Making short stay hospital care work in practice

A co-designed, “shared stakeholder value model” could be key to making short stay hospital programs a success, according to healthcare funding expert Sharon Naidoo of Bupa.

Speaking to Informa Connect ahead of the Short Stay Hospital Forum, Ms Naidoo expressed optimism about the short stay model, but said collaboration and open mindedness to innovation would be key to ironing out its challenges.

“We now have clear support for the short stay model and we know that it can be delivered without compromising patient outcomes. However, we need a lot of structural and process reforms to make it work in practice.

“We need to consider different stakeholder perspectives – i.e the hospital, doctor, patient, health fund – and there needs to be some equity in in how the commercials are split, whilst giving equal, if not more, priority to health outcomes,” she said.

How would a shared value model work?

Ms Naidoo says funding is one of the key levers in a shared value model; and that existing mechanisms need some reform.

At present, hospitals are largely funded according to the length of patient stays, despite the fact most healthcare overheads are acquired rapidly after admission.

As Ravi Carouthers, Head of Health Fund Relations and Revenue at Healthe Care, said in a recent interview, “One of the common views is that shorter stays equate to lower costs, because there’s less time in hospital; and therefore the remuneration from the funders should be lower than say a three or four day stay in hospital after a hip or knee replacement.

“In actual fact, 70 – 80 percent of healthcare costs are acquired in the first six to seven hours of hospital admission – so the economics of a short stay program often don’t stack up. Add to that the additional resources required for short stay hospital care – more allied health, patient education programs etcetera – and it’s enough to make it unviable for some providers.

“Funding hospitals on the basis of their bed days might seem reasonable at a glance, but it’s not always a commensurate reduction in overheads, so we need to explore other options.”

Ms Naidoo says a shared value model would need to factor in appropriate incentives for efficient healthcare, as well as improving customer and provider experience. To achieve this, a high degree of teamwork would be needed across the sector.

“A well-designed funding model should have adequate provisions for different length of stay outcomes i.e. across short stay, inlier and long stay outliers. If care model changes apply, this should be considered in the funding model.

“As funders, we should be reaching out and engaging with key groups to understand what the model should look like – its key challenges and opportunities. There is no single perspective that holds all the weight, so we need to make sure we all align.”

Collaboration could also identify friction points and, in turn, help clinicians pivot into short stay care, she argued.

“From a funding perspective, we are just one step removed from on-the-ground activity. So it’s necessary to engage stakeholders and understand what’s possible, and where the opportunities are for us to do things a little differently. It might be that we different solutions for different situations, for example.

“We’re asking specialists to do deliver care very differently and grapple with losses in funding in some areas while it’s funnelled into others. That comes with challenges and requires a change in behaviour and mindset.”

Screening is essential

Alongside funding considerations, Ms Naidoo says it is vital patients are adequately screened for short stay care. This would ensure commercial incentives do not outweigh patient outcomes.

“We need to make sure patients are suitable for short stay types of procedures and have protocols in place in the event of a complication.

“Patient eligibility should be managed by the treating doctor with support from his or her care team. Any decision to enrol the patient into a short stay program should be purely at their discretion, because we want to make sure there’s strong clinical governance behind these interventions.”

Continuing the debate

With the rise of chronic disease and an ageing population, Ms Naidoo believes short stay care has an important role to play. However, discussion is urgently needed on how to refine it for mainstream practice, she argued.

“One of the ways we can make our healthcare system more sustainable is to look for more efficient ways of delivering care, whilst maintaining quality.

There’s evidence from other markets – local and international – which suggest short stay programs can achieve this. But a lot of things need to shift before they can.

“I’m really keen to join the dialogue and solve these challenges with people across the sector.”

Opening up debate on this issue, Sharon Naidoo will take part in a panel discussion on funder perspectives at the Short Stay Hospital Forum, hosted by Informa Connect on July 30 at the Rendezvous Melbourne.

Joining her on the stage are Bill Prentice, CEO, Ambulatory Surgery Centre Association (ASCA), USA; A/Prof Daevyd Rhodda, Orthopaedic Surgeon, Sunshine Coast Orthopaedic Group; Jane Griffiths, CEO, Day Hospitals Australia.

The event will bring together private healthcare operators, specialist and doctor perspectives, private health insurers, healthcare property funds, healthcare real estate leaders, specialist healthcare providers, government, construction groups, architects and innovative tech providers.

Learn more and register your tickets here.

About Sharon Naidoo

Sharon Naidoo is Head of Healthcare Funding at Bupa. In this role, she designs and implements healthcare funding models to ensure appropriate payment, funding integrity and encourage innovation and optimal patient outcomes.

A systems’ thinking healthcare strategist, Ms Naidoo has a wealth of experience in claims risk management, healthcare analytics and funding.

Prior to Bupa, Ms Naidoo has worked for other large private health insurers and consulted both locally and abroad, focusing on healthcare strategy and analytics.

Her key areas of interest are value-based healthcare and health system performance.