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in­ patients and the hospital both feel the pressures of cost containment. \ New Financial Constraints A Shared Responsibility When faced with purchasing a house, car, or major appliance, most people shop around for a good price. In today's world, it is also necessary to be an informed consumer in the area of health care. We have been hearing about insurance companies and Medicare restricting even further the services covered. This is an attempt to hold their costs down and to keep insurance premiums from going up. Medicare has received the most publicity with the new Prospective Payment System based on DRGs (Diagnos­ tic Related Groups) What this means is the hospital now receives one fixed sum payment for each patient, depending on the physician's diagnosis, no matter how long the patient is hospitalized The fixed sum does not vary regardless of the number of lab tests, X-rays, and minor procedures performed. In fact, many of these tests and procedures are no longer considered reason for hospitalization because -they can be done on an out-patient basis. Neither are yearly physicals, evaluations, custodial care, or resting up before surgery acceptable reasons for admission. Only an acute level of care should be given in the hospital. Patients who no longer need that kind of care can be discharged to continue recuperation in their own homes with necessary equipment and assistance--with a family member or in a nursing home or convalescent center. These alternatives are rrf^ch less costly than hospital care. The Memorial Hospital staff has the responsibility of informing patients when their stay can no longer be reimbursed by Medicare. To remain as a patient beyond that time by agreeing to pay for the additional days is a choice many persons cannot afford. The Social Service staff of Memorial Hospital will 'help patients and their families consider the alternatives available to them in order to plan for care needed after discharge. Time becomes important: Time to understand and accept new limitations a patient's illness or condition may place on him, time to accept the need for a change in lifestyle, in living arrangements, in the degree of independence a person has enjoyed. Because hospital stays will be shorter in some instances, patients and family members are urged to work closely with Social Service staff when it appears some kind of post-hospital care may be needed. Asking questions of the physician, nursing staff and therapists and reading available literature are important in dealing with the changes. Memorial Hospital will continue to provide the highest level of care possible. However, Medicare will not pay for admissions or extended lengths of stay that are not medically necessary by their standards. For Memorial Hospital to continue serving patients in this area, all of us need to become informed about the new federal regulations and to plan in accordance with them. Clergy Welcome Support Services Program The series of programs establishing a dialogue between community clergy and hospital personnel is continuing. This program is helping members of the energy in their relationship with patients and with employees at the hospital, said Rev. Earl Kinney, pastor of the First Baptist Church of Woodstock. « * All of us, including hospital personnel, are learning how together we can do a better job of serving patients, both while hospitalized and after they return home." The first/meetings were with members of the nursing staff and with intensive care nurses. The third program was with the physicians An emergency room physician, t a general practicioner and a psychiatrist talked with the clergy \ Hospital staff members have participated in "role playing" interaction and provided a glossary of terms specific to each hospital area. Reverend Kinney said the Woodstock Ministerial Association is interested in developing a chaplaincy program to provide even more service to patients. The new chapel will open this summer^nd will provide a place for meditation, meetings withMmilies and for patients to go to on their own. / A committee consisting of Reverend Kenneth Ahl- strand, co-pastor at Grace Evangelical Lutheran Church; Reverend Randy Walker, pastor at the Free Methodist Church; and Reverend Kinney coordinates the clergy support services program with the Memorial Hospital education department. -8-