1. Hader, Richard PhD, NE-BC, RN, CHE, CPHQ, FAAN

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As healthcare costs continue to escalate-requiring more individuals to pay out of pocket for care-coupled with increased competition from providers, it's certainly possible that consumers will soon be scouring the newspaper or Internet to find where they can receive discounted diagnostic or treatment services.

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Competition for healthcare services, particularly elective surgical procedures that tend to be profitable, has moved from the local to the global market. Entrepreneurial healthcare organizations are now competing for the limited healthcare dollar by providing boutique services, which can translate into a lucrative bottom line. To grow the business, these healthcare providers aren't just marketing their services to the local community, but rather enticing the consumer to travel to their facility by offering substantial savings. Despite the travel and lodging costs, the savings enjoyed from discounted healthcare services may well be worth the time and effort necessary to receive care from organizations that are hundreds or even thousands of miles from home. Is it conceivable that we'll soon be clipping coupons and making hotel and flight arrangements to enjoy financial savings on receiving our hip or knee replacement?


Many businesses now require their employees to significantly share in the cost of healthcare premiums. Payers (insurance companies) are beginning to require that the insured person receive care at a specific facility because financial incentives have been negotiated to provide cost-effective care. Financial agreements between the payer and the provider will become increasingly more common as a method to control escalating healthcare costs. These savings will be passed on to the consumer, but they might have to travel to realize such cost reductions.


As nursing leaders, we typically aren't the primary financial negotiator, but we're held accountable and responsible for ensuring that the care provided remains of the highest quality at the lowest possible cost. Keen assessment skills and the translation of evidence-based care into practice are essential components to ensure patients choose your organization for their care. Savvy consumers won't only search for a bargain price, but they'll also investigate key measures of quality. Hospital-acquired complications such as infections will be the financial responsibility of the provider, not the patient. It will become increasingly necessary to ensure that the care provided by the nursing staff is appropriately supervised and that care processes are constantly being evaluated for the highest quality outcome.


We've long been taught patients look for hotel concierge-type services when choosing their healthcare provider. In the future, patients will be defining excellent service as care that's delivered throughout the healthcare continuum, which is clinically integrated and places the burden of ensuring the continuity of care on healthcare organizations rather than on the individual patient. The healthcare reform legislation requires that organizations be held accountable for ensuring that the service they provide to patients is seamless and efficient. This can only be accomplished by ensuring that nursing care is congruent with best practice and is well communicated throughout the patient's healthcare experience.


It might appear farfetched that our patients will be clipping coupons out of their Sunday morning paper for care. However, it's very likely that our patients want and deserve quality, cost-effective care and are willing to travel to the best provider to receive it.


Richard Hader

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