Tempestade na saúde: saiba quais são os ventos que podem trazer um mundo de oportunidades

Segundo dia do Simpósio sobre Soluções para a Segurança do Paciente com Resultados para as Organizações de Saúde no 8º AnestEdu

Segunda parte da matéria sobre a palestra de Roberto Gordilho, Maturidade de gestão e transformação digital. Veja aqui a primeira parte.

Assista ao vídeo desta palestra no canal do AnestEdu

A transformação digital, as transformações nos modelos de remuneração e monetização, os processos de consolidação e, no sistema público, a falta de atualização na tabela do Sistema Único de Saúde (SUS) estão criando uma turbulência, no sistema de saúde, que atinge principalmente os hospitais. “Anestesiologistas, cirurgiões, gestores, todos dependemos da sustentabilidade do sistema de saúde para viver, mas hoje a realidade dos hospitais brasileiros é uma perfeita tempestade com mudanças trazidas pelo cenário externo, somadas ao conjunto de problemas internos de gestão, e nenhum hospital tem opção de ficar de fora”, disse o consultor Roberto Gordilho abrindo a palestra Maturidade de gestão e transformação digital no 8º AnestEdu. “Não adianta a gente dizer que quer ou não quer, quer mais ou quer menos. Vai acontecer.”

Gordilho disse que o foco do negócio saúde deixará de ser tratamento e cura e passará a ser prevenção. Tratamento e cura, porém, não vão diminuir, ao contrário, vão aumentar. O negócio prevenção, no entanto, vai crescer rapidamente ao lado. “Em todos os hospitais por onde tenho passado, pergunto: qual é o seu negócio, é doença ou saúde? Porque se for saúde, há um mundo de oportunidades. Mas se for doença, você está doente. E esse mundo de oportunidades pode ser uma tempestade ou a salvação.”

Veja tambémFusões e aquisições na saúde: prepare-se, o próximo a ser comprado pode ser você

A tempestade que chega ao sistema de saúde

Roberto Gordilho explicou cada um dos ventos que, juntos, formam a tempestade que atinge o sistema de saúde e levará pelos ares quem não estiver bem fundamentado, mas trará oportunidades para quem estiver preparado:

  • Transformação digital: ocorrendo em todos os setores da sociedade, incluindo a saúde. Mas realmente entendemos que transformação é essa?
  • Transformação do modelo de remuneração: o modelo fee per service – remuneração por serviço – tende a desaparecer para dar lugar ao modelo de remuneração por performance – fee per performance. Assim, o risco também muda de lugar, sai das mãos do cliente e passa para as mãos do prestador de serviço de saúde.
  • Transformação do modelo de monetização: o hospital é um grande distribuidor e desaprendeu a ganhar dinheiro com serviço, mas terá que reaprender.
  • Processos de consolidação (abordado no post anterior): formação de grandes redes na saúde, com grande impacto no dia a dia das instituições – atualmente nas grandes e médias cidades e instituições, mas logo nas pequenas também.
  • Para quem trabalha no sistema público: dez anos sem atualização da tabela SUS. Se for atualizada em 2019, será em 2%, não vai recuperar as perdas.

Veja também: Sistema de saúde seguirá existindo, mas você estará dentro? Mudanças estão aí e o 8º AnestEdu mostra os caminhos

Transformação digital na saúde

A transformação digital está na moda. “Cada fornecedor vem com uma proposta e normalmente diz que transformação digital é comprar o novo prontuário eletrônico, comprar a nova versão do sistema, é implantar o módulo novo. Não é. Transformação digital é repensar a forma de operação com o paciente no centro. É utilizar novas tecnologias para ganhar eficiência, qualidade e segurança, pensando no paciente”, afirmou Roberto Gordilho.

Segundo o consultor, o que fizemos nos últimos vinte anos foi trabalhar a operação, ou seja, buscar otimizar o fluxo de dados, o controle, o faturamento e, “quando desse, melhorar a vida do paciente”. Ele disse que esse foi o foco da informatização, mas o problema é que a saúde é o único segmento da economia que, ano a ano, quanto mais tecnologia mais caro fica.  “Se isso acontecesse com computadores ou celulares, nenhum de nós teria esses equipamentos”, lembrou. Gordilho afirmou, no entanto, que isso vai mudar e, em breve, uma curva na relação uso de tecnologia/custo na saúde provocará não necessariamente uma queda drástica nos preço de medicamentos e equipamentos, mas uma mudança na lógica do mercado pela utilização em grande escala de tecnologias que, aliás, não são novidade:

  • Big Data: “Já está no nosso dia a dia, todo banco, toda empresa de varejo tem”.
  • Inteligência artificial: “Todo mundo que fala com a Siri ou com o assessor do Google está usando inteligência artificial”.
  • Mapeamento genético: “Nos Estados Unidos, há uma empresa chamada 23andMe que por 99 dólares faz seu mapeamento genético”.

Com um exemplo simples, Gordilho explicou como o uso de dados pessoais irá levar à popularização da tecnologia em saúde: se prontuários médicos forem digitalizados ou se dados médicos forem colhidos diretamente de pacientes, por exemplo, por wearables ou internet das coisas presente em eletrodomésticos, e processados por computação cognitiva, a lógica da saúde pode mudar completamente. “E não há nada disso que não esteja pronto. A única dificuldade para convergir todas essas tecnologias é a comunicação, que ainda é cara, mas há uma coisa chamada 5G que vai convergir tudo, porque resolve o problema da comunicação. E quando tudo isso estiver unido, vai mudar a forma não apenas como entendemos o negócio saúde, mas como entendemos o negócio comércio, a indústria automobilística, etc. Na saúde, entretanto, no aspecto de assimilação de novas tecnologias, dentro das instituições, ainda estamos muito atrasados no Brasil”, declarou.

Segundo Gordilho, são empresas que hoje já lideram os mercados de big data e outras tecnologias, como Google, Apple, Microsoft, e abordam esses mercados com a lógica de cobrar 10, 20 dólares de um bilhão de pessoas, e não vender cinco mil equipamentos em um ano, que irão protagonizar a transformação digital na saúde. E vai ser muito rápido.

Transformação do modelo de remuneração na saúde: o risco muda de lugar

O pagamento por pacote, hoje muito negociado com as operadoras de planos de saúde, é um intermediário da mudança entre a remuneração por serviço para a remuneração por performance, pontuou Roberto Gordilho: “A maioria dos hospitais brasileiros, porém, não consegue nem mesmo calcular com eficiência o custo de um pacote”.

Segundo ele, atualmente apenas quem trabalha com a área financeira das instituições está preocupado com os conceitos de eficiência, eficácia, efetividade e economicidade, que farão parte das instituições em todas as áreas e devem estar na rotina de todos os gestores que trabalham dentro do hospital. E de todos os funcionários, na verdade, pois, como explicou, no modelo de remuneração por performance, o risco muda de lugar, ou seja, atualmente, ele fica com o consumidor, mas passará para o prestador de serviços de saúde: “Todo problema que o hospital consegue colocar na conta vai para a operadora que, no final do ano, transfere como reajuste para o consumidor. Mas na remuneração por performance, o risco muda de lugar. Se eu contratei o hospital para resolver o problema e ele não resolver, o custo será do hospital, que terá um valor fixo para realizar todo o tratamento”, afirmou. “Vejam que mudança conceitual importante: atualmente, se não resolvemos, o que acontece? Mais procedimentos, mais faturamento. Quando há problema, há mais faturamento. E de uma hora para outra, será ‘se der problema, problema seu. Resolva’”, declarou Gordilho.

E o custo não é barato. No ano passado, pelo Índice de Preços ao Consumidor (IPCA), foram 2,8% de inflação. Os reajustes dos planos de saúde, no entanto, conforme informou Gordilho, chegaram a 16%, 20%: “Antigamente, falava-se que a inflação da saúde era o dobro da inflação normal. Hoje, é seis, sete vezes, tomando como referência o ano passado. Esperamos que, na média, não continue assim ou não vamos aguentar, o sistema vai ruir”.

Veja também – 8 perguntas da administração ao corpo clínico: o que o gestor hospitalar sempre quis saber e teve coragem de perguntar

Transformação do modelo de monetização na saúde

Atualmente, os hospitais são grandes distribuidores, ou seja, obtêm seus resultados financeiros majoritariamente da venda de materiais e medicamentos (Matmed) e órteses, próteses e materiais especiais (OPME). Entretanto, as operadoras já estão “apertando” as negociações relativas a pagamentos de Matmed e OPME e criando formas de pagamento direto aos fornecedores, e a tendência é que as margens sejam cada vez mais reduzidas. “Muitos fornecedores estão saindo do Simpro e do Brasíndice e passando para negociação direta, ou seja, a principal fonte de receita e resultado do hospital está se esgotando, e ainda não aprendemos a ganhar dinheiro com serviço, ou melhor, desaprendemos em vinte anos”, apontou Gordilho.

Então, que será de nós? Segundo o consultor, além de os hospitais encontrarem novas formas de negociar com as operadoras, será preciso encontrar novas formas de monetizar, voltando às diárias e taxas, ao serviço, e aprender a fazer o melhor de forma econômica e sustentável: “Não é opção. Daqui a dois, quatro anos, esse modelo todo mudou, portanto, não temos muito tempo para preparar as instituições para o novo modelo”.

Falta de atualização da tabela SUS

Os hospitais que trabalham com o SUS, atualmente recebem a metade do que recebiam há dez anos pelos mesmos serviços. Há dez anos, o SUS não atualiza a tabela. Nesse tempo, a inflação acumulada, segundo o IPCA, foi de 88%. Segundo Roberto Gordilho, em valores reais, isso significa que os hospitais, pelos mesmos serviços, recebem hoje 55% do que recebiam há dez anos, o que obviamente não é sustentável. “Para complicar, se considerarmos a inflação da saúde como o dobro da inflação normal, temos uma situação em que, em dez anos, a receita caiu pela metade e os custos dobraram. Essas instituições recebem a metade e gastam o dobro”, afirmou.

Aparentemente, para esse problema não há solução à vista. O que você pensa sobre isso? Você trabalha com o sitema público, privado ou os dois? Qual desses ventos da tempestade na saúde o tem atingido mais? Você acha que está bem preparado e bem fundadamentado para enfrentar isso tudo? Vamos conversar!

E se você precisa de apoio em sua área anestésica, conte com a WMC Anestesia: contato@wmc.med.br e (41) 3556-0936 / 99152-3713

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