Published by: Larry Gage on 3/31/2010 1:20:30 PM
Yesterday, President Obama signed into law the second leg of health reform, the Health Care and Education Reconciliation Act of 2010. While most of the key components of reform will not take effect for several years, it is by no means too soon to begin preparing for implementation. Last week, at the annual meeting of the AAMC's Council of Teaching Hospitals and Health Systems (COTH), I was privileged to hear a presentation by Dr. Glenn D. Steele, President and CEO of the Geisinger Health System, on the challenges presented by health reform. Geisinger is often cited (by President Obama, among others) as one of the most visionary systems in the country -- an industry leader, for example, in the use of health information technology to create an integrated delivery system. Dr. Steele listed several challenges that will be faced by all providers, even high performing health systems like Geisinger.
First and foremost, Dr. Steele expressed concern that the nation simply does not yet have the available resources to meet the likely increased demand generated by 32 million additional insured individuals. The shortage of primary care providers has been well documented, but Steele suggested that there would also be a shortage of hospital services as well in many parts of the country. Unless this problem is addressed, he feared that care for many of the newly insured would continue to be provided in emergency departments and other inefficient and impersonal settings.
Dr. Steele also listed several other obstacles to a successful implementation of reform that will need to be addressed:
- An unjustified variation in the way care is provided to patients with similar diseases and conditions -- not just geographically, but within individual hospitals;
- A continued fragmentation of caregiving for many patients, despite recent attention to the need for better coordination among doctors, hospitals, long term care and other providers;
- Perverse payment incentives, with too many third party payers still paying for units of service rather than outcomes; and
- A system in which the patient is still largely a passive recipient of care, not an active participant in managing his or her care (or state of good health).
I believe there is actually some good news for NAPH members and other safety net hospitals in the serious concerns expressed by Dr. Steele. For one thing, many NAPH members have already begun addressing these systemic problems and developing solutions that point toward true integration and patient-centered care. And even for those who may be further behind the curve, at least there would appear to be more of a level playing field for safety net hospitals (vis-a-vis the rest of the industry) than is often thought to exist.
NAPH will be addressing these issues and concerns in our new strategic plan and at our annual conference in June.