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Hospitals Brace for a Financial Pounding

Philip Betbeze, for HealthLeaders Media, September 24, 2010

I wrote a story for HealthLeaders magazine's September issue about the ACO conundrum. It's an interesting window into how hospital and health system CEOs are running their ever-growing multifaceted organizations, and preparing for a future of greater accountability. Problem is, they're having a tough time, in many cases, translating what accountable care means to their bottom lines.

As you might imagine, it's sometimes difficult to get these people to wedge a media interview into their busy schedules, so inevitably, while I'm talking to these folks, I try to ask as many questions as I can in the time allotted, even if those questions don't necessarily relate to a specific story on which I'm working.

You might guess, correctly, that healthcare reform legislation offers myriad challenges about which these CEOs are uncertain. Sure, it's law, but regulators will be defining it for years to come, which means hospital CEOs are in a difficult place. What they think is coming in terms of reimbursement, patient demand, and endless other concerns, promises to provide a constantly shifting ground from which to make decisions that are long term in nature, expensive to implement, and represent a calculated gamble for these CEOs. Sometimes, they even ask me questions, even if they're rhetorical.

Here are a few I've heard in these conversations recently:

Q: What is an accountable care organization, and how can I construct one within my hospital or health system so we're not left behind?

A:Well, there are some demonstration projects, but beyond a basic framework, it's hard to tell what will work and what won't.

Q: Will sources of revenue that hospitals once depended on, such as disproportionate share funding and continuing medical education, be cut?

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