1997 through expert eyes.

Everyone seems surprised by the transformation that has occurred within the health care industry. In some ways it would be even more surprising if few or no changes had taken place. Although dealing with change can be challenging, I still maintain it is better to be involved in a fluid industry than a stagnant one.

The beginning of the new year presented the perfect opportunity to explore the changes ahead in 1997 from some health care leaders' perspectives. Nursing Homes posed the questions: "What will happen with regard to the health care industry in 1997, and what changes would you welcome?"

Smith Jenkins, Jr., Network Director for the Veterans Administration: "The Veterans Administration (VA) will move toward developing performance criteria that improve efficiency in our health care delivery system. One goal is to reduce the number of inpatient bed days and enhance outpatient capabilities. Another is to increase customer satisfaction in all areas. To assist us with this, Congress has recently approved the Eligibility Reform Act, allowing for more options.

"The challenge for 1997 is to help people understand that there is an effort to redistribute resources so that they reach the patient. Teamwork is important during this transitional time. The VA has a common goal and we must begin to work and think as an integrated network."

Christine MacDonell, National Director, Rehabilitation Division, Commission for the Accreditation of Rehabilitation Facilities (CARF): "It has become evident that the lack of information, plus misinformation and a nostalgic feeling for 'the good old days,' has created in many cases an adversarial mindset among major stakeholders responsible for influencing the delivery of rehabilitation.

"The way we deliver care has changed. In 1997, integrated health care will continue to be discussed in every sector of health care. The concepts that will be focused upon are decreasing fragmentation and redundancy in services, providing a comprehensive continuum across settings and levels of care, integrating clinical practices with outcome-focused care, defining populations served, and satisfying and maintaining the health and well-being of that defined population.

"Also, as consumers become more involved participants in their health care, data on customer satisfaction will be necessary for every health care provider to gather, analyze, and show that they are making changes to improve satisfaction.

"Our organization would like to see shifts in thinking this year so that all of this can happen. These shifts in thinking include process orientation becoming outcome orientation, cost orientation transforming to discussion of value, benefit-driven decision-making changing to patient-centered use of benefits, and customers converting from passive to active participants in care, including having a voice in the selection of benefits and providers.

"CARF would like accreditation to be seen as: 1) a realistic self-assessment tool; 2) a survey report prioritizing tasks necessary for improvement, in addition to recognizing and reinforcing strengths; 3) a source of assistance in accelerating the pace of performance improvement; 4) a tool that teaches new and better ways to deal with competition; 5) an expediter of health care integration; 6) a resource to help integrate business with delivery of health care; and 7) a measurement of progress and of focus on the same goals."

Kevin Cornish, Manager, Ernst & Young LLP, Tampa, FL: "Health care reform issues that were placed on the back burner because of the election will begin to gamer more Congressional attention and activity. Specifically, this will include reform initiatives to begin the development of a prospective payment system for home health services. The issue of salary equivalency guidelines for speech and occupational therapy will also finally be addressed. I also look to have the Federal government establish, with assistance from the industry, a standardized methodology for measuring outcomes that will be able to be used among all health care settings."

Clair Jones, Director of Rehabilitation Services, Sharp Healthcare Systems, San Diego, CA: "There will be a growing interest in consumers' choice issues in relation to health maintenance organizations (HMOs). Legislators will be more interested in taking action regarding perceived inadequacies of HMOs. There will also be more scrutiny by lawmakers of mergers, acquisitions and conversions. The demand for post-acute rehabilitation services will continue to rise due to demographics, but a greater focus will be on prevention and better management of patients. Providers will question the value of such costly expenditures as the necessity of acquiring more than one accreditation, having memberships in multiple professional and trade organizations, and supporting conference attendance and sponsorship. Hospitals will continue to re-evaluate and expand skilled nursing services within their own facilities. Acute rehabilitation units will develop more post-acute beds without relicensure in order to diversify case mix and treat patients with less intense therapy needs, enabling the hospital to attract more HMO patients.

"I would like to see a single inpatient reimbursement system based on patient acuity needs and functional levels. I would also like to see the elimination of the Health Care Financing Administration's acute rehabilitation regulations, specifically the 75% diagnostic rule and intensity guideline, which is obsolete."

Rita Munley Gallagher, PhD, RNC, Senior Policy Fellow, American Nurses Association, Washington, DC: "From the American Nurses Association's (ANA) perspective, everyone, irrespective of age and/or physical condition, has an equal right to health care services. Those services should be available within a national health care system characterized by continuous, coordinated, comprehensive, cost-effective care. Such a system should provide universal coverage that is not dependent on employment status, age and/or income, and must permit individuals to retain their independence for as long as possible.

"Today's health care system demands that professional nursing interface with a variety of groups to meet the challenges inherent in long-term care. The ANA, the state nurses associations, and individual nurses must sustain activities designed to enhance the provision of nursing services and improve the quality of health care in the United States. In order to meet that goal, the ANA will continue its collaborative efforts to reach consensus and advance nursing's community-based long-term care agenda.

"No part of the health care system generates as much passionate discontent as does long-term care. As is true for other health care professions and industries, long-term care is faced with an unprecedented level of uncertainty regarding the future. Levels and types of services to be provided, payment sources, integration of delivery systems, and Federal and state involvement in the provision of care are all in flux. There is little doubt that the LTC financing and delivery system is badly in need of reform. Critical policy issues must be addressed in devising a new national health care policy."

Hugh A. Jones, Regional Manager, Kaiser Permanente, Southern CA: "Competitive pressures continue to lead to mergers and acquisitions among HMOs. Expect to see continued merger activity among for-profit health care firms in 1997 and the forming of other new alliances, networks and relationships among health care organizations to maintain the balance between quality medicine and effective management.

"Another trend likely to continue is the proliferation of report cards and surveys to try to help businesses and consumers compare health care organizations using criteria such as customer satisfaction and to what extent they are providing or receiving quality, cost-effective care.

"I would like to see health care providers continue utilizing new pharmaceutical products, surgical procedures and technologies to decrease hospitalization and length of stay for various procedures. Because more people will be able to go home earlier or avoid hospitalization altogether, more hospital beds will stand empty. There may be more alliances formed among community hospitals for facility-sharing as a result of this trend."

As always, your comments and suggestions are both welcomed and appreciated, and should include your name, name of your organization, address and phone number. Correspondence should be sent to Laura Hyatt, Hyatt & Associates, 2956 Kelton, Los Angeles, CA 90064.

Laura Hyatt is President of Hyatt & Associates, Los Angeles, CA.