Looking Into the Career Crystal Ball Part 3

(This is part 3 of ADVANCE's 3-part series on the future of health care career opportunities. Please see the Career Center archives for parts 1 and 2.)

We've all heard the expression; 'money makes the world go round'. It might not be true, but it plays a crucial role in health care. In the final part of this web-exclusive series, ADVANCE looks at how reimbursement issues from managed care and government-funded agencies may affect health care staffing. The partnership between payers and providers is a difficult one because managed care has an imperative to try to be cost effective, states Pam Cipriano, PhD, RN, FAAN, chief clinical officer for the University of Virginia Health System. Actually, she adds, "most health care institutions today embrace that philosophy as well." Sometimes, she continues, "the bureaucracy with any kind of payer-whether it's a managed care plan or the government-has so many regulatory requirements that it takes away from the caregiver's time. As we've seen an escalation in the amount of documentation and requirements to prove that everybody's being appropriate and prudent with resources, it really has taken away time from caregivers-whether that be physicians, nurses, therapists or whoever." Balancing Care and Money Issues The goal of any managed care organization is that "the highest quality, most appropriate care is delivered in the most appropriate, efficient settings," states Larry Altman, vice president of Corporate Marketing Communications & Product Development for Horizon Blue Cross Blue Shield of New Jersey. Part of that, he says, "is to help make sure that members receive appropriate care in the most cost-effective manner." Health care is a unique part of the economy, Altman explains. "It has been and remains focused on helping people live healthier, longer lives. At the same time, there's always been the issue of who pays for that." Managing care to ensure that the best care is delivered in the best manner to the right people at the right time is becoming more important, he says. "I think more and more organizations are recognizing that to deliver effective high-quality health care, it's critical to approach it with an efficient management-oriented mindset," Altman continues. "Health care is already a significant portion of our gross national product and it's growing-society as a whole needs to expend its resources wisely if it's going to continue to provide the best quality care." "There has been a trend to be much more economically responsible and to treat the health care profession as a business," adds Martin Ford, dean of Cooperative Education and Career Services at Drexel University in Philadelphia. For years, he says, health care "was looked at as a service, and then things got so expensive, it really became a business." "From a financial perspective, it's being looked at a whole lot closer," he continues. "Health care managers will need to become very astute on how to deliver the needed services while maintaining control of personnel and other service delivery costs." The Impact of Medicare Managed care organizations are only part of the picture. The other, publicly funded side of the issue is Medicare. "Medicare is clearly one of the places where the challenge facing the country to provide the best quality care as efficiently as possible comes to a head," Altman says. Not only does Medicare affect a huge number of people in the country and a growing population of older Americans, but it also has a direct impact on the federal budget. As a portion of the Gross Domestic Product (GDP), Medicare expenditures are projected to increase "from 2.4 percent in 2001 to 5 percent by 2035 and then to 8.6 percent by 2076."1 However, these projections also show a system that will only be solvent until 2030. Coverage for the last year of life accounts for 27 percent of Medicare costs.2 These are areas where people will look to allied health professionals to provide services in an efficient and affordable way. Creating New Jobs Along the Way So, what does this information about managed care and Medicare really tell us about job futures? Job growth is a given, but what areas will see the greatest increase? And, for those already in the field, how will job responsibilities change in response to the business realities of modern health care? "In relation to the issues we've been facing with managed care and a greater emphasis on maintaining accurate medical records, one of the areas where we're going to see the largest growth is medical records and health information," says Sue Valerio Sladen, director of Cooperative Education and Career Services at Drexel University in Philadelphia. Essentially, she explains, an aging population and managed care changes have increased the demand for detailed documentation of patient services. This increased demand on the part of managed care means the demand for medical records and health information technicians will increase. Sladen points to the Bureau of Labor Statistics projections, citing, "Employment of medical records and health information technicians is expected to grow much faster than the average [36 percent or more] for all occupations through 2010, due to rapid growth in the number of medical tests, treatments, and procedures which will be increasingly scrutinized by third-party payers, regulators, courts, and consumers."3 As more and more hospitals become part of hospital systems, there will be an increased need to manage records over a number of facilities. As well, information technology (IT) can help manage the distribution of services and equipment on the individual patient level. Another consequence of the way that health care is being managed and the projection going forward, Sladen says, is increased reliance on therapy assistants and LPNs. "Inherent in that will be a need to provide better training." Creating career ladders for LPNs and assistants provides advancement opportunities within their scope of practice as well as ensure that they're equipped to perform their job and new duties that they're asked to carry out. As we move to a system that has more patients on Medicare, and more people accessing care via HMOs, the demand for allied health professionals - and the demands on their time - will increase with efforts to reduce costs. Changes to health programs won't necessarily mean an end to staffing woes, though. The fact is that not enough people are entering health related fields. Across the board, people are looking at how to attract more people into nursing and allied health professions. To successfully navigate the new obstacles of health care staffing, providers will have to learn to balance their recruitment and retention programs with cost-saving measures and an eye to increasing technology and automation. At the same time, they'll need to keep a strong focus on who their clients are and what their needs will be. While no one has a crystal ball providing all the answers, one thing is guaranteed - staffing shortages, technological advances, increasing demand and financial concerns mean that adaptability will be the key to a successful health care career. References: 1. 2002 Medicare Trustees Report www.hcfa.gov/pubforms/tr/2002/secib.htm Accessed July 1, 2002 2. www.ahcpr.gov/research/sep01/901RA16.htm Accessed July 9, 2002 3. http://stats.bls.gov/oco/ocos103.htm: Accessed July 10, 2002 Nicole Benkert is on staff at ADVANCE.