Patients can also be advocates for treatment. They are learning more about treatments and effects (through reading, the Internet, etc.) and they are asking questions about their treatment. They are becoming “partners” in their treatment.

Environmental issues are becoming big issues for hospitals. Managed care health plans and the Health Care Finance Administration (HCFA) are developing value-based reimbursement systems. The Massachusetts Blue Cross health plan has a pilot program that will reward hospitals by paying them more in reimbursement if they perform better in these prevention processes. HCFA will reimburse hospitals at a higher level for by-pass patients who are discharged on specified secondary prevention therapies. That’s compelling and makes good business sense.