Evolving medical landscape creates new challenges
BY DAVID L. DUNLAPThere is no question that this is a challenging and yet, I believe, exciting time to work in healthcare. Roper St. Francis Healthcare is a microcosm of the broader and more complex national healthcare landscape — a landscape that is changing due to shifts in reimbursement, consumer behaviors and expectations. These shifts demand that those of us in healthcare leadership work together to create new efficient models for patient care.
Much remains uncertain regarding how healthcare reform through the Accountable Care Act (ACA) will ultimately play out, but one thing is known: many current models for delivering care are unsustainable. We are being asked to deliver better care with fewer resources. As your community healthcare provider, we will lead the way in transforming our own culture and environment to excel in this evolving terrain.
This is an interesting moment. We know what is on the horizon and are working toward it, but we are still operating within systems that will soon be, but are not yet, obsolete. We are living between two worlds — moving toward a healthcare world where value will be the primary driver for cost and reimbursement, but in the meanwhile, still using a volume-based model.
This transitional moment creates challenges, but it is also one of those rare moments ripe for self-evaluation. Fundamental changes are required, and our determined, collaborative efforts toward innovation and improved efficiency will enhance our ability to deliver excellent care for this community.
So how will this new landscape look? What exactly does value mean in terms of healthcare, and how do we achieve it without compromising our number one priority — the well-being of our patients?
The old world, or in many ways still our current healthcare world, operates under the assumption that patient needs are best met in the acute care or hospital setting, that doctors or health services/departments operate in isolation at times, and that “more is better” from a health industry perspective.
However, in this new reality reimbursement models are shifting to a model based on value and population health/wellness, not volume/number of procedures. We will be meeting patient needs more in the outpatient/community setting and less in the acute care setting, and we will be aligning our resources for more integrated care.
In this emerging paradigm, “value” means much more than “low cost.” Value will mean delivering better outcomes along with greater efficiency, and there will be greater transparency in reporting outcomes for hospitals and doctors.
Other significant factors are simultaneously at play. Probably the most obvious and urgent factor impacting Roper St. Francis and other providers across South Carolina is the significant cuts in Medicare and disproportionate share reimbursement that result from the ACA plan for Medicaid expansion. These cuts are intended to redirect funds toward expanding Medicaid coverage to 330,000 currently uninsured South Carolina citizens. However, providers across the state will forgo an estimated $11 billion in federal funding from 2014 to 2020 if South Carolina opts out of this Medicaid expansion. Also, this infusion of federal dollars would produce an estimated 44,000 new jobs in South Carolina.
Meanwhile, as costs to deliver care continue to rise, inpatient volumes nationally are expected to decline by an estimated 3 percent over the next decade. Healthcare providers are in a vulnerable position. We will not be able to cost cut our way to success, we must redesign the way care is delivered.
The leadership of Roper St. Francis has been re-envisioning care for years. Our extensive network of doctors and diagnostic and ambulatory facilities already emphasizes community-based outpatient care. Our evidence-based protocols help assure quality and reduce hospital readmissions. Our palliative care and new Roper Hospice programs enhance the continuum of care. And our internal Wellness Works program incentivizes preventive and wellness care.
Despite this transitional time, our patients can expect our continued commitment to providing the highest quality care and “value.” Strategic cost management coupled with care-delivery redesign will lead to a more integrated, evolved and enhanced system of care, one that reduces duplication of services, improves care coordination between providers and ultimately adds value to our patients and our communities’ health.David L. Dunlap is president and CEO of Roper St. Francis Healthcare.