Chal­lenges await

Hospi­tal ex­ecs pon­der do­ing more with less, and do­ing it bet­ter

Modern Healthcare - - Editorial -

Health re­form had hospi­tal ex­perts crib­bing Win­ston Churchill last week, say­ing that pas­sage of the fi­nal bill was the end of the beginning of the re­form process, and not the beginning of the end.

While the politi­cians in Wash­ing­ton were back­slap­ping and pre­par­ing to board jets for Easter re­cess, hospi­tal leaders were left to pon­der a 906-page fed­eral law and the not-en­tirely con­vinc­ing bud­get es­ti­mates that leave open many ques­tions.

Among them: Who will pro­vide all the pri­mary and pre­ven­tive care for 32 mil­lion newly in­sured pa­tients? Will the rev­enue in­crease from in­sured pa­tients make up for the loss of $155 bil­lion in Med­i­caid re­im­burse­ment? Will pro­vi­sions in the law that work to de­crease re­im­burse­ment kick in be­fore other newly en­hanced in­come starts to roll in?

The law has more goals and pi­lots than the Air­line Soc­cer League, in­clud­ing lit­tle-no­ticed changes to not-for-profit reg­u­la­tions; ex­per­i­men­tal pro­grams to test ac­count­able-care or­ga­ni­za­tions and bun­dled pay­ment sys­tems; and an over­all move­ment to­ward in­te­gra­tion and away from episodic care.

“This will again chal­lenge us to do more with less. Oh, and by the way, do it bet­ter,” said Chris Van Gorder, pres­i­dent and CEO of San Diego-based Scripps Health, lec­tur­ing in Chicago to thou­sands of con­fer­ence­go­ing hospi­tal ex­ec­u­tives last week dur­ing his first pub­lic ad­dress as chair­man of the Amer­i­can Col­lege of Health­care Ex­ec­u­tives.

De­spite the over­whelm­ing sense that re­form will spell more chal­lenges than ever for hos­pi­tals, many ex­ec­u­tives said they were ex­hil­a­rated to rise to the oc­ca­sion. “It’s a great op­por­tu­nity. It’s a very ex­cit­ing time, a very chal­leng­ing time. They’re not kid­ding when they say it’s the chance of a life­time,” said Dave Fish, pres­i­dent and CEO of 102-bed St. Joseph’s Hospi­tal, Chippewa Falls, Wis.

Fish com­pared health­care re­form to other mo­men­tous fed­er­ally driven projects like ru­ral elec­tri­fi­ca­tion and the construction of the in­ter­state high­way sys­tem. “You can see how those im­pacted the qual­ity of life for all peo­ple in this coun­try. That same po­ten­tial is here. Yes, there will be a lot of steps, and po­ten­tially some mis­steps,” he said, “but this has the po­ten­tial to deal with the ac­cess that peo­ple have to the health­care sys­tem.”

Many hospi­tal ex­ec­u­tives agreed that the most sig­nif­i­cant im­pact for them is prob­a­bly the ex­pan­sion of health in­sur­ance to 32 mil­lion more Amer­i­cans than have it to­day.

Kyle DeFur, pres­i­dent of 772-bed St. Vin­cent Indianapolis Hospi­tal, the largest acute-care fa­cil­ity owned by Catholic health­care be­he­moth As­cen­sion Health, said the law cre­ates an im­me­di­ate need for ex­ec­u­tives to think about how to pro­vide the more cost-ef­fec­tive care they’ve long ad­vo­cated for: pri­mary and early-in­ter­ven­tion care.

“There are not enough pri­mary-care physi­cians to meet that need to­day. There needs to be some creative so­lu­tions with physi­cian ex­ten­ders, but also we need more pri­mary-care physi­cians,” DeFur said. That will put even more pres­sure on hos­pi­tals to find ways to af­fil­i­ate with physi­cian groups or to hire doc­tors out­right, two trends that have al­ready been build­ing for years.

But along with that comes a need to train pa­tients on how to ac­cess the sys­tem through those lower-cost routes in­stead of go­ing to the emer­gency room, as they’ve been do­ing.

Chip Kahn, pres­i­dent of the Fed­er­a­tion of Amer­i­can Hos­pi­tals, said the law should “re­bal­ance” hospi­tal fi­nances by sig­nif­i­cantly re­duc­ing un­com­pen­sated care and the need for cost­shift­ing char­ity care to com­mer­cial pay­ers.

Man­aged-care com­pa­nies have been forced to pay higher rates to keep hos­pi­tals open to serve their mem­bers, so re­duc­ing the cross-sub­si­dies could tame the rate in­creases that they have been pass­ing on to em­ploy­ers, Kahn said, not­ing, how­ever, that gov­ern­ment in­sur­ance pro­grams will con­tinue to un­der­pay providers.

Roughly half of the 32 mil­lion newly in­sured are ex­pected to be cov­ered by the ex­panded

DeFur: Not enough pri­mary-care docs to meet the need to­day.

Sen. Tom Harkin (D-Iowa), left, and fel­low se­na­tors ap­plaud Se­nate Ma­jor­ity Leader Harry Reid (D-Nev.) at a re­form news con­fer­ence March 25.

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