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2003 - New Year, New Problems? New Year, Old Problems?
Ring out the old and ring in the new. As we look ahead to this brand new year, we cannot help but look back and reflect on the momentous year in healthcare that was 2002 - a year woven with chronic change and controversy, as well as incredible growth and positive transformation. As the medical community continues to grow and morph, it is reasonable to wonder what the next 12 months hold for our patients and us as healthcare professionals as we continue to learn what works and what does not work.
The first studies of quality indicators in long-term care and a comprehensive report on OASIS outcomes were published in 2002. Multiple government reports investigated the fiscal and overall "health" of home health care. Uncertainty about the future stability of Medicare funding continued to come in and out of focus. Heated debates about competitive bidding took place inside and outside of the Beltway, along with a myriad of proposals on how a Medicare prescription drug benefit should or should not look. And last but far from least, the nation continued to suffer from a raging nursing shortage.
The 107th Congress adjourned at the end of 2002 with competitive bidding still on the table and with no decision on repealing the 15% cut in home health reimbursement mandated by the Balanced Budget Act of 1997 (BBA 97). Republicans and Democrats were unable to come to any reasonable agreement on two aspects of the pending drug benefit: first, whether our government can afford a Medicare prescription drug benefit; and second, how it should be realized. Did the fact that 2002 was an election year have anything to do with these issues not being settled? We can only speculate. But how interesting that these particular issues - extremely "hot topics" with the American voting public - were left unresolved. Most likely they will be investigated and resurface for discussion with renewed vigor again early in 2003 when the 108th Congress convenes.
The national nursing shortage will not be resolved in 2003 or 2004 or for many years to come. Neither Congress nor any other regulatory body can can mandate a solution to this problem; it will have to come from within the grassroots of the nursing profession. Some states are in the process of regulating and prescribing acceptable safe and reasonable patient-to-nurse ratios and others won't be far behind. For now, however, the major problem resolution will have to come from individual employers and nurses working together to find new and creative ways to provide quality patient care. We may see an increasing use of technology to assist in this endeavor - expanding the use of telemedicine, on-line interactive health assessments, or other remote means of providing "hands-off" care.
This year, we can look forward with certainty to an increasing number of patients requiring quality ostomy, wound, and continence care, delivered by competent clinicians at a lower cost and in a compressed timeframe. Patients will be more educated than ever before and will expect topnotch care with positive outcomes, increasing demand on our skill and ingenuity.
No one has a crystal ball. Our world is in a very tenuous state that could erupt at any moment and change the way we approach the practice of medicine. This sense of foreboding can serve either as a shot in the arm or as a final blow to an already struggling system. If 2002 was an example of how we are able to accept perpetual change, learn, and move forward, 2003 should be a good year that will only make us stronger, swifter, and better at what we do.
