Have you ever stopped to read a typical healthcare plan? This is a passage from mine: Subject to the terms, conditions, exclusions, and limitations of the Policy, you are covered for Health Services, provided that such Health Services are deemed Medically Necessary and are provided by or under the direction of a Participating Provider. Status of Participating Provider is subject to change without notice. The fact that a physician has performed or prescribed a procedure or treatment or the fact that it may be the only treatment available does not mean that the procedure or treatment is Medically Necessary and covered under the policy Ã¢Â?Â¦ Sound confusing?
It is. And as difficult as today’s health delivery systems may be for consumers, they can often be just as complex and challenging to healthcare professionals. “There are 7 primary factors for why health care is so complex today.” Says Marylou King an Attorney with The American Health Lawyers Association in Washington DC. “The first one is clearly the cost of healthcare and the rise of expenditures, the second is managed care, the third is aging of our population – the fourth is the persistent problem of the uninsured, the fifth is new technology, the sixth is the regulatory complexity that providers have to function under, and finally the structure of the healthcare system itself, is highly fragmented and adds to the complexity of the current environment.”
Navigating the complexities of such a healthcare system can almost be as challenging as medicine itself. Just as the physician attends medical school to gain the ability to treat disease, hospital executives train to obtain the skills they need to improve the nations healthcare system. One of several institutions that specialize in educational programs for health management professionals is The American College of Healthcare Executives. Michael Waters with ACHCE explains. ‘We are a college in the traditional sense, in that we do have a body of knowledge, but we go far beyond bricks and mortar. We have educational programs, peer review programs, a credentialing process, a code of ethics that speaks to the ethical behavior in our field, and we have publications that are both scholarly and practical in their content.” By accessing this information either by attending classes at the College, or through on going professional development seminars, Administrators like Stephanie McCutcheon, with the Bon Secours Health System gain practical knowledge to better provide high quality, affordable healthcare to communities throughout the nation.
Says Stephanie, “It’s a wonderful forum for further education along key areas of focus for our field, leadership, management, finances, relationships with physicians, relationships with employees. “Many of us who chose the health profession or the medical profession as a calling, as well as a professional pursuit, did so because we would like to contribute something to the human condition, while curing disease like cancer is critical, ensuring that the organizational systems that allow something like that to occur are in place, from my perspective and my contribution, are equally important. I think the healthcare executive never knows what he or she is going to face on any given day, the changes that they have to keep up with, those challenges require constant education, constant awareness of what is going on in the industry at a policy level, at operational levels, as well as at clinical levels, for patient care.” Organizations like ACHCE allow us to do that.”
Ultimately better-educated, better-informed health administrators mean better outcomes for patients, and improved healthcare throughout a community. We live in a time of unprecedented advances in medical science. From surgical procedures once thought impossible, to unraveling the secrets hidden within the Human Genome. As we continue to improve our abilities to overcome illness, the next great challenge facing healthcare may not only be curing disease, but seeing that the discoveries found in the science lab are made available to everyone.