While panelists at Wednesday's Nashville Health Care Council Wall Street analysis event had plenty to agree on — the need for Medicaid expansion, the likelihood of further hospital and managed care consolidation and the very low chance of an ACA repeal — one topic had the panel divided.
Led by Community Health Systems Chairman, President and CEO Wayne Smith, the discussion ranged from perception to prediction, but the panel of analysts were not in consensus about a long-term "doc fix," a way to better control what physicians are paid by Medicare. While Congress has continued to kick the can in regards to replacing the Sustainable Growth Rate adopted in the late 1990s, each short-term postponement of physician pay cuts has heightened the financial need for a long-term solution. (Click here for some good background from The Washington Post.)
While local analysts Whit Mayo of Robert W. Baird and Frank Morgan of RBC Capital Markets told the event's audience that a permanent solution was likely — Morgan said that, if anything actually gets done in D.C. on this issue this year, it will be a long-term plan — Credit Suisse's Ralph Giacobbe and Bank of America Merrill Lynch's Kevin Fischbeck disagreed.
Fischbeck predicted only a 20 percent likelihood of a long-term fix, because it is politically easy to continually pass the small bills and Giacobbe said political gridlock will continue to be too strong to allow for a real solution.
The Nashville Health Care Council has begun recruiting executives to take part in its 2014 Fellows program. The group is looking to bring together about 30 people for eight full-day sessions that will tackle some of the thorniest and most pressing issues facing the industry. The goal is to lay the groundwork for some collaborative approaches to change. Click here for more info on how to apply.
Health care technology focused business startup accelerator Healthbox announced today it has added HCA as a financial sponsor of its inaugural Nashville program. Terms of the arrangement were not disclosed.
HCA joins Healthbox anchor partner BlueCross BlueShield of Tennessee, the Nashville Health Care Council and the Nashville Entrepreneur Center as a sponsor.
“At HCA, we continually seek out new technologies and models to deliver care at both higher levels of quality and efficiency,” R. Milton Johnson, HCA president and chief financial officer, said in a release. “We’re excited to join the Healthbox community and help develop these early-stage companies here in Nashville.”
Healthbox is led by founder and CEO Nina Nashif.
Editor’s note: This is the fifth in a series of posts this week from the Nashville Health Care Council’s International Health Care Mission to Paris. To view others, click here.
As we ended the last session of the Council’s international mission in Paris on Friday, delegates reflected on the learning opportunities offered to them over the past five days. We began the trip anxious to understand what France was doing to achieve its strong outcomes and low health care GDP. Many insights were gained, but, as in so much with health care, there is no simple answer.
We assumed quality measures would help us understand the country’s health standings, but were surprised to discover that little data is available in this area. There isn’t standardization across the system and we found no organized effort to collect data. Most Council delegates agreed that since patients who want reimbursement for doctor visits did use their general practitioner to monitor their care, there is an understanding of the importance of primary care in France, something the U.S. has been emphasizing more only in recent years.
We discussed France’s firm commitment to freedom of choice. But while choice is there in theory, we had questions about whether there were true choices throughout the country. In more rural, economically depressed areas, there is an access problem and lack of providers. Even in the urban, wealthier areas, private hospitals appeared limited in the services they were allowed to offer.
Among the experts we spoke with, opinions were varied as to the degree of satisfaction with the system. There is not widespread commitment to wellness or prevention, nor an understanding of their relationship to controlling health care costs. And, although the country doesn’t appear to have the large obesity problem we do in the U.S., it was noted that many of the health care professionals we came into contact with were smokers – including one who talked about the importance of smoking cessation.
There is no doubt that the French have a better system for the poor to access and receive health care. And perhaps because of good prenatal care for all expectant mothers, France does have a lower infant mortality rate than the U.S.
There is definitely an entitlement mentality here. And, without doubt, in France, it is believed that health care is an inalienable right.
The differences between the French and American systems are complex and cultural. We are at different stages and, as one speaker noted, it appears that the French are shifting closer to the U.S. system while health care reform in the U.S. is shifting us more towards the current French system.
Editor’s note: This is the fourth in a series of posts this week from the Nashville Health Care Council’s International Health Care Mission to Paris. To view others, click here.
Nashville Health Care Council members on the International Mission in Paris started their day with a discussion about their impressions of the French health care system based on the first three days of meetings, presentations and hospital visits. Among the comments:
• We heard a lot about the need to control costs, but no clear plan.
• There have been many good things we could learn from the French, but their operational processes are not similarto those in the U.S.
• French patients receive all their health care information from the government and providers, not from advertising or the media as in the U.S., so there is no level of consumerism.
• What will change the system here? Will those who can pay for care drive it?
• The French have a centralized system but still struggle with many of the same issues we do in the United States.
• There is a hierarchical structure that makes it difficult to report problems with physicians.
• There is no motivation to commit fraud when there is no profit in it.
The rest of the day’s activities included a panel with French private health care CEOs, a briefing on the public-private partnership between France and Franklin-based Healthways and discussions about hospital performance, the utilization of e-health tools and health care financing trends in the European Union.
Much of what the CEO panel told us confirmed what we heard earlier in the week. The current system was created in a time when it was believed that health care is priceless, but in today’s world it does have a cost and the government that controls it has less and less money.
There is growth in demand, but it is difficult for the private hospitals to get approval to provide services to meet those demands as the government tends to favor public hospitals. Sensitivities for the private providers are physician fees, drug costs and reimbursement. On the positive side, outpatient services are profitable and growing and private providers are shifting toward them.
The session closed with a panelist saying, “We must rebalance a system that is at risk.”
To that end, the next session highlighted Sophia, a partnership between the public insurance system in France and Healthways. It is based on the recognition that the insurance system needs restructuring for more cost efficiency and needs to move from being a payer to being an active risk manager that encourages citizens to participate in their own well-being.
The pilot program, launched in 2008, was focused on diabetes and has seen improvement in diet and exercise and treatment compliance among participants. The team will tackle asthma and cardiovascular disease beginning this fall.
The discussion about performance reminded us again of the cultural and philosophical differences between France and the United States. Performance measurement is a new concept here and one that is not popular. The country has always spent a lot of money on health care but never before asked for accountability from providers or patients.
The government has formed an agency to assist in improving performance. It is working hand-in-hand with providers and regional health authorities on a hospital-by-hospital basis so that each can learn from the other’s best practices. The effort is just a few years old, and while improvements have been made, leaders feel there is still room to improve.
The e-health arena is another area that needs improvement. The director of ASIP, France’s public agency of shared information system for health, cited the need for the right balance between regionalization and centralization as well as defining the role of public versus private involvement.
As in the U.S., privacy concerns also present e-health challenges. We learned earlier in the week that the supplemental insurance companies are not allowed to keep data about members, either individually or aggregated. Using information technology to streamline the system is a long-term goal.
Editor’s note: This is the third in a series of posts this week from the Nashville Health Care Council’s International Health Care Mission to Paris. To view others, click here.
What better way to understand the health system in France than to visit a hospital? Today, our group of Nashville Health Care Council members divided up to tour a private not-for-profit hospital, a private for-profit hospital and a public hospital in Paris. On our tours, we found trends and challenges similar to those at American hospitals, including more hospital-employed physicians, increased employee recruitment needs and static reimbursement levels.
American Hospital of Paris
The 144-bed American Hospital of Paris, a private, not-for-profit hospital, finds expansion of services difficult for two reasons: 1) The high cost of land in Paris makes physical expansion difficult and 2) The government limits the services private hospitals can offer. To help overcome this, AHP markets to foreign patients, who now account for 40 percent of its revenue.
The hospital, pictured here in a Wikipedia photo, has 782 employees and 376 doctors. As a not-for-profit, it must charge its patients, who then are reimbursed by social security and, if they have it, their private insurance. AHP also solicits private donations to offset operational costs.
The hospital’s history is worth a note. It was founded in 1904 by an American doctor and a French doctor in part to treat the many Americans living here at the time. It was used to treat American soldiers in World War I and during the German occupation in World War II, an American doctor used it to shelter British, Canadian and U.S. airmen who had been shot down over France. Its mission is to provide the best of American and French care.
Clinique de l’Alma
The Clinique de l’Alma, a 60-bed private, for-profit hospital also relies on foreign patients for revenue. A nephrologist and his family own 75 percent and an investment fund owns 25 percent. The hospital’s primary services are dialysis, urology, orthopedics, gynecology and gastroenterology. It has 150 employees and 60 doctors.
Hospital leaders at de l’Alma identified a mix of operational and health practices among their challenges. As in the U.S., more hospitals in France are directly employing physicians. Many physicians here prefer the steady income of hospital employment. But the government only allows public hospitals to do so, putting the private hospitals at a disadvantage when it comes to recruiting medical staff. Officials also cited general human resources issues resulting from difficulty in finding qualified employees and strict hiring and firing laws.
France has seen an increase of two to three percent in renal disease due to aging and an increase in diabetes related to obesity. Interestingly, a drop in the availability of kidneys for transplants because of fewer traffic accidents also has driven the rise in demand for dialysis.
Hospital Saint Louis
Hospital Saint Louis, the public hospital our group visited, is part of Paris’ 37-hospital system. Saint Louis has 563 beds and 3,200 employees, which includes 700 doctors. As part of the tour, our group visited its dermatology museum, the site of the first school of dermatology built in 1800. Dermatology is still offered there along with a variety of services including hematology, oncology, plastic surgery, transplants and burn treatment.
The hospital collaborates with the others in the Paris system. As noted earlier, it also has the option of directly employing its own physicians but it shares the same challenges recruiting nurses and other employees. And as with the private hospitals, Saint Louis and the other 36 hospitals in the city’s system operate at a deficit.
It does have one marketing advantage. It has developed a state-of-the-art laboratory that cuts the time to process tests by as much as 50 percent. As a result, it is now working to win lab work from private and public hospitals throughout the country.
Again, we end the day reflecting on the similarities between the challenges and opportunities France faces with those we have at home.