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.