Becker's Hospital Review

18 THOUGHT LEADERSHIP Q: What is the biggest challenge on the horizon for Northwell? MD: e biggest challenge is the huge growth in government payer business — Medicare and Medicaid. e problem with Medicaid — especially in a union environment — is it doesn't cover your costs. e government is a big part of a potential future issue there. By increasing Medicaid, the more of your business becomes Medicaid and the worse you end up doing, unless you can increase your commercial payer business to continue to cross-subsidize. We also have a lot of union negotiations over the next couple of months, which will put a strain on our 2023 budget, but we will resolve it. Q: How do you see hospitals and health systems evolving as CMS, commercial payers and patients continue to push more services to outpatient settings, where they can arguably be performed at a higher quality and lower cost? MD: I think it's going to continue to grow. For example, Northwell has 23 hospitals — 21 of which it owns — yet it has 890 outpatient facilities. We've been ahead of this curve a long time. Our primary expansion is in ambulatory care, not in-hospital care. Like I said, only 46 percent of Northwell's total business is its hospital business. If you're relying on the hospital to be the core provider of the future, you're going to lose. You've got to take a little bit of a hit by going out and expanding your ambulatory presence. But the more you expand ambulatory and grow in the right locations, the more you increase market share, which brings more of the necessary inpatient care back to your hospitals. Our hospitals are growing and getting busier in addition to our outpatient centers because we are growing market share. If we enter a new community and see 100 people, five of them will need to be hospitalized. at's a new market. Ambulatory cannot be disassociated from its connection to the inpatient market. Q: Many financial experts are projecting a recession in 2023. How might that affect hospitals and health systems, and how can they best prepare? MD: Even if we do have a recession, it doesn't mean that people don't get sick. In fact, people's problems increase. Our business does not slow down if we have a recession; our business will probably increase. On the revenue side, it won't necessarily affect our government reimbursement, which we don't do well on anyway. e things you worry about during a recession is if employers give up the coverage of their staff. en those employees with no insurance may go on a state Medicaid program, and that might affect hospitals. In the healthcare sector, even in a recession, the need for hospital services actually increases. No recession could be as bad as what we experienced during COVID, yet we managed it. We had a problem that we didn't even understand, and we worked through it. I think healthcare deserves an extraordinary credit for what was done during COVID. If there is a recession, we will deal with it. It's just one of those things that happens, and we will respond to it in as comprehensive a way as we can. I can't control it, but I can control our response. Leadership to me is about having a positive disposition; basically saying that whatever happens to you, you're going to win. n 2,500+ attendees 4 days of sessions 218+ elite hospital and health system speakers October 3-6, 2023 Navy Pier // Chicago, Illinois 8TH ANNUAL HEALTH IT + DIGITAL HEALTH + RCM ANNUAL MEETING The Future of Business and Clinical Technologies BECKER'S HOSPITAL REVIEW

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