Pres arm2011 jun13_long
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Maintaining Their Mission in Difficult Times: Key Strategies of Safety Net Hospitals Sharon K. Long University of Minnesota AcademyHealth Annual Research Meeting Seattle, WA June 13, 2011
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Transcript of Pres arm2011 jun13_long
Maintaining Their Mission in Difficult Times: Key Strategies of Safety Net Hospitals
Sharon K. LongUniversity of Minnesota
AcademyHealth Annual Research MeetingSeattle, WAJune 13, 2011
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Importance of Safety Net (SN) Hospitals
• Critical role in the health care system now– Core provider of care for Medicaid, uninsured and
underinsured populations– Central role in medical education– Provide services not available at other hospitals
• Role will continue under health reform– Expect 23 million to remain uninsured under health
reform– Medicaid enrollment expected to increase by 16 million
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Case Studies of Five SN Hospitals
• Bellevue Hospital Center • Denver Health• Parkland Health & Hospital System • San Francisco General Hospital • Virginia Commonwealth University Medical
Center
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Impact of the Recession on SN Hospitals - I• Changes in demand for care
– Increase in ED and outpatient care
• Changes in population seeking care– More uninsured and Medicaid, including “first timers”
• Changes in care needs of patients– Increase in ED patients with primary care needs – Increase in acuity level of ED patients, including
patients with ambulatory care sensitive conditions– Increase in patients with mental health needs
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Impact of the Recession onSN Hospitals - II
• Mixed picture on revenues– Negative:
• More uninsured/self-pay• Cuts to Medicaid reimbursements for some• Lower state/local funding for some• Lower GME funding for some
– Some positive offsets: • Enhanced federal match through ARRA • Additional Medicaid funds for some, including
increases in DSH, supplemental payments or waivers • Increased state/local funding for some
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Key Strategies by SN Hospitals in Response to the Recession
• Increase revenues• Reduce costs• Improve efficiency
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Increase Revenues
• Maximize revenue from current patients– Maximize enrollment in public programs– Improve coding for care that is delivered– Improve billing and collections
• Establish new revenue sources: “grow the pie”– New “niche” services (e.g., CCH)– New patient base (e.g., commercial patients)– New market areas (e.g., new clinics in suburbs)
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Reduce Costs
• Eliminate waste and duplication• Prevent overutilization• Take advantage of economies of scale
– e.g., joint purchasing, outsourcing
• Refine staffing mix – e.g., leverage physician time with PA and NP;
leverage RN time with LPN
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Improve Efficiency
• On-going system review and redesign• Cost-efficiency: “Do more with less”
– e.g., improve triage in ED, patient scheduling
• Care-efficiency: “Do better with less”– e.g., nurse lines, telemedicine, co-locating clinics
• Quality-efficiency: “Do better with more”– e.g., high-tech beds to reduce bedsores; clinical
management review/feedback
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Factors that Supported SuccessfulResponses to the Recession by SN Hospitals
• Strong leadership – Long-term vision, including support for innovation
• Shared sense of mission & alignment of incentives– Management and staff– Physicians and hospitals
• Integrated health care system– Whether by ownership or collaboration
• Strong HIT system & effective use of HIT
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Concerns in Preparing for Health Reform
• What will happen to revenues?– Medicaid & Medicare reimbursements; Medicaid DSH
and other supplemental payments; GME
• How many people will remain uninsured and underinsured?
• Will there be sufficient staff to care for the influx of newly-insured patients?
• Challenge of uncertainty—need to start now to be ready for 2014
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Getting Ready for Health Reform
• Build on current systems to develop ACOs– Expand relationships with community
providers– Expand current medical home models
• Build on strategies to attract/retain insured populations
• Strong interest in global payments– Supports ROI for primary care, urgent care,
investment in quality
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Acknowledgments• Research conducted in conjunction with the
Kaiser Family Foundation• Co-authors:
– Terri Coughlin, Urban Institute– Sharon Long, University of Minnesota– Jennifer Tolbert, Kaiser Family Foundation– Edward Sheen, Stanford University
• Thank you: Case study participants at the safety net hospitals included in the study and stakeholders in their communities
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