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Itís Friday, November 9, 2012, and Your Phone Rings


The person on the other end of the line wants to know what should be done about the country’s health care delivery system.  That person has just won an election to serve as the United States’ president for the next four years. He (and I say “he” only because at this point there are no females running for the office) has taken a few days to sort out he and his family’s life after a long and arduous campaign and is now ready to get to work.

What would you say to this person?  How would you respond as a spokesperson and representative for major providers of America’s health care delivery system?  Tough questions but that was exactly what the American Hospital Association’s Regional Policy Board 6 was planning for this past week at its meeting in Kansas City.  (RPB 6 includes health system and hospital representatives from North Dakota, South Dakota, Minnesota, Iowa, Nebraska, Kansas and Missouri.)

Of course there were a few “unknowns” in that formulation that just might have stifled the group’s ability to come up with any final answers like:

•    Just who is this person I’m talking to?
•    Which political party (ies) is (are) in control of which houses of Congress?
•    How did that Supreme Court ruling turn out last June?

That said, it is fair to say that most of the 50+ participants spoke to a future health care delivery system that is focused on being more efficient and better devoted to improving peoples’ health as opposed to just treating them when they are sick.  They also noted that they are feeling more confident that their respective systems are evolving in a manner that will accommodate that model of care.  At the same time, there is frustration – great frustration with all the new rules and regulations that they are all working so hard to comply with and understand.  ICD 10, meaningful use, RAC’s, gain sharing, physician supervision, quality and patient safety reporting, Medicaid eligibility and payments to states, Medicare coverage reform (like vouchers) are a few examples.

That level of frustration also extends to the twilight zone providers currently find themselves occupying.  We’ve talked about this zone several times in the past as providers try to maintain services under current reimbursement models that primarily reward “volume, not value”.  At the same time those same providers are being asked by the policymakers to focus their organizations on “population health” by devising new medical home models, adopting broader bundled payment mechanisms, etc., that just don’t comport with what we have been used to all these years.

But when all is said and done, RPB 6 appeared ready to move ahead focused on rewarding value, not volume; quality, not quantity.  It’s a consistent message for this part of the country.   But based on what we heard from those beyond our borders, this view may not be universally held by other regions of the country.  So if this transition is to occur it appears that at least for now, caveats will creep in and the needs of the present will cloud the vision we have for the future of the nation’s health care system of care and coverage.  Sound familiar? 
 
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