Issue link: https://beckershealthcare.uberflip.com/i/731691
46 POPULATION HEALTH "e core goal of bariatric care revolves around maintaining patient dignity," says Ms. Suchomel. Bariatric waiting room chairs are de- signed to look like loveseat versions of pre-existing chairs and scattered throughout the room to avoid the creation of "obesity-only" sections. Every renovation, retrofit and equipment accommodation aims to pre- vent a bariatric patient from feeling marginalized or treated differently because of their condition, says Suchomel. An inpatient room for bariatric patients also entails specific require- ments, outlined by the Facility Guidelines Institute, a nonprofit orga- nization that offers guidance on the planning, design, and construc- tion of medical facilities in the U.S. A typical hospital bed, which usually costs up to $2,000, is about 35.5 inches wide and requires three feet of open space on all sides. A bariatric bed, ranging in price from $2,000 to $5,000, can expand to 40 or 50 inches wide and needs five feet of open space. A normal doorway has a 45.5 inch opening, which can prove difficult for fitting a larger bariatric bed through. At VA hospitals, all bariatric rooms have doors with double leafs that can open up to make more room for patients and equipment, says Ms. Suchomel. Patient bathrooms usually contain a wall-mounted toilet that makes it easier for hospital staff to clean underneath. However, these have a tendency to break off the wall if bearing excessive weight, so bariat- ric rooms are typically equipped with floor-mounted toilets, some of which withstand up to 1,000 pounds, says Ms. Suchomel, although some wall-mounted toilets do exist for heavier patients. To retrofit a bathroom for obese patients, a post must be installed under the toilet to provide extra support. Showers include larger grab bars and a hand- held showerhead so staff can help patients bathe, if need be. "Probably the biggest decision surrounding bariatric accommodation is the type and amount of lis hospitals should install," says Ms. Su- chomel. e first question to answer when discussing lis is whether the li should be portable or ceiling. Portable lis require 7 by 10.5 feet of space to operate, costing less than $500 for a manual li and at least $2,000 for motorized portable lis. Permanent ceiling lis only need 5 by 10.5 feet, yet cost upwards of $5,000. While some hospitals hesitate to buy the costlier ceiling lis, they can save valuable square footage in the construction of new bariatric rooms. If hospitals are looking to retrofit a room to accommodate obese pa- tients, the process is more difficult and costly, says Ms. Suchomel. To install a permanent li, the room's ceiling must be taken out and rebuilt to include the equipment. Nurses li approximately 1.8 tons during an eight hour shi and 52 percent of them complain about chronic back pain. Since patients are getting heavier and heavier, lis are more important than ever. Oak- land, Calif.-based Kaiser Permanente recently completed a project that put lis in every single patient room in the intensive care units at all of its 381 hospital locations, says Ms. Suchomel. While both retrofitting and construction can rack up a hey price tag, Ms. Suchomel says strategies exist to navigate a tight budget. For exam- ple, transverse lis on rails can be installed in rooms, and the motors used to power them can be moved from room to room as necessary to save money by not purchasing all the motors all at once. n Interventions to Keep Chronic Illness Patients on Their Meds Could Save Billions By Kelly Gooch I nterventions to keep patients with chronic disease med- ication adherent leads to improved health outcomes and lower medical spending, according to a study from the CVS Health Research Institute. The study, published in The American Journal of Managed Care, also found there is even more opportunity to lower medical spending if medication adherence resources focus on patients with three or more chronic comorbidities, such as hypertension, diabetes and high cholesterol. In fact, researchers said a preliminary analysis shows pay- ers could save approximately $38 million to $63 million per 100,000 members by focusing resources on these specific patient populations. "There is extensive evidence supporting the relationship between better adherence, improved health outcomes and reduced healthcare costs, but efforts to improve medication adherence, while effective, can be costly," Troyen A. Bren- nan, MD, CMO of CVS Health, said in a statement. "We are now trying to better understand how to maximize health- care resources to have the greatest impact on adherence and provide the maximum benefit for payers and patients. This research indicates that targeting adherence interven- tions to patients based upon their adherence history and comorbidities would result in greater cost savings and a better use of healthcare resources." For the study, researchers reviewed de-identified medical and pharmacy claims data of more than 1.2 million patients with at least one of three chronic diseases, including dia- betes, hypertension and high cholesterol, over a two-year period. Researchers found the best strategy for cutting costs in- volved focusing on patients who are adherent and keep them adherent. They cited the example of a patient with hy- pertension who was initially adherent, but became non-ad- herent, and spent an additional $2,663 on medical care. According to the study, the number of comorbid conditions directly influenced the magnitude of lower medical costs when adherence behavior improved. Researchers said patients with three or more chronic conditions had up to seven times greater savings than patients with one or two conditions. In conclusion, researchers encouraged clinicians and policy makers determining how to cost-effectively deploy adher- ence promotion programs to consider these findings in set- ting population health management priorities. n