The Healthcare Financial Management Associations annual meeting may have appeared on the surface to be a bit of a boondoggle: four days at the Mandalay Bay Hotel and Casino in Las Vegas. But the meeting itselfHFMAs 2008 ANI: The Healthcare Finance Conferenceactually delivered some grim news. Speakers offered up signs that the hospital industrys coffers are a likely target in cash-strapped Washington, while a noted financial guru pointed his finger at chief financial officers and other financial executives as needing to do more to improve quality.
Richard Umbdenstock, president of the American Hospital Association, in a morning keynote speech on Wednesday, took a while to get to his point but it was a big one. After describing the importance of the patient and how hospitals may have to put aside their own interests at times to improve the healthcare system, he identified one of his greatest fears: the healthcare reform that so many seek could turn into hospital reform, meaning hospital reimbursement takes a whack.
Later that day, Nancy Bell, senior managing director, healthcare finance, for Stevens & Lee, Reading, Pa. , predicted that Umbdenstocks fear likely will become reality. You will be paid less over the next eight years, no matter who is president, Bell said. She noted that Medicare sops up more of the federal budget than education and transportation combined. Throw in Medicaid and military healthcare programs, and you have a big target on healthcares back on Capitol Hill, she said. In general, its believed in Washington, these are the good ol days for healthcare, she said.
And even before a major overhaul comes, the tweaks and tests that healthcare reimbursement is currently undergoing will continue, with bundled payments gaining momentum. I hate to tell you, but bundled payments are coming at you, Bell said.
Meanwhile, also on Wednesday, Lisa Dobson Gould, an attorney and shareholder at Bennett Bigelow & Leedom, noted that fraud and abuse enforcers may be cranking up their oversight as a result of the switch to the MS-DRG system. Hospitals are not going to always get the new coding right at first, and there will be cases of miscoding. Historically, changes to the DRG system have led to more regulatory oversight, and as soon as the CMS moves to MS-DRGs, well expect to see the new subpoenas roll out, Gould said. Her colleague, David Robbins, president of the firm , said that much of the fraud and abuse activity is being driven at the state level through Medicare fraud contract units, which typically work out of state attorneys general offices. He noted that the acronym MFCU is pronounced muh-foo-koo. It sounds nasty, because they are, Robbins said. MFCUs often go after smaller providers because they are easier targets, he said.
Early Thursday, in a move that may have tempered what was to follow, the HFMAs board gave its Board of Directors award to its own Patient-Friendly Billing project. That bit of self-congratulation can be forgiven considering the wallop delivered by the keynote speech that followed from management guru Tom Peters. He came out swinging at the healthcare industry from the get-go, noting that his first idea was not polite. (His slideshow is available at his Web site.)
Peters told attendees that despite our good work in some areas, like patient safety, we still havent reached up to the awful level. The high number of hospital-caused drug errors and infections is a disgrace, Peters said. Peppering his speech with anecdotes concerning his own and acquaintances experiences in healthcare, Peters came across as someone who cared. He attributed the industrys biggest problems to its overly quantitative culture, with financial executives not paying enough attention to hiring people-focused executives. Culture is the game, he said. We need a few less numbers people and a few more anthropologists, Peters said.
Moreover, low-cost, successful efforts like pre-surgery checklists indicate that its not money thats needed to improve quality, but attention from the executives in a position to make changes happen. You gotta deal with it, Peters said.
He said the role models healthcare should be looking to are leaders that care about the soft stuff: Dwight Eisenhower, Benjamin Franklin and Southwest Airlines former head, Herb Kelleher. Peters pointed out that Eisenhower won World War II by relying on the development of friendships. Franklin, over tea, convinced France to support America. And he noted Kellehers secret to success was: You have to treat your employees like customers.
Paul Barr is news editor of Modern Healthcare, based in Chicago. He can be reached at [email protected]