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Hi Jodi:
As I said before, we can never find a pefect system for all. Perhaps using
the teleological priniciple- we all must be contended with the end results that
do good to most (rather the impossible 'all').
I do, however, wish to point that I really do not even think the push for
'productivity' is necessary at all, and especially a watch-dog from another
discipline (DON?). Besides, advocating for 'self-regulation' by the
practitioners themselves, not only do I expect the highest ethical character
from each; but also I believe the indices for funding without the mention of
productivity will by itself take care of the issue of a lazy or incompetent
employee. His superiors will notice that he is purposely denying services to
make it easy for his 8 hour day, or ofcourse his career growth/ increments for
his wages are still based upon his/ her performance.
Factors on which an institution's funding may depend upon could be
many:
1. Staffing based upon organizational size
2. Routine costs met- laundary, maintenance, housekeeping, suppplies,
etc.
3. Additional funding per department/ discipline based upon number of
clients/ episodes served last reporting period (remember cost per patient has
been capped, somewhat based upon clinical factors/ LOS, etc.)
4. Adjustment to funding for staffing if required based upon last year's
cost report
5. Incentive fundings based upon good surveys and financial penalties as
well, if inadequate services revealed through the survey process or otherwise.
Surveyors roles would not remain just to enforce compliance, but also to monitor
outcomes. (We need the carrot and the stick). So the good facilities have a good
chance to make continued profits. Bad ones, time to close? This will also
control the amount of profits made, especially ones that are suspicious to begin
with or made by wrong means eitherway.
6. Other incentive/ compensation programs for underserved areas,
remote area health care facilities, etc..
I am sure there are many more ways. But who is listening? And, who knows
even if this would ever work.
Just my thoughts....
Joe
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