Three leaders from safety-net hospitals discussed their institutions' modern-day roles and relevance in the healthcare landscape at the Becker's Hospital Review 5th Annual Meeting in Chicago.
Panelists included Todd Gorlewski, senior vice president and CFO of St. Barnabas Hospital in Bronx, N.Y., Alan Channing, president and CEO of Sinai Health System in Chicago, and K. Malik, MD, chairman of the Department of Emergency Medicine at Saint Anthony Hospital in Chicago. The discussion was moderated by Peter Myhre, senior vice president of Wells Fargo Equipment Finance.
The panelists began by discussing the unique challenges safety-nets face today, and have faced for many years, long before the Patient Protection and Affordable Care Act existed. Mr. Gorlewski said leaders at St. Barnabas Hospital have different worries from those of large systems or academic medical centers, who might complain about margins going from 14 percent to 9 percent and talk about population health in generalized, vague terms.
Yet despite their payer mixes — ratios many in the healthcare business would tag as undesirable — the panelists said their institutions are at the forefront of population health management in a very intimate, real way. "Until you hand a MetroCard to a mother with three kids and a social worker with them, who are going home to their walk-up that might lose heat, you don't know what population health is," said Mr. Gorlewski.
Mr. Channing stressed the educational role of safety-nets. Some of healthcare's talking heads enjoy placing more responsibility on patients — to ultimately have more "skin in the game" — but Mr. Channing said this is an unfair expectation. Some patients, he said, can buy a bag of chips from a convenient store as their breakfast, lunch and dinner on a good day.
"Do they want to buy that bag of chips to sustain themselves? Probably not," said Mr. Channing. "But do they know how to go grocery shopping? Is there a store in their food desert? If we're not teaching people how to shop or cook, then we're not going to be able to help people 'have skin in the game.' They don't have the knowledge base to be able to participate."
Dr. Malik has a special view of the safety-net hospital, one that has taken shape over time spent in Saint Anthony's emergency room. "You ask [patients] who their doctor is, and I can't tell you how many times they tell me, 'You are.' I'm the ER doctor," he said. The need for patient education begins right there: "You open the Pandora's box for everything in the diagnosis book." On the spot, Dr. Malik and his colleagues must explain conditions many physicians might view as basic, such as hypertension and heart disease, often with the help of a translator.
Dr. Malik said consolidation has raised other hospitals' awareness of the true critical nature of America's safety-net hospitals. "We know the imperative role safety-nets play in the ecosystem of hospitals. If you start shutting down safety-net hospitals, are the neighboring hospitals willing to take on an immense burden of health [issues]? There are very skilled, seasoned hospital leaders who are now learning the value of safety-nets."
Mr. Gorlewski agreed. Other hospitals — even those with sterling reputations and healthy financial sheets — would likely fall short when faced with the responsibilities of safety-net hospitals. "I almost dare them to do what we do without using us," he said. "They have the faculty to use a proton machine and to disjoin twins you'll see on the cover of People magazine, but they can't do 80,000 ED visits like we do."
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