Engines for reform: Changing how hospitals deliver care

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Some hospitals do prefer the status quo, but as CEOs of The Mount Sinai Medical Center and Montefiore Medical Center, we want to challenge it by improving the health of our patients while controlling costs because we know that health care is too expensive. The fact is that non-profit teaching hospitals such as ours — with over 60 percent of our patients in Medicare and Medicaid and a less than three percent operating margin — can still be engines for much needed payment reform. 

Both of our institutions are actively testing new care models that change the incentives to improve care and provide savings, including Accountable Care Organizations (ACOs), innovation grants, and bundled payments. These models require hospitals to go beyond the four walls of our institutions – to physician practices, health centers, nursing homes – and establish critical, new partnerships with other providers based in our community. As participating ACOs, we will bend the cost curve through enhanced services to support patients and care coordination in all of those settings. The goal is continuous care of the whole patient, rather than isolated — and inevitably more complex and expensive — episodes of care. There is financial risk in this new model, but we view it as our responsibility to embrace it.   

As such, we support a larger shift along these lines and reforms that move away from fee-for-service health care, and transition toward a system of shared savings. What this means is essentially a more coordinated system of care, one that aligns payers, providers and patients. For example, consider a patient with heart failure who begins to show signs of deteriorating health. A designated nurse or case manager is checking in with the patient regularly – offering help, answering questions and having a close relationship so that early signs of worsening heart failure can be managed. That means no visit to the emergency room, and no hospitalization. The savings accrued from better management of the patient is then reinvested into the health care system to employ the nurse and others. 

If this model were adopted for the subset of patients enrolled in both Medicare and Medicaid, it is estimated we could reduce health spending by as much as $15 billion annually. However, we believe that any new payment system must include strong quality measures and take into account that some communities face unique social and economic challenges and have higher numbers of patients with complex care needs.

Changes that ensure that healthcare dollars are used for patients such as administrative simplification and medical malpractice reform must also be considered. Congress and the administration will fail to curb the current rate of spending if they ignore these options and instead pursue ostensibly “easy” savings through provider cuts, such as reductions to funding for the training of our country’s doctors. Such shortsighted decisions would undermine our institutions ability to drive innovation in American medicine and be leading success stories in how healthcare can be better and of greater value. 

We want to be part of the solution and to do that, we are willing to lift our feet out of fee for service for all and step up to embrace changes that improve how we deliver care and bring spending back in line. We can come together around these ideas and move the conversation — and our health care system — forward for our country.
 

Dr. Davis is president and CEO of The Mount Sinai Medical Center and Dr. Safyer is president and CEO Montefiore Medical Center.

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