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Straight Talk
A weekly update from management on the issues that matter most.

Dec 28, 2017
For the past eleven years, I have shared an evaluation of my beginning calendar-year predictions. I understand self-grading creates a bias, so you be the judge.

Coverage and access are uncertain—9.4% of the nation was uninsured in January, 2017.  CMS Administrator Seema Verma tweeted last week that by December 5, the end of this year’s ACA open enrollment period, nearly 9 million people in 39 states had signed up for insurance on the federal exchange.  The individual mandate— the requirement that everyone has insurance or pay a penalty at tax time—was repealed effective in 2019 in the newly enacted tax bill.  “This is important, but it’s not the heart of the ACA, by any means,” says Sara Collins, Vice President of Health Care Coverage and Access for the non-profit Commonwealth Fund.  I think I got this one right—uncertainty persists.


Migrating from volume to value will persist—Accountable Care Organizations (ACOs) are groups of doctors, hospitals, and other health care providers who come together voluntarily to give coordinated high quality care to Medicare patients.  Southwest Florida has a few ACOs; NCH is planning to start one in January.  Mandatory bundled payments were anticipated last year with total joint replacements going first, followed by heart attacks, congestive heart failure, bypass surgery, and pneumonia.  Total joint replacement care costs with bundled payments were going down at NCH with the same or better outcomes.  The Federal Government abruptly curtailed the bundled payment program for reasons that are not clear.  Half-credit—some decisions from the Feds are unexplainable.


More physicians will combine with healthcare systems—The Physicians Advocacy Institute showed the number of physician practices owned by hospitals/healthcare systems rose 86% from 2012 to 2015, with 32,000 additional physician practices employed.  The same institute noted increased costs, perhaps because healthcare systems and hospitals care for everyone whether patients can pay or not, thus shifting costs to those insured. 


The NCH Physician Group added 35 physicians/surgeons as well as 14 nurse practitioners and physician assistants last year for a total of 201 professionals.  Typically, the NCH Physician Group adds young, well-trained, Board Certified colleagues who want professional satisfaction, work/life balance, and appropriate compensation/benefits.  As much as I enjoyed private practice for twenty-three years, conditions have changed and so must we.  Full credit, but this one wasn’t a hard call.


Prevention in Southwest Florida will continue to gain momentum—Last week’s Straight Talk stated, “Over a third of our community from Immokalee to Marco Island to Bonita/Estero is familiar with the Blue Zones Project in Southwest Florida.  Deb Logan and her team have helped to change the lives of at least 10% of our neighbors representing about 40,000 healthier citizens who, in turn, will share their success.  We have 18 restaurants, 2 grocery stores, 8 faith-based organizations, 22 worksites, 16 schools, 14 home-owners associations/country clubs, and 51 other organizations that are Blue Zones approved.  Another 350 more organizations are well on their way.”  Full credit, and in the long run our community’s health is probably the most important long-term project we have going for us, although many wouldn’t consider this a traditional healthcare system initiative.   


Learning best practices from Mayo and the forty-six Mayo affiliates will grow—This prediction is an obvious big win for all as we continue to emulate and assimilate Mayo’s 153-year-old culture.  Mayo Rochester, like NCH, earned a Five-Star rank this year from Medicare and Medicaid (CMS) based on fifty-seven objective metrics.  Clearly full credit. 


Our healthcare environment is beginning to be more responsive to consumerism, transparency, decreased reimbursement, and most importantly the need for objective quality.   More on these subjects in next week’s beginning-of-the-year predictions as we all focus on helping everyone live a longer, happier, and healthier life.


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Allen Weiss, MD

President and CEO

You may contact Dr. Allen Weiss and The NCH Healthcare System by clicking here.