Hackensack Meridian Health co-CEO Robert Garrett: Hospitals should 'take the lead' on healthcare reform

With recent events in Washington, D.C., it is unclear what the future holds for healthcare. However, that doesn't mean hospitals need to remain stagnant, according to Robert Garrett, co-CEO of Edison, N.J.-based Hackensack Meridian Health.

Mr. Garrett became co-CEO in 2016 following the merger between Hackensack (N.J.) University Health Network and Neptune, N.J.-based Meridian Health. Prior to that, he was president and CEO of the HUHN since 2009.

Mr. Garrett recently spoke with Becker's Hospital Review about healthcare reform, the challenges it brings and how hospitals should respond.

Note: Responses have been edited for length and clarity.

Question: If you could eliminate one of the healthcare industry's problems overnight, which would it be?

Robert Garrett: I would eliminate the lack of coordination of care because I think so many different caregivers are responsible for patients. Sometimes those handoffs are smooth and sometimes they're not. I think there needs to be, in general, better coordination of care. I think through efforts like accountable care organizations and clinically integrated networks, we're making a lot of progress there, but I do think there is more opportunity for the healthcare team to come together and coordinate care. I've seen some great examples of where that's done. There are hospitals that practice multidisciplinary rounding where physicians, nurses, other members of the team like pharmacists and physical therapists, actually round on patients at one time. We're doing that in many of our Hackensack Meridian hospitals. I was just at one of our hospitals, Mountainside in Montclair, N.J., and they have high reliability rounding on patients. So the team goes into the patient room and does an overall assessment of the patient's condition in front of the patient, and then the patient has an opportunity to say if they felt they missed anything. So I think there's a lot of good going on in that space in terms of coordination of care, but if there was one problem generic to healthcare right now it is still having pockets of lack of coordination.

Q: How do you maintain optimism and engagement among employees amid the uncertain future of healthcare reform?

RG: We do a lot of communication with our team members and with our medical staff. I think the best way team members stay optimistic is they know our strategies really transcend whatever healthcare reform might bring. So no matter what comes out of Washington, D.C., even what comes out of state and local governments, there are some basic themes that are really important — like transparency on prices and services and quality that we provide to patients — that we need to be very consumer-focused, that we need to provide more affordable care by providing efficient operations each day and that team members can certainly participate in that as well. Our system also has a strong focus on the coordination piece — better alignment between hospitals, physicians and even insurers. So I think the way our team members and healthcare workers in general can stay optimistic in this era of uncertainty is to stick to certain principles, that no matter what comes out of healthcare reform or Washington, D.C., these principles will be the road to success for a healthcare organization. If you can stay within those boundaries, I think there is room for and reason to be optimistic.

Q: What challenges must hospitals address as the national healthcare debate continues?

RG: I would call the first challenge the folks that are most disadvantaged in our society and whether they'll be covered in the future by either Medicaid or some other form of insurance. These are the most disadvantaged people in our nation. They are often in need of healthcare services on a frequent basis. I think that's a big challenge for all of us to figure out.

We definitely didn't support the rollback of the Medicaid expansion, which was part of the GOP's proposed ACA replacement plan, because we felt it was going to be very difficult, as these patients who were previously insured may have become uninsured. Without insurance, many of these people may come to a hospital emergency room for primary care, which is not the most efficient nor the best way for primary care to be delivered. And from the hospital perspective healthcare reform is a big challenge because our Medicare rates and also our charity care reimbursement was cut significantly when the ACA passed, and those pools of money evaporated. So even under what was proposed in healthcare reform, those Medicare cuts were not going to be restored just because Medicaid expansion was being rolled back. In New Jersey, those charity care dollars are no longer there to be distributed as well. So that's a huge challenge for the hospital industry. If you think about it, we almost take a double hit. We made a sacrifice when the ACA was passed, but that sacrifice was made with the belief that more people would be insured under Medicaid and under Medicare, and that did happen. However, we made those cuts and if we take back those people's insurance, we're going to be really hit twice.

Q: How specifically is Hackensack Meridian preparing for these challenges?

RG: On the consumer front, we are trying to provide access to healthcare by building an incredibly large ambulatory care network so people can receive healthcare closer to their homes, in their own communities, at more affordable prices than coming to a hospital. That could mean ambulatory surgery centers, urgent care centers, wellness and fitness centers. The whole array on the full continuum of care is what we've been providing. We think that's what consumers want and that's how we've been helping to meet that challenge. With respect to transparency, our health network has taken steps to give consumers more information about quality and pricing. As an example, on our website we're posting patient experience, readmission and hospital-acquired infection data so consumers and the public can see how our hospitals are doing. We're also posting pricing information for the most common procedures. Both of those initiatives are in the process of being rolled out across our network, but they do appear on websites within our network now.

Q: What is your advice to other hospitals trying to navigate healthcare reform?

RG: We need to take the lead. We should not be waiting for Washington, D.C. We should be taking the lead on healthcare reform, and we should all embrace these principles on transparency, on being more consumer-focused, on providing more affordable healthcare through operational efficiencies, and continuing to align so we can coordinate care better. So continue that alignment between hospitals, physicians and insurers. We also need to advocate for the needy, the folks that are most disadvantaged in our society. We have a responsibility to do that. My best advice would be for our colleagues in the healthcare industry to follow these principles and take the lead in these categories. We shouldn't wait for Washington, D.C., or in our case Trenton, N.J. We should really be taking the lead. We are healthcare leaders. We should put together healthcare reform that makes sense for our entire nation and system.

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