AHA Seeks 'Shared Responsibility' After Obama Meeting

John Commins, for HealthLeaders Media, February 25, 2009

American Hospital Association President Richard J. Umbdenstock told President Obama this week that U.S. hospitals will answer his call for "shared responsibility" to help the nation's fiscal future, as long as everybody else does, too.

"We believe we have to be part of the solution, but so do vendors, suppliers, other providers, employers, and consumers themselves. It's not going to be solved by any one approach or putting it on the shoulders of any one stakeholder," Umbdenstock says in an interview with HealthLeaders Media.

"Hospitals are the ones that hold this somewhat broken and disjointed system together on Main Street day in and day out for America's communities and patients in need," he says. "We are calling for reform, but not just in the form of short-term payment cuts and reductions, that will just force the system to get more out of kilter and out of balance than it already is."

Umbdenstock was among the several dozen people who met for more than three hours on Monday with Obama and key White House officials in what was billed as a fiscal responsibility summit. The meeting also included members of Congress, leaders of business and professional organizations, and advocacy groups.

No firm resolutions or action plans came out of the meeting. However, Umbdenstock says he was "pleased, as a representative of hospitals and other provider organizations, that the tone was one of solving a shared national problem."

"The president and his team set the context at the opening session," Umbdenstock says. "We as a nation have to start thinking about the long-term fiscal situation and fiscal stability of the country and they see the rising cost of healthcare as the major issue driving the challenge going forward as the population ages, as demand increases, as new procedures and technologies keep coming on line, and so on."

The Washington Post reports that Obama urged the group to "build off this afternoon's conversation and work together to forge a consensus." White House Budget Director Peter Orszag told the summit that slowing the growth rate in healthcare costs is "the single most important thing we can do to improve the long-term fiscal health of our nation. Let me be very clear: Healthcare reform is entitlement reform. The path of fiscal responsibility must run directly through healthcare," the Post quoted Orszag as saying.

Umbdenstock says he told the administration that America's hospitals appreciate the approximately $150 billion earmarked for healthcare spending in the stimulus plan, including the supplemental funding for Medicaid and COBRA, and $19 billion for healthcare information technology implementation incentives.

"Those are all positive steps that we thought were necessary at the moment and can be built upon in the future" he says. "Hospitals are right in the middle of this economic crisis, in some ways even more so than other enterprises. Like other enterprises, we are having our financial challenges, access to capital challenges, but we also have challenges in the form of more people losing coverage and turning to the hospitals as a safety net." Umbdenstock says he made it clear to the White House that hospitals are ready for responsible reforms.

"We believe you have to cover everybody in the system so they are getting the right care at the right time and in the right place and not just relying on emergency rooms or waiting until they are terribly advanced in their illness," Umbdenstock says. "We do need payment reform to address the government underpayment in the public programs and therefore the cost shift, but also to align incentives and drive some constructive changes in the delivery system. We also need administrative simplification. We have too many ways of billing and filing for reimbursement."

Umbdemstock says the Obama administration knows that AHA supports evidence-based medicine, but only if all of the parts are in place. "What we are worried about is that—at the moment—we don't have a significant portion of the services provided that have been validated. We don't have national agreement on the evidence," he says. "We've got a large research and consensus process ahead of us, and we are a little worried that some of the payment mechanisms will get out ahead of the evidence, which would be wrong and hard for us to support."

While he can't predict what the healthcare system will look like in the coming years, Umbdenstock says change is coming. "The future will be different. The delivery system will be different and the incentives will be different, and that's OK," he says. "The challenge will be getting from here to there through the period of change. That is where we can't afford to have crazy things done in the short-term that will jeopardize these community institutions or the services that patients need."

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at jcommins@healthleadersmedia.com.
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