What 5 Hospital CEOs Expect After Today's Election
The following is an excerpted transcript of the event's discussion, featuring five hospital and health system leaders' thoughts on the 2012 election. Participants included: Larry Anderson, CEO, Tri-City Medical Center (Oceanside, Calif.); Teri Fontenot, President and CEO, Woman's Hospital (Baton Rouge, La.); Steve Goldstein, President and CEO, Strong Memorial Hospital (Rochester, N.Y.); Dean Harrison, President and CEO, Northwestern Memorial HealthCare (Chicago); and Bill Leaver, President and CEO, Iowa Health System (Des Moines). Chuck Lauer, former publisher of Modern Healthcare and career coach, moderated the discussion.
Chuck Lauer: We're right in the front of a major change possibly — it will either be Barack Obama or Mitt Romney and depending on who you talk to, you're not quite sure what will happen. What impact do you think the election will have in terms of the industry and many of the programs that have been undertaken?
Steve Goldstein: I think this is one of the most important elections that we've seen in decades because it really does differentiate different positions. What will happen with the Affordable Care Act of 2010? What will be the foundation of Medicare and Medicaid? Will abortion be legalized throughout the United States or not? These are all issues that will play out.
I think one of the more important issues is that there are a lot of folks right now standing on the sidelines. If you look at what's happening with exchanges, if you look at what's happening with Medicaid, [it's] not clear yet that the 32 million people that have potential access for health insurance through the [ACA] will be able to achieve that. Many states, six states in particular, have said they will not offer exchanges. Fourteen have started putting them in place. Many are just their dipping toe in and waiting to see what happens with the election.
The same issue occurs in Medicaid. Not all states — in fact a number of states have indicated that they will not expand their Medicaid rolls. So I think who becomes president will make tremendous difference in how our delivery systems are shaped, whether or not sequestration and all of its consequences develop and, frankly, the potential of fee-for-service system over time. I think it's just an enormously important time.
Chuck Lauer: Teri Fontenot, one of the things you didn't mention is that you are the current chairman of the American Hospital Association. How do you react to what Steve has just said? Do you agree with him?
Teri Fontenot: Absolutely, I agree with what Steve says. Steve serves on the board of the AHA with me so we hear a lot of the same things. But if we take it to less macro sense — I certainly agree that the delivery system and what happens with the Affordable Care Act is going to be very critical — but when you take it down to the hospital-level or hospital system-level and what we do every single day, there is not going to be as much of an impact.
We already are working very hard to be held more accountable. There's a lot of transparency. Certainly what Steve referred to as how people will be insured or covered, that has some impact, but what we do day to day operationally, I don't see that it has much of an impact, really, at all. We know that the current cost structure for care in our country is completely unsustainable.
Chuck Lauer: Bill Leaver, you're way up in Iowa. What's your take on where things are headed and what's happening?
Bill Leaver: Well I would agree with Teri. I think that what we're working on in the efforts around gearing up to do population health, care coordination — all those things are going to be meaningful whether or not Republicans gain control of the White House or Democrats retain control. I think delivery and payment reform will be here to stay.
We believe fee-for-service is going to be a thing of the past, and the accountable care organization financing in the current law is transitory to something different, which is most likely a bundled global payment. In our view, the real key is who is going to have control of that global payment. … I do think the issues around the Medicaid expansion and covering the uninsured will be impacted by who wins this election. I think if the balance power shifts, that will be rethought. But I think there is bipartisan support for payment and financing reform.
Larry Anderson: I don't disagree with what anyone said so far. But I do think that we have to look at it from an employer standpoint. All hospitals are huge employers. We've done some analysis for just our hospital — we employ 2,400 people and we're insured using UnitedHealthcare as our platform for that and they're also our capitated partner. I have to say it drives the cost of our healthcare benefits for our employees up $10 million over the next six years. That's our estimate. We're not only talking about the uninsured in America, we're talking about everyone in America is impacted by this.
Chuck Lauer: Dean?
Dean Harrison: The only thing that I would add that hasn't been mentioned is one of the things we hope for, no matter what happens with the election, is to create more access for patients. There are a number of us involved in academic medical centers, and there is a lot being thrown around about future funding for graduate medical education. For those of us training the next generation of physicians, we have a lot of concern over where the money will come from to ensure that we're able to continue providing education to produce the physicians who will be available, especially primary care physicians, to take care of patients.
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