With healthcare topping the new administration’s agenda, it seems that once again healthcare leaders are facing uncertainty. Will Obamacare be repealed, revised or remain is anyone’s guess and something on the minds of healthcare leaders across West Tennessee. With no crystal ball to predict the future, West Tennessee Medical News talked with four healthcare leaders about what may be instore for the New Year. While none seem to think the road ahead will be an easy one to navigate, each is hopeful that improvements can be made to the system.
“The incoming administration continues to say that they will repeal the Affordable Care Act on day one, although the president-elect did speak of “amending” the ACA right after he won the election. I think replacing it will be a more significant challenge and can’t feasibly be done in the short-term,” said Darrell King, vice president, West TN Medical Group for West Tennessee Healthcare.
“There is a lot of work that will need to be done to ensure we have a healthcare system that works for the patients, families and the physicians. The Affordable Healthcare Act did not provide accessibility or affordability as presented by President Obama,” said Donna Klutts, CEO West Tennessee Bone and Joint Clinic. “I am optimistic about the nominations of President-Elect Trump of Seema Verma for the Administrator for the Centers for Medicare and Medicaid Services and orthopedic surgeon Tom Price, MD, of Georgia to head the Department of Health and Human Services.”
“Dr. Price’s experience as a practicing physician and respected leader in Congress, make him a solid choice. Dr. Price has proposed a plan to replace the ACA, but he also understands that the healthcare system in our country is in transition from volume-based to value-based payments. The investment toward this end by health systems and medical groups across the country is significant, and to completely unwind everything would not be wise,” said King. “The nomination of Seema Verma is important as well. She has a great deal of experience with state Medicaid programs. We may well see the end of Medicaid expansion as we know it and a move toward Medicaid block grants for the states. Many of the value-based initiatives that will affect providers have come from CMS and aren’t an integral part of Obamacare, but could suffer collateral damage if the ACA is repealed.”
“The goal of improving access to affordable, high quality care is just and right. Healthcare costs are one of the highest causes of bankruptcy in our country and have contributed to wage stagnation due to increased benefit spending for employers, and makes us less competitive with others. We need to find a way to sustainably provide for catastrophic coverage and provide for “pre-existing conditions” and encourage healthy choices,” said Bill Mariencheck, Jr., MD, chairman of the Board of Directors for the Jackson Clinic. “I try to stay out of politics, but “mandates from Washington” do not seem to have worked so far. Those of us in physician groups, hospitals, and insurance companies are spending huge amounts of time and money ‘clicking boxes’ of regulatory requirements that do not improve care. I hope that some very smart policy makers nationally and locally will work on specific ways to accomplish this and encourage those ‘at the ground level’ of providing healthcare to work together to achieve success.”
King is not sure that totally repealing and replacing the ACA is in the best interest of patients or WTH. While it would be hard to say what specific changes he would like to see implemented, efforts need to be toward improving it and moving away from fee-for-serve medicine to value-based care. “Most healthcare providers understand the need to have to provide quality patient care in a more cost-effective, less wasteful manner,” said King. “I would remind lawmakers that we have invested heavily in systems and infrastructure to make this happen, and we don’t want to see the baby thrown out with the bathwater on the ACA. Further, I would advise them to continue to seek the input of, and engage healthcare providers across the country.”
“The ACA should be to provide quality healthcare in a more affordable and responsive approach,” said Klutts. “Instead, from a physicians practice view, it has impeded the patient and physician relationship to where the insurance payers are making or delaying healthcare. These processes are administratively expensive, laborious and time-consuming and the patient is anxiously awaiting the results of the insurance company’s answer.”
From a nursing perspective, Jan Zimmer, chief nursing officer at Tennova – Regional Jackson, sees collaboration as key. “Now more than ever before, collaboration will be required to manage the continuum of care for our patients more effectively,” she said. “This collaboration must extend beyond the traditional walls of the hospital and include healthcare partners from the pre-hospital setting as well as the post-hospital setting.”
Collaboration has proven effective for the Jackson Clinic. Partnering with payors such as Blue Cross/Blue Shield to monitor, in real time, patients’ results in blood pressure control, diabetes control, cholesterol control and other metrics has helped identify patients at particularly high risk of adverse outcomes and design new ways to reach out to them for more intensive outpatient interventions to reduce long term consequences of heart disease and stroke. “On an inpatient side,” said Mariencheck, “we have partnered with West Tennessee Healthcare and JMCGH in multiple service lines over that past 8 years and quantitatively improved outcomes in heart attack management, reduced surgical site and central IV-line infection rates, helped reduce ventilator time and costs in our ICU, and reduce 30-day readmission rates.”
“I think physicians in West Tennessee are concerned about the future of healthcare, especially as it relates to their ability to practice independently and comply with the various mandates from Medicare and other initiatives – not altogether part of the ACA,” said King. “This is leading many of them to either grow their existing practice or find a partner in a larger medical group. This trend will likely intensify and continue.”
“While there is no way to confidently know what specific changes will come from Washington, what is certain is that we in the U.S. and locally spend far more on healthcare than our peers in other developed nations and it is not clear what value we get in return from that increase in cost,” said Mariencheck. “The Institute for Healthcare Improvement proposed years ago a framework for progress based on improving quality, improving cost, and improving the experience of healthcare. Those goals will be as valid in the future as they are now, and successful healthcare systems have been and will continue to execute strategy based on those.”
“While we know there will be changes ahead, what those changes might be are still hard to predict,” said Zimmer. “What we do know is that strengthening our efforts to work with all healthcare providers in designing new systems and processes to meet the needs of our patients will better manage their health over time.”
“I don’t think we will know what exactly is coming down the pike until after the inauguration. Increasing premium costs (average 25 percent nationally) have made Obamacare not such a great deal for patients. This coupled with high deductibles, create new challenges for healthcare providers seeking payment for the services they provide,” said King. “Providing quality patient care at the lowest cost is still our goal. With rural healthcare facilities closing their doors and a national physicians’ shortage, we can expect to be challenged to provide access to patients seeking healthcare. We will have to come up with new and creative ways to provide this access, especially for primary care.”
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