Portneuf Medical Center and Legacy Hospital Partners, Inc. announced the appointment of Norman F. Stephens as the new CEO of PMC effective June 1. Stephens comes to Pocatello from Palmer, Alaska, where he has served as CEO of Mat-Su Regional Medical Center since 2004. Prior to his time in Alaska, Stephens was CEO at Pampa Regional Medical Center in Pampa, TX, and CEO of the Rehabilitation Hospital in the Lutheran Health Network in Fort Wayne, IN. Stephens' experience also includes multiple executive positions with Continental Medical Systems in Las Vegas, and Fresno, CA.
Gay Nord has been appointed CEO of Overland Park Regional Medical Center, effective June 1. Since 2004, Nord has served as the chief of HCA Kingwood Medical Center, a 211-bed hospital in Houston.
Edward Downs has been named CEO of Renaissance Hospital Dallas. Downs comes to RHS Dallas from LifeCare Hospital of Dallas. Before becoming a hospital executive, Downs was president of an e-Healthcare Consulting firm focused on regulatory inspections and start-ups.
Providence Health & Services has appointed Deborah Burton, PhD, RN, CNAA, as vice president and CNO. Burton, who has been with Providence since 2004, is the first CNO for Providence's System Office and will be based in Renton, WA.
Are we riding the next wave of consolidation? Most likely we are on the cusp, according to Kathleen Henchey, principal at Noblis Center for Health Innovation, a nonprofit consulting firm. The economy is stalled, reform is already happening, and one thing we know for sure is that reimbursement is heading south. These three factors create fertile ground for consolidation. And, with bundled payments a possibility, "it is like back to the future again with capitation," says Henchey. "This is what drove the last wave of mergers back in the 90s."
Henchey says Noblis is seeing increased interest in affiliations, so much so it decided to survey its current customers last month. The Noblis survey of 84 healthcare leaders at provider organizations found that nearly one-third of hospitals were "much more interested" in doing some type of affiliation than they were a year ago. The survey also showed that those most interested in an affiliation with another organization were either already in some type of partnership or had poor operating margins.
Henchey says she's surprised to see the increased interest in affiliation compared to a year ago. "It was significant to us because affiliation can be a last resort for some organizations."
At the same time, the Noblis survey found that 71% of organizations with an existing affiliation had better than break-even operating margins compared to only 43% of those with no affiliations at all. "You can probably make the case that affiliation actually is achieving what it is supposed to do, which is economies of scale and reducing fixed costs," she says.
While affiliation can range from anywhere from a joint purchasing alliance to a full merger, Henchey says she is seeing more mergers than in recent years and attributes this mainly to the struggling economy. "There is a growing sense for many that we can't go it alone anymore. We are getting more requests to do board education sessions on what it means to affiliate," she notes.
There is also more interest in clinical affiliations. Moreover, Henchey says, physicians are playing a larger role in affiliations today than in the past.
"One of the drivers of affiliation that is different this time around is the sense of affiliating to get physicians on board." With organizations having trouble recruiting docs and shortages predicted in the future, Henchey notes that Noblis is doing a lot of physician strategy work. Similarly, the HealthLeaders Media annual survey of hospital executives shows that the physician shortage is one of the top three trends that will strongly negatively impact their organization in the next three years.
Lessons learned from the past: As we look at the possibility of increased consolidations and affiliations, organizations should heed lessons from the past. Namely, just because market conditions are pushing organizations to come together doesn't mean the leadership or cultural problems that torpedoed affiliations in the past aren't just as important today.
Do you really have a compelling case for change? The pressure to affiliate has been turned on, but that doesn't make it right for your organization if resistance is high. "You need the organizational will to make it happen and that is usually more of a stumbling block than figuring out whether it is a good idea or not," says Henchey.
Know what you are willing to give up. In some cases you might have to give up relationships with vendors or other parties if you form an affiliation with another hospital. "That is one of the things to think through," says Henchey. "If I affiliate with this organization what does it mean for my partnership with this other group?"
Be honest about your cultural readiness. "It can't just come from the C-suite or the board," says Henchey. Even when there is a rational case for affiliation, it doesn't mean there will be a cultural fit if two organizations come together.
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With less access to the debt capital markets, more hospitals and health systems are looking for capital in medical office building real estate, says Tim Schier of Cain Brothers.
In light of growing shortages of primary care physicians across the country, the role of community-based nurses needs to be reexamined during the healthcare reform debate, according to an American Academy of Nursing (AAN) group.
Without changes soon, various areas could experience "Massachusetts-style growing pains," in which consumers have difficulties finding primary care physicians when they seek medical services, said Donna Shalala, the former Health and Human Services secretary, who spoke Friday as part of AAN's "Raise the Voice" campaign that she chairs.
This shortage of physicians is likely to escalate—possibly resulting in a shortage of 44,000 physicians by 2025—in the areas of general internal medicine and family medicine, said Tine Hansen-Turton, JD, who is CEO of the National Nursing Centers Consortium in Philadelphia.
At the same time, 80,000 (out of about 145,000) nurse practitioners are providing primary care—becoming one of the fastest growing groups of primary care professionals nationwide, Hansen-Turton said. Now may be the time to "think outside the box" and increase reliance on non-physician groups such as nurse practitioners and physician assistants, and expand to nontraditional settings such as nurse-managed health centers and convenient care clinics.
The nurse managed health center could be a solution, for instance, for primary and preventive care in areas serving low income and vulnerable populations, said Hansen-Turton. Currently, more than 250 of these community-based centers exist throughout the country in various urban, rural, and suburban locations—but their "true potential" remains untapped, she added.
Most of these centers are either independent nonprofits or academically based clinics, Hansen-Turton said. The centers, which last year recorded 2.5 million patient visits, generally are staffed by nursing practitioners, clinical nurse specialists, registered nurses, healthcare students, and collaborating physicians.
In Pennsylvania, nonphysician healthcare models were established about two years ago. The state's governor, Edward Rendell (D), said that the project, called "Prescription for Pennsylvania," has been able to help patients with chronic care problems receive treatment and assist them through a patient-centered medical home model.
While increasing access to health insurance will help improve access to healthcare, more recognition is needed of nurse practitioners' roles in providing primary care and expanding access, according to Shalala, who is currently president of the University of Miami. Keeping this in mind, nurses "need a seat at the table" during the current healthcare reform debates and more federal attention in terms of funding for the health centers.
Most families who aren't covered under an employer-based health plan can't afford to buy health insurance on their own, a new study by HHS' Agency for Healthcare Research and Quality shows.
The study, Wealth, Income, and The Affordability of Health Insurance, published in the May/June 2009 issue of Health Affairs, shows that measuring families' median net worth—the value of their savings, plus other assets, minus debt, rather than just income—provides more precise estimates of the percentage who could purchase policies if they chose to do so. Until now, most studies have used income alone to estimate how many more Americans could be covered by health insurance.
The study challenges the contention that the 23.8 million uninsured Americans under age 65 who don't have an employer-based health plan but have incomes above the federal poverty line can afford insurance but choose not to purchase it.
"This study has important implications for defining who can afford to pay for health insurance in the next wave of healthcare reform," says AHRQ Director Carolyn M. Clancy, MD. "We need accurate, evidence-based findings to ensure that we are providing policymakers with reliable information."
The survey found that the median net worth of families who purchased health insurance was $105,819—nearly 35 times greater than the median net worth of only $3,057 for families who were uninsured. Median net worth means that half the families had net worth above or below that amount. In contrast, the median income of families who purchased health insurance was $41,086—only 2.3 times greater than the median income of $17,690 for families who were uninsured.
Using 2002 and 2003 data from AHRQ's Medical Expenditure Panel Survey, the survey also found that 4.1% of families with access to employer-based health insurance were poor (family income below 100% of the federal poverty line) and 11.1% were low income (family income 100-199% of the federal poverty line). Among families without access to employer-based health insurance, 33.8% were poor and 28.4% were low income.
Didem Bernard, an AHRQ economist, says the model based on income alone works for estimating who will enroll in employer-based health insurance. It does not work well for who will purchase non-group coverage, however, because it overestimates health insurance enrollment for people with low net worth and underestimates for people with high net worth.
Leading groups in the healthcare industry have offered to squeeze $2 trillion in savings from projected increases over the next decade, White House officials announced. The pledge comes amid a debate over how to overhaul the nation's healthcare system, and Obama administration officials predicted that it will significantly increase momentum for passing such changes this year. The groups aim to achieve the proposed savings by using new efficiencies to trim the rise in healthcare costs by 1.5% a year, the officials said.
The recession has barely slowed the growth of concierge medical practices, which charge hefty membership fees for highly personalized care and around-the-clock access. Across the country, physicians with boutique practices say they are losing far fewer patients for financial reasons than they had expected. While some new practices are not filling as quickly as they might, they continue to attract a steady flow of patients willing to pay thousands of dollars for the privilege.
