Cartoon – Discovering Your Own Voice
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U of Iowa Hospitals & Clinics CEO: ‘Everything in healthcare doesn’t need to be done by a hospital CEO’
Despite branching out through nearly 60 outpatient clinics, the University of Iowa Hospitals & Clinics in Iowa City — which includes the only comprehensive university medical center in the state — by and large remains a healthcare destination.
As such, demand for inpatient services hasn’t waned, but has kept on par with the surge in outpatient demand that the entire industry is seeing, Suresh Gunasekaran, the CEO of University of Iowa Hospitals & Clinics and associate vice president for the University of Iowa Health Care, told Becker’s Hospital Review.
That’s not to say strategic threats don’t exist. The biggest ones threatening the University of Iowa Hospitals & Clinics are retail medicine providers that cherry-pick services but aren’t able to provide coordinated care, Mr. Gunasekaran said.
“It’s great that today there’s more convenient care being provided by retail providers. The biggest threat, though, is if healthcare consumers start believing that getting disconnected care is worth it,” he said. “We’re in the business of connected care.”
Tackling this challenge will require input from all parties, not just the hospital CEO, he said. Here, Mr. Gunasekaran expands on how University of Iowa Hospitals & Clinics is facing the threat of uncoordinated retail medicine, and answers questions on board oversight and the changing role of the hospital CEO.
Question: What do you consider your biggest strategic threat?
Suresh Gunasekaran: Major threats are those healthcare services that don’t believe in team-based care, that focus on cherry-picking a corridor of healthcare without thinking about the health of the whole person.
There’s unmet demand in communities for [accessible healthcare]. If Walmart is willing to offer a clinic, they may be the only clinic for 20 miles. What I’d hope is these kinds of Walmart and CVS providers look at how they partner with players like us. In that sense, we don’t view retail medicine as a threat as much as an opportunity. But when they’re not collaborative, that’s a threat to us. It’s only good if the care is coordinated.
Q: U of Iowa Hospitals & Clinics has its own retail clinics. How do they play into the larger consumerism trend healthcare is seeing?
SG: We’re in our fifth year of offering retail urgent care clinics. We offer a setting that’s lower cost and very competitive with other retail clinics. We’ve seen a lot of uptake and growth within this model, but it’s our ability to say: Hey, urgent care and retail healthcare absolutely have a place, but they need to be connected to our lab in radiology and to our specialists.
The next frontier for us is how to partner with other retail clinics. It’s easy to partner with yourself, but it’s more challenging to make it work with others.
Q: U of Iowa Hospitals & Clinics is a state agency, so your board is really the board of regents of the state of Iowa. Have you faced increased pressure from the board to take up any initiatives?
SG: The board of regents has asked we keep a couple issues front and center. There continues to be inadequate maternal healthcare resources for the young moms of Iowa, with more and more hospitals unable to recruit staff to deliver babies. Data shows maternal death is increasing in Iowa, which is a very, very troubling statistic. So we are bringing the full strength of the University of Iowa together on this. We just got a huge research grant from the federal government to create better models for maternal health across the state.
Mental health is another area, and a huge area of priority for our governor. We are looking at expanding our residency program to rural areas that are underserved for mental health. Other things we’re looking at is the workforce shortage and social determinants of health.
Q: How do you think the CEO role will evolve over the next decade? Will we see more hospital CEOs take stances on bigger public issues?
SG: Hospitals within the healthcare industry have [historically] been very insular. You almost could run your business without worrying about the rest of the system. Now with healthcare reform and greater governmental and employer scrutiny of healthcare costs, folks are asking hospital systems to answer for what’s going on in a broader industry. And of course, CEOs have to embrace that journey.
Are we going to get involved in those multiple different steps? Not just access to care, not just the pricing of care, not just care coordination, not just how to get the community to get engaged in their own health. The CEO of the future has to have a stance on all of these, because it’s impossible to go where we need to go without being involved.
Perhaps the CEO is not that important. At the end of the day when you look at these issues, it’s important that we’re at the table, but the community needs to come first. It’s an opportunity for employers to take the lead. It’s an opportunity for the government to take a lead. Everything in healthcare doesn’t need to be done by a hospital CEO, and in the future, probably isn’t best done by a hospital CEO. We need to be one part of the team.
Q: You’ve been leading the University of Iowa Hospitals & Clinics for a little over a year now. Is there any piece of advice you would go back and give yourself on day one?
SG: Never lose the voice of the patient. I got that at the end of my first year, and I think that beginning with the voice of the patient would’ve been very, very powerful. It’s somewhat impractical that you show up to a new job, and of course, you’re going to meet the people within your organization first. But never forgetting the voice of the patient and being able to hear who you are in their eyes and in their words would have been very powerful [on day one]. But I’m making up for lost time.
7 health systems with strong finances
https://www.beckershospitalreview.com/finance/7-health-systems-with-strong-finances-01072020.html
Here are seven health systems with strong operational metrics and solid financial positions, according to reports from Fitch Ratings, Moody’s Investors Service and S&P Global Ratings.
1. Durham, N.C.-based Duke University Health System has an “Aa2” rating and stable outlook with Moody’s. The three-hospital system benefits from its role as the academic medical center of Duke University’s School of Medicine and is a nationally recognized and leading provider of tertiary and quaternary services, according to Moody’s. The credit rating agency expects the health system to maintain operating cash flow margins in the double-digit range.
2. Edison, N.J.-based Hackensack Meridian Health has an “AA-” rating and stable outlook with S&P and Fitch. The health system has a solid financial profile and a strong presence in a large and demographically favorable market, according to Fitch. S&P expects the health system’s depth of clinical services and operations to contribute to its stable financial performance.
3. Fountain Valley, Calif.-based MemorialCare has an “AA-” rating and stable outlook with Fitch and S&P. The health system has a strong balance sheet and financial profile, according to Fitch. The credit rating agency expects MemorialCare’s cash flow to improve due to its market strategy, which focuses on revenue diversification.
4. Portland-based Oregon Health & Science University has an “Aa3” rating and stable outlook with Moody’s and an “AA-” rating and stable outlook with S&P. OHSU, which is the only academic medical center in Oregon, has favorable operating performance, strong philanthropy and its clinical offerings draw patients from across Oregon and neighboring states, according to Moody’s. The credit rating agency expects OHSU’s revenue to continue to grow.
5. Boston-based Partners HealthCare, which is changing its name to Mass General Brigham, has an “Aa3” rating and stable outlook with Moody’s. The health system has an excellent reputation in clinical care and research, a seasoned management team, large size and diversity of revenue sources across several locations and lines of business, according to Moody’s. The credit rating agency expects Partners to achieve an operating surplus in fiscal 2020.
6. Norfolk, Va.-based Sentara Healthcare has an “Aa2” rating and stable outlook with Moody’s. The health system has a leading market position in its core service area, strong patient demand, and solid margins, according to Moody’s. The credit rating agency expects Sentara’s liquidity and debt metrics to remain at recent levels.
7. Livonia, Mich.-based Trinity Health has an “AA-” rating and stable outlook with Fitch and S&P. The health system has a significant market presence in several states and a strong financial profile, according to Fitch. The credit rating agency expects the health system’s operating margins to continue to improve.
Every American family basically pays an $8,000 ‘poll tax’ under the U.S. health system, top economists say
The U.S. health-care system is the most expensive in the world, costing about $1 trillion more per year than the next-most-expensive system — Switzerland’s. That means U.S. households pay an extra $8,000 per year, compared with what Swiss families pay. Case and Deaton view this extra cost as a “poll tax,” meaning it is levied on every individual regardless of their ability to pay. (Most Americans think of a poll tax as money people once had to pay to register to vote, but “polle” was an archaic German word for “head.” The idea behind a poll tax is that it falls on every head.)
Despite paying $8,000 more a year than anyone else, American families do not have better health outcomes, the economists argue. Life expectancy in the United States is lower than in Europe.
“We can brag we have the most expensive health care. We can also now brag that it delivers the worst health of any rich country,” Case said.
Case and Deaton, a Nobel Prize winner in economics, made the critical remarks about U.S. health care during a talk at the American Economic Association’s annual meeting, where thousands of economists gather to discuss the health of the U.S. economy and their latest research on what’s working and what’s not.
The two economists have risen to prominence in recent years for their work on America’s “deaths of despair.” They discovered Americans between the ages of 25 and 64 have been committing suicide, overdosing on opioids or dying from alcohol-related problems like liver disease at skyrocketing rates since 2000. These “deaths of despair” have been especially large among white Americans without college degrees as job options have rapidly declined for them.
Their forthcoming book, “Deaths of Despair and the Future of Capitalism,” includes a scathing chapter examining how the U.S. health-care system has played a key role in these deaths. The authors call out pharmaceutical companies, hospitals, device manufacturers and doctors for their roles in driving up costs and creating the opioid epidemic.
In the research looking at the taxing nature of the U.S. health-care system compared with others, Deaton is especially critical of U.S. doctors, pointing out that 16 percent of people in the top 1 percent of income earners are physicians, according to research by Williams College professor Jon Bakija and others.
“We have half as many physicians per head as most European countries, yet they get paid two times as much, on average,” Deaton said in an interview on the sidelines of the AEA conference. “Physicians are a giant rent-seeking conspiracy that’s taking money away from the rest of us, and yet everybody loves physicians. You can’t touch them.”
As calls grow among the 2020 presidential candidates to overhaul America’s health-care system, Case and Deaton have been careful not to endorse a particular policy.
“It’s the waste that we would really like to see disappear,” Deaton said.
After looking at other health systems around the world that deliver better health outcomes, the academics say it’s clear that two things need to happen in the United States: Everyone needs to be in the health system (via insurance or a government-run system like Medicare-for-all), and there must be cost controls, including price caps on drugs and government decisions not to cover some procedures.
The economists say they understand it will be difficult to alter the health-care system, with so many powerful interests lobbying to keep it intact. They pointed to the practice of “surprise billing,” where someone is taken to a hospital — even an “in network” hospital covered by their insurance — but they end up getting a large bill because a doctor or specialist who sees them at the hospital might be considered out of network.
Surprise billing has been widely criticized by people across the political spectrum, yet a bipartisan push in Congress to curb it was killed at the end of last year after lobbying pressure.
“We believe in capitalism, and we think it needs to be put back on the rails,” Case said.
Medicare for All’s missing mental health discussion
America’s mental health care system is in dire need of an overhaul, but the real specifics are largely missing from the 2020 debate about health care.
Why it matters: Suicide and drug overdose rates continue to rise, and the U.S. faces a shortage of mental health providers and a lack of access to treatment.
The big picture: Private insurance is plagued with holes in mental health coverage. Even even though insurers are legally required to cover behavioral health the same way as physical health, they don’t.
Yes, but: “Medicare to All” may not solve the problem, Mental Health America president and CEO Paul Gionfriddo told me.
- “Medicare would need to be redesigned significantly,” he said.
- Medicare has its own coverage flaws. It would also be crucial to design a system that encourages preventive and early identification services rather than just post-crisis care.
There’s also a shortage of mental-health providers. Paying mental health providers more could help address this, but care delivery would also need to be redesigned, Gionfriddo said.
- Rural areas, for example, would likely still struggle to attract and support these providers because of their remoteness and population size.
- “The big wild card is how many mental health providers would participate in a Medicare for all program or opt out of insurance entirely,” said the Kaiser Family Foundation’s Larry Levitt.
For Democrats who support Medicare for All, highlighting how it could help mental health care could have a political upside.
- “Talking about mental health care needs humanizes the candidates, indicts the shortcomings of private insurance and provides rationale for the need for significant reforms around the current system,” Democratic health consultant Chris Jennings said.
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HENRY KOTULA 