Harris M D
Visiting Nurse Association of Eastern Montgomery County, Abington, Pennsylvania.
Nurs Clin North Am. 1988 Sep;23(3):559-68.
The DRGs and their aftermath have had an effect on all who are involved with home health care services, including the patient and provider. The staff of home health agencies must be competent, caring professionals who must also be able to cope with the regulatory issues that affect patient care. The effects on patients and families have also increased. Today's health care environment is requiring that they be responsible for self-care programs for many hi-tech procedures as well as care for those who are terminally ill. They are discovering that reimbursement is not available for the many services that they consider necessary, but that third-party payers consider these services to be of a custodial nature and, therefore, nonreimbursable. The effect on physicians is an increased amount of paperwork for home care services, as a result of frequent admissions to and discharges from service and changes in the frequency of visits or treatment plans. There is also the need for the timely signing of the required forms for agencies to meet the requirements of the Medicare program. The effects on the agencies include attempting to maintain financial solvency while providing quality health care services; maintaining staff morale and productivity; making hi-tech services available at an increased cost on a 24-hour basis by qualified staff to remain competitive; and guaranteeing safe, sound policies and procedures for patients and staff. Certainly the advent of DRGs has also had an impact on the nursing profession as it relates to home health care. The benefits of community health nursing identified in the past are no longer applicable in 1988. The job characteristics have changed and are no longer as attractive as they once were to nurses. In a recent publication I said there are times when I feel that I know what a swimmer experiences when being pounded by unrelenting waves in a rough surf. There is hardly time to catch your breath before the next wave hits. The DRG aftermath is just one of these waves. In spite of these never-ending waves, and the multiple internal and external changes, administrators must manage in an effective and efficient manner. We can survive the present turmoil and help to shape the future of the home care industry. Peter Drucker suggests in Managing in Turbulent Times that one should feed the opportunities and starve the problems. The challenge is to view our never-ending waves as opportunities that can take us to new heights in 1988.
诊断相关分组（DRGs）及其后续影响已对所有涉及家庭医疗服务的人员产生了影响，包括患者和提供者。家庭健康机构的工作人员必须是有能力、有爱心的专业人员，他们还必须能够应对影响患者护理的监管问题。对患者和家庭的影响也在增加。如今的医疗环境要求他们对许多高科技程序的自我护理计划负责，同时还要照顾绝症患者。他们发现，许多他们认为必要的服务无法获得报销，但第三方支付者认为这些服务具有监护性质，因此不可报销。对医生的影响是，由于家庭护理服务的频繁入院和出院以及访视频率或治疗计划的变化，家庭护理服务的文书工作量增加。机构还需要及时签署所需表格，以满足医疗保险计划的要求。对机构的影响包括在提供优质医疗服务的同时努力维持财务偿付能力；保持员工士气和生产力；由合格员工以增加的成本全天候提供高科技服务以保持竞争力；以及为患者和员工保证安全、健全的政策和程序。当然，DRGs的出现也对与家庭医疗护理相关的护理行业产生了影响。过去确定的社区健康护理的好处在1988年已不再适用。工作特点发生了变化，对护士来说不再像过去那样有吸引力。在最近的一篇文章中我说，有时我觉得自己知道游泳者在汹涌海浪中被无情海浪冲击时的感受。在下一波海浪袭来之前，几乎没有时间喘口气。DRG的后续影响就是其中一波海浪。尽管有这些永不停息的海浪以及众多内部和外部的变化，管理人员必须以有效和高效的方式进行管理。我们能够在当前的动荡中生存下来，并帮助塑造家庭护理行业的未来。彼得·德鲁克在《动荡时代的管理》中建议，人们应该抓住机会，摒弃问题。挑战在于将我们永不停息的海浪视为能在1988年将我们带向新高度的机会。
