Wednesday, Jan. 19th, the US House of Representatives voted 245-189 to repeal the health care reform legislation that was signed into law last year. But, we all know, that it was symbolic, because health care changes are on the docket for all Americans and Louisville’s healthcare landscape is preparing.
Take Jewish Hospital & St. Mary’s HealthCare (JHSMH)—News reports have indicated that its merger, anticipated to be finalized this year, will create the state’s largest health system with 11 acute-care hospitals. The new system would have more than 3,000 physicians.
Marty Bonick, the President/CEO of the Jewish Hospital Medical Campus and Senior VP, JHSMH has a lot of change management ahead of him with Jewish being onboard in this merging of efforts involving U of L Healthcare, and the St. Joseph Health System/Catholic Health Initiatives. As one of America’s fastest-growing research universities, U of L is focusing on translational research that can move quickly from the lab to the marketplace. Bonick and I, and others, have been in an occasional dialogue for a couple of months on what is next for patient care. His blog, Hospital Life, tells the day-to-day trenches story of life at Jewish.
On Finding the Disease Management Balance
Hospitals and physicians across the state have been battling high incidences of cancer, heart disease, diabetes, and stroke for a number of years, according to the statistics from the Henry J. Kaiser Family Foundation.
CHI committed to investing $300 million into the Kentucky deal, and the obvious question is how is that going to benefit patient care? Bonick indicates the changing incentive structures of healthcare reform will put the focus on “manage better, and lose less dollars,” not “do more, get more dollars” as in the past physician care model. “Physicians in our state have come to the parties in this new partnership and said, ‘Can’t we lobby against this, reform is unconstitutional,’ but it is obvious that we have had a broken healthcare system and we can’t afford to keep going like this. We fundamentally need to manage patient care better,” he says.
What that means at the Jewish campus and in its new partnership that will crisscross the state is to be able to participate in deploying statewide its strengths, such as the robust cardiac network and oncology services, but also a greater, deeper magnification of disease management.
This will involve more than sub-specialties seen today, he indicated. Disease management is not just dealing in the episodic care from person to person, but to capture information and data in real time and to be able to analyze that and move in real time with answers, he explains.
“Hospitals will be in a continuous learning mode and disease specific care will continue. “Outpatient physicians have not hooked in to a seamless continuum of care. We’ve got a long way to come in this state,” he points out. HITECH funding from the federal level has allowed for the formation of a statewide data repository, but HIPAA rules on sharing patient data may stymie the transformation of managing care in the short run, he adds.
“There’s almost a dis-incentive for prevention. We need aligned incentives to set up transformation.”
Moody’s Investor Service recently downgraded Jewish’s bond rating to Baa1 from A3, in part, because of “declining inpatient and outpatient volumes.” Will hospitals like Jewish expect to see that change under healthcare reform? Probably not. In theory, prevention and even unemployment will continue to impact patient volumes from inpatient to outpatient, as it has in recent years, Bonick agreed. Patients are going to see insurance rates that increase and move to higher deductible plans, like Jewish employees have, and this in turns makes Louisvillians, employed or not, ask “Do I really need that elective procedure? Can I live with back pain, knee pain, etc…a bit longer?”
More Referral Networks
Bonick pointed out that Kentuckians can expect the Jewish-CHI-U of L network to offer stronger referral networks and centers of excellence to leverage specialties and avoid duplicating physician pools, which will help avoid the pitfalls of the growing rural physician shortage. In cultural habits for health according to Kaiser, Kentucky ranks 44th and Bonick pointed out that we are not tough enough on smoking and not aggressive enough in reviewing and changing our school meal programs, for example. “Healthy living comes from healthy lifestyle choices.”
More Clinical Trials
Jewish will anticipate doing more clinical trials, he added, to find answers to disease management and the new merged system will allow for a competitive nature in this with say, Cleveland Clinic. Research protocols and opportunities should provide more answers for patient care in the not-too-distant future.
“The federal and state government doesn’t do strategic planning—they do election cycle planning. All the healthcare reform, moving toward the patient care improvements desired, will not happen in one term unfortunately,” Bonick surmises…. Look for a continuing dialogue here on what we can expect in health horizons and healthcare reform issues.
