HJLR Mar/Apr 2019

dialogue 16 MAR / APR 2019 I  Healthcare Journal of little rock   think that is a lot more complicated today. The question alludes to it being primarily payer driven. I wouldn’t say primarily, but that is one major element. If you say payer, meaning the federal government as the larg- est payer, or commercial insurance com- panies as the second-largest payer, they have had an impact. If you have the ability to dictate payment terms to hospitals, you can make them change—and they have. One example of that is value-based purchasing programs like Medicare, where you are penalized or rewarded based on certain outcomes that cause you to evolve differ- ently. The requirement for electronic med- ical records was federal-government driven because they said we will pay you to do this, and oh, by the way, if you don’t do it, not only will we not pay you, but we’re going to penalize you later. You had to do it. So, the payers, whether it is the government or major insurance companies, can cause hospitals to evolve or change. I think there have been an equal number of hospitals and health systems who want to change, but one of the major challenges in doing that is how to bring the payers along with you. If you decided as a health system to do a better job of caring for the community outside the hospital walls, how do you get paid for that? Everyone wants better health outcomes, but we have this payment mechanism that is driven by “you do something, we pay you.” Many health systems, including Baptist Health, would like to know we are mak- ing an impact on people’s health and well- being outside the hospital, but how are we going to finance it?The other consideration is howmuch more hospitals are integrated with communities and physicians than they were 20 years ago, particularly inArkansas. If you go to the West Coast or East Coast, this notion of physician employment and being part of the health system was in place 20 years ago, but inArkansas, it really wasn’t. We have seen a dramatic change in the number of doctors who are now affiliated with an institution versus being independent. The level of integration has definitely evolved, and I don’t know that it is payer driven, but the economics matter in that discussion. Editor What do you see as the future of hospitals, and in particular, the future of Baptist Health in Little Rock? Wells While hospitals will certainly con- tinue to evolve and change, there will always be a need for hospitals to provide care for the most complex patients. How- ever, when you think about clinical tech- nology and this notion of “faster, smaller, smarter, cheaper,” you can’t help but think that more and more care can happen out- side of the hospital walls. What was once done only in a hospital became available in a clinic, and then in a retail setting, in some cases, without clinical supervision. Finally, care that once could only take place in an institutional setting is being moved to the home environment. For the most part, hos- pitals and health systems are doing all of these things. At our Little Rock campus, we are a statewide referral center, so while we serve the people of Little Rock and the sur- rounding communities, we always try to balance our role in the state with our role as a community hospital. Hospitals in gen- eral will continue to be where you have the most sophisticated and complex types of health care being provided, and you will see other non-complex routine health care continue to move outside the hospital. Bap- tist Health’s hospital in Little Rock will con- tinue to be an aggregator of high-end tech- nology—things you can’t afford to replicate in multiple places. You have to concentrate that high-end technology, both for the state and people locally. Baptist Health will con- tinue to be a leader in innovation, clinical care, and reputation. Our faith-based min- istry will continue to be what we really focus on. We will continue to be a place where we value people, both our employees and the people we serve. That is what we hang our hat on—working well with doctors, valuing employees and our patients, and staying true to our faith-based mission. That is our strategy. n …care that once could only take place in an institutional setting is being moved to the home environment.