Death Without Dignity

T he present health care environment conflicts with the values in· ternalized by many clinicians Patient care seems to be subordinated to a set of rules governing the length of hos· pitalization. The decision makers in health care seem to take a clerical rather than a clinical perspective. As one frustrated clinician exclaimed, "Forget TLC; it's DRGs that count." Although the feelings in this type of situation are quite real, the facts may have become distorted. This book not only presents the facts in a clear, concise, and logical fashion but also provides structured proactive responses for clinicians haVing difficulty with the new prospective payment system. The opening chapter establ ishes the prospective payment system as an effective response to out-of-control health care cOSts. After a brief history and brief descriptions of preViously rejected cost control systems, the prospective payment system makes sur· prisingly good sense. The authors maintain that diagnosis-related groups (DRGs) cannot be viewed as inappropriate or detrimental to good patient care The entire list of DRGs is included-each DRG is presented with its mean length of stay·-and the concept of "winners" and "losers" is discussed. Financially, some medical conditions (e.g., chronic obstructive pulmonary disease, lens procedures, etc.), bring gains to the hospital, whereas other illnesses (e.g., dia· betes, atherosclerosis, etc.), result in losses The authors present another concept that may be unfamiliar to clinicians, the viewing of the clinicians' services as a "product" that mayor may not be valued in the health care marketplace. The increasing competition between hospitals and even between services or departments is another change in the health care environment that requires adaptation on the clinician's part. This book assists clinicians in understandi ng the changes brought on by the prospective payment system, and in developing an opportunistic perspective. There are several self-assessments in the book that help the reader gain a greater self·understanding and facilitate the necessary shift in values. Additional chapters are devoted to the acquisition of tbe managerial skills needed by clinicians to respond to the current challenges. The experienced manager may find these chapters superfluous, but they take the earlier material to the application stage. I strongly recommend this book for the new department head or for cl inicians who find that their services lack the necessary administrative support. Although many organizations employing occupational therapists are currently exempt from DRGs (e.g., psychiatric, rehabilitation, and longterm care facilities as well as children's hospitals), all clinicians can benefit from this excellent presentation of proactive strategies. DRGs are viewed in the book as an opportunity, not a threat, to the growth of occupa tional therapy services Peter Talry