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The Election Is Over, But Not the Shouting

Cheryl Clark, for HealthLeaders Media, November 8, 2012

The fiscal cliff is of immediate concern to hospital executives. "I anticipate that the fiscal cliff situation will cause the Congress and President to reduce reimbursement even more to hospitals and physicians," says Chris Van Gorder, president and CEO of Scripps Health, the San Diego-based, four-hospital system that has been named among the nation's leading hospitals. "I suspect the government will say they are not reducing Medicare/Medicaid benefits—only reducing provider reimbursement—but the impact will trickle down to patients and impact their access to care.

"I will be the first to admit that there is waste in the healthcare delivery system that must be reduced, and we at Scripps are working very hard with our physicians to build a higher-quality system which can deliver care at a lower cost," Van Gorder told HealthLeaders Media. "But it does take time to rebuild a very complicated and fragmented delivery system. … I'm concerned that the combination of reimbursement called for in the ACA [and] additional cuts caused by the ‘fiscal cliff,' combined with challenges at the state level, will be very difficult for many, if not most, hospitals to absorb. I'm particularly concerned about safety net (DSH) hospitals, as they already deal with a poor payer mix, difficult patients, and will face significant reduction in their DSH reimbursement starting in 2014."

Mark Schneider, vice president of information systems for nine-hospital MedStar Health in Baltimore and Washington, D.C., sounds a similar note. "No one is going to be comfortable until prices come down," he told HealthLeaders Media. More patients will be coming through the system because more people will be covered, and he fully expects continued tightening of reimbursement—either what's covered or the actual rates.

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