A new model for hospitals is being created by the Affordable Care Act (ACA) and its impact will be felt by patients, staff and visitors, even in foodservice. That was the message Kris Schroeder, administrative director of support services for Seattle’s Swedish Health System, gave to fellow attendees at the 2014 national conference of the Association for Healthcare Foodservice (AHF).
Speaking on a panel about the need for healthcare reform and its effects, Schroeder said that the overall effect of the ACA will be to “create healthier communities”—but not without some pain points for foodservice.
“The goal of healthcare reform will be to improve the patient experience of care, improve population health and reduce costs,” Schroeder said. “All of these will require employee engagement and all will involve foodservice.”
Regarding the patient experience, foodservice staffs will be charged with continuing to improve the overall quality of food while trying to find the best meal delivery model for their hospital. Schroeder said departments will have to balance the desire for a more personalized service for patients with the resulting costs and determine which will be best for the institution: traditional tray service, room service or a hybrid of the two.
On the clinical side, she added, hospitals are going to be treating sicker inpatients, which will mean that registered dietitians will need enhanced skills.
“Malnutrition coding will become mainstream and it will become a revenue stream for hospitals,” Schroeder suggested. “In addition, other new models of care will emerge, such as ‘pre-hab’ programs, which will get people stronger for surgery, in order to enhance recovery.”
When it comes to improving the health of the community population, foodservice will need to take the lead in terms of making an increasing and sustained focus on healthful food choices. This will include providing healthy beverages, doing more purchasing of local, fresh foods and even growing more produce on-site and choosing to do things like serving antibiotic-free meats.
“Employee wellness programs will grow as we use our own employees as test markets for population health management,” she noted. “Lines will blur between inpatient and outpatient nutrition care, and there will be opportunities for nutrition professionals along the entire continuum of care.”
Some of those might include having more RDs embedded in community settings or “medical neighborhoods,” having RDs working with primary providers to assist in educating patients about lifestyle changes and even doing outreach programs in the community.
Finally, Schroeder said, cost containment will have to become a major focus of foodservice, even more so than is currently the case. Among the changes that could occur could be doing revenue/man-hour analysis of operations to determine the appropriate hours of service, taking a longer view toward sustainable expense reduction and cost management, standardizing menus and leveraging economies of scale.
She added that discretionary spending will be looked at very closely, leading to such changes as cuts in catering, reduction of service to physician lounges and even eliminating employee discounts. Central production could become the norm in large healthcare systems, and more corporate partnerships such as the one Swedish currently has with Starbucks could occur in order to drive revenue.
Schroeder’s comments echoed those of Frank Tremulak, executive vice president and COO of Geisinger Health System, in Danville, Pa. Taking a more global view, Tremulak said, “healthcare as historically and currently provided and financed is not sustainable.”
He added that foodservice departments will be expected to decrease costs in the areas of food and personnel, both in terms of how many people are employed and what their salary and benefit packages will be. At the same time, they will be counted on to find new revenue streams whole maintaining and even enhancing the patient experience.
Agreeing with Schroeder that discretionary spending will be scrutinized, he noted that “generous” hospitality services won’t be supported under the reform model and asked the question, “How do we redefine ‘coach’ and ‘first class?’”
And Chad Lefteris, VP of operations for Rex Healthcare, in Raleigh, N.C., the third member of the panel, said foodservice departments will have to become better at creating “a food culture” and coming up with creative and innovative services to improve the patient experience and generate more revenue.