If only there was a crystal ball that could show what healthcare changes and improvements would come to West Tennessee in the next decade, administrators, medical personnel, insurance professionals and consumers would know how best to prepare. Since there is no crystal ball, maybe lessons learned over the last ten years can help form a roadmap of sorts for the future. And who better to analyze those lessons than four outstanding healthcare leaders from across the region? Each brings not only different perspectives, but also varying opinions on some of the most impactful lessons learned and where things are headed.
Lisa Piercey, MD
When deciding what has had the greatest impact on healthcare in West Tennessee and its effect moving forward, there was no clear answer. Looking at the past ten years as both a physician and a healthcare leader, Lisa Piercey, MD, who now serves as the state's Commissioner of Health, cites the opioid addiction epidemic as one of the biggest issues.
"It took hitting rock bottom to jolt the system and bring people to the table around this central issue. The legislature regulated prescribing limits, pharmacies are doing their part and mental health has ramped up to meet the demand for addiction treatment. It is a tremendous example of cross section collaboration that is seeing early progress on many fronts," said Piercey. "The addiction epidemic has brought to the forefront the effects adverse childhood experiences can have on the lifelong mental and physical health of a patient. It has changed the narrative from what is wrong with you, to what happened to you."
William Preston, MD
Also from a medical perspective, William Preston, MD, President and Chairman of the Board for the Jackson Clinic, PC., says that while many things have had significant impact over the past decade, probably the biggest impact on the Jackson Clinic is the ongoing shift from a system based on fee-for-service to a one based on quality and value.
"Every provider in our region will agree that physician reimbursement has been stagnant for the past decade, yet the costs to deliver care have continued to rise every year. That is an unsustainable trend," said Preston. "Also, the tremendous increase in high-deductible health plans that place more of the first-dollar costs on the patient, slows the revenue cycle significantly. These things are occurring against a backdrop of system changes that mandate increasing data collection, measurable quality metrics, and "value" as demonstrated by lower cost and high patient satisfaction. It is easy to see why medical practices are feeling squeezed."
West Tennessee Healthcare's Chief Nursing Officer, Tina Prescott, lists the Affordable Healthcare Act and the lack of Medicaid expansion in Tennessee as having an impact on healthcare services available across the area that will have a lasting effect well into the next decade. "As several healthcare systems in West Tennessee have maneuvered through the changes in this landscape, difficult decisions were made that resulted in changes to access points for healthcare, including the closure of several hospitals in West Tennessee, the effects of which will be far reaching," she said. "Our healthcare system has made strategic decisions with the closure of certain hospitals, along with the merger and acquisition of others, to improve access to care across the area. Our focus on ensuring appropriate healthcare services are available in our rural communities is something we will continue to address in the next decade."
"The shift from volume to value will have the greatest long-term impact. There is clearly very little appetite on the part of patients, employers, and the government to support cost escalation at the rates seen in the past. There is a limited amount of money allocated for health care services, yet the patient population continues to grow. CMS and most commercial payors are insisting the healthcare system pay providers based on the value and outcomes they provide rather than on what they do and charge," said Preston. "This is a fundamental shift in the way the system has done things for the past 50-60 years. It requires monumental changes in our relationships with patients, the way we are compensated, and how we handle the data generated in the delivery of healthcare services. This is expensive as well as labor and time intensive. It highlights the challenge of delivering the highest quality care to each patient on an individual basis while at the same time managing healthcare needs across an entire population."
"One of the biggest lessons learned that will have benefits in the decade ahead has come from the shift to payment models based on population health. When we look upstream, we find social factors that must be addressed in order to impact the health of a population, and that leads us to collaborate with those outside of healthcare," said Piercey. "The number one predictor of early mortality is income, but that is beyond the scope of healthcare. It takes a team approach to tackle social issues such as economic disadvantages, transportation, lack of insurance or home life, which all impact a patient's health and ability to get better."
The advent of the Electronic Medical Record (EMR) or Electronic Health Exchange is one of the more significant developments in this decade for Jon Ewing, Chief Operating Officer for the Woman's Clinic. "The EMR has imparted a co-management approach to the health of a patient that in the past relied on trust in the advice given by physician to the patient. Now, it is a bi-directional decision with training, research and data from the provider to the patient as the patient enters the visit with a vast knowledge from what they have learned on the internet," he said. "This increase in knowledge on the patient side can help the provider in discerning a diagnosis and treatment plan with a better empathy of patient anxiety, concern and preference."
Rural Healthcare is going to have challenges regardless of the decade. Piercey says all rural areas have issues that are not unique to that area. This can be an impetus to change what is done about rural and underserved populations across the state, especially in terms of how that care is delivered, as long as quality is preserved by how it is implemented.
"Given the rural area that we serve, lingering issues will be centered around how we deal with access to healthcare across the region. The access to both primary and specialty care will continue to be vital to the health of our region across the lifespan. Working as a healthcare system with other healthcare providers in the region to ensure access and quality care will continue to be our vison and a critical mission that is worthy of our resources," said Prescott. "Strategic partnerships, working closer with physicians in the operations of the healthcare system, and the strategic placement of healthcare services will be potential areas of success. Problem areas that we will continue to face will involve maneuvering the difficult financial landscape to provide services to all patients and access to providers regardless of their ability to pay for their services."
"To give our patients a high degree of satisfaction with our services, we will have to adjust to their preferences for convenience and access while keeping quality high," said Preston. "All of this means The Clinic will continue to need multiple service options spread across rural West Tennessee to meet patients where they live and work. The era of healthcare being anchored by the large hospital that draws in patients from far and wide to receive all services within its four walls is over."
"The challenge for leaders of tomorrow will be innovative thinking for service delivery and change. It seems that efficiency and quality outcomes measurement are paramount to the success of healthcare organizations within an ever-changing climate of regulated healthcare," said Ewing. "Adapting to pay for performance models will be the eventual future. While these drivers for quality and low cost are essential in the healthcare delivery models of tomorrow, a compromise of service cannot be one of the innocent victims of these regulatory pushes."
"The government has told us what the future changes are going to be," said Preston. "In October, the Deputy Director of HHS said 'we're going to be able to see a move away from the old modes of inpatient hospitalizations, the most expensive kinds of care, being immediately resorted to by the public. We're going to see the healthcare sector move away from that and into wider and greater number of sites of care outside of the old-fashioned inpatient hospital system.' I believe the healthcare sector is moving that way anyway. It already has. It seems that anyone who denies this reality is fooling themselves."