‘There is always a way to find common ground’

Hospitals took some bumps and bruises last year as public angst over surprise billing, patient lawsuits and the high cost of care swelled. Many of those policy debates will

Dr. Melinda Estes continue in 2020, but American Hospital Association Board Chair wants consumers and policymakers to hear a broader story. Estes, the 47th physician to serve as board chair of the 122-year old organization, wants to elevate the perception of hospitals in public discourse. The CEO of St. Luke’s Health System in Kansas City, Mo., is also focused on spreading innovation across the industry. Estes spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: One of your priorities as AHA board chair is to strengthen the perception of hospitals with both policymakers and consumers. How can the AHA work on that?

Estes: One of the things that I’d like to do this year is work together as a field to shed light on and shape the conversations about how all of our members— big and small, rural and urban, teaching, specialty hospitals—are working toward the dual missions of providing great care while helping to move our country’s health system forward.

There are so many examples on a daily basis of the good work that hospitals are doing in their communities. And increasingly not just looking at the H as the four walls of a hospital, but the H as health in the community, reaching out and engaging with our patients, with our neighbors, where they live, and looking at other factors that impact their health. The second piece is trying to continue to elevate hospitals and health system leadership into national policymaking roles because we need to be sure that as healthcare policy is being made, that our patients’ needs are at the core of what we’re trying to accomplish.

MH: Do you feel like some of that messaging gets lost because of the debate over surprise billing or hospitals suing patients?

Estes: What happens sometimes is when you have an issue like surprise billing that takes front and center, you lose some of the other conversation around the day-to-day work that’s being done, the impact on communities, the fact that hospitals in many communities are often the largest employer, providing good jobs in the community and are a driver of the health and vitality of a community.

And when you look at some of the conversations that are going on in the country, one of the things that worries our patients is will their hospital be there for them when they need them to be. There’s an opportunity then to tell that part of the story.

MH: Do you mean be there in terms of the financial struggles some hospitals are facing?

Estes: Correct. Given the turbulence that we find in our industry, I think many of our patients understand that hospitals are a bit overwhelmed at times and want reassurance that we will be there to provide the care they need when they need it.

MH: At the J.P. Morgan Healthcare Conference a couple of weeks ago, several well-performing health systems talked about their plans to expand their footprints or grow their innovation programs. How concerned are you about independent and rural hospitals being left behind?

Estes: We are worried because certainly all hospitals are not in the same position. When we talk about innovation, we tend to talk about disruptive innovation or transformational innovation and we immediately go to the technology sphere. … The flip side of that is there’s a lot of process innovation that does not require large dollars, does not require tremendous technology investment. That’s one of the things the AHA is working on with our Center for Health Innovation and at conferences for rural hospitals—how do we scale that lower-level innovation to a broader group of the field?

MH: The center is 2 or 3 years old, right?

Estes: It is 2 years old.

MH: What are your perceptions of how it has evolved?

Estes: I was fortunate to chair the inaugural innovation center leadership group. I might highlight one thing, which is the design studio work that is being done. There was a desire to tackle two or three big problems that impact all of us in healthcare.

One is behavioral health networks because there continue to be a shortage and a maldistribution of behavioral health resources in our country. The second is the usability of the electronic health record. One of the things we hear from physicians and clinicians in particular is that technology, particularly the electronic health record, is both a godsend and a burden. The third one is this notion that as we take on more and more risk, are there things that we, as providers, can come together to do to approach that in a little different way?

MH: How do you think about the debate over price transparency in relation to the perception of hospitals with policymakers and consumers?

Estes: Transparency is an important issue and the AHA has put together a price transparency task force; St. Luke’s chief financial officer is a member. I think much of the conversation around that table right now has been around surprise billing and putting together a series of principles that we can, as a field, agree to.

But this ties in very much to the work that has gone on at the AHA for a very long time around value and affordability. Affordability in my view translates often to what a consumer pays out of pocket. Given the number and complexity of insurance arrangements and other arrangements, it has not been very easy for us to tell somebody what they have to pay. A lot of our members have very good priceestimator tools … I think there’s real opportunity for us to take the good work that’s been done and scale it.

MH: Are there areas around price transparency where you think there is room to work with the CMS?

Estes: My personal bent is that there is always a way to find common ground, especially when both parties have the same goal, which is to move American healthcare to provide the best care for our patients that we can. How some of the regulations have been proposed has been problematic, but I certainly believe that there will be common ground. ●

“We need to be sure that as healthcare policy is being made, that our patients’ needs are at the core of what we’re trying to accomplish.”