NY Health Act

NYAPRS Note: Paul Keckley is a highly respected healthcare analyst who puts out a very thoughtful weekly report. I found his advice to hospitals illuminating for community based providers who deliver care coordination and social determinant focused services…and I hope you do too.

Back to the Future for Hospitals? (Excerpts by NYAPRS)
The Keckley Report February 27, 2017

…The numbers of physicians employed by hospitals has grown from house specialties (radiology, anesthesiology, pathology and emergency medicine) and fulltime faculty in academic medicine to more than 40% of all U.S. practicing physicians representing every specialty.

(Some years ago,) futurists warned hospitals that an aging population, cost pressures and specialization meant few would survive. They cautioned about the need to demonstrate value in local communities. They encouraged capital investments in focus factories, outpatient facilities and programs. They heralded the centricity of physicians to care coordination and burgeoning advances in medical innovation. And most said hospitals face extinction unless they make radical changes in their strategies and investments.

What’s new for hospitals is the pace and the politics.

Pace: The numbers of physicians employed by hospitals has grown from house specialties (radiology, anesthesiology, pathology and emergency medicine) and fulltime faculty in academic medicine to more than 40% of all U.S. practicing physicians representing every specialty. The rate of multi-hospital affiliations has accelerated from one in eight to three of four.

Medical error, the leading cause of death in the U.S., is in the spotlight accounting for 251 deaths and a trillion in added cost. And one in eight consumers is receiving care from alternative providers while avoiding conventional techniques of delivery.

Politics: The politics of healthcare is also unique. Back in the day, hospitals, physicians, drug and device manufacturers played co-dependent roles with manageable turf battles. Politicians were interested observers and regulators watched for misdeeds. But as cost controls became prominent themes and managed care took hold, food fights broke out….

Inter-sector friction became a staple: insurers vs. hospitals, insurers vs. drug companies, hospitals vs. insurers, physicians vs. everyone else and so on.

…Along the way, the federal government has expanded its role to industry change agent, flexing its muscles via sweeping reforms, budgetary constriction and compliance risk expansion. Congress, state legislators and governors can’t dodge healthcare these days: it’s arguably the most complicated, least understood, most competitive industry policymakers and politicians confront today. All agree it needs to change; none agree on how, when and how much it will cost.

What are the takeaways for hospitals?
Hospitals are in the business of health management; they’re no longer in the facility-management industry. Their future will be defined by the value they create in care coordination from cradle to grave, not the buildings they build. They’ll be the integrators of financing and delivery, organizers of preventive, acute and post-acute services and the bridge between social determinants and care delivery….

The competition that did in Blockbuster was Netflix and Redbox. The video rental industry’s 15,000 U.S. sites are a bygone era. The competition that did in Borders was not Barnes and Noble, it was Amazon. And the competition that threatens most hospitals is not the hospital across town, it’s the delivery system in the region that delivers a wider range or programs and services with a stronger value proposition for consumers, employers and lenders/investors.

…The competition that did in Blockbuster was Netflix and Redbox. The video rental industry’s 15,000 U.S. sites are a bygone era. The competition that did in Borders was not Barnes and Noble, it was Amazon. And the competition that threatens most hospitals is not the hospital across town, it’s the delivery system in the region that delivers a wider range or programs and services with a stronger value proposition for consumers, employers and lenders/investors.

The punch list for every hospital includes cost reduction, physician performance and clinical effectiveness. In each of these, the low hanging fruit has been addressed. The next actions will be tougher: outsourcing, affiliations, centralization of programs, deployment of capital in homes and work places, digital solutions, retail health, alternative therapies and much more.
Data about how….adherence to evidence-based practice is managed, alternative health is integrated, social determinants considered and enterprise value is defined are in the public domain. Hospitals must operate in the reality that data-inspired public scrutiny is the new normal.

Paul

P.S. Today, the President will meet with Republican Governors to discuss their views on Repeal and Replace. Medicaid block grants will be high on the agenda, with GOP governors in expansion states calling for continuation of funding as well as high risk pools ($12.5 billion annually) to address assurances about coverage for the 133 million Americans with pre-existing conditions.

Tomorrow, the President will deliver his first State of the Union address (technically an address to a joint session of Congress) where healthcare reform will be a prominent topic. The politics of healthcare will be on full display this week.

http://us7.campaign-archive2.com/?u=f28977f2ec664fb9f10de0685&id=48b280676a&e=4659194bc0