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 27 Year of Healthcare Reform Rich Umbdenstock everybody and you have to change the delivery system and drive a lot of that through the payment system changes. The bill did a lot of other things that we thought were important. One of which was to move, at least temporarily, Medicaid payment rates for primary care physicians to Medicare payment levels. That was important. Comparative effectiveness research we thought was very important. We also supported the bill's emphasis on wellness and prevention. Q: President Obama campaigned with the intent to introduce healthcare reform legislation. After he was elected, when or how did the AHA first begin to develop its response to these efforts? RU: We started actually in 2006 because we assumed healthcare reform would be a major debate topic in the presidential election, just given the pressures around cost and some of the need for reform in the system. So, we started building a reform framework at our January 2006 board retreat so that we'd be ready post-election. It became our mantra that healthcare reform needed to be comprehensive and balanced. We identified five areas where reform should focus. Addressing any one of which would be insufficient to truly reform the system. We felt that everybody really needed to participate from their respective position in the system in order for reform to truly work. It couldn't all RU:  Certainly the coverage expansion, and that potential was tops. We were pleased to see significant insurance reforms in there. We were supportive of delivery system reforms and the willingness to experiment or do demonstration projects around things like accountable care organizations, bundling, medical homes, gainsharing and so on. "If it's all cuts and no expansion of coverage, that's the worst possible outcome for hospitals." be on the backs of hospitals and physicians. Individuals were going to have to make changes, purchasers were going to have to make changes and the government should make a lot of changes to help improve the system. So those were our original goals, but first and foremost definitely a focus on coverage. Q: When the Act was passed and signed into law in 2010, what was the AHA most excited about? Most worried about? I think it's also telling those delivery system payment reforms were done on a test basis because nobody really knew at the time, and I would argue today we're still not sure, exactly the form of payment system and form of performance incentives we want going forward, or more practically how to get from the fee-for-service system to a new payment system. So we were very much supportive of those delivery system experiments and demonstrations. We were also very pleased that certain things didn't happen in the bill. We were supportive of the fact that there was no public option, and that as these exchanges or marketplaces roll out, providers will have the opportunity to negotiate those payment rates. [We were pleased] those payments weren't set at the low levels Medicare and Medicaid currently pay providers. We were also cognizant that not everybody got everything they wanted. We had a much more explicit connection between the payment reductions and the coverage ramp-ups in the original agreement we had with the Senate finance committee. But, that explicit connection went away during the rewrites of the bill, and today we find ourselves with this uncertainty about coverage as the cuts keep rolling. Since then we've had to make a lot of adjustments. There have been other cuts that have occurred on top of this, so that's made life both difficult and disappointing in many ways, people have tried to put hospitals into the Independent Payment Advisory Board structure, for example, after we already agreed to payment reductions, so there have been a lot of bumps along the road.  

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