Former AHA Chair Teri Fontenot on ACOs, abortion

Teri Fontenot is president and CEO of Women's Hospital in Baton Rouge, the largest birthing and neonatal intensive-care facility in Louisiana. Fontenot spearheaded the construction of a new 350-bed, $350 million facility that opened two years ago. Fontenot was the 2012 chair of the American Hospital Association board of trustees. She was named to Modern Healthcare's 100 Most Influential People in Healthcare in 2011 and 2012. Modern Healthcare Editor Merrill Goozner talked with her about accountable care organizations, the controversy over abortion access in her state and how a women's hospital can improve care for low-income women. This is an edited transcript.

Modern Healthcare: You took out a very large bond issue for building your new hospital, but your recent financial statements show your situation is improving somewhat. What have you been doing to improve the financial picture?

Teri Fontenot: We moved the hospital to a greenfield campus because we knew that we needed to expand, and we needed larger spaces for our ancillary services like pharmacy and imaging. We actually have fewer beds at our new campus. But we were able to more than double the size of our physician office building, and we have plans for expansion into other services that support women beyond obstetric.

Modern Healthcare: What are you doing on accountable care organizations?

Teri Fontenot: We will never be a true ACO because we don't plan to take on premium risk. But the types of services we traditionally provide have had some sort of fixed payment. Our largest payer is Medicaid, which pays us a flat amount per day. So we've had the incentive for years to figure out how to get good outcomes on a fixed payment. Because our doctors still are mostly in private practice, where we see opportunity going forward is becoming more aligned and integrated with them than we are now.

MH: Won't becoming more integrated with physicians doing prenatal care potentially reduce your admissions or the use of your NICU?

Fontenot: It absolutely will. But our mission is to improve the health of women and infants. We were the first hospital in our state that put a hard stop on early elective inductions, and that reduced admissions into our NICU significantly. Being able to align better with the doctors gives us the opportunity to work with patients prenatally where we don't really have a good opportunity now.

MH: Have you been able to work with employers and insurers to convince them that there's a better value proposition there?

Fontenot: We certainly have approached them about it and told them that we are very interested in experimentation with them. Hopefully, through data analysis we will be able to convince them we can improve the outcomes. But we have no contracts like that yet.

MH: You don't perform elective abortions at Women's Hospital. Louisiana has a new law that would require abortion providers to have admitting privileges at a hospital within 30 miles before they can perform elective abortions. How is that playing out?

Fontenot: Those opposed to the law feel like it's going to limit patient safety and limit access to care. Those who support the law believe that if patients have a problem, currently they are showing up in hospital emergency departments and there's not any information about that patient or her condition.

MH: Why aren't local providers willing to provide elective abortions?

Fontenot: In Baton Rouge, obstetricians working at hospitals like Women's have decided that's not something they're interested in providing.

MH: Would ACOs be a better way to go for your low-income women patients?

Fontenot: Most definitely, because many times patients, when they become pregnant, really don't have a medical home. When the obstetrician is providing prenatal care, the patients may have other conditions such as STDs, HIV or gestational diabetes. Women's Hospital could work more collaboratively with the physicians during the prenatal period, being able to share information through electronic health records, and improving outcomes and hopefully premature births.