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 and monitor the impact of those treatments without being in an acute setting like a hospital," he says. Siva Subramanian, PhD, founder and COO of CareInSync, a mobile care collaboration platform for coordinating evidence-based patient care across care teams, says he envisions the hospital of the future as "hyperconnected" in being completely mobile and virtual. That doesn't necessarily mean the patient will receive care in a home setting from clinicians at a hospital, though. He says providers will often be the ones working remotely. "As inpatient care becomes increasingly complex, providers will become even more specialized, meaning more disciplines involved in the care of the patient in conjunction with more challenging care coordination needs," Dr. Subramanian says. "In the hospital of the future, we're going to see this reversal of telehealth, where the patient is immersed in a virtual world and has a care team virtually connected surrounding that individual at whatever location and time." What we know as telehealth today will also likely expand in the future, according to Ms. Empson. She says providers will work to meet the need to reach broader communities with their best clinicians, and the solution will involve virtual communication. "The best way, in many cases, to do that is through technology and through telemedicine," she says. Conclusion Whatever the hospital of 2035 ends up looking like, it will surely be drastically different from what we have today, Dr. Morris says. And the changes we can't foresee might have the biggest impact. "When I was growing up in the '60s, I figured by now I'd have a flying car," says Dr. Morris. "I don't, but, on the other hand, some things I would have never expected are commonplace today. It's the disruptive technologies we can't predict that will probably make the biggest change to healthcare." n MORE ONLINE: Want more information on the future of healthcare? See the following articles available at www.BeckersHospitalReview.com: n Hospitals of Tomorrow: 10 Characteristics for Future Success (November, 2013) n Remember When it Was Called a "Hospital System"? (October, 2013) n The Acute-Care Continuum: The Future of Hospital-Based Care (June, 2013) Staying Strong Under Pressure: Nonprofit Hospitals Discuss the Year Ahead (continued from page 1) reimbursement cuts under the Patient Protection and Affordable Care Act along with other payment reduction measures such as sequestration. On top of all that, CHI isn't sure how the health insurance exchanges established under the reform law will play out and what they will mean for the system. "There's a lot of mist and fog out there," Mr. Rowan says. CHI isn't the only one sizing up these concerns and challenges. Across the nation, nonprofit hospitals and health systems face mounting financial pressures including pay cuts and uncertainty about the effect of healthcare market reforms. In the third quarter of 2013, Moody's Investors Service downgraded 10 nonprofit hospitals and health systems compared with eight upgrades, illustrating a trend of weakening nonprofit hospital credit profiles. Reduced patient volumes due to a shift toward observation stays and the rise of high-deductible health plans and a corresponding increase in bad debt have strained nonprofits' finances. The forecast for the future paints a similarly gloomy picture. An October report from Moody's concluded the ambiguous effects of the health insurance exchanges will hurt nonprofit hospitals. Although the exchanges are expected to shrink the uninsured population, risks such as the possibility that commercially insured patients will switch to exchange plans with lower reimbursement rates could turn the development into a credit negative for nonprofits, according to Moody's. In the face of current hardships and grim predictions for the years ahead, CHI and other nonprofit healthcare organizations are working to stay fiscally strong while meeting the demands of reform. "We'll continue to adjust and set the goals higher and higher in terms of how we ultimately maximize our quality to the lowest possible cost per unit of service," says Alec King, senior vice president at Texas Children's Hospital in Houston. "It's a race without a finish." 13 Medicare, Medicaid and sequestration: Big cuts for nonprofits Medicare and Medicaid pay cuts are one of the most pressing concerns nonprofit providers face going forward, says Caroline Steinberg, vice president of trends analysis at the American Hospital Association. "Hospitals operate on very thin margins, so that kind of cut really hits the bottom line," she says. Dan Steingart, assistant vice president at Moody's, also identified government payer reimbursement reductions as a major source of stress for hospitals and health systems. "Compounding that fact are what have been very sluggish volume trends and volume that's moved from an inpatient to an outpatient setting," he says. The PPACA contains cuts that will reduce Medicare expenditures by an estimated $379 billion from 2012 to 2021, according to Congressional Budget Office projections. Furthermore, the law will reduce disproportionate share hospital payments — which go to providers who provide high levels of charity care — by $64 billion during the next six years. Outside of the PPACA, providers also face nearly $45 billion in Medicare sequestration cuts during the next decade. Moody's is projecting median revenue growth for its rated hospitals to decline to a range of 3 percent to 3.5 percent in fiscal year 2013 as a result of these cuts and volume pressure; median revenue growth was 5.2 percent in FY 2012. Furthermore, hospitals in the 25 states that have opted not to expand Medicaid in 2014 will face additional hardship, since they won't see more insured patients to make up for the pay cuts, Ms. Steinberg says. "They're not getting the promised coverage expansion that they thought they would," she says. "The Supreme Court decision [to make Medicaid expansion optional] really hit hospitals hard." Meanwhile, in states that are expanding Medicaid under the PPACA, providers hope the development will help strengthen their margins. Becker's Hospital Reivew 5th Annual Meeting May 15-17, 2014 • Swissôtel • Chicago, Illinois Keynote speakers include: The Most Business- and Quality-Focused Meeting in the Hospital and Health System Arena 100+ sessions and 190+ speakers Register by April 1 Barry Arbuckle, PhD Joe Torre Toby Cosgrove, MD Forrest Sawyer for Early Registration Discounts For more information visit, www.BeckersHospitalReview.com and click on "Conferences."

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