Hospitals Brace for a Financial Pounding

A:Probably. To what degree, no one knows.

Q: Will reimbursement per unit of service proceed on a downward slope as more people are insured by Medicaid, a notoriously poor payer?

A:There's little doubt about it. But how steep will that curve be?

Q: Will an influx of new, sicker patients overwhelm clinics and emergency departments?
A.: Probably. It happened in Massachusetts when the previously uninsured got coverage, and their uninsured level was much less than most states.

Q: How do you make smart investments in bricks and mortar that will serve everyone seeking care while not going broke in the process? Will government entities scale back their subsidies in the form of tax breaks?

A:Well?I'm out of answers. No one knows for sure.

And that's what struck me as I talked to these leaders about the impact of healthcare reform. If some of them are asking me these questions, they just don't know.

"It's fair to say we're not sure where to place our bets," says Gene Diamond, CEO of the Northern Indiana Region of Sisters of Saint Francis Health Services.

He's not the only one who's told me essentially the same thing. Yet decisions have to be made. In this case, best guesses. But I think organizations are holding back until the picture gets a little less murky. Yes, hospitals are still building, and they're still hiring, but they're doing these things based on what they do know. Many of them are already short of physicians or so-called physician extenders.