Becker's Hospital Review

Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 viders who can treat patients in their new health plans. Will these narrow networks include safety nets? The jury is still out, judging from insight from a couple of different experts on the payer and provider sides. An executive vice president with Blue Shield of California told The New York Times the payer would tailor networks to avoid providers in more affluent areas. "Not many folks who are uninsured or near the poverty line live in wealthy communities like Beverly Hills," Juan Carlos Davila said in the report. This frame of mind points toward safety-net hospitals as the more efficient option, but Bruce Siegel, MD, president of America's Essential Hospitals — formerly the National Association of Public Hospitals and Health Systems — said this isn't exactly the case. Insurers have told AEH's member hospitals that they are not preferred providers because their patients are sicker and have complicated conditions, and Dr. Siegel said some health plans will "cover only selected services at our hospitals, like trauma care, or they offer rock-bottom rates," according to the The New York Times report. Along with uncertainty around their patient volumes and reimbursement levels from health exchange products, safety-nets in states that did 11 not expand Medicaid — such as Grady — are facing another budget pressure: cuts to the Medicaid Disproportionate Share Hospital program. in fiscal year 2010. Mr. Haupert says he's seeing safety-nets subtly take on a different mission today compared to years past. Safety-net hospitals were expected to need less money from the Medicaid DSH program under PPACA since the law was expected to dramatically expand insurance coverage. To lessen the cost of Medicaid expansions, the PPACA reduced Medicaid DSH funding by $18.1 billion between fiscal years 2014 and 2020. To allow time for coverage expansion to take effect, the cuts are back-loaded. They start at $500 million, or 4 percent of current national DSH spending, in 2014 and will reach $5.6 billion, 49 percent of current spending, in 2019. "Twenty years ago, a safety-net was almost entirely focusing its energy and efforts on how to provide the most care to the most people that fit the definition of 'poor,'" he says. "I think every safety-net now is looking at how it continues to fund that mission." Grady expects to lose about $45 million in DSH funding by 2018, which would have been offset by the Medicaid expansion had the state taken a different route. Mr. Haupert has previously said he doesn't see the loss as a death knell, but it will affect the profit Grady has managed to turn. What does the jump from safety-net to provider of choice look like? Mr. Haupert has a rich background in safety-net healthcare. Before he came to Grady in October 2011, he served as COO with Parkland Health and Hospital System in Dallas, which provided roughly $600 million in uncompensated care Mr. Belokrinitsky from Booz & Company says many safety-nets may have to expand their reach to new neighborhoods and strengthen their capabilities for certain specialties and services. Grady is doing just that. The system has created clinical service lines, such as a stroke center, burn care and a cardiac clinic, that help differentiate it from other providers in its market. "We become one of the providers of choice for those things, so we attract stronger payer mix," says Mr. Haupert. "But we're clear: The goal is not to abandon the mission but fund the mission." The system has also intensified its focus on primary care and patient access. It has six neighborhood health centers in the two-county area it serves, all of which have been designated as level three patient-centered medical homes. On its main campus, Grady has specialty clinics to which the neighborhood clinics refer. Poor physician satisfaction keeping you up? For more than three decades, The Greeley Company has worked closely with physicians and hospitals, helping them to successfully reevaluate and restructure their relationships. The result is a level of trust that enhances physician leadership, physician satisfaction and physician-hospital relations, and delivers a better night's sleep for all concerned. So don't let poor physician satisfaction keep you awake at night. Call the Greeley Company today at 888-749-3054, and rest easy. Physician-Hospital Alignment I Medical Staff Operations l Education Clinical Process Improvement l Regulatory Compliance l Accreditation The Greeley Company | Bring us your biggest challenge.

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