Health Care Reform and the Presidential Election

As evidenced in the recent debates, the presidential candidates don’t agree on much. But they do agree on one thing – Obama Care as we now know it cannot go on.  Donald Trump wants to repeal it entirely.  Experts say a Republican president would have to clear a very high bar in getting Congress to kill the Affordable Care Act outright.  Hillary Clinton wants to “fix” the ACA, promising to broaden the accessibility of health coverage to otherwise excluded populations and reduce its cost.

Just this week, it was revealed that beginning next year, insurance premiums for customers who purchase insurance through healthcare.gov will increase an average of 22% while the number of providers participating in the market place will drop by 28%. Federal health officials were quick to note that an overwhelming majority of customers will qualify for financial aid which can sharply cut the amount they pay in premiums. Regardless, this sobering announcement all but ensures that on January 21, 2017 health care reform will be at the top of the new Congressional and Presidential agendas.

In the meantime, and with just two weeks left in the presidential race, I would guess that there is a small percentage of the American electorate—maybe more now after this week’s announcement—for whom the issue of health care, more specifically health care reform, will be the deciding factor when they step into the voting booth on November 8. I would argue, however, that the fate of health care reform does not stand with the new president alone and that the outcome of the presidential election is not the best predictor for what health care will look like eighteen months down the road.

The future of health care will lie more at the feet of Congress than who will reside at 1800 Pennsylvania Avenue come January. Let’s not forget that the most recent change in health care reform came in 2015 as part of the Bipartisan Budget Act of 2015 when then Republican Speaker of the house, John Boehner, struck a deal at the eleventh hour in an effort to insulate incoming Speaker Ryan. This deal changed the eligibility of off-campus hospital outpatient departments for reimbursement of services under the Outpatient Prospective Payment System, among other provisions.

 

When the dust of this contentious election season settles, that’s when we’ll find out if the new president and Congress will be mired in partisan gridlock or whether they’ll see their way to affecting some real progress.  It’s going to take a bipartisan approach to fix the problems facing health care. The model as it stands now is simply not sustainable.

Culture Trumps Strategy

I often get asked, “how do you develop and retain a strong, high performing team?”  For us here at Jupiter Medical Center, it starts with building an authentic culture of dignity and mutual respect. We strive to demonstrate to our team members that, first and foremost, we value them as people. And while we certainly hold them accountable for their work and their actions, we seek to provide them with a work environment where they feel supported from a professional perspective as well as an emotional and a personal one.

I truly believe that in order to enhance team member performance and get the best out of my colleagues, I need be as supportive about their time away from the hospital as I am during work hours. For me, it is equally important to provide team members the tools needed to deliver their best work inside the hospital as it is to help them achieve and maintain that all important work/life balance. I want my team members to have fulfilling lives outside of their jobs. I want them to spend time with their families, contribute to their communities, explore their passions and take care of themselves. If they are able to find fulfillment outside of work, this will enable them to bring their best into the medical center each and every day.

This philosophy of management is the cornerstone of the transformational culture model known as Relationship-Based Care. In order to build and maintain a culture of mutual respect and authenticity here at Jupiter Medical Center, all of our team members—regardless of their position - are required to attend a three-day (24 hours) training seminar in Relationship-Based Care. Over the course of three days, team members focus on their own wellbeing and self-care as well relationship building and leadership skills.

We realize that this training is a significant investment in both time and resources, but we believe it is an investment worth making. This approach to management not only allows us to be compassionate and authentic leaders and employers, it also makes strong financial sense. Retaining team members is important from a bottom line perspective as high turnover leads to increased costs and decreased performance. In a 2015 study  by Health eCareers, one-third of healthcare recruiters ranked employee turnover as their top staffing concern and according to the National Health Retention and RN Staff Report for 2016 put together by Nursing Solutions, Inc., hospitals of similar size to Jupiter Medical Center experienced a 21.5% turnover in healthcare employees last year.

The fact is, 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.

Not Ready for Prime Time

For me, one of the biggest sources of frustration with the current state of health care is the required implementation of electronic medical records systems (EHR). This is due, in large part, to two key factors: cost and inefficiency.

Because the federal government mandated that hospitals adopt and implement “meaningful use” of EHR system as part of the American Recovery and Reinvestment Act in order to maintain their existing Medicaid and Medicare reimbursement levels to avoid non-compliance penalties, software vendors were quick to develop astronomically expensive EHR systems. Not only were these systems incredibly costly, they were not ready for prime time. By that I mean, they were full of glitches and not fully designed to make the collection of patient data easier and more efficient to work with, which should have been the goal.

According to a recent article in Becker’s, hospitals across the country have spent tens of millions of dollars — and a handful of medical systems have shelled out upwards of a billion — on the implementation of EHR technology systems. This is in large part due to the fact that many hospitals are adopting system-wide packages in an effort to fast track compliance and efficiency versus implementing modules one at a time.

While some will argue that vendor charges are only part of the steep price tag, and that lack of training and other budget items (storage, infrastructure upgrades) make up a significant portion of the cost, I would counter that from what I have experienced, this is not the case. The price of purchasing these systems (i.e. vendor charges) are ridiculously high and I can’t help but think that government mandates have paved the way for those looking to profit above what is fair and reasonable.

Frustration over cost is also compounded by the fact that these systems are not fully functional and not meeting their intended objectives. In addition, their use often impedes the patient and care giver interaction.

I believe in technology and its power, especially when it comes to the integration of technology and health care. In fact, I think it is the future of this industry. However, as this specific technology exists now, it is simply not ready for prime time use. It forces its users to spend more time focused on collecting data than taking care of patients—

and that is never a good thing.