One hears about the recession-proof nature of health care. It’s true that the industry doesn’t take the same unemployment hits as is typical of other industries, so let’s look a little closer at medical coding certification.

Employment: Hospitals rank second as a source of private-sector jobs nationwide. In urban areas, hospitals are among the top ten employers, and are often the largest employer in rural areas. Health care, broadly, contributed more jobs to the economy than any other industry in the last several years.

Demand outstrips supply: The demand for many health professionals outstrips supply.  Workforce shortages have persistently plagued hospitals over the last several years. In 2007, as well as in previous years, it has ranked in the top five issues confronting hospital CEOs according to a poll conducted by the American College of Healthcare Executives. Staffing problems are widespread across health care professions. Therapists physical, occupational and speech are in especially short supply and increasingly difficult to recruit from year to year.  Vacancy rates for these positions exceeded 11 percent by year-end 2006.  Registered nurses, pharmacists, nursing assistants, licensed practical nurses, and laboratory and imaging technicians all have vacancy rates in the range of six percent for technicians to eight percent for RNs.   Shortages exist in coders as well.

There is also growing national concern over shortages of physicians already a problem in several states that is expected to worsen as demand outstrips supply. By 2020, the U.S. may be short 85,000 physicians. It is not just the frontline clinicians that are difficult to hire and retain. Hospital executive positions have high turnover. As many as half of nurse executives, and 14 to 18 percent of chief executive officers, will leave their jobs in a year.

Pervasive staffing problems challenge the ability of the hospital to perform its most fundamental functions.  Studies show that there is an association between registered nurse staffing and hospital related mortality, failure to rescue, and higher risk of complications, among other negative patient outcomes.

In addition, beds that are not staffed cannot be filled by patients, undermining the admissions process, especially admissions from the emergency department (ED). Nearly half of all hospital emergency departments report being at or over capacity, and the majority of urban hospitals experience time on diversion when they are closed to incoming ambulances. The primary reason for going on diversion is a lack of staffed critical care beds. Staffing shortages, overall, are among the top five conditions that lead to ambulance diversion.

In addition to ED overcrowding and diversion, about half of hospitals report that staffing shortages contribute to decreased staff satisfaction.  Decreased patient satisfaction, reduced numbers of staffed beds, increased length of stay, increased wait times for surgery, as well as cancelled surgeries also follow in the wake of staffing shortages.  Low staff satisfaction is a persistent problem for many hospitals. Hospital-based nurses, for instance, have job dissatisfaction rates that are three to four times higher than the average U.S. worker.  Low dissatisfaction rates among nurses is not an American phenomenon, but occurs in other countries where it has been studied, such as Canada, England and Scotland.

Aging, Chronic Disease Impacts

Today, half of all hospitalized patients have one or more chronic condition, such as diabetes, heart disease and asthma. The prevalence of chronic illness is expected to steadily increase. By 2030, it is estimated that 171 million people will have at least one chronic illness. By this same year, older adults will account for more than 20 percent of the population. While older adults are expected to live longer, this will not be without personal health challenges. More than 75 percent of adults over age 65 suffer from at least one chronic condition, and many have multiple conditions. Among current Medicare beneficiaries, 20 percent have five or more chronic conditions.

In the future the hospital must provide patient-centered care which means better meeting the
needs of all of its patients, including the underserved, the aged and the chronically ill
who will fill its beds in greater numbers.

Aging is not the only factor driving the burgeoning ranks of the chronically ill. Owing to its significantly higher rates of obesity and smoking, the U.S. has a significantly higher rate of associated diseases such as diabetes, hypertension and heart disease than European countries.  According to the Centers for Disease Control and Prevention (CDC), 80 percent of diabetes, heart disease and stroke could be eliminated through reductions in smoking and obesity.

There is widespread recognition that care for the chronically ill in the U.S. is falling short. An oftcited report from RAND indicates that the chronically ill receive approximately half of recommended care. At the root of this issue is the predominant organization of the health delivery and payment system to support the diagnosis and treatment of acute, or episodic, conditions. Patients with chronic illness, especially those with multiple conditions, often receive care from multiple providers and take many medications.  Because this care is uncoordinated, patients may experience duplicative services and testing, avoidable hospitalization, and adverse drug events.77 As a result, care is often fragmented, ineffective and costly for people with chronic diseases.

Optimal care for people with chronic diseases involves coordinated, continuous treatment by a multidisciplinary team of health care professionals. These patients need education and tools to support self-management, and connections to community resources for their social, mental health and home health needs.

For the hospital of the future, providing patient centered care means better meeting the needs of
all of its patients, including the underserved, the aged and the chronically ill who will fill its beds in greater numbers.

Patient-Centered Transformation Results

To increase their reliability in delivering patient centered care, hospitals have employed improvement tools (Six Sigma, Lean, etc.) that have proven effective for transforming other industries. A glimpse of that transformation can be seen at hospitals like Virginia Mason Medical Center in Seattle, which has applied these tools to improve the quality of care for patients with low back pain and other conditions, increase adherence to evidence-based care, and decrease costs. In ThedaCare hospitals in southern Wisconsin, application of these methods to general medical units has allowed the hospitals to reduce medication errors, the average amount of time these patients are hospitalized, and the fees charged for certain procedures.New York-Presbyterian Hospital used these tools to reduce average length of stay for patients undergoing cardiac and orthopedic procedures, reduce medication errors and patient falls, and increase patient satisfaction rates.