Thursday, January 26, 2017

Let's Talk about CON

Since my last blog post went up Tuesday morning, I have received numerous calls, texts and emails from readers who are enthusiastically engaged with the topic of the potential deregulation of the Certificate of Need (CON) in Florida. 

As I explain in my previous post, our primary goal at Jupiter Medical Center is to provide our patients with the highest quality and most accessible health care at the fairest price possible. With that in mind, there is no conclusive evidence that deregulation improves quality, cost or access to health care. In fact, I believe that it puts all three at risk. Deregulation will result in higher cost to consumers as well as decreased access to care especially in the poorer rural communities.

I realize it isn't productive to simply state my opposition to deregulation. Instead, I have spent significant time trying to think about opportunities to affect a positive outcome. To that end, I recommend the following:
  1. If the government wants deregulation in health care, they should find ways in which to make it easier for health care providers to offer ambulatory services, as this type of care is often designed to provide services to consumers via a retail-like experience. Let’s create a system where the State of Florida incentivizes providers to build a world-class ambulatory network across the state with the appropriate controls in place.
  2. Our legislative leaders in Tallahassee should assemble and convene a bi-partisan workgroup comprised of patients, health care leaders and legislators. I recommend that they task them with both defining the problems and offering solutions to providing high-quality, accessible and reasonably-priced health care in our state. We need to move away from ideology and politics so we can focus on the responsibility of caring for the health and wellness of our community and neighbors. I will be the first to sign up to help.

This is a vitally important issue affecting all members of our community, especially those that are most vulnerable. I encourage you to remain engaged - repost, tweet and share this discussion. You may also reach out to me directly at and offer your thoughts. I look forward to working on this together.

Tuesday, January 24, 2017

To CON or not to CON

I recently returned from Tallahassee, where I made a presentation to the Florida House of Representative’s Health Innovation subcommittee on the potential deregulation of the Certificate of Need (CON), here in the State of Florida. 

For those outside of the industry, the Certificate of Need program is a regulatory process that requires certain health care providers to obtain state approval before offering new or expanded services. The CON program in Florida regulates the construction of new hospitals, hospices, skilled nursing facilities, and care facilities for the developmentally disabled, as well as certain hospital services.

The deregulation of CON is a hot topic in the health care sector and while there is not currently a bill in front of lawmakers, legislators are weighing the pros and cons of maintaining the practice. I felt it was important for them to hear from those directly involved in providing care to Floridians.

As a health care provider, our goal at Jupiter Medical is three-fold: 1) to improve patient outcomes and the quality of care we provide; 2) maintain or, when possible, decrease cost; and 3) improve access to the services we offer. If we can do these things at the same time, then we are batting a thousand.

With this goal in mind, I have spent a lot of time studying the positives and negatives of CON deregulation. Research is all over the map regarding whether deregulation improves quality, lowers cost and increases access. There are those who believe that it will achieve these goals, while others feel it will have the opposite effect.

I am a strong believer in the free market system and understand that healthy competition can be good for business and consumers. This is not about competition - we compete every single day at Jupiter Medical Center. This is not about a free market economy. Free market economics does not apply to acute hospital care. We must take care of every patient that walks in the door. 

What the regulation of CON is about is what is best for the consumer. As someone who provides health care in a non-profit setting within a specific local community, and whose primary responsibility is to the people we serve, my recommendation is to continue Certificate of Need for acute care hospitals.

The deregulation has the potential to negatively impact the consumer in the following ways:

  • Cost: It is true that with deregulation, we will see more hospitals come into the community. However, with the arrival of these new hospitals comes the likelihood that independent hospitals will get consolidated into larger health care systems. This will mean less choice and higher cost for the consumer. The reality is that larger hospital systems are reimbursed for the work they do at a significantly higher rate than independent nonprofit hospitals, which results in the consumer footing a larger portion of the bill.
  • Quality: While I don’t believe there is a correlation between CON and quality, what is well-documented through extensive research is the fact that the more times a hospital performs a specific procedure, the more proficient it becomes and the better the outcomes. With CON in place, hospitals gain expertise in specific procedures due to increased volume among fewer hospitals.
  • Access: With the deregulation of CON comes more hospitals which means more hospital beds. This also means more pressure to fill beds. In our community, we have plenty of beds and do not need more. Many of the hospitals in our region are operating at less than 60% capacity. Where additional access is needed is in the ambulatory and post-acute service markets - in everything from physical therapy rehabilitation centers to urgent care facilities to imaging facilities. This is why I support deregulation of CON for these types of services.

And so, for those consumers who want to ensure high-quality, affordable and accessible health care for themselves and their families, I encourage you to reach out to your elected officials and make your voice heard. 

Finally, I would ask government officials, health care leaders and those that have an opportunity to play a role in the future of health care in Florida, to think about what would be repaired - if anything - by deregulating Certificate of Need. Would changing Florida’s healthcare planning process through Certificate of Need improve health care for your community and constituents? I think you will find the answer to be no.

Friday, January 13, 2017

Top 7 Things to Remember in the New Year

The beginning of the new year provides not only the opportunity to reflect on last year achievements, but to get pumped up for what lies ahead. Since this is my first foray into the blogging world in 2017, I want to thank you for your support and engagement over the past several months.

As we begin another year, I thought it would make sense to reflect on some of my previous posts as a way to help set leadership goals. When setting your goals for 2017, think about how you want to lead and collaborate with team members in the coming months. Here are some leadership tips to help you have the most productive and positive year yet:
  1. Be authentic. This is simple. Be honest and straightforward. Don’t ask of others what you are not willing to do yourself. In doing so, you will build a foundation of respect and honesty with and within your team, allowing for greater loyalty and productivity.
  2. Be accountable. Take responsibility for every step on the path to achieving the task at hand and embrace and accept the outcomes of these decisions - whatever they may be. By doing this, you will develop an unparalleled trust with and among your team - they will know you mean what you say, that you have their back and that you can be trusted.
  3. Don’t get stuck under the squeaky wheel. We tend to spend a lot of time focused on the employee who makes the most noise and proves to be most difficult. Instead, start focusing your energy on those who demonstrate the desire and ability to contribute to your organization.
  4. Improvise - all of the time. Much of your success will come from your ability to be flexible and improvise when it comes to your business. How you embrace change and capitalize on new realities effecting your business can make all the difference in the work you do.
  5. Play with others and get outside of your own backyard. You never know where you will find the next best idea. Take time to go and learn from others outside your sector. While industries outside your own might operate on a different scale than your company and there will certainly be aspects of their business that will not apply to your work, there is still a tremendous amount of knowledge to be gained from them. We can learn from their systems, their culture, their processes and their leadership style.
  6. Work as a team. Managers who work collectively with fellow team members to identify a change or goal, then create and execute a plan to work through the change or achieve that goal, are the ones who will be successful. The reality is that in today’s workplace, you can have fantastic ideas and innovative strategies to grow your business and lead your market…but if you don’t have dedicated team members that are invested in its execution, you won’t get where you want to go.
  7. Focus on being sustainable. The world is rapidly changing and so is business. In order to survive and thrive, focus your energy on swimming with the tide. Figure out how to maximize your strengths and the work you do in relation to what is happening in the world around you.

And so, as you begin the year, I encourage you to take some time to map out your leadership strategy. Spending a few minutes now to think about how you want to lead, will pay off big in the months ahead.