Pres arm2011 jun13_long


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Pres arm2011 jun13_long

  1. 1. Maintaining Their Mission in Difficult Times: Key Strategies of Safety Net Hospitals<br />Sharon K. Long<br />University of Minnesota<br />AcademyHealth Annual Research Meeting<br />Seattle, WA<br />June 13, 2011<br />
  2. 2. Importance of Safety Net (SN) Hospitals<br />Critical role in the health care system now<br />Core provider of care for Medicaid, uninsured and underinsured populations<br />Central role in medical education<br />Provide services not available at other hospitals<br />Role will continue under health reform<br />Expect 23 million to remain uninsured under health reform<br />Medicaid enrollment expected to increase by 16 million <br />2<br />
  3. 3. Case Studies of Five SN Hospitals<br />Bellevue Hospital Center <br />Denver Health<br />Parkland Health & Hospital System <br />San Francisco General Hospital <br />Virginia Commonwealth University Medical Center<br />3<br />
  4. 4. Impact of the Recession on SN Hospitals - I<br />Changes in demand for care<br />Increase in ED and outpatient care<br />Changes in population seeking care<br />More uninsured and Medicaid, including “first timers”<br />Changes in care needs of patients<br />Increase in ED patients with primary care needs <br />Increase in acuity level of ED patients, including patients with ambulatory care sensitive conditions<br />Increase in patients with mental health needs<br />4<br />
  5. 5. Impact of the Recession onSN Hospitals - II<br />Mixed picture on revenues<br />Negative: <br />More uninsured/self-pay<br />Cuts to Medicaid reimbursements for some<br />Lower state/local funding for some<br />Lower GME funding for some<br />Some positive offsets: <br />Enhanced federal match through ARRA <br />Additional Medicaid funds for some, including increases in DSH, supplemental payments or waivers <br />Increased state/local funding for some<br />5<br />
  6. 6. Key Strategies by SN Hospitals in Response to the Recession<br />Increase revenues<br />Reduce costs<br />Improve efficiency<br />6<br />
  7. 7. Increase Revenues<br />Maximize revenue from current patients<br />Maximize enrollment in public programs<br />Improve coding for care that is delivered<br />Improve billing and collections<br />Establish new revenue sources: “grow the pie”<br />New “niche” services (e.g., CCH)<br />New patient base (e.g., commercial patients)<br />New market areas (e.g., new clinics in suburbs)<br />7<br />
  8. 8. Reduce Costs<br />Eliminate waste and duplication<br />Prevent overutilization<br />Take advantage of economies of scale <br />e.g., joint purchasing, outsourcing<br />Refine staffing mix <br />e.g., leverage physician time with PA and NP; leverage RN time with LPN<br />8<br />
  9. 9. Improve Efficiency<br />On-going system review and redesign<br />Cost-efficiency: “Do more with less” <br />e.g., improve triage in ED, patient scheduling<br />Care-efficiency: “Do better with less”<br />e.g., nurse lines, telemedicine, co-locating clinics<br />Quality-efficiency: “Do better with more”<br />e.g., high-tech beds to reduce bedsores; clinical management review/feedback<br />9<br />
  10. 10. Factors that Supported SuccessfulResponses to the Recession by SN Hospitals<br />Strong leadership <br />Long-term vision, including support for innovation<br />Shared sense of mission & alignment of incentives<br />Management and staff<br />Physicians and hospitals<br />Integrated health care system<br />Whether by ownership or collaboration<br />Strong HIT system & effective use of HIT<br />10<br />
  11. 11. Concerns in Preparing for Health Reform<br />What will happen to revenues?<br />Medicaid & Medicare reimbursements; Medicaid DSH and other supplemental payments; GME<br />How many people will remain uninsured and underinsured?<br />Will there be sufficient staff to care for the influx of newly-insured patients?<br />Challenge of uncertainty—need to start now to be ready for 2014<br />11<br />
  12. 12. Getting Ready for Health Reform<br />Build on current systems to develop ACOs<br />Expand relationships with community providers<br />Expand current medical home models<br />Build on strategies to attract/retain insured populations<br />Strong interest in global payments<br />Supports ROI for primary care, urgent care, investment in quality<br />12<br />
  13. 13. Acknowledgments<br />Research conducted in conjunction with the Kaiser Family Foundation<br />Co-authors:<br />Terri Coughlin, Urban Institute<br />Sharon Long, University of Minnesota<br />Jennifer Tolbert, Kaiser Family Foundation<br />Edward Sheen, Stanford University<br />Thank you: Case study participants at the safety net hospitals included in the study and stakeholders in their communities<br />13<br />