Becker's Hospital Review

12 Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 payor leverage. Other key factors the CEOs were concerned about in the ACHE study included Medicaid reimbursement, decreased government funding, Medicare reimbursement, bad debt and decreasing inpatient volumes. (See chart below). Source: www.ache.org/pubs/research/ceoissues.cfm 6. Orthopedics In 2011, nearly 600,000 knee replacements were performed in the United States for a total cost of about $9 billion dollars. This statistic, while meaningless in itself, gives some sense of why so much effort is still placed on hospital alignment with orthopedic physicians and how important orthopedic dollars are to individual health and hospital systems. 7. Population health Increasingly, parties talk about population health, or the improvement of an entire population's health, as a potential answer and approach to healthcare. However, despite its potential benefits, it is hard to see how population health is likely to work in very fragmented, large communities because, in part, it may be difficult to coordinate such efforts and for systems to reap the benefits of investments in population health management. In contrast, where a hospital is the key provider in an area and there is not a lot of competition, it is easier to see the hospital system wholly engaging in population health. 8. Healthcare information technology Healthcare information technology is an area of great interest and one which has seen a great disparity between the amount of money put in and the general lack of results to-date. One constantly hears the refrain of decreased productivity in physicians, particularly for the first few years after electronic medical records are installed, as well as concerns with up-coding through the use of EMRs and concerns that the national labor force is not well-positioned to actually service and handle the growth of EMR technology. In addition, providers will increasingly be held hostage to one or two different systems that the major EMR companies offer, which may not be a positive development. For example, Paul Levy, former CEO of Beth Israel Deaconess Medical Center in Boston, cited the following from a Forbes report and provided comments in a recent blog post:8 Customers, such as New Hampshire's Dartmouth-Hitchcock Medical Center, are feeling the pinch. DHMC, which implemented Epic last year at a cost of $80 million, expects a weak operating performance in 2012, partly because of expenses related to Epic. Now, re-read the definition of the Stockholm syndrome and see if it isn't apt. But it doesn't have to be this way, as I have noted in quoting an article by Kenneth Mandl and Zak Kohane in the New England Journal of Medicine: It is a widely accepted myth that medicine requires complex, highly specialized information-technology ystems. This myth continues to justify soaring IT costs, burdensome physician workloads and stagnation in innovation — while doctors become increasingly bound to documentation and communication products that are functionally decades behind those they use in their "civilian" life. We believe that EHR vendors propagate the myth that health IT is qualitatively different from industrial and consumer products in order to protect their prices and market share and block new entrants. In reality, diverse functionality needn't reside within single EHR systems, and there's a clear path toward better, safer, cheaper, and nimbler tools for managing health care's complex tasks. The burden that EMRs impose can be significant. In the opinion of one physician quoted in a Wall Street Journal article,9 "Tasks that once took seconds to perform on paper now require multistepped points and clicks through a maze of menus. Checking patients into the office is an odyssey involving scanners and the collection of demographic data — their race, their preferred language and so much more — required by Medicare to prove that we are achieving 'meaningful use' of our EMR. What 'meaningful use' means no one knows for sure, but our manual on how to achieve it is 150 pages long." n  References: (Endnotes) 1 erritt Hawkins Inpatient/Outpatient Revenue Salary 2010 report. M 2 Lowry, A. & Pear, R. "Doctor Shortage Likely to Worsen with Health Law," The New York Times, July 28, 2012; see also Sataline, S. & Wang, S. "Medical Schools Can't Keep Up," Wall Street Journal, April 12, 2012. 3 andry, R. & Yarbrough Landry, A. "Factors Associated with Hospital BankruptL cies: A Political and Economic Framework," Journal of Healthcare Management, July/ August 2009. 4 Wilde Mathews, A. "Can Accountable-Care Organizations Improve Health Care While Reducing Costs?" Wall Street Journal, January 23, 2012. 5 loyd, J. "Doctor Burnout: Nearly Half of Physicians Report Symptoms," USA L Today, August 21, 2012. 6 cheinbaum, C. "The Many Dangers Posed by Burned-Out Doctors," Businessweek, S August 22, 2012. 7 ang, S. "Rise in Knee Replacements Boosts Federal Health Costs," Wall Street W Journal, September 26, 2012. 8 evy, P. "The Stockholm Syndrome and EMRs," Not Running a Hospital Blog, OcL tober 17, 2012. 9 alinoti, A. "Physician, Steel Thyself for Electronic Records," Wall Street Journal, V October 22, 2012. REGISTER TODAY! Becker's Hospital Review Annual Meeting CEO Strategy, ACOs, Physician-Hospital Integration, Improving Profits and Key Specialties Co-Chaired by Chuck Lauer and Scott Becker May 9-11, 2013; Chicago Westin Michigan Avenue, Chicago For more information and to register, visit: www.beckershospitalreview.com/4th-annualbeckers-hospital-review-meeting.html

• Cover