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One of the main drivers behind all this tech activity is the meaningful-use requirements under the HITECH Act. Although industry leaders often grumble about the difficulty of meeting meaningful use, about half or respondents are satisfied with the criteria. Most (53%) said that the requirements are on target, although 39% did say the bar was set too high. Only a handful said the bar is too low.
The requirements are key to improving healthcare, says Phyllis Schuck, CIO of Pinehurst (NC) Surgical Clinic.
“The biggest issue facing healthcare today is how to create a service line that crosses the episode of care and puts the patient first,” she says. “Care today is fragmented, duplicated, and reimbursed on the wrong model. We should be reimbursed based on outcomes and on delivering preventive care. Healthcare accountability is long overdue. I see the governmental push with ARRA as a means to get the data platform in place that is needed to make healthcare accountable.”
Quality: Concerns of a Lesser Priority
For healthcare leaders specializing in quality improvement, the past year has represented monumental change, and that fact was reflected in many of their answers to several questions in the 2011 HealthLeaders Media Industry Survey.
For starters, only 58% of those who responded listed quality and patient safety among their organization’s top three priorities. That must mean that 42%, or nearly half, believe their organizations have subordinated quality as a priority. In 2010, 65% of quality leaders listed quality and patient safety among their top three priorities, and in 2009, 84% did.
The other top three priorities for 2011 listed by quality leaders were patient experience or patient satisfaction (chosen by 44%), and developing an accountable care organization (24%).
Also, while 32% of quality leaders think the industry is on the right track, 39% put it on the wrong track.
Regarding reform, most have a positive view of the Patient Protection and Affordable Care Act (41% versus 15% negative), though 64% say reform has weakened morale at their organization. Finally, only about one-fourth of those responding said they think withholding money from hospitals for “never events” is an effective way to improve quality.
With the prominence of quality measures now set in law, with each institution’s scores being much more transparent and public, why aren’t quality leaders ecstatic?
The answer may lie in the bill’s unintended consequences, says David J. Shulkin, MD, president of 642-bed Morristown (NJ) Memorial Hospital.
There’s a lot of irony at work here, he says. While the healthcare reform legislation’s language is geared to quality improvement, it also aggressively targets reduced spending, and unfortunately, that’s the impact that has every hospital executive’s full attention, Shulkin says.
“If you’re in the quality field, the real message in healthcare right now is that there’s going to be a lot less money available, and the institutional thinking is becoming more bottom-line oriented. What’s at stake is a potential loss of tens of millions of dollars to hospitals, and the quality component has been significantly dwarfed by that,” Shulkin says. “It’s fundamentally turned perceptions upside down.”
That’s a considerable change from the past for quality officials, he says. “There hasn’t been a direct tie between support for quality initiatives to the finances of an institution. But now, as facilities become more financially stringent, that’s been a distinct threat to people in the quality field.”
Now, he says, “instead of having the imperative to improve because it’s the right thing to do, we’re seeing a shift, with institutions more concerned about adjusting their cost structure, or their physician alignment strategies, or forming an accountable care organization.”
Quality, he says, “has been replaced by these more dramatic imperatives, and they’re seeing the ultimate future of healthcare under a very different light of how they’ll be paid and how they’ll have to perform in the future.”
Other findings from the survey bolster Shulkin’s perception that quality leaders’ thinking has undergone a sea change.
Two-thirds, or 66%, of quality leaders believe healthcare reform legislation has weakened their institution’s financial position, a share significantly greater than top leadership, of whom 58% said the new law has weakened their financial position.
In general, however, quality leaders seemed to be slightly more positive about healthcare reform mandates than did executive leadership survey respondents. For example, of quality leaders responding, 45% said that increased regulatory scrutiny expected from the healthcare reform laws would have a negative or strongly negative impact on their organizations, while 62% of executive leaders responded that way.
Marketing: Hesitant on Priorities
Amid the uncertainty of accountable care and the increased pressure on marketing to help boost the bottom line, marketing leaders are unsure of their role in physician sales. The majority of respondents indicated that they wanted to dedicate more FTEs to physician sales (47% say four or more FTEs is ideal, while only 24% have that many), yet 42% also said their strategy for marketing to physicians is neutral, not very aggressive, or not aggressive at all.
This discrepancy may be caused by marketers anticipating an emphasis on physician sales in the near future, but not yet dedicating resources in that area.
“With the push to define and then build ACOs, everyone knows keeping your network tight and keeping referrals in your network is going to be more important than ever,” says Brooke Tyson Hynes, vice president of public affairs and communications for Tufts Medical Center in Boston.
Physician sales should be a strategic priority regardless of where an organization is in forming an ACO, says Patrick Buckley, president and CEO of Milwaukee-based PB Healthcare Business Solutions.
“Given how critical physician referrals are to a hospital’s bottom line, the number of respondents who believe their organization is aggressively marketing to physicians should be much higher,” he says.
Marketing leaders have increased their focus on physician sales in the past year, however. About 57% of this year’s respondents said they routinely manage or influence physician relations or sales, compared with just 36% of respondents in the 2010 survey.
Another change in focus that marketing leaders have indicated is in their organization’s top three priorities. This year, fewer marketing leader respondents rated quality/patient safety (21%, down from 43% last year) and physician retention (16%, down from 36%) as a top-three organizational priority, replacing them with cost reduction (40%, up from 34%) and reimbursement (23%, up from 13%).
Patient experience maintained its spot as a top-three priority (37%, on par with 36% last year).
“Everyone is thinking about how healthcare is changing even more dramatically than it’s changed in the past and taking a deep look inside and asking, ‘How are we going to do things differently? How are we going to reinvent what we do? How are we going to be innovative in how we approach all these changes?” Hynes says. “There’s a real sense that things will change.” Still, Hynes found the decrease in respondents listing quality as a top priority puzzling.
“You can’t separate reimbursement and quality, because we’re going to be reimbursed on how well we deliver care,” she says. “You used to get paid based on your brand and your market weight, but the movement is toward reimbursement for high quality.”
Despite the sometimes wavering opinions of survey respondents, Hynes says she believes marketing leaders are optimistic about changes in coming years.
“It is stressful and it is it frustrating, but there’s a bit of excitement because the traditional mix of what made an institution successful isn’t necessarily going to mean success in the future.”
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