What does the Affordable Care Act ruling mean to St. Luke's Health System?
First of all, it means that all the hard work, time, and effort that our boards, physicians, employees and leaders have devoted to our vision of transforming health care by aligning with physicians and other providers to deliver integrated, seamless, and patient-centered quality care across all St. Luke’s settings through our Triple Aim of better health, better care, and lower costs has positioned us well for the future.
And because of that, we have an advantage over many other health care providers across the country that took a wait-and-see attitude, certain that the Supreme Court would throw out the law.
The survival of the law also means that our decision to participate in the Medicare Shared Savings Program starting in January was particularly prescient.Here are some of those strategies and initiatives that we consider most important, and will be even more so given the court’s ruling:
myStLuke's: Our implementation of digital medical records is the foundation for our success. A single electronic medical record promotes integrated care and makes it seamless for patients, and will greatly advance our hard-wiring of evidence-based medicine practices into patient care. The online electronic medical record is very patient-centered, and as evidence of how much patients desire this feature, we already have 6,434 people registered and 35 to 50 patients signing up every day.
As we measure and report more and more quality measures for ambulatory care, myStLuke's will be instrumental in ensuring our success and ability to improve across all providers involved in the care of a St. Luke’s patient.
The Medicare Shared Savings Program: Participation in this program will come through our accountable care organization and accountable care offering for Medicare patients.
This program will help us develop our capabilities and competencies around providing accountable care, coordinating care, and managing care transitions, so that all of these skills, processes, and lessons can be applied to our other patient populations. Through our participation, we expect to demonstrate the provision of better care at a lower overall cost for the patients we serve.
Clinical integration: Even as we prepare to participate in the Medicare Shared Savings Program, we are working to create a larger network of providers who will be clinically integrated as we work with payors in a shift from fee for service to payment for value. Right now, reimbursement systems do not reward work we undertake to improve health.
This must change, and we are leading the effort to transform the clinical and business models so as to support the promotion of health. As I have written before on my blog and said many times, the real key to lowering health care costs is to improve health, and we have already seen what is possible through our success with our Healthy U program.
Systemic quality alignment: Our efforts to align our quality initiatives across the System have already resulted in our saving lives through our sepsis initiative and in achieving quality performance in many areas that place us among the top 50 health systems in the country.
In the future, under health care reform and changes still to come, we can fully expect a greater focus on value, which encompasses quality, and greater transparency. And a provision under the health care reform law requires the creation of a public physician quality report on the Centers for Medicare & Medicaid Services' website, much like already exists for hospitals.
All of our improvements will situate us well, as more and more quality information becomes available and more and more patients select their health care providers based on this data.
HCAHPS: Because the reform law survives, so do the financial rewards and penalties components for hospital performance on the Hospital Consumer Assessment of Healthcare Providers & Systems Survey. We have done a lot of work to promote the patient experience, and this positions us well in terms of those financial considerations. In addition, through the Medicare Shared Savings Program we will have to report results from outpatient patient satisfaction surveys, affecting our quality results, which will in turn affect our shared savings return.
TEAMwork: It is clear that physician and hospital payments are going to be under more and more pressure, and we must reduce costs wherever we can. Our focus on implementing Lean principles through our St. Luke’s program of TEAMwork has gotten us off to a good start and will be critical to our future success. We must all look for ways to be more efficient and reduce unnecessary costs.
Innovation: The solutions to fix health care are not to be found in our past ways of doing things. Success requires new approaches and new thinking. We are already far ahead of most health care systems with our creation of the Center for Health(care) Innovation and our work that approaches solutions in a nonconventional manner.There has never been a time of greater uncertainty in health care. While the Supreme Court has provided greater clarity, we realize that we are not out of rough waters. We have an upcoming election and no doubt, there will be efforts to whittle away at this law, or even repeal it.
Because Congress was not able to find ways to reduce the deficit, significant across-the-board reimbursement cuts are scheduled to impact hospitals next year. Congress has also not dealt with the physician fee schedule, and physicians may be facing reimbursement cuts from Medicare of more than 30 percent next year. State Medicaid programs also are under tremendous pressure to cut costs, and we are the largest Medicaid provider in Idaho.
No doubt, we will be impacted by whatever the state decides to do with the program. In 2014, the ranks of Medicaid will increase by 150 percent. There is already a physician shortage, and this will undoubtedly become more acute in 2014. It also means that more people will now show up in emergency rooms because they have insurance, but not access.
Right now, things are about 10 percent terrifying and about 90 percent exciting. I try to keep focused on the exciting part! All of us in health care are used to a rapidly changing world, and the St. Luke's leadership team has already demonstrated how effectively it can plan during a time of extreme uncertainty and many new laws, regulations, and rules being promulgated. It is hard to imagine that we could be better prepared for whatever is coming ahead.
I am very privileged and honored to lead this outstanding organization, especially at a time when we have the opportunity to be a national leader and to transform health care. We have the best employees any health system could ever hope to have, and we have the strongest leaders I have ever had the privilege to work with. We have highly engaged and wise community board members who make sure we are on the right track. We have amazing community support, and we have the most engaged physicians of any health system I know. Despite the fact that we still face many uncertainties and much more regulation to come, we will stay focused on our vision and strategies, and we know that we are going to be successful.
I am thankful for everything our board members, physicians, and employees do for St. Luke’s, for our patients, and for all the communities we serve.
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.