Becker's Hospital Review

16 16 THOUGHT LEADERSHIP Care, staff, value-based models: 5 leaders on priorities in 2024 By Mariah Taylor and Ashleigh Hollowell H ospital leaders across the country are gearing up to find new ways to tackle persistent issues like nurse retention and recruitment, how to navigate Medicare Advantage plan nuances, preparing to respond when communities are in crisis, standardizing and developing policies and more. Here are the priorities of five healthcare leaders as they head into 2024: Anthony Aquilina, DO. Executive Vice President and Chief Physician Executive at WellSpan Health (York, Pa.): is year we are continuing to understand how we best manage in a value-based world, especially when the government payer sector is growing. We believe that we can succeed in a value-based world, but need value-based reimbursement models. With the significant challenges right now with Medicare Advantage plans, we are working to better understand how we are going to participate in the process and get closer to the premium dollar. Jill Kalman, MD. Executive Vice President, Chief Medical Officer and Physician-in-Chief at Northwell Health (New York City): One of the challenges that we've been focusing on for years is delivering care in our communities. We have an entire group focused on community and population health that partners with our community — schools, faith- based leaders, and more — to learn what their needs are rather than thinking we know what they need. We look at food insecurity, housing, transportation and everything that touches access to healthcare. We then pair that with the enormous public health crises in our communities, for example, behavioral health crises for adults and adolescents. What are we not doing that we need to do? How do we partner with those communities to find what assistance they need? We take that on as these public health crises also define health. Part of the way we identify these crises is using high level data like sophisticated ZIP code analysis. We view our patients and communities as the whole person from poverty level, transportation needs, health needs, food needs, and further connect with these communities through technology. Vikram Kashyap, MD. Vice President of Cardiovascular Health at Corewell Health (Grand Rapids, Mich.): I think we have to be very cognizant of keeping our teams engaged, being responsive to their needs, being proactive, and making sure that well-being and life balance are top priorities — and not just saying that but promoting mechanisms to ensure that that happens. We are tackling staff needs in three ways. First, is an educational grant for our staff members so they can enhance their skills and bring that back to the bedside. We are also offering our young faculty, within five years of their training, an Innovations grant to travel to other sites and learn an innovative technique. We found a tremendous amount of professional growth and pride as a result of these grants, not just from the young faculty, but from their mentors and others supporting them. Lastly, we had a recognition ceremony celebrating some of our most loyal workers that have been continuously working for 30, 35, 40 years or more at our institution. Also, we celebrated a few physicians as our 2023 master clinicians. And another dozen or so non-physicians were selected as heroes of our institute — providing exemplary care to patients in a compassionate manner. Stacy Bentil, DNP, RN. Director of Nursing Services at a Connecticut-based health system: If we focus on just the nursing practice part of the healthcare sector, a major challenge is of course the Hospitals won't see a 'V-shaped recovery' By Alan Condon H ospitals are starting to dig themselves out of a formidable operating trench, but results for the sector still lag far behind pre-pandemic levels, according to Fitch Ratings. However, median operating margins will gradually improve, while a larger expense base is unlikely to see huge gains over the next two years, Fitch said. This year "will not be markedly and certainly not the V-shaped recovery we're hoping for," Kevin Holloran, senior director and sector head at Fitch, said in a Jan. 4 news release. "Nonprofit hospital margins are still below both pre-pandemic levels, but more importantly they will tread below the 'magic number' operating margin of 3%." Nonprofit hospitals continue to battle the "labordemic" with widespread staff shortages, intense wage pressure and heightened inflation. Fitch projects a "trifurcation" of credit quality emerging from these struggles that will become more prominent this year. This translates to a larger risk of downgrades for hospitals already struggling to return to a degree of pre-pandemic normalcy, and follows a 2023 that saw a 3:1 ratio of hospital downgrades to upgrades, according to Fitch. The report noted recent downgrades among hospitals and health systems of smaller size and scale and described Washington and Pennsylvania as challenging states in which to operate. "IT implementation issues, significant capital spending and aggressive expansion initiatives that simply did not work out as intended will further cloud outlooks for smaller hospitals and some providers in Washington and Pennsylvania," Mr. Holloran said. Fitch also raised concern about a "dreaded" second year of debt service covenant violations, which "may intensify the potential for bondholders to declare an event of default and perhaps accelerate bond repayment," according to Mr. Holloran. n

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