This is one of my favorite sayings in life. It’s easy for people who aren’t required to comply with their own mandates to just wave their arms and expect others to perform heroics.
I was reminded of this during the February 26 panel discussion I moderated at the HFMA Dixie Institute in Tampa. The panel consisted of senior executives from the Alabama, Florida, South Carolina, and Tennessee state hospital associations. Kathy Reep, VP of Financial Services at Florida Hospital Association, kicked off her comments by declaring to the audience, “I don’t know how you do it! With the many, many issues you are facing as hospital leaders, it’s amazing that you are able to keep your doors open.” The reality is that a growing number really aren’t able to.
Most of the panel discussion revolved around the multitude of hospitals’ challenges:
· Industry consolidation
· Rural hospital closures
· ER overcrowding
· Diminished mental health services resources
· The opioid crisis
· Continuous threat of Medicare cuts
· Chronic Medicaid underfunding
· Continuously changing commercial health plan requirements and practices
· Threat of DSH cuts
· Continued uncertainty surrounding the Affordable Care Act
· Complying with confusing and sometimes-conflicting mandates
After hearing this list, I asked the audience, “Is everyone depressed yet?” Laughter.
Since we only had 50 minutes, these are about the only issues we had time for. Several people told me later how strong the session was and wished we had had more time to further explore coping mechanisms and possible remedies.
The reality is that hospitals face incredible challenges. I saw this firsthand when a family member recently spent nearly a month in a rehab facility. Even though that organization is reportedly one of the better local facilities, we experienced many missed hand-offs and much inattention caused in large part by understaffing resulting from steadily diminishing payments. At some point, systems break.
Certainly, hospitals have much room for improvement. but neither the public nor most politicians have any idea how complex the provider world is. During my 19+ years as EVP of Georgia Hospital Association, I frequently said to our hospital CEOs exactly what Kathy Reep said, “I don’t know how you do it.”
This may sound like extreme wining on my part, and maybe it is. Most hospital executives know what they signed up for when then entered the field, and working as a hospital leader can be rewarding both personally and financially. However, it would be refreshing if policy makers did more than impose change after change without providing the means to implement these required improvements. Can anyone say, “Unfunded mandate?”
About the only positive moments during the panel session were my observations about how emerging, disruptive technology holds the promise of ushering in clinical breakthroughs and transforming many of the suboptimal industry processes. Those of you who work in the tech sector should celebrate the role you are playing in moving the ball down the field, even if it is ever-so-slowly.