Healthcare may have never been a field for executives who wanted a stable set of operating challenges from year to year, but the fast clip of fundamental change recently has set heads spinning all across the country. Witness the four-day agenda last week for the American College of Healthcare Executives' 54th annual Congress on Healthcare Leadership, which included educational sessions on everything from creating accountable care organizations and adapting to performance-based reimbursements to understanding the future of the Patient Protection and Affordable Care Act.
'We've come to a precipice'
Reform's impact, physician integration are hot topics
Healthcare may have never been a field for executives who wanted a stable set of operating challenges from year to year, but the fast clip of fundamental change recently has set heads spinning all across the country.
Witness the four-day agenda last week for the American College of Healthcare Executives' 54th annual Congress on Healthcare Leadership, which included educational sessions on everything from creating accountable care organizations and adapting to performance-based reimbursements to understanding the future of the Patient Protection and Affordable Care Act.
“I think it's really evident, not just from the range of speakers but the (audience) questions, that there is a recognition that we have come to a precipice, and incremental change is unlikely to carry us into the future effectively,” said Eric Buckland, who worked as a CEO at different hospitals for 30 years before becoming executive director this year for the Oregon Rural Healthcare Quality Network, Tillamook, Ore.
ACHE President and CEO Thomas Dolan said more than roughly 4,700 people attended the conference this year, compared to last year's record-setting 4,500 attendees.
The organization's newly seated board chair, Rulon Stacey, president and CEO of the Poudre Valley Health System in Fort Collins, Colo., in his opening session remarks, voiced his support for industry leaders' work. He said healthcare executives all share “an inner desire to help people in need. At your core, that is who you are.”
One of the conference's sessions focused on the struggles hospital executives face in dealing with the integration of physicians. Two prominent healthcare executives highlighted how difficult that process will be for systems that head down that path. The executives, Dan Wolterman, president and CEO of the Memorial Hermann Healthcare System in Houston, and Alyson Pitman Giles, president and CEO of Catholic Medical Center in Manchester, N.H., were co-presenters.
Wolterman described a 20-year process that began in 1983 that led to the creation of a separately incorporated legal entity called the Memorial Hermann Physician Network, known as MHMD, under the Memorial Hermann Healthcare System corporate structure. Some 2,000 of the network's 3,500 physicians are clinically integrated independent physicians. That means they can collectively enter into contracts with payers without running afoul of federal antitrust laws.
To participate as a clinically integrated physician, Wolterman explained, a doctor must agree to four criteria: participate in evidenced-based medicine, protocol development and implementation; participate in a preferred electronic health-record platform; submit quality data for both inpatients and outpatients; and agree to transparent use of data to elevate quality and reduce costs. “If you're not committed to evidence-based medicine, it won't work,” Wolterman said. He added that MHMD will be part of Memorial Hermann's application to become a Medicare-certified accountable care organization under the Patient Protection and Affordable Care Act.
Meanwhile, Catholic Medical Center's efforts to integrate its operations with physicians are still on hold, as Giles explained in her personal account of how CMC's affiliation plans with the Dartmouth-Hitchcock Clinic were all but derailed by everyone from local activists to the media. “I'm trying not to sound quite so bitter, but it's been bitter,” Giles said as she read newspaper accounts attacking her and the affiliation plans, first proposed in February 2009, to the several hundred executives who attended the session.
Giles said Catholic activists wrongly accused CMC of allowing prohibited reproductive services through the affiliation, while women's rights groups wrongly accused CMC of denying those same services through the affiliation. She said the agreement properly addressed both concerns. “I'm not Catholic, and that's part of the problem. They think I'm doing abortions in my office,” said Giles, jokingly saying later that she, a Protestant, considered converting to Catholicism but decided against it. In addition to local opposition from both sides, the state attorney general criticized the affiliation, Giles said, and the Federal Trade Commission is investigating the proposed deal.
Meanwhile, a Washington expert in a keynote address tried to get attendees to take action in order to stave off the federal government. Richard Pollack, the American Hospital Association's executive vice president for advocacy and public policy, said that whether the Patient Protection and Affordable Care Act stays in place, is replaced or gets repealed, now is the healthcare industry's last opportunity to control costs lest it essentially get taken over by the federal government.
“In many cases, this is our last chance through creativity and innovation and leadership on our own to deal with bending the cost curve,” he said. And if the industry fails, it will face a number of onerous solutions including spending caps, global budgets and rate review, Pollack said. He predicted that many of the core provisions of the reform law will go unchanged. Those provisions include insurance reform, delivery system reform, payment reform, transparency and information technology, he said.
Less certain is the law's requirement that individuals have health insurance, he said. Republican opposition to the individual mandate and the provision's mixed reviews in the federal court system have created uncertainty, Pollack said. If the provision is repealed or struck down, it would be extremely problematic for hospitals as 16 million people would lose private health benefits under the law, Pollack said, leaving hospitals with payment cuts and no way to make up the difference.
Visit modernhealthcare.com/section/liveat -ACHE for more ACHE news and for video interviews with attendees such as Dave Bernd, CEO of Norfolk, Va.-based Sentara, and Donna Sollenberger, executive vice president and CEO of University of Texas Medical Branch Health System in Galveston.
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