (ASCO 2017; 2016). 3.1.3 Staff ratio MRMC has an efficient workforce that offers a favorable practitioner: patient ratio. Currently, it has one of the best nurse-to-patient ratios in the United States of 1:6. It is exposed to a high number of combined oncology specialists of nearly 1,500 employed by CTCA (CTCA, 2012). Among them include physician assistants, doctors of nursing practice and nurse practitioners. This is an indicator that the oncologist workforce at CTCA is currently stable in spite of the growing demand for cancer services. There is also a huge potential to expand the workforce, as the employment of advanced practice provider is experiencing rapid growth, which has enhanced the pipeline of practitioners willing to select a vocation oncology. Interest in clinic-based oncology is relatively low, which creates uncertainties regarding future stability of the workforce. A 2014 study of oncology fellows indicated that a majority, nearly 56 percent, preferred academic-based clinical setting, while only about 37 percent indicated an interest in working in hospitals (Vose, 2016). Additionally, the growing demand for cancer care as a result of improved access may still overwhelm its existing workforce. As expected, the trend is also evident in the entire cancer service sector. In 2014, the United States had nearly 11,500 medical oncologists and haematologists, which represented a minimal rise by 1.6 percent compared to 2013. On the whole, some 18,000 medical practitioners offer oncology specialty care, such as pediatric hematology, radiation oncology, surgical oncology, and gynecologic oncology (Kirkwood, 2017). Also, approximately 3,000 advanced practice specialists who offer cancer care countrywide. At the same time, an aging workforce coupled with a declined interest in private practice careers still poses a threat to MRMC’s future efficiency. This creates uncertainties regarding future stability and efficiency of the workforce. This reflects the current trend in the cancer care service sector. A report by Kirkwood (2017) reveals that the current oncologists are aging, whereby those aged 65 years and beyond surpass the new entrants aged 40 years and below. A study of oncologists who currently work in a practice setting indicated that youthful oncologists prefer working in group practice rather than working in private and solo practice compared to their older peers. Reduced preference for solo and private practice appears to have been provoked by an increased emphasis on using medical home model to deliver cancer care, which has in turn driven augmented emphasis on team-based care by practitioners from a range of backgrounds and specialty fields, such as genetic counsellors, urologists, pathologists, primary care physicians, gynaecologists, and palliative care specialists. A growing demand for cancer care services is also triggered by an aging population and newly insured patients as a result of the Affordable Care Act (ACA) 2010. In the U.S., cancer patients are continuing to integrate conventional treatments like radiation and chemotherapy with complementary healthcare interventions like massage therapy, acupuncture, and naturopathic medicine (Seely et al., 2012). Consistent with these findings, the integrative oncology, as a health service at MRMC, has made sure that patients can access evidence-based oncology care equitably, safely and efficiently (Seely et al., 2012). 3.2 Equity Because of its location in Zion city and the high cost of cancer treatment charges at MRMC, the organization does not provide equitable cancer care to its target population in Chicago. Evaluation of inequity assumes an occurrence of a subgroup that has unmet needs (DIS) more than those of the more privileged group in a given population (ADV). Hence, it is significant to add another evaluative measure (ND) that identifies the amount of need. The measure can be expressed using a similar unit to that of the outcome which expresses need reduction. In table 2, need is indicated in respect to avertable deaths from cancer in the hospital’s target populations. As earlier established by established that in Chicago, the ADV community receives better quality cancer care, as only 19 percent of whites are reported compared to DIS community, where 38% of women die from breast cancer (Thometz, 2017). Differences in terms of geopolitical units, such as urban-rural differences embody a basis for the inequity. The geographical disparity in ratios of health personnel distribution per rural and urban population is key indicators of inequity. Related measures of access are also common. Hence, it is established that measures of the proportion of the population in urban areas of Illinois have reasonable access to the hospital and can travel within an average of an hour to reach a health unit. At the same time, the urban-rural disparity in cancer care consultations is less for those in rural areas than consultation (ASCO, 2017. There is an apparent inequity in the distribution of oncologist specialists at MRMC, particularly as the organization serves patients from rural and urban areas. This creates an imbalance in the distribution of workforce, as rural areas are underserved by oncologists (CTCA, 2012). The trend is reflected in the larger cancer care sector; cancer care currently experiences imbalanced geographic distribution of its labor force (Seely et al., 2012). Corresponding to rural or semi-urban places like Goodyear, Arizona and Tulsa, Oklahoma where Americans aged 55 years and older live, who make up a bulk of cancer cases, most MRMC oncologists are heavily concentrated in urban places like Zion city in Lake County and Chicago. For this reason, diagnosing cancer presents challenges to the realization of first-rate quality care, particularly as MRMC does not work on doctor referrals. Instead, patients make decisions by themselves to visit the center. This leads many U.S. cancer patients in search of cancer care service at MRMC to travel long distances for diagnostics and treatments at the centers. While the high number of oncologist specialists is an indicator that the organization’s workforce is currently stable in spite of the growing demand for cancer services, they continue to age (Kirkwood, 2016). On the other hand, the high cost of cancer medicine at MRMC has increased the burden for patients. For this reason, patients with breast cancer at MRMC have had to contend with two critical issues. These include increased costs of medicines for breast cancer, which increases disease burden on patients, and increased cost of shifting and deductibles, which have also increased patient burden (Cisco Systems 2008; Shelton, 2010). The trend has affected the entire cancer service sector. Indeed, a 2016 study indicated that some 24 percent of American citizens admitted to having a difficult time buying prescription drugs, while 72 percent view considered the prices of cancer medicines to be unreasonable (Vose, 2016). 3.3 Effectiveness The effectiveness of cancer care service at Midwestern Regional Medical Center is measured in terms of the comparative operating efficiency of the hospital, patients’ satisfaction with services, medical staff satisfaction with the services, and clinical terminal quality (Jiang et al., 2016). 3.3.1 Comparative operating efficiency Technological advancements, including increased use of Big Data, have also increased the effectiveness of cancer care services at alls CTCA facilities, including at MRMC (Cisco Systems 2008). An assessment of the patients Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) in 2017 indicates that 88 percent doctors and 87 percent of the nurses effectively communicate. Additionally, 79 percent of the patients always receive help whenever there is a need (Health Grades, 2017). This is because of ths hospitals’ greater emphasis on application of large and intricate datasets to report to cancer treatment and delivery of cancer care at CTCA. Some big data projects are also ongoing among public and private cancer treatment centers including CancerLinQ, ASCO rapid learning system, and PCORnet. 3.3.2 Clinical terminal quality By examining the four curative effects that reflect the clinical terminal quality of Midwestern Regional Medical Center such as “cured, improved, uncured, and death,” the hospital appears to provide effective care. Of the 598 discharged patients for breast cancer in 2014, a majority were either cured or reported an improvement (Gerlach, 2017). The National Quality Measures for Breast Centers Program (NQMBC) has also awarded the organization as being the best in the country, among 43 national cancer centers, for providing effective breast cancer care for the fourth successive time, since 2013. The NQMBC found the organization to be providing effective pathology, cancer registry, and imaging. A study by Citrin et al. (2012) showed that MRMC offered effective breast cancer care, which made the hospital to appeal to a wider market across the country. All participants had received conventional breast cancer treatment suitable for their stages, and in line with the National Comprehensive Cancer Network guidelines. However, cases of surgical procedure infections have been noted. MRMC had 13 surgical-site infections in about 114 surgeries among its patients in 2015(Consumer Reports, 2017). 3.3.3 Patients’ satisfaction A majority of the patients appear to be satisfied with the services. An analysis by the HCAHPS in 2017 indicates that 79 percent of the patients are satisfied with the cancer care at the hospital, and always receive help whenever there is a need (Health Grades, 2017). A survey of 598 new patients in the hospital in 2014 by the National Consortium of Breast Centers found a majority of the patients to have been satisfied with the services (Gerlach, 2017). An earlier study by Long and Sheehan (2010) showed that patients had a satisfaction rate of 96% during the previous 14 months. Conclusion To a great extent, MRMC provides efficient and effective cancer care services. However, it does not provide an equitable cancer care service. MRMC provides a efficient cancer care services in ADV communities than in DIS communities in Chicago, although they still have more significant outcomes DIS in terms of reducing mortality rates. MRMC has an efficient workforce that offers a favorable practitioner: patient ratio. However, there are sometimes delays in attending to patients due to “preauthorisation.” Additionally, the growing demand for cancer care as a result of improved access to healthcare due to ACA 2010 and an aging workforce coupled with a declined interest in private practice careers overwhelm its existing workforce. MRMC also provides effective cancer care services. Adoption of information systems has increased the effectiveness of cancer care services at MRMC. By examining the four curative effects that reflect the clinical terminal quality of Midwestern Regional Medical Center such as “cured, improved, uncured, and death,” the hospital appears to provide effective care. However, cases of surgical procedure infections have been noted. However, MRMC does not provide an equitable cancer care service to its target population in Chicago. Because of its location in Zion city and the high cost of cancer treatment charges at MRMC.A high number of MRMC’s oncologist specialists are also concentrated in urban places. Recommendations To increase accessibility to cancer care services, MRMC should encourage all its cancer patients to procure health insurance. To reduce surgical procedure infections, MRMC should come up with a new and updated evidence-based guidelines or recommendations, which should be incorporated in comprehensive surgical quality improvement initiatives. MRMC should also engage policymakers in improving the payment reforms. Given that the United States is currently shifting to value-centered from volume-centered value-based healthcare reimbursement systems, there is a need for private and public payers to engage cancer care providers and cancer patients with the view of developing new payment models capable of supporting patient-centered cancer care in a range of cancer care clinical settings. MRMC should also adopt advanced health information technology to reduce cost of operation. It should also encourage suppliers of health information technology to come up with technologies that encourage interoperability and reduced cost. Cost-efficiency can help reduce cost of drugs. MRMC should also come up with structural transformations to reduce administrative burdens that add to cost and inefficiency in providing care. It should rationalize and standardize how oncology practice is focused on efficient use of time and resources to avoid taking up patients’ time and resources. References ASCO. (2017). U.S. Cancer care system poised for transformation, but challenges loom large. Retrieved from https://www.asco.org/about-asco/press-center/news-releases/us-cancer-care-system-poised-transformation-challenges-loom Begley, C., Lairson, D., Morgan, R., Rowan, P. & Balkrishnan,R. (2013). Evaluating the healthcare system. Chicago: Health Administration Press. 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