Becker's Hospital Review

28 Sign up for the COMPLIMENTARY Becker's Hospital Review CEO Report & CFO Report E-Weeklies at www.BeckersHospitalReview.com or call (800) 417-2035 Q: 2014 is a big year for Obamacare. The individual mandate will go into effect and in order to help individuals obtain coverage, insurance coverage from the marketplaces will take effect, and, in some states, Medicaid coverage will expand. What do these three major changes mean for hospitals? What should hospitals be doing now to ensure they are ready for these changes? RU: Well certainly we understand our role and want to play a prominent role in helping identify those who can benefit from the new coverage, help inform them what's available, and what their options are, and help them get enrolled. Every day, even prior to this new coverage, hospitals have played this role as people have presented for service and talked with our financial departments about what sources of payment might be available. We've also got to continue to focus on improvement in quality and safety and decreases in cost. I think we're seeing significant improvements in quality and safety. Infection rates are coming down, readmissions rates are coming down, early elective deliveries are being eliminated and all of that is starting to show up also on the cost side. I think we're making a significant "There's an awful lot of reform going on in the private sector absent the ACA." contribution to the rate of reduction in the annual increase in healthcare costs, so that's going to continue. One would expect plans in the exchanges to drive a pretty hard bargain in terms of being part of the delivery network in those plans, so, again, you want your quality high and your costs as low as possible. As a result, we have to continue to work on the value equation. And then lastly we really need to continue the efforts that are underway at the community level to connect the various sites and levels of care to more of a coordinated system, whether that's done virtually or whether that's done in a controlled or owned system sense. One of our biggest challenges is to get the freedom to make those changes, particularly on the integration side. There remain a lot of laws and regulations, Stark provisions, civil monetary penalty provisions, antitrust provisions and so on that make it very difficult to integrate the system. We understand why those things were put in under a fee-for-service system, but if we're going to get to a coordinated system of care, and one where providers and practitioners are going to be incented to work more closely together, we have got to rethink those barriers. That's a significant area that we've tried to work on for years, and we're just going to have to keep trying. I'm amazed every day at how well members are adjusting and how hard they're working and the successes they're making but I know they feel incredibly challenged to get this work done and they do fear a significant rise in demand come Jan. 1st or next year, but they're working hard to make sure they're in the best position to manage that on the behalf of the patients and community. n

• Cover