DB2-74

Kimberlee Alexander

Provide your opinion and rationale of what you think is the best fit in a DM for application in the healthcare environment in general? What about in the healthcare environment faced in the COVID-19 pandemic? Discuss with relevant examples in both scenarios.

            I think the best decision making (DM) model for applications in healthcare environments first depends on the quality and availability of the data, and how valid the outcome status can be predicted.  The DM should also take into account the data and the potential outcomes as a result. The time frame of the treatment or the life expectancy as a result of the data should also be considered.  Having a short term issue as opposed to long term issues will affect the DM choices.  My preference would be for clinical guidelines to provide the path for resolutions based on the patient data, health values and treatment plans.  Unfortunately, the health insurance companies are also in the decision making process based on their internal processes, the benefits the patient has purchased and the expectations for recovery.

            The total knee replacement surgery, which once was an inpatient only procedure for the Medicare population, has gradually gained steam to become an outpatient and much cheaper alternative.  Medicare issued guidelines for the inpatient care to be on a 90 day clinical pathway to recovery based on empirical data obtained from years of the experience. The result of the data analysis of years of patient outcomes has resulted in most procedures being removed from an inpatient only list and will now be performed on an outpatient basis.  This outcome means, Medicare will reimburse at a much lower rate that the inpatient services while also shifting more financial responsibility to the patients.

            While the clinical guidelines were ultimately used to reduce the reimbursement, the interim results are the standards that were developed to determine who should quality for the total knee procedures.  These procedures should be performed to improve the quality of life, the ability to be self-sufficient and live relatively pain free.  However, prior to this experiment, these procedures were being performed on patient that hadn’t walked in years, such as nursing home patients.  Yes, their x-rays indicated they had bone on bone arthritic changes in the knee joint but they were no longer ambulatory so the radiology findings should not have been a determining factor.

            During the Covid-19 Pandemic, a lot of clinical guidelines are being used but also now a lot of intuition.  With hospital administrators not having a specific guideline to follow for a Pandemic, no help from the Federal Government for obtaining the equipment needed to manage the crisis and the potential risk of financial ruin, their best bet was their own intuition.  With the ups and downs of patient volumes as related to the spikes in the disease process and patient’s requiring ventilators, many facilities initially put together field hospitals to assist in dealing with the expected patient volumes.  While that was ultimately not needed in Lexington, Kentucky; that is not the same across the rest of the states.  The supply of PPE has been significantly impacted resulting in innovate methods to obtaining, cleaning and resulting equipment.

            By having the ability to remain fluid during the Pandemic, some facilities will survive while others will not be able to weather the financial storms.  If the relief from the government can prop up those facilities that are struggling until they can return to some certainty of a patient flow, to ensure they have a financial stream, the intuition decision making model of experience will be the best teacher for the new normal.