NAPH's Siegel to Take Charge of 'Safety Net' Hospitals

I reached Bruce Siegel, MD, MPH, on his cell phone as he walked in Washington D.C., and in our 20-minute conversation, we probably used the term "safety net" more than any other, referring to the far-reaching oversight of the National Association of Public Hospitals and Health Systems where he is incoming CEO.

Oh, those safety nets, tattered and torn: amidst economic recession, budget cutbacks, and many more patients in need. Dr. Siegel, are the nets going to hold?

Well, maybe. Surely if Siegel has his way, the safety nets will definitely hold, and become stronger, but there is a long journey ahead and he's just beginning. He is soon to become head of the group that represents 140 metropolitan hospitals and health systems under the NAPH umbrella, which provides "high volumes of care to low income people, the uninsured, the underserved, regardless of ability to pay." In taking his new position in October, Siegel will become the first African-American to lead a major hospital association and, in his words, be a "tireless advocate" for safety net hospitals.

Siegel comes to NAPH from George Washington University School of Public Health and Health Services, where he served as director of the Center for Health Care Quality and as professor of health policy at the George Washington University School of Public Health and Health Services.

"It's exciting and it's a little intimidating," Siegel told the GW Hatchet, the campus paper. "The only thing I can say is I'm going to do the very best job and I'm going to do it for the patients.

Siegel says one of the biggest tasks he faces is the challenge imposed by the upcoming 23 million Americans who potentially may join the health insurance rolls in the wake of healthcare reform. While expanding health insurance is terrific, the access won't be enough, he says. Unless there are available doctors for them in the community, Siegel says, noting the lack of primary care physicians, for instance, it's not going to mean much.

 "We have to do a lot more than just give people an insurance card," he says.  Look at Massachusetts; "a card isn't enough," he adds.

The strain on the safety net could become overwhelming, he acknowledges, with thousands more turning to emergency departments, and the lack of primary care physicians. For many of the poor, and currently uninsured, they see their main option for care as the ED, Siegel says. "They either don't know about the alternative, or the alternative isn't there," he says, referring to a family physician, for instance.

 Educating patients is extremely important, and will become an essential part of the evolving NAPH framework, he says, especially for those patients who speak little English or have English as a second language.

"We have a small window to get ourselves ready," he says referring to the potential influx of the uninsured into the healthcare system. "We have insured who have chronic diseases, and (healthcare) systems are fragmented, and overwhelmed."

Siegel is a polite, dignified man with a gentle demeanor. But as he says, one of his biggest roles will be that of lobbyist for the hospitals.  The need is dire.

According to an August NAPH report, "Safety Net Health Systems: An Essential Resource During the Economic Recession," member hospitals have reported a 17% increased in uncompensated care costs, on an average member basis, compared to the beginning of the recession, averaging more than $4.6 million per member, with some incurring more than $30 million in additional costs. These health systems also have treated up to 15% more uninsured and Medicaid payments at a time when states are facing large budget shortfalls. An addition 23% more uninsured patients have been treated under the "safety net" since the beginning of the recession, the report states.

"America's public hospitals are in a precarious situation and Medicaid cuts at the state level will hinder their ability to continue serving as our nation's health care safety net, the impact will weaken the fragile viability of the nation's safety net and force public hospitals to close their doors due to inadequate financing," Larry S. Gage, the NAPH President, has stated."

Siegel is joining the association, says Gage, with a certain degree of understatement, at a "very challenging period."

Last month, the Wall Street Journal reported that public hospitals owned by the government are "drowning in debt caused by rising health-care costs, a spike in uninsured patients, cuts in Medicare and Medicaid and payments on construction bonds sold in fatter times."

Siegel is no stranger to the healthcare maladies facing urban areas, in particular. Siegel had been president and CEO of two different NAPH members: Tampa General Healthcare and the New York City Health and Hospitals Corp. He was also a health commissioner in New Jersey.

Siegel isn't afraid to cause a stir, either. As the GW paper noted, the university's Department of Health Policy under Siegel's leadership "made waves in the healthcare community with its research on minority health care and the reaction of a public rating system of healthcare providers.

"The biggest contribution we've made to research is that we've shown that hospitals and doctors who treat large numbers of minority Americans can really improve the quality of care they provide," he told the campus paper.

Siegel will be applying that social consciousness as he evaluates medical home programs, electronic record innovations, and other "best practices," he says, to improve the standing of the public hospitals.

"A big part of my job will be getting to the policy makers on the Hill, and the executive branch.  I have a story to tell."  As for being an African-American, "others can decide if that adds to my story or not," Siegel says, quickly adding that civil rights issues are often woven into healthcare issues.

Once he assumes his new post, Siegel won't be walking around Washington D.C., though. "I'll be traveling around the country, telling the story how critical it is to support (public hospitals) and millions of people are dependent on them every day."

 "Health reform may have passed, but our work is just beginning," he says.