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5 Things Hospital CEOs Want from Trump

Analysis  |  By Philip Betbeze  
   November 17, 2016

Hospital administrators hope the unexpected election result will bring regulatory relief and no financial headwinds.

The electoral college has spoken, and the markets' verdict for hospitals was swift and sudden. Hospital stocks were down double digits in the wake of Donald Trump's presidential win and have not recovered much on fears the new administration's policies will punish hospitals.

After all, you can't say "Affordable Care Act," which has been a net positive for hospitals, these days without hearing "repeal and replace" in the next breath.

Podcast: The GOP's Path to 'Repeal and Replace' May Not Be So Easy

But healthcare leaders are resilient, and they hope cooler heads will prevail as the Republican Party appears poised to remake, if not repeal, a law it professes to disdain entirely.

Here are five wishes several hospital and health system leaders hope the new administration will grant as the turbulent healthcare industry ratchets up to an even higher level of upheaval.

1. Greater Affordability

Affordability is a stated goal of any administration's work on healthcare, but how it's achieved is where differences in ideology become apparent.

Toby Freier, president of Minnesota-based New Ulm Medical Center, a 50-bed hospital within the 13-hospital Allina Health nonprofit chain, says huge strides are being made in rural communities on affordability.

"There's great value being provided by rural providers already, and with the right support and a framework for funding reimbursement for things like telehealth that leverage tertiary systems into rural communities, rural providers can help on affordability and better outcomes," he says.

"I'm hoping the next administration gets that connection and that the pathway to greater affordability can be achieved. At the same time, [hospitals] have to demonstrate higher value for the healthcare we're providing and we have to own up to affordability issue."

Nancy Howell Agee, president and CEO of Carilion Clinic in Roanoke, Virginia, a seven-hospital nonprofit system, says all involved in healthcare reform must understand the frustration and concern about healthcare costs.

"We cannot ignore that some people feel marginalized and are very worried about the growing cost of healthcare," she says. "It's our responsibility to minister to that need."

2. Reduction in Regulations

This is an area where hospitals and health systems and a Trump administration may find common ground. From MACRA to MIPs, innovation is encouraged.

But some say innovation can be strangled by overly complex and conflicting government regulations. Howell Agee is hopeful the complexity will be lessened. Under the ACA, "the rollout of regulations…has been staggering," she says.

3. Renewed Emphasis on Consumer-driven Care

Nevertheless, Howell Agee says that Trump's apparent lack of tolerance for burdensome regulations and bureaucracy, seems to indicate that high deductible health plans (which are not directly affected by government regulation) will continue.

This would mean that hospitals and health systems would need to continue to develop their abilities to reach consumers directly and make their value cases convincing.

"It seems likely that consumer-oriented healthcare will accelerate," she says.

4. No Reduction in Coverage

Perhaps the biggest fear of hospital and health systems executives is that a Trump administration will roll back Medicaid expansion and perhaps dismantle the Obamacare exchanges, which were experiencing problems well before the election.

"I hope we don't take a step backwards [away from] the goal of coverage," says Freier.

Health system executives have a responsibility to help encourage better coverage so that bad debt levels don't strangle them financially. But the flip side of that equation is doing their part to keep healthcare affordable.

Freier says he's encouraged that a Trump administration seems interested in looking into the skyrocketing prices of some prescription drugs, which have also hurt hospitals.

Millions Could Lose Medicaid Coverage Under Trump Plan

Although Virginia has not expanded Medicaid, it's been a financial boon to hospitals in states that have. Agee agrees that maintaining coverage that an estimated 20 million Americans gained through the Affordable Care Act is essential for both hospitals and patients.

"The key construct of the ACA, [meaning] more insured Americans, is crucial if we are to continue on a pathway for a healthier America," she says.

5. Better and More-targeted Incentives for Top Performers

Freier says he hopes that in future reforms, lawmakers strive for both value and greater access and recognize the challenges providers are navigating in terms of trying to better coordinate care. Those who overcome those hurdles should be rewarded.

"We're already managing a fast pace of change in a short period of time," he says. "There's more that can be done to align incentives and appropriately reflect the risk of a given population."

John Phillips, president of Methodist Mansfield Medical Center, a 254-bed hospital in the nine-hospital, Dallas-based Methodist Health System, says rewarding hospitals and health systems that are demonstrating value is key.

"Continuing to reward those providers who are truly fostering patient centered care delivery, improved patient outcomes and a lower cost is the right direction for healthcare and those we serve," he says.

Moreover, Phillips says the dialog among healthcare providers about the direction of the industry has never been more robust and he offers a vision of unity of purpose regardless of the swift change in priorities that are likely to affect the industry in short order.

"Let's use this opportunity to find solutions for our staff, physicians and patients as opposed to letting any change pull us apart," he says.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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