Prepping for Healthcare Reform
Prepping for Healthcare Reform | Elliott Moore, Mountain States Health Alliance, Michael Stahl, University of Tennessee's Physician Executive MBA program, Andy Hall, Wellmont Health Systems, healthcare reform, Medicare, American Recovery and Reinvestment Act of 2009, TennCare

Fear of the unknown, healthcare legislation, worries local providers, physicians

The size and scope of federal healthcare legislation is far from certain, but providers and medical professionals throughout East Tennessee are preparing for a variety of scenarios nonetheless.
The idea is to be ready for new rules and regulations regarding reimbursement and other core business issues, say those who are tasked with monitoring the various forms of the legislation as it has worked its way through the U.S. House of Representatives and the U.S. Senate. There are many components that hospital systems don't care for, primarily a public option, while doctors are worried about any downgrade in Medicare and Medicaid reimbursement rates. Both sides applaud the goal of providing more insurance to the poor, which will reduce emergency-room crowding, but wonder how those coverages will translate into payment once those individuals make their way to doctor's offices instead.
In short, there's a million moving parts and it's tough to keep an eye on them all. Tough, but necessary, said Andy Hall, director of government relations for Wellmont Health Systems.
"A lot of the things we've gone through this past year have been a great primer for what's ahead," Hall said. "We've had to focus on cost-cutting measures, with layoffs, but also on process improvements and increased efficiency. We've really buckled down hard on that."
Hall says that Wellmont officials share the concerns of state leaders with regard to new federal mandates that may be passed along to them without proper financial support. Tennessee currently is using dollars from the American Recovery and Reinvestment Act of 2009 to meet some of its TennCare and related expenses, so when that's gone in 2011 the state won't be in a position to absorb any new costs, he said.
"If there's a shortfall, they'll shift to hospitals and healthcare facilities to cover that, and it's already well defined at the state level for what's going to happen," he said. "There will be further provider cuts in the state, and the national picture is just as cloudy. We're working with the American Hospital Association to stay abreast of the situation, and we'll continue to do that until we know what this animal is going to look like."
The legislation is one of many hot topics in the classrooms of the University of Tennessee's Physician Executive MBA program, where physicians are looking at the issue as both business owners and care providers, said Michael Stahl, director.
"We have endeavored to help physicians who are interested in a leadership role acquire the knowledge and skill sets, the tools and techniques, to be able to deliver quality health care, " said Stahl of the program, which was begun in 1998 and has graduated 322 physicians from 44 U.S. states and nine countries. "We are all about improving quality, which can be done through process improvements, which leads to improved patient outcomes while also reducing costs. We're not going to be teaching physicians to design a future with any one particular feature of a bill in mind, but keep doing what we're doing with regard to improving quality and reducing costs."
Those twin outcomes are highly valued and overarching enough that they should be the focus of any and all debate, Stahl said, adding that a bureaucratic approach from Washington might be indistinguishable from that of an HMO executive to the American people, who have vocally opposed interference in the doctor-patient relationship in the past and continue to do so.
"This could be an even bigger step in third-party controls, and our physician leaders need to double their efforts to create a lean healthcare approach, to reduce errors and improve processes, so that they are ready for what might come," he said.
Preparedness is also the watchword at Mountain States Health Alliance, even though it's hard at this point to know exactly what to prepare for, said Elliott Moore, assistant vice president of community and government relations.
"If Congress moves toward some kind of realignment of the financial incentives with hospitals and physicians, we need to do what we can to be ready to change some of the ways we are providing services and how we have been paid," Moore said. "I think we're going to be in tougher times for hospitals financially, and so we'll be looking at opportunities for new partnerships so we can continue to provide care in the most efficient way possible. We don't know what's out there with readmissions, bundling and other issues, but we know we need to be creative about how we look at our partnerships and our services."
Should the public option come out of the legislation, or an opt-out clause for states be inserted, Moore said she thinks that hospitals will be more supportive of the overall package. Like Hall, she is keeping tabs on the American Hospital Association's efforts to influence the legislation, and hopes for a positive outcome.
"We have expressed some concerns about the Medicare cuts on the front end, and also the benchmarks in terms of coverage and payments," she said. "We'd like to see some model programs first to test some of these new methods rather than just a full national rollout, and I think we'll see some concepts that the hospital industry is promoting make it into the final legislation."
For his part, Hall agreed that a smaller rollout of new regulations and programs might be better, and he hopes that "cooler heads will prevail.
"Health reform is needed in this country, everybody realizes that," he said. "How we get there … everyone has their own opinion, but when we're talking about shifting mandates down, I'm not sure how we can do that. There's a lot that's up in the air now and it's scary to think about, but there's a lot we can focus on here now that they want to do with reform, issues that we can address without major new legislation."

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