Even the climate-controlled glass atriums at Nashville's Gaylord Opryland Resort and Convention Center couldn't shield a record crowd of 4,000 at the Healthcare Financial Management Association's Annual National Institute last month from industry storm clouds.
Professional turnover, billing and collection problems, and looming quality standards were among the topics addressed between breaks in the resort's pristine acres of indoor gardens, winding rivers and pathways, and waterfalls.
But HFMA Chairwoman Joyce Zimowski and her handpicked keynote speaker, Boston Philharmonic conductor Benjamin Zander, portrayed the positive possibilities of leadership during their general session to begin the three-day event. "I'm not depressed. In fact, I'm eager," Zimowski said, after ticking off industry challenges such as staff shortages and climbing malpractice costs. Zimowski, vice president of financial performance improvement at Unity Health System in Rochester, N.Y., urged financial professionals to "go beyond the numbers" and find out how their hospital operations actually work in order to help them improve.
With the federal government and private payers pushing schemes to tie clinical outcomes to reimbursement rates, a 90-minute panel discussion on pay-for-performance initiatives drew rapt attention as four industry experts clashed over how quality measurement should be carried out.
Citing a cacophony of new initiatives, Jack Bovender Jr., chairman and chief executive officer of for-profit hospital chain HCA, called on Congress to create a board to oversee and coordinate pay-for-performance programs. Bovender said that absent an organized approach, healthcare providers will face higher administrative costs as they try to comply with the data requirements of different programs. He also questioned the validity of some quality measures being promoted, such as selecting heart programs with the greatest case volumes.
Panelist Karen Ignagni, president and CEO of America's Health Insurance Plans, whose prominent private insurer members are driving the pay-for-performance movement, agreed on the need for consensus. Ignagni supported the idea of a public sector-private sector partnership to address the issue but stopped short of endorsing a congressionally mandated task force. She didn't say whether AHIP had the power or intent to sit the likes of Aetna, Anthem, Humana and UnitedHealth Group around the table and push them to agree on parameters. "That's the issue," Ignagni said. "Who will convene the stakeholders?"
Meanwhile, Sister Geraldine Hoyler, senior vice president of finance and treasury at Catholic Health Initiatives, warned against treating healthcare as a "commodity" in which hospitals that take the sickest patients would be penalized. She called for an "intake measure" to categorize patients by their health status upon admission.
But panelist Stuart Guterman, director of the CMS' Office of Research, Development and Information, said any strides in paying for quality first require "vast improvement" in hospital data systems. Without delving into specifics, Guterman said the CMS is "putting together a report for the (White House) to recommend some avenues of action to promote improvement in healthcare information technology."
The panel was moderated by Harvard Business School Professor Regina Herzlinger, who also received the HFMA's Board of Directors' Award for her research. Also honored was former HFMA Executive Director Robert Shelton, a 2004 inductee into Modern Healthcare's Hall of Fame who died in September 2003.
Meanwhile, the HFMA reported an increase in net income, from $320,000 in 2003 to $1.8 million in fiscal 2004, ended May 31. Total revenue jumped 13.3% to $18.8 million from $16.6 million in the previous year.
-with David Burda