Becker's Spine Review

22 22 HEALTHCARE NEWS Health systems turn to buyouts By Kelly Gooch H ospitals and health systems are implementing various strategies as they look to drive efficiency and plan for short-term and long-term growth. One strategy seen at several systems in recent months: offering buyouts and voluntary separation to workers. There are a number of factors contributing to the strategy. Organizations are looking to cut costs to shore up their finances and looking to meet evolving technology and workforce needs. Urbana, Ill.-based Carle Health initiated a voluntary separation program for some employees earlier in November, citing a need to reduce expenses in the long term. The program is "a mutually beneficial program used to support long-term cost reduction while supporting non-patient care team members interested in leaving the organization with financial support," health system spokesperson Brittany Simon told Becker's. It is not available to employees who work in direct patient care areas. Ms. Simon said the program will not affect the scope and quality of care provided at the health system. She attributed the decision to ongoing financial challenges in healthcare. Hospitals and health systems have seen some improvements in terms of finances. For the first three quarters of the year, hospital operating margins were up 19% compared to the same period last year, according to Kaufman Hall's October "National Hospital Flash Report." Net operating revenue per calendar day was up 6% and inpatient revenue was up 3%. Still, compared to 2020, year-to-date operating margins in September were down 2%. Coral Gables, Fla.-based Baptist Health cited its financial picture when it announced this summer that it would offer its executives at the director level and above an opportunity to apply for voluntary separation. Bo Boulenger, the health system's president and CEO, told staff: "With financial headwinds stemming from rising costs, decreased reimbursement, staffing shortages and other industry factors, we must continue to focus on being a more efficient organization." Buyouts and voluntary separation have also made it to the digital side. Somerville, Mass.-based Mass General Brigham announced in November that it is offering employees in its technology division buyouts. The health system said the buyouts are to trim its workforce in today's changing healthcare environment. "As care delivery changes, whether in a hospital or clinic setting or delivered remotely through in-person or virtual appointments, the tools and technology used to reach patients and support our mission also continues to evolve," Mass General Brigham told the Boston Herald. "As a result of these changes, we have undertaken a comprehensive review of our digital team … to better align our workforce resources and skills with our organizational needs and those of the communities we serve." Digital staff members have until Nov. 15 to apply. Mass General Brigham will disclose how many workers accepted buyouts on Nov. 22. n managing it is difficult. Neither employers nor employees can reliably learn which physicians are low- or high-performing without provider-level quality data. "Even though employers do not oen interface directly with health care providers, employers can shi their health plans toward accountable care models, where physicians manage cost and quality across the spectrum of care delivered to their patient panels," JP Morgan wrote in its analysis. "Within these arrangements, provider quality data can be leveraged to both improve a provider's own clinical practices and to facilitate high- quality specialty referrals." If employers and payers lean more heavily on providers to demonstrate appropriate, high- quality care, it will have been a long time coming. While "value-based care" has been in the zeitgeist for years, fewer employers by name have publicly stepped up to command greater control over the cost and quality of care. is pursuit may have been the stuff of closed-door rate negotiations or health plan network design. But in a time when employers are miscalculating union tactics and demands while seeking stabilized talent, it would make sense if large corporations looked outward and turned up the heat as healthcare purchasers. Walmart is one of the few and early major employers to recognize and act on the variation it experienced in employee healthcare. Aer establishing its Centers of Excellence program in 2013, in which it partners with vetted health systems for defined episodes of care, the retail giant learned of the complete lapses in quality that employees had previously received from healthcare providers that Walmart did not vet or approve. Lisa Woods, vice president of physical and emotional wellbeing with Walmart, said in 2019 that 10% of employees who received a cancer evaluation at Mayo Clinic in Rochester, Minn., learned that they, in fact, do not have cancer. ey receive a different diagnosis entirely; 55 percent receive a different treatment plan. Some Walmart associates learned that their cancer diagnoses were based on biopsies that were never completed at their local hospitals or medical groups. Another 54 percent of Walmart associates were told they need spine surgery locally, only to visit a COE to learn they could avoid surgery in their treatment. Ms. Woods said pre-pandemic that the deficiencies and variation in care — from misdiagnoses to inappropriate care — are not limited to one region. "Unfortunately, it is all over the country. It's everywhere," she said. n

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