(123rf.com image)

Changes to Medicare and Medicaid, possible budget cuts for medical research, and health care consolidation have all been in the news recently. The health care sector has seen many changes in recent years, and more are likely on the horizon.

How are health care providers adapting to those changes? We posed questions to hospital and medical school administrators to get their thoughts on the new world of medicine. Following are their answers to emailed questions.

The panelists are:

Donna Carmichael Isgett, president and CEO, McLeod Health

Dr. Phyllis MacGilvray, dean, University of South Carolina School of Medicine Greenville

Mark O’Halla, president and CEO, Prisma Health

Q. How do you expect the new administration to affect health care, for example, potential elimination of the ACA, cuts to Medicaid, or budget cuts to health care research? And how will that impact your organization?

Donna Carmichael Isgett, president and CEO, McLeod Health: There is much uncertainty around our current health care environment in Washington. There is conversation around Medicaid reductions, market place subsidy reductions and potential changes to 340B pharmacy pricing. It is seldom understood the extreme financial vulnerability of hospitals and health systems. A recent release from Kaufman Hall stated that 37 percent of hospitals are still losing money. Any reductions in the fragile payment systems could certainly result in reduced access to care for patients.

Dr. Phyllis MacGilvray, dean, University of South Carolina School of Medicine Greenville: Our medical school does not provide direct patient care, but we do train the next generation of physicians. These medical students train in the clinical learning environment. Potential cuts to programs that support patient care access will impact the clinical learning environment. Potential cuts to research will also reduce student access to research opportunities.

Mark O’Halla, president and CEO, Prisma Health: We are closely monitoring the budget bill passed by the House of Representatives last month, which includes up to $880 billion in health care cuts. Based on this substantial target, it is fair to assume some level of reductions to Medicare and/or Medicaid funding and Health Insurance Exchanges. However, at this time, it is very difficult to assess exactly what areas of health care spending will be impacted and whether non-Medicaid expansion states like South Carolina will be as significantly impacted as states that have adopted Medicaid expansion. Payment reductions associated with potential reduced funding for these important programs would negatively impact revenue to our organization along with all hospitals and health systems throughout the country. We are modeling potential impacts and assessing potential mitigation strategies and tactics if our payments are materially reduced.

 

Q. Regarding medical research, have you been affected by any cuts and, if yes, what are your plans for fundraising?

Isgett: McLeod Health is not a research organization. We do offer access for our patients to clinical trials for advancing therapies. We don’t anticipate any changes in this availability.

MacGilvray: Not yet. The proposed reduction in Indirects to 15 percent will impact our grants that are funded through the NIH (National Institutes of Health).

O’Halla: We remain committed to advancing transformational research that delivers lifesaving treatments and innovative care models to our patients. Federal research funding is crucial to driving scientific breakthroughs. In addition to federal support, we will continue to pursue a broad range of funding sources, including non-federal partners such as the Patient-Centered Outcomes Research Institute (PCORI), foundations, industry, and philanthropy.

Q. A recent poll showed that American consumers are not happy with their health care. Have you undertaken any steps to improve the care you provide? And what one thing would help you improve delivery of care?

Isgett: Consumers are frustrated with the lack of timely access to care, including both primary and specialty care, plus the fragmentation they experience. McLeod Health has undertaken several improvements beginning with a unified medical record including all outpatient and inpatient encounters readily available within Epic My Chart. This has tremendously improved both the patient’s and the care teams’ access to complete information to develop a unified plan of care. Additionally, we are working to remove waste from the work of our providers using ambient listening technologies to improve the time they spend with the patient instead of documenting in the computer. Finally, we are growing our educational programs to increase physician residency programs to help train more providers for the future.

MacGilvray: We train the next generation of physicians to provide holistic, compassionate care to their patients through shared decision making and principles rooted in lifestyle medicine.

O’Halla: At Prisma Health, we are deeply committed to earning the trust of our patients and community by providing compassionate, patient-centered care. From primary care that feels like a personal partnership to innovative specialty programs like organ transplantation, we fundamentally believe that every step of the journey is taken alongside our patients. We achieve this through our commitment to continuous improvement fueled by the voices of our patients. We are active listeners of our communities and bring our patients to the table and solicit their feedback on their care experience, new projects we undertake, improvements we are considering, and even have them at the interview table when hiring senior leaders. For Prisma Health, this is what it means to be true partners in care, working together with our patients to improve their well-being, not just for them.

Q. How are you handling the cost of tech, such as protecting patient data, guarding against ransomware, and IT upgrades? 

Isgett: Protecting patient data is a critical priority for our system. We employee a full-time senior information security officer with an internal team to help guard against ransomware attacks.  Additionally, we practice downtime procedures to assure uninterrupted care delivery could be maintained. We strive to maintain the latest technology to support the evolving health care landscape.

MacGilvray: We have a budget in place for IT, and the school manages student data, not patient data.

O’Halla: Prisma Health has established a robust, standards-based information security framework. This framework includes layers of information security tools, vigorous environmental monitoring, and continuous employee education. Managing our tech costs has focused on application rationalization and utilization of our core enterprise class systems to deliver necessary functionality to our health system and our patients.

Q. Do you expect further consolidation in health care?

Isgett: Consolidation trends certainly continue across the nation; however, the advantages of this consolidation have been difficult to quantify. McLeod Health prides itself in being a local, regional health care system where local people work daily to care for local people. We are not a hospital operating company, but instead stay true to our mission of being a regional health care delivery system for the last 119 years.

MacGilvray: Not sure.

O’Halla: Yes. Every year it becomes more difficult for independent hospitals or smaller health systems to generate sustainable operating margins and invest the capital necessary to reinvest in their infrastructures and adopt the latest technologies in medical equipment, information technology, etc.  In addition, smaller entities generally struggle with payor contracting as commercial payors have already significantly consolidated and carry a lot of weight during negotiations.

Q. Rural hospitals continue to close because of their budgets. How does that impact health care overall and your organization in particular?

Isgett: The health of rural community citizens will be in jeopardy with the continued reduction in rural hospitals. McLeod Health at the core of its mission has remained committed to rural hospitals and their operations. We currently operating in four communities in our region as the sole provider. We work diligently to develop a system of care that maintains a local presence while utilizing more advanced tertiary services within the system as needed by those we serve.

MacGilvray: Our medical students train in rural areas of South Carolina.

O’Halla: Rural hospitals typically serve smaller populations with a higher proportion of uninsured or underinsured patients, which leads to significant financial strain. As a result, many of these facilities are closing across the country. These facilities are needed in our communities for several reasons. Oftentimes, this is the same population that tends to be of a higher age group, lower socioeconomic status, more likely to smoke, have a higher incidence of obesity, greater likelihood of opioid misuse, and an overall poorer health condition. We have experienced that usually health care services are more intense, and the patients tend to require more frequent visits. With the closure of rural facilities, residents are traveling farther distances for very basic health care needs. Most times, patients aren’t able to make the needed visits to maintain their health. In addition, with the closure of the hospital (and emergency room), patients with stroke symptoms, traumatic injuries, heart attacks, and other severe illnesses may experience life-threatening outcomes. This has an enormous impact on health care outcomes and puts an even larger demand on surrounding health care facilities (which may be 30 miles or more away). The closure of health care providers in the surrounding areas has made it even more difficult to recruit physicians to these markets. Consequently, health care utilization has declined, which will ultimately impact patient outcomes.

Q. Do you have anything to add that we didn’t ask about?

Isgett: Much is stated today about letting the free market work in health care. However, hospitals don’t meet the principles of a free market! Hospitals are required to care for anyone who presents to them in an emergency regardless of their ability to pay. They are the safety net for care. There is a very delicate financial balance they must maintain for survivability that is often unappreciated by those who need their services.