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Changes to Medicare and Medicaid, possible budget cuts
for medical research, and health care consolidation have all been in the news
recently. The health care sector has seen many changes in recent years, and
more are likely on the horizon.
How are health care providers adapting to those changes?
We posed questions to hospital and medical school administrators to get their
thoughts on the new world of medicine. Following are their answers to emailed
questions.
The panelists are:
Donna Carmichael Isgett, president and CEO, McLeod Health
Dr. Phyllis MacGilvray, dean, University of South
Carolina School of Medicine Greenville
Mark O’Halla, president and CEO, Prisma Health
Q. How do you expect the new administration
to affect health care, for example, potential elimination of the ACA, cuts to
Medicaid, or budget cuts to health care research? And how will that impact your
organization?
Donna Carmichael Isgett, president and CEO,
McLeod Health: There is much uncertainty around our current
health care environment in Washington. There is conversation around Medicaid
reductions, market place subsidy reductions and potential changes to 340B
pharmacy pricing. It is seldom understood the extreme financial vulnerability
of hospitals and health systems. A recent release from Kaufman Hall stated that
37 percent of hospitals are still losing money. Any reductions in the fragile
payment systems could certainly result in reduced access to care for patients.
Dr. Phyllis MacGilvray, dean, University of
South Carolina School of Medicine Greenville: Our medical school
does not provide direct patient care, but we do train the next generation of
physicians. These medical students train in the clinical learning environment.
Potential cuts to programs that support patient care access will impact the
clinical learning environment. Potential cuts to research will also reduce
student access to research opportunities.
Mark O’Halla, president and CEO, Prisma
Health: We are closely monitoring the budget bill passed by the
House of Representatives last month, which includes up to $880 billion in
health care cuts. Based on this substantial target, it is fair to assume some
level of reductions to Medicare and/or Medicaid funding and Health Insurance
Exchanges. However, at this time, it is very difficult to assess exactly what
areas of health care spending will be impacted and whether non-Medicaid
expansion states like South Carolina will be as significantly impacted as
states that have adopted Medicaid expansion. Payment reductions associated with
potential reduced funding for these important programs would negatively impact
revenue to our organization along with all hospitals and health systems
throughout the country. We are modeling potential impacts and assessing
potential mitigation strategies and tactics if our payments are materially
reduced.
Q. Regarding medical research, have you been
affected by any cuts and, if yes, what are your plans for fundraising?
Isgett: McLeod Health is not
a research organization. We do offer access for our patients to clinical trials
for advancing therapies. We don’t anticipate any changes in this availability.
MacGilvray: Not yet. The
proposed reduction in Indirects to 15 percent will impact our grants that are
funded through the NIH (National Institutes of Health).
O’Halla: We remain committed
to advancing transformational research that delivers lifesaving treatments and
innovative care models to our patients. Federal research funding is crucial to
driving scientific breakthroughs. In addition to federal support, we will continue
to pursue a broad range of funding sources, including non-federal partners such
as the Patient-Centered Outcomes Research Institute (PCORI), foundations,
industry, and philanthropy.
Q. A recent poll showed that American
consumers are not happy with their health care. Have you undertaken any steps
to improve the care you provide? And what one thing would help you improve
delivery of care?
Isgett: Consumers are
frustrated with the lack of timely access to care, including both primary and
specialty care, plus the fragmentation they experience. McLeod Health has
undertaken several improvements beginning with a unified medical record
including all outpatient and inpatient encounters readily available within Epic
My Chart. This has tremendously improved both the patient’s and the care teams’
access to complete information to develop a unified plan of care. Additionally,
we are working to remove waste from the work of our providers using ambient
listening technologies to improve the time they spend with the patient instead
of documenting in the computer. Finally, we are growing our educational
programs to increase physician residency programs to help train more providers
for the future.
MacGilvray: We train the next
generation of physicians to provide holistic, compassionate care to their
patients through shared decision making and principles rooted in lifestyle medicine.
O’Halla: At Prisma Health, we
are deeply committed to earning the trust of our patients and community by
providing compassionate, patient-centered care. From primary care that feels
like a personal partnership to innovative specialty programs like organ
transplantation, we fundamentally believe that every step of the journey is
taken alongside our patients. We achieve this through our commitment to
continuous improvement fueled by the voices of our patients. We are active
listeners of our communities and bring our patients to the table and solicit
their feedback on their care experience, new projects we undertake,
improvements we are considering, and even have them at the interview table when
hiring senior leaders. For Prisma Health, this is what it means to be true
partners in care, working together with our patients to improve their
well-being, not just for them.
Q. How are you handling the cost of tech,
such as protecting patient data, guarding against ransomware, and IT
upgrades?
Isgett: Protecting patient
data is a critical priority for our system. We employee a full-time senior
information security officer with an internal team to help guard against
ransomware attacks. Additionally, we
practice downtime procedures to assure uninterrupted care delivery could be
maintained. We strive to maintain the latest technology to support the evolving
health care landscape.
MacGilvray: We have a budget in
place for IT, and the school manages student data, not patient data.
O’Halla: Prisma Health has
established a robust, standards-based information security framework. This
framework includes layers of information security tools, vigorous environmental
monitoring, and continuous employee education. Managing our tech costs has
focused on application rationalization and utilization of our core enterprise
class systems to deliver necessary functionality to our health system and our
patients.
Q. Do you expect further consolidation in
health care?
Isgett: Consolidation trends
certainly continue across the nation; however, the advantages of this
consolidation have been difficult to quantify. McLeod Health prides itself in
being a local, regional health care system where local people work daily to
care for local people. We are not a hospital operating company, but instead
stay true to our mission of being a regional health care delivery system for
the last 119 years.
MacGilvray: Not sure.
O’Halla: Yes. Every year it becomes
more difficult for independent hospitals or smaller health systems to generate
sustainable operating margins and invest the capital necessary to reinvest in
their infrastructures and adopt the latest technologies in medical equipment,
information technology, etc. In
addition, smaller entities generally struggle with payor contracting as
commercial payors have already significantly consolidated and carry a lot of
weight during negotiations.
Q. Rural hospitals continue to close because
of their budgets. How does that impact health care overall and your
organization in particular?
Isgett: The health of rural
community citizens will be in jeopardy with the continued reduction in rural
hospitals. McLeod Health at the core of its mission has remained committed to
rural hospitals and their operations. We currently operating in four
communities in our region as the sole provider. We work diligently to develop a
system of care that maintains a local presence while utilizing more advanced
tertiary services within the system as needed by those we serve.
MacGilvray: Our medical students
train in rural areas of South Carolina.
O’Halla: Rural hospitals
typically serve smaller populations with a higher proportion of uninsured or
underinsured patients, which leads to significant financial strain. As a
result, many of these facilities are closing across the country. These
facilities are needed in our communities for several reasons. Oftentimes, this
is the same population that tends to be of a higher age group, lower
socioeconomic status, more likely to smoke, have a higher incidence of obesity,
greater likelihood of opioid misuse, and an overall poorer health condition. We
have experienced that usually health care services are more intense, and the
patients tend to require more frequent visits. With the closure of rural
facilities, residents are traveling farther distances for very basic health care
needs. Most times, patients aren’t able to make the needed visits to maintain
their health. In addition, with the closure of the hospital (and emergency
room), patients with stroke symptoms, traumatic injuries, heart attacks, and
other severe illnesses may experience life-threatening outcomes. This has an
enormous impact on health care outcomes and puts an even larger demand on
surrounding health care facilities (which may be 30 miles or more away). The
closure of health care providers in the surrounding areas has made it even more
difficult to recruit physicians to these markets. Consequently, health care utilization
has declined, which will ultimately impact patient outcomes.
Q. Do you have anything to add that we didn’t
ask about?
Isgett: Much is stated today
about letting the free market work in health care. However, hospitals don’t
meet the principles of a free market! Hospitals are required to care for anyone
who presents to them in an emergency regardless of their ability to pay. They
are the safety net for care. There is a very delicate financial balance they
must maintain for survivability that is often unappreciated by those who need
their services.