AHA executives explain why 2015 Medicare rates will increase financial burden on hospitals
The controversial reform for next year’s Medicare inpatient payments has hospitals feeling burdened by the amount of financial stress heading their way. This double-down policy has hospital payment systems buckling down to cushion the financial blow in the upcoming year, and the industry is already talking about how to handle the economic hardship.
The 2015 proposal for The Centers for Medicare and Medicaid Services serves Medicare’s hospital inpatient prospective payments, offering a small inpatient increase of 1.3 percent. This proposal also comes with a “market basket” increase of 2.7 percent for hospitals that report on quality metrics and qualify for the EHR incentive program.
“The policies announced today will assist the highly committed professionals working around the clock to deliver the best possible care to Medicare beneficiaries,” said CMS Administrator Marilyn Tavenner in a media release. “This proposed rule is geared toward improving hospital performance while creating an environment for improved Medicare beneficiary care and satisfaction.”
In addition to these reforms, the organization is also suggesting increased reductions for hospital readmissions. Compared to the 2 percent from this year, the agency is calling for a three percent downward adjustment along with a new penalty for hospitals with a large proportion of patients who acquire preventable conditions and infections during their stays. If and when this proposal is approved and put into fruition in 2015, 25 percent of hospitals with the highest hospital-acquired condition rates will see a one percent reduction in inpatient payments.
“The AHA and other advocates and stakeholders are still digesting the 1,600-plus page proposal, but at first glance, argued AHA Executive Vice President Richard Pollack, it seems the requirements ‘would put further stress on vital care for seniors,’ amid “an unprecedented amount of change.”
Additionally, industry experts pose the question to this up-and-coming 2015 policy: how will these hospital reforms affect long-term care institutions? Following the proposal’s suggestions, long-term care hospitals will see a .8 percent rise in its rates, and those hospitals which choose to participate in the program will see a 1.5 percent increase for operating diagnosis-related group payments from a total incentive pool totaling $1.4 billion.
Premier, the group purchasing organization, “is deeply disappointed that CMS failed to address fundamental problems in the two midnight benchmark,” said Blair Childs, senior vice president, in a media release. “This leaves hospitals trying to implement an unclear, unfair policy where they will soon be subject to audits.”
How these organizations perform and respond to these soon-to-be imposed standards will be interesting— to say the least. Whether it is a short-term care or long-term care facility, this double-down policy’s controversial nature will be sure to ruffle feathers within the hospital finance sector, as the public anxiously waits to see if hospital care standards change as a result.
Women leading in healthcare means better patient outcomes
I know I’m pointing out the obvious, but women are different to men. In the context of healthcare—a woman’s physiology, symptoms and sometimes even treatment options are different from a man's. We have witnessed this in cardiovascular health, where there is ample research and evidence that women’s symptoms are often different to men’s. We also know that heart disease is responsible for 1 in 3 deaths in women annually—it is the number one killer.
The fact is women do not always get the treatment they need. A lot of that has to do with who is treating them, how they are being treated by their physicians and the healthcare systems that are designed to support patient needs.
The proof is in the research at the care level; a 2017 study of hospitalised patients over the age of 65, examined differences in outcomes based on the gender of the treating physician. The results of the study concluded that patients treated by female physicians had lower mortality and readmission rates compared with those cared for by male physicians.
Gender equity starts at the top
I believe that gender equity in healthcare starts at the top with the leaders who set expectations around workplace culture, and that trickles down to the workforce.
You might think gender has nothing to do with how patients are treated—a patient is a patient, regardless of age, ethnicity, religion, creed, color or gender. But I believe there is a correlation between female leadership in healthcare and better patient outcomes—for men and women. Despite a predominantly female workforce in healthcare (65% of healthcare workers are women), only 13% of healthcare CEOs are women.
The disparity in the number of women in the healthcare C-suite is irrefutable, but I believe the more diversity we have at the boardroom table in hospitals and health systems— and that includes women—the more perspectives we bring to the decisions that ultimately impact patients and their families.
Female healthcare leaders are also caregivers
Many women are still the primary caregivers at home. The responsibility of grocery shopping and meal planning, making doctor and dentist appointments for children and elderly parents, and everything in between still tends to fall to women.
This lived experience gives women the ability to think about innovations and solutions from the perspective of the caregiver—not just the patient. The fact is when someone is sick in the family, it affects the whole family.
As a woman, I often think about solutions and technologies that facilitate holistic healing and health that support the whole family. Bringing the mentality of inclusion to healthcare leadership means programs like the American Heart Association’s Go Red for Women campaign, will ensure research and treatment for cardiovascular disease in women will get the attention it deserves and ultimately, better outcomes for patients.
The bottom line and meaningful work are equally important
A 2019 study found that public companies with a female CEO were more profitable than their competitors with men at the helm, but that didn’t come at the cost of job fulfillment.
Women who lead companies and organisations can influence their workforce by rallying around a common cause. Having meaningful work and the opportunity to make a difference in the world is powerful motivation that doesn’t have to come at the cost of profitability.
The work we do at Abbott is a good example—I consistently reinforce the good that comes from the research and development of the products we make with my team. Clinical trials, like the current LIFE-BTK trial, is consciously recruiting female principal investigators who work with underserved populations to enroll patients from communities of color and women. Knowing the work we do has a social impact on society might be difficult to quantify, but in my opinion, it’s priceless and could lead to meaningful treatment options that improve patient outcomes in the long-term.
Emotional intelligence and empathy are not soft skills
Interpersonal skills, problem-solving and self-awareness are considered “soft skills”—skills that might not be required to do the job, but in leadership positions, they are no longer “nice to haves,” they are “need to haves” if you are going to inspire high-performing teams.
Research suggests women tend to score higher on social and emotional competencies than men. In the words of Joanne Conroy, the CEO and President of Dartmouth-Hitchcock Health in New Hampshire, “Diverse representation at the table changes the conversation. It becomes more collaborative; there is more listening and less interrupting. We have better conversations about how we are functioning as a team and we create a safe space when people can be honest with their feedback to all members of the team, including the leader.”
I’m not suggesting women have a monopoly on soft skills, however having gender diversity around the boardroom table means a diversity of skills. Being aware of your team’s morale and what motivates them is equally important as managing your supply chain.
When it comes to health, we know that patients want more personalised care. The emergence of artificial intelligence (AI) has the potential to generate data that is tailored to the health needs of women and ultimately lead to better treatment options and outcomes. But the data insights generated by AI are only as good as the patients’ data available for analysis. To maximize the potential of AI—and meet the expectation of personalised care for patients—healthcare leaders need to be aware of who is and isn’t being included in studies and clinical trials, like women, and telegraph the need for greater inclusion to their teams.
These ideas are just the tip of the iceberg. Sure, we have come a long way since Elizabeth Blackwell—the first female physician in the United States—founded New York Presbyterian Hospital. Sure, there is still plenty of work to do, but I do hope my contribution is paving the way for more women to take on leadership roles in healthcare and make a positive impact on lives of all patients and their families.