On April 6th, Kenneth will serve on the keynote panel “The Future of Reimbursement: What to Expect from Medicare, Medicaid, Commercial Pay, and Other Payers” at Becker’s Hospital Review 11th Annual Meeting. As part of an ongoing series, Becker’s is talking to healthcare leaders who plan to speak at the conference, which will take place on April 6-9, 2020 in Chicago.
To learn more about the conference and Kenneth’s session, click here.
Question: What, from your perspective, is the biggest challenge about the future of work for hospitals, and what can they do about it? (i.e. automation, desire for more flexibility, clinician shortages, etc.)
Kenneth Gacka: The uncertainty surrounding federal health care policy decisions is the biggest challenge for hospitals at this time, in my opinion. There are many policy proposals circulating that range from full repeal of the ACA to “Medicare for All”. While these proposals currently lack many details, I do think they have the potential to lead to serious, negative consequences for hospitals, if key details and trade-offs are not given appropriate attention. During this time of uncertainty, advocacy and education of policymakers will be important to influence ultimate legislative decisions. Moreover, I think it is incumbent upon hospital leadership to continue to aggressively innovate and drive strategies to improve quality, access and affordability, amidst the backdrop of the political debate.
Q: How can hospitals reconcile the need to maintain inpatient volumes with the mission to keep people healthier and out of the hospital?
KG: This is a delicate dance for hospitals because most still operate under traditional fee for service payor contracts which inherently have incentives that are misaligned with the end goal of keeping people healthier and out of the hospital. Organizations with well-established provider-sponsored health plans can have an edge in managing this balance. However, owning a health plan is not possible for all, so we’ve also seen an increasing number of joint ventures between hospitals and payors as well as other unique payment model pilots designed to allow both sides to share in the risk and upside potential. Importantly, it is common to hear most organizations taking steps to actively manage the transition from volume to value by leading initiatives focused on improving quality, promoting wellness and reducing costs of care. It’s important for hospitals to continue to pursue these strategies as I do think they are key for the future evolution of the health care industry regardless of the payment model. To date, despite much attention, we are far from the inflection point in this transition, so bold strategies will have to be pushed to truly change the care and payment paradigm.
Q: What do you see as the most exciting opportunity in healthcare right now?
KG: Data and advanced analytics offer countless opportunities to meaningfully change many aspects of the health care industry including diagnosis, treatment, monitoring and even running the business of health care. With the proliferation of data that is becoming available from wearable devices and electronic medical records, I’ve been excited to see the ideas coming from health systems, start-ups and larger companies that haven’t historically played in the health care space. In the coming years, I think we will see innovations that have the potential to positively disrupt our sector.
Where do you go for inspiration and fresh ideas? Beckers, of course! In all seriousness, the conference speakers are the best in the industry and the sessions are relevant to leaders in hospitals both large and small. And I don’t have to look any further than my inbox daily for the most recent healthcare news and best practices.
What do you see as the most exciting opportunity in healthcare right now? The most exciting opportunity in healthcare today is the move to value-driven care with the patient at the center focusing on wellness and prevention instead of treating signs and symptoms with volume-driven sick visits and hospitalizations. Accountable care, the merit-based incentive payment system (MIPS) and value-based payment programs are driving providers from volume to value-based care with incentives to reward both the physician and the patient!
Healthcare has had calls for disruption, innovation and transformation for years now. Do you feel we are seeing that change? Why or why not? Yes, hospitals that are driving change and transformation are receiving high marks in quality and patient-satisfaction. They are investing in technology to coordinate care and making access easier for their patients. At the same time, they are educating and preparing their workforce to be responsive to innovative change. The age of volume-driven fee-for-service medicine is gradually giving way to value-based care. Hospitals must transform to become organizations that reward value instead of volume and develop delivery methods that use evidence-based practices, procedures and technologies to attain optimal outcomes and achieve greater efficiencies. Many primary care providers have heard the call for value and are joining ACO’s and working to meet this demand. Sadly hospitals that haven’t transformed to ensure the highest quality patient-centered care and the most competitive prices are being bypassed by the primary care physicians, the patients and the payers. “
