Issue link: https://beckershealthcare.uberflip.com/i/772284
32 Executive Briefing those payments to survive." The higher deductibles give patients more skin in the game. "When we [put the risk in the hands of the consumers] there is going to be pain because people are going to get less," said Rick A. Sheff, MD, a principal and CMO with The Greeley Company, referring to current Medicaid beneficiaries who will receive less assistance. "The most vulnerable will suffer the most pain when we go into the market-driven system." 4. Providing a safe place for community members. Hospitals face challenges serving changing demographics, including ref- ugees and immigrants who enter the country legally and illegal- ly. Benjamin Anderson, CEO of Kearny County Hospital in Lakin, Kan., which covers 12 counties in Southwest Kansas, reported a large refugee population in his community. His hospital serves refugees from 30 different countries and began receiving phone calls as soon as Mr. Trump was elected. "As a hospital, we have become a safe place for them in prena- tal care and beyond, facilitating conversations where we say you don't have to leave [our community], you are okay," said Mr. An- derson. "Culturally, how do we navigate the perception — maybe not reality — when these people are coming from a place where they were targeted and now they think they'll be targeted here? We have a moral responsibility to care for these people regard- less. From a financial side, we also have the responsibility to maintain a viable fiscal picture. That puts us — the hospital — in the middle." 5. Finding and eliminating waste. Healthcare expenditures are unsustainable and there are only a few ways to bend the cost curve, the most tenable being cutting waste. Cutting waste by reducing medically unnecessary tests and treatments remains a challenge, as patients with insurance don't bare the entire fi- nancial risk for treatment and physicians are taught to provide as much care as possible to keep their patients healthy. Steven Defossez, MD, vice president, clinical integration with Massachu- setts Health & Hospital Association in Burlington, Mass., noted that most experts believe 30 percent to 40 percent of what doc- tors and hospitals do is wasteful, and he discussed how incen- tives should change in the value-based environment to improve care and "eliminate the waste." "The drivers of this wasteful spending include: unaligned incen- tives, self-referrals, the fee-for-service system, unnecessary ad- ministrative burden, imperfect knowledge and defensive medi- cine. If we can eliminate this wasteful spending, those savings can be redirected to achieving the triple aim of affordable, accessible, high quality healthcare for all of our residents," he said. "With the baby boomers moving into the retirement age group, utilization will skyrocket if no changes are made. This is unsustainable and will lead to Medicare insolvency within 15 years." Dr. Defossez went on, "In my judgements, the alternative payment models are an experiment and to date ACOs en masse haven't saved a dollar, so by themselves they aren't guaranteed to be the secret sauce. Yet there are individual ACOs with sterling quality records, which are financially not only saving Medicare money, but are sharing in the savings and financially thriving. This is also true in the private payer market. This gives us hope and encour- ages me to believe that new models of care, properly executed, with collaborative and inclusive leadership, can realign incentives and achieve the quadruple aim." The challenge is for both clinicians and patients to develop the most beneficial treatment plan. There are some patients — par- ticularly in the Medicare population — who undergo tests and treatments without seeking additional options because their physicians ordered the tests. Other participants found provid- ing patient education on unnecessary care helped patients make decisions about foregoing unneeded healthcare services; on the other hand, some patients demand tests and treatments even when they are unlikely to have clinical benefit. "Shared decision-making, the crux of the movement to eliminate waste, begs the question of whether the patient will consume the next marginal piece of healthcare service or not," said Dr. Sheff. "Right now third party payment drives much of that decision-mak- ing." The participants also discussed end-of-life care, medical mal- practice and bureaucratic paperwork as potential areas to target for eliminating waste. 6. End-of-life care. Americans place high value on end-of-life care, continuing to treat patients to the fullest extent. Many Amer- icans don't have living wills instructing their families on end of life wishes and in the United States it costs around $18,500 for hos- pital care in the last six months of life, according to a Penn Med- icine report. Steven Hattamer, MD, chief of anesthesia for NAPA, discussed spending less on end-of-life care when possible and using healthcare dollars elsewhere, such as for pediatric vaccina- tions. Dr. Hattamer also sits on the American Society of Anesthesi- ologists board of directors and is chair of the Anesthesia Section Council at the American Medical Association. But it can be difficult for clinicians to discuss end-of-life care and spending with patients face-to-face. "There are really a lot of hard conversations that need to be had in this country around end-of- life," said Dr. Weiss. 7. Where to go from here. Most hospitals' missions drive them to pursue the triple aim with or without the ACA. However, the participants opined that incentives matter and that the Medicare Access and CHIP Reauthorization Act was passed with support from both parties in Congress with alternative payment models. Programs like MACRA will likely continue during a Trump presi- dency and hospitals are preparing to function in a value-based environment. The participants also discussed combating physician burnout as well as data gathering and reporting as specific steps to success over the next four years. Finally, while the conversation around healthcare in politics is synthesized to taglines like "death panels" in the public arena, hospital and healthcare executives can ap- proach their representatives for more nuanced discussions about the issues and weigh in on how lawmakers can assist providers in achieving their goals: high quality care at a lower cost. n As a clinician-led organization, North American Partners in Anesthesia (NAPA) is redefining healthcare, delivering unsurpassed excel- lence to its partners and patients every day. In three decades, NAPA has grown to become one of the nation's leading single-specialty anesthesia and perioperative management companies, serving more than one million patients annually in more than 200 health- care facilities throughout the Northeast, Mid-Atlantic, Midwest and Southeast. Our highly skilled teams of clinicians participate in groundbreaking leadership development and customer service training programs to deliver optimal results to patients, surgeons, healthcare administrators and staff. Through our exceptional perioperative leadership, research, innovations and state-of-the-art technologies, NAPA offers real solutions driven by evidence-based outcomes to dramatically accelerate operational efficiencies, increase satisfaction ratings and enhance safety and profitability. For more information, please visit NAPAanesthesia.com.