This document discusses emerging influences in the U.S. healthcare system. It describes how the implementation of electronic health records through the American Recovery and Reinvestment Act has benefited an emergency services department by improving data collection and information sharing. However, it has also introduced challenges as staff adapted to new technology. The document also notes concerns around upcoming workforce shortages as large numbers of medical professionals retire while the elderly population grows substantially. Suggested strategies to address these issues include expanding the roles of physician assistants and nurse practitioners, obtaining quality awards to improve desirability, and promoting medical tourism to generate additional revenue.

1. Running head: EMERGING INFLUENCES 1
Emerging Influences in the United States Healthcare System
Edward J Draper
Siena Heights University
Perspectives in Healthcare Management – MGT 301

2. EMERGING INFLUENCES 2
Emerging Influences in the United States Healthcare System
Introduction
You are sitting in front of the board of directors in the organization’s budget hearings.
The budget you have developed has significant changes from what you had planned in your
business plan and capital improvement plan in the years past as you have noticed that
reimbursements for medical care are down. These reimbursements have always been
approximately sixty percent of your budget and now the tables have turned and they only
represent forty percent.
You have to make cuts that you had not anticipated and these cuts are going to affect
people’s lively hood. For years you have been trimming costs by interviewing vendors to obtain
the best price on your supplies; but now, that will simply not be enough. You have cutout the
specialized equipment which would make the employees jobs easier and most definitely safer;
however, it simply was not enough.
A decision has to be made, whether to cut patient care staff or the quality assurance
supervisor. Since the department was already running at minimum staffing for patient care
providers, you have chosen to cut the quality assurance supervisor position. As not uncommon
with a union organization, the contract allows that supervisor to displace the least senior
employee as she had more time on the job and was just as qualified of the position (UW/SEIU
1199, 2015). Now two people’s lives have been effected.
As you sit in the meeting waiting your turn to present, you cannot help but wonder if you
have failed as a manager. You have been tasked with leading your section of the organization.
Your plan, which would improve overall quality, patient and staff satisfaction, patient and staff

3. EMERGING INFLUENCES 3
safety, as well as bring the latest technology into the department has to change. This plan cannot
go through as designed without the necessary funding. Many of the basic functions of the
manager have been effected by the loss of funds, but will the board of directors see the drastic
change as an unforeseeable circumstance or a failure in planning?
There are many influences emerging in the United States healthcare system. It is the
leader’s responsibility to be prepared for as many as possible; also, for that leader’s plan to
flexible enough to shift with the business forecast. So to prepare for this, we will walk through a
few of the emerging influences in the United States healthcare system, in hopes that we can
hopefully make some of the unforeseeable circumstances on the horizon foreseeable.
American Recovery and Reinvestment Acts (ARRA) 2009
I manage an Emergency Medical Services department in Northern Michigan. We have
begun to see a few changes in our system because of the American Recovery and Reinvestment
Acts (ARRA) of 2009. One being the requirement of implementing electronic healthcare records
(EHR). ARRA required implementation of EHR by no later than 2014 (Mears, 2012). This
investment has cost us $5,800.00 per year since implementation in 2009. Fortunately, we were
given enough notice that we were able to budget for the implementation of the program.
Initially, many of our staff who had been accustomed to writing paper patient care
records were not pleased with the change. There was quite the learning curve and with that came
a fair amount of discontent and resistance from the individuals whom were not computer savvy.
Many suggest that the quality of their documentation has suffered because the software does not
request as much detail as they had put in their paper documentation.

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Since implementation in 2009; however, we have seen numerous benefits to the
electronic healthcare record. We are now able to quickly ascertain run and procedure statistics
and can use these in our quality improvement program, which stems training and education to
mirror actual organizational needs rather than simply what the educators believed to be
important. Prior to the electronic patient care reports, it was nearly a full-time job collecting and
sorting the data.
We have also seen improvement in health information being exchanged as the prehospital
provider record has followed the patient through the continuum of care. As Mears (2012)
suggested, the hospital staff can now use the information from our patient care records as part of
their determination of how they will continue the patient’s care. After our employees close out
their patient care report, it is sent automatically to the medical records department at the hospital
where it is attached to the patient’s medical record. Our local hospital’s trauma services
department has already expressed the benefit they have seen from reviewing the prehospital
documentation when considering their treatment plan for their patients.
One step that is still to be implemented is the feedback from the hospital healthcare
record to our patient care documentation. To be complaint with the standards, prehospital
agencies must use software which reports information to the National EMS Information System
(NEMSIS), which under version 3, will have a parallel partnership with Health Level Seven
(HL7) and through this our documentation software has developed an interface which will allow
feedback to import data back into our software for the patient (EMSCharts, 2013). This will
allow admit, discharge, and transfer data. This will hopefully be a step toward closed-loop
treatment outcomes, which will further help our providers improved on their diagnosis and
treatment skills.

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Are We Prepared for the Tsunami?
As the Baby-Boomer population continues to grow this brings major concerns to light.
One is, for the next few years, we will have a huge number of later generation workers in the
workforce and that, in the next 15 years, a large majority of them will be transitioning into
retirement. Bill Toland (2014) points out, that by 2029, one-fifth of the United States population
will be at least 65 years old. He further suggests that this number would be approximately 76
million people and nearly 50 million of them will be exiting the workforce around that time.
The biggest concern will be the number of new medical providers entering this field of
work and how we will balance the need for providers as the percentage of elderly increases as a
whole and with it takes thousands of medical providers from the field at the same time (Toland,
2014). How are we going to fill the gap? Are we going to rely on immigration of trained
providers or change the current system? I believe it will be a combination of both. There is
already a shift toward using more physician assistants and nurse practitioners and even
considering the expansion of their scope of practice, which will give them the opportunity to
provide for a greater number of these individuals, ultimately requiring fewer patients to directly
see a physician (Iglehart, 2014).
In addition to the new retirees, there is a good chance that they will still have elderly
parents themselves to take care of, furthering the burden as they become increasingly less able to
do so. This will push the burden onto the healthcare industry to care for what many consider
basic needs. Furthermore, the number of providers specializing in geriatrics is on the decline;
there are currently about 7,500 certified geriatricians in the United States and the number we
need to meet the demand at this time is closer to 17,000 (Olivero, 2015). To top it off, geriatrics
is one of the lower paying areas of specialization. In her article Doctor Shortage: Who Will Take

6. EMERGING INFLUENCES 6
Care of the Elderly, Olivero (2015) suggests that geriatrics is the only sub-specialty of physician
who actually anticipates making less money for taking additional schooling.
How Do We Stay Afloat?
So this brings us to the question, how do we stay afloat? We have no choice but to
consider options which would make our services more desirable. This can be done in a few
different ways. It can be done by ensuring our service is managed effectively and of a high
quality. Some organizations ensure this by obtaining awards or status. An example is an
organization in the manufacturing industry, service company, small business, education,
healthcare, or nonprofit company can apply for an award called the Malcolm Baldrige National
Quality Award which is presented annually by the President of the United States (Link & Scott,
2010). In order to receive the award, the recipients show achievement and improvement in the
following areas: Leadership, Strategic Planning, Customer and Marketing Focus, Measurement
Analysis Knowledge Management, Human Resource Focus, Process Management, and
Organizational Performance Results. This ideology ensures that the organization is operating at
its best and is utilizing each of the management functions effectively.
Another area that can be looked at is found in the opportunity section of the SWOT
analysis. Finding areas where our organization can expand gives us a cushion when the areas
discussed above cause lower reimbursements. One example of an opportunity is found in when
is now known as medical tourism. In an article on theguardian.com, Christina Sherwood (2014)
suggests that an estimated $15 billion dollars in revenue leaves the US annually when Americans
travel to obtain healthcare. If an organization can make themselves more attractive to
individuals locally as well as draw from other areas and capitalize on this idea, they can reap the
additional revenue from keeping the business. Sherwood (2014) suggests that facilities can

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partner with large companies and offer bundled medical packages as a way to keep medical
tourism domestic rather than them traveling out of the country for services.
Conclusion
There are emerging influences coming to the United States healthcare system that if
managed appropriately, will be beneficial to both the patients and the organizations offering the
care. It is ultimately the responsibility of the leadership to ensure the organization’s viability
throughout the changes and to be prepared for them as they come. As part of the planning and
organizing stages of the manager’s responsibility, laws, and opportunities need to be evaluated.
We need to forecast and evaluate any potential threats and prepare for the consequences of them
while ensuring the organization continues to flourish and the staff of the organization are as
secure as they can be.

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References
EMSCharts. (2013) Retrieved from https://www.emscharts.com/pub/product-hospital.cfm
Iglehart, J. (2014) Meeting the demand for primary care: Nurse practitioners answer the call.
Retrieved from http://www.aacn.nche.edu/downloads/aacn-future-task-force-inglehart-
pc-article.pdf
Link, A.N., Scott, J.T. (2010) The malcolm baldrige national quality award. Public goods, public
gains, 96-113
Mears, G., MD. (2012). How the american recovery and reinvestment act of 2009 will affect
ems. Retrieved from http://www.jems.com/articles/print/volume-37/issue-
12/technology/how-american-recovery-and-reinvestment-a.html
Olivero, M. (2015). Doctor shortage: Who will take care of the elderly? Retrieved from:
http://health.usnews.com/health-news/patient-advice/articles/2015/04/21/doctor-shortage-
who-will-take-care-of-the-elderly
Sherwood, C. (2014). US states vie to lure medical tourists seeking healthcare alongside
vacations. Retrieved from http://www.theguardian .com/business/2014/dec/12/
Toland, B. (2014). Baby boomers creating 'Silver Tsunami' in workforce. Retrieved from
http://www.post-gazette.com/business/career-workplace/2014/12/21/Baby-boomers-
creating-Silver-Tsunami-in-workforce/stories/201412210003
UW/SEIU 1199 Contract (Effective 7/1/13 - 6/30/15) Article 22 Seniority, Layoff, Rehire.
(2015). Retrieved from https://www.washinton.edu/admin/hr/laborrel/contracts/1199/
contract/a22.html