While reduced inpatient admissions are cause for concern, Ubbing says she is particularly concerned about site-of-service legislation in Congress that would equalize reimbursements for care provided regardless of the setting.
"You are doing so many things today on an outpatient basis that you didn't used to. There are some cost savings in that just by its nature," she says. "But that shift by itself is not as concerning to me as the idea of the level payment regardless of site of service. The reimbursement difference is predicated on the idea that hospitals have to be 24/7, 365 days, and nonselective of patients. That issue, should that come to the fore, I would be much more concerned about than the outpatient shift."
Ubbing says the uncertainty is a negative for the not-for-profit hospital sector but that individual health systems are rising to the occasion.
"You partner where you can. You get as efficient and lean as possible," she says. "We have a number of independent hospitals in southeastern Ohio. Some of our conversations are around how can we work better together. Can we have a virtual system that would drive down costs and that would have reasonable buying power and negotiating power in the marketplace so we are viable with payers and vendors? That is some of what we are working on right now with our colleagues who in some cases are as much colleague as competitor geographically, to see if we can't make it."