Mark Stensager is CEO of Guthrie Healthcare System, a three-hospital system in Sayre, Pa. that is integrated with the Guthrie Clinic, a 229-physician group. Here he makes some observations about healthcare reform.
1. This is a period of preparation. The next few years will be a period when the federal government, states, hospitals and others will explore their role in reform. As a member of a state advisory committee the reform law that has just begun to meet, Mr. Stensager hopes to have a hand in crafting Pennsylvania's role.
2. Much of the law will be state-administered. Even though this is a federal law, everything from expanded Medicaid to insurance exchanges will be state-administered. "That is a good thing," Mr. Stensager says. "It means there will be a lot of variation among the states."
3. ACOs aren’t well defined yet. Accountable care organizations, as defined in the law, are quite open-ended, he says. For example, Medicare beneficiaries can choose whether or not they want to join an ACO. He says many hospitals and systems, including Guthrie, are holding back from starting ACOs because they want to know if they will work. "It will take millions of dollars to build an ACO," he says. "Hospitals first want to know the upside opportunity on this."
4. What hospitals can do now. Hospitals can focus on efficiency and quality, because these will be important no matter what happens to healthcare reform. Guthrie has made a major investment in information technology and expects to comply with new "meaningful use" standards for federal IT payments to providers. The healthcare system is also working with affiliated physicians in Guthrie Clinic on clinical protocols and processes.
5. A different approach from the old Clinton reforms. President Clinton's unsuccessful healthcare reform bill focused on setting up competing managed care organizations in a classic HMO format, but President Obama's law focuses on coverage reform. An estimated 32 million more people will be getting coverage. "That’s huge," Mr. Stensager says. In the future, however, healthcare reform is going to have to address payments. "I believe payment reform is an important next piece of where we're going," he says.
6. Role of managed clear is not clear. The law talks about paying a certain amount of money to serve a certain population, which basically is the capitated model under managed care. But the law doesn’t endorse managed care, and it even refers to making fee-for-service payments. "Managed care was rejected by the public in the 1990s and it is considered a bad word," Mr. Stensager says, but he doesn’t think it can be avoided.
7. Implementation will depend on public's reaction. In the next few years, proposed regulations will be debated and there will be many pilot studies to determine the direction of reforms. "The administration is mindful of getting public backing," Mr. Stensager says. He thinks the public is ripe for a change of view. Employers have been ratcheting up deductibles and copayments, and eventually, the public will start saying, "I don’t want to pay so much." At that point, "They’ll be forced into managed care," he says.
8. Public seems to be coming around. The latest polls show the public is gradually warming to healthcare reform. Mr. Stensager believes many criticisms of the reforms have been unrealistic. For example, Don Berwick, MD, the new CMS administrator, was excoriated for talking about rationing. "We already have rationing," Mr. Stensager says. "It’s just not explicit."
Find out more about the Guthrie Healthcare System.
1. This is a period of preparation. The next few years will be a period when the federal government, states, hospitals and others will explore their role in reform. As a member of a state advisory committee the reform law that has just begun to meet, Mr. Stensager hopes to have a hand in crafting Pennsylvania's role.
2. Much of the law will be state-administered. Even though this is a federal law, everything from expanded Medicaid to insurance exchanges will be state-administered. "That is a good thing," Mr. Stensager says. "It means there will be a lot of variation among the states."
3. ACOs aren’t well defined yet. Accountable care organizations, as defined in the law, are quite open-ended, he says. For example, Medicare beneficiaries can choose whether or not they want to join an ACO. He says many hospitals and systems, including Guthrie, are holding back from starting ACOs because they want to know if they will work. "It will take millions of dollars to build an ACO," he says. "Hospitals first want to know the upside opportunity on this."
4. What hospitals can do now. Hospitals can focus on efficiency and quality, because these will be important no matter what happens to healthcare reform. Guthrie has made a major investment in information technology and expects to comply with new "meaningful use" standards for federal IT payments to providers. The healthcare system is also working with affiliated physicians in Guthrie Clinic on clinical protocols and processes.
5. A different approach from the old Clinton reforms. President Clinton's unsuccessful healthcare reform bill focused on setting up competing managed care organizations in a classic HMO format, but President Obama's law focuses on coverage reform. An estimated 32 million more people will be getting coverage. "That’s huge," Mr. Stensager says. In the future, however, healthcare reform is going to have to address payments. "I believe payment reform is an important next piece of where we're going," he says.
6. Role of managed clear is not clear. The law talks about paying a certain amount of money to serve a certain population, which basically is the capitated model under managed care. But the law doesn’t endorse managed care, and it even refers to making fee-for-service payments. "Managed care was rejected by the public in the 1990s and it is considered a bad word," Mr. Stensager says, but he doesn’t think it can be avoided.
7. Implementation will depend on public's reaction. In the next few years, proposed regulations will be debated and there will be many pilot studies to determine the direction of reforms. "The administration is mindful of getting public backing," Mr. Stensager says. He thinks the public is ripe for a change of view. Employers have been ratcheting up deductibles and copayments, and eventually, the public will start saying, "I don’t want to pay so much." At that point, "They’ll be forced into managed care," he says.
8. Public seems to be coming around. The latest polls show the public is gradually warming to healthcare reform. Mr. Stensager believes many criticisms of the reforms have been unrealistic. For example, Don Berwick, MD, the new CMS administrator, was excoriated for talking about rationing. "We already have rationing," Mr. Stensager says. "It’s just not explicit."
Find out more about the Guthrie Healthcare System.