One could be forgiven for mistaking the American College of Healthcare Executives' 2013 Congress on Healthcare Leadership for a 2008 Obama For President campaign stop, as talk of hope and change have dominated conversations and presentations.
More specifically, talk of mergers, acquisitions, partnerships, and the development of strategies to manage the health of populations represents the change hoped for by healthcare's top leaders. But hope and change at the ACHE Congress, which runs March 11–14 in Chicago, are tempered by fear and caution.
Just to put a point on the rapidity of the changes facing healthcare, the Cleveland Clinic and for-profit hospital chain Community Health Systems announced a partnership, one of dozens announced since the U.S. Supreme Court affirmed the majority of the Patient Protection and Affordable Care Act last summer.
Strange times indeed.
In previous years at the ACHE Congress, talk of health insurance exchanges, the Medicaid expansion, and other changes being brought about largely by the PPACA was largely esoteric. This year it is evident that leaders are having to deal in a very real way with a declining revenue environment and a healthcare system that attempts to reward them (and punish them) based on value.
Attendees of the ACHE Congress have been treated to dozens of presentations this week showing that leaders are not only contemplating the changes they'll have to make, but also that they are making serious investments in labor, systems, and facilities to help meet the challenges of the future.
As hospitals and health systems try to plan the shift away from fee-for-service, they're aggressively hiring nurse practitioners, physician assistants, and other allied health providers to help extend their physician talent. And they're buying or partnering with organizations like federally qualified health centers, physician practices, skilled nursing facilities, home health, and even health plans.
These investments are a calculated risk, as hospital and health system leaders are hoping to replace some of the revenue loss that will happen as they attempt to keep patients out of the high-cost environment of the acute-care hospital. Most are expecting a revenue cut of about 20% over time as commercial rates settle toward Medicare reimbursement rates.
Urbana, IL–based Carle Foundation Hospital and Carle Physician Group, which merged three years ago, currently has 21 openings for advanced practice providers and expects to hire 40 more over the next few years. These people are difficult to find but necessary to improve access.
Bob Edmondson, chief strategy officer for Westminster, MD.-based Carroll Hospital Center, has invested heavily in disease management experts and patient navigators, but is unsure whether the accountable care organization route is right for his organization. Yet Carroll and other hospitals often face a new threat of competition from many fronts, including physicians.
"Are we going to go toward ACOs, or are we just going to be a part of one? In some markets, health insurers are running them. Cigna is setting up 300 nationwide," says Edmondson. And physicians can form ACOs, too, if they have the critical mass. "This is a real red flag. If the physicians can get their act together and collaborate, they will be formidable."
By next year's ACHE Congress, when most of the provisions of the PPACA have been implemented, healthcare executives will begin to see whether their investments are paying off, in the form of wringing waste and inefficiency from a healthcare system that is very rapidly becoming unaffordable.
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Philip Betbeze is the senior leadership editor at HealthLeaders.