By Joe Southern
Leaders of the four largest hospital systems in Fort Bend County discussed various issues and challenges they are facing amid all the turmoil in the nation’s healthcare industry during a State of Healthcare forum held Wednesday at Safari Texas Ranch by the Fort Bend Chamber of Commerce.
Over the course of an hour they discussed issues ranging from the Affordable Care Act (aka Obamacare) to staffing concerns. The speakers included Joe Freudenberger, CEO of OakBend Medical Center; Greg Haralson, CEO of Memorial Hermann Sugar Land and Southwest hospitals; Chris Siebenaler, CEO of Houston Methodist Sugar Land Hospital; and CHI St. Luke’s Sugar Land Hospital Vice President Wes Garrison, filling in for CEO Rob Heifner.
The hot topic is the effort in the Donald Trump administration to repeal and replace Obamacare.
“We need to change the language. You can’t repeal and replace or else you wind up in the same place,” Freudenberger said. “You’ve got 20 million people that are covered in some form under Obamacare. If you repeal it you’ve got to find a way to cover those 20 million people and why start re-creating the wheel? Why not fix the problems that we have?”
His colleagues agreed.
“Don’t throw the baby out with the bathwater, so to speak,” Haralson said. “There are some good elements of Obamacare … There’s elements of Obamacare that makes sense.”
He said term healthcare reform is a misnomer.
“Most of this was all well-intended but it was much more insurance reform than it truly was healthcare reform,” he said. “So how can we do insurance reform that makes sense and something that can truly be what we call the Affordable Care Act, where it becomes truly affordable? I don’t know the answer to that.”
Siebenaler said the current political discussion is misguided.
“The politics behind what is being discussed really doesn’t add up to people who are operating a hospital day in and day out,” he said. “So from my standpoint it (Obamacare) was kind of set up to fail and everyone knew it was not necessarily going to be successful and that insurance companies were going to bail out of their part because they could not make money on it.”
Siebenaler theorized that Obamacare was designed to evolve.
“Everyone knew, we’re going to get this out and once the genie is out of the bottle, then we’ll have to figure this out,” he said.
“And so I think this is the opportunity to figure it out and to keep things that do make sense and ultimately it will be up to us to make some tough decisions because it’s ultimately about cost management. The funding mechanism, I honestly don’t know how we’re going to do the funding mechanism behind this because the state’s not going to expand Medicaid and the insurance companies are not going to take on more risk.”
The chief executive officers said that changes in funding will have to come, and soon, because the current system is unsustainable.
“Our healthcare system is the best in the world but we’ve proven over and over again … we can’t continue to afford the model that we currently have,” Haralson said. “I don’t mean that to be gloom-and-doom but we are going to have to figure out ways to pay for the type of care that we receive. We can’t continue to run deficits and these types of things. I’m hopeful that we come up with a model that keeps us whole and it needs to look like what we have today.”
He said the system needs to be changed so services to patients are more streamlined and less redundant and that an equitable method of payment is devised.
OakBend’s Freudenberger said Americans have come to expect a high standard of care, often beyond what they can afford. He said Fort Bend County has 43,000 people receiving insurance under Obamacare.
“Obamacare is a challenge … the question I always ask is how can we afford providing what is expected, the Cadillac care, the American healthcare system notwithstanding whatever you might hear of it in a scary world. How do we afford to provide that for everyone that lives in the United States? No other country does that. Every other country in the world, they ration healthcare,” he said.
Haralson said the hospitals have been serving as a safety net for the poor at a very high price.
“Those that even have insurance on the exchange have a $5,000 deductible. They might have $400 cash they can spend in most cases, so eating $5,000 for a healthcare visit or a hospital visit is not going to happen,” Haralson said. “That totals up at Memorial Hermann to more than $400 million per year in costs we provide for the region. That’s just the costs, not the charges, so don’t mix the two.”
He said one way the burden cold be eased on hospitals is if the state would consider expanding Medicaid – something Texas politicians have been loathe to do.
“How are we going to make this the right healthcare system for an entire country and are we going to be willing to pay for it or are we going to have a sense of entitlement, which one of those wins out?” he said.
The CEOs said one of the factors driving up the cost of healthcare is the fact that people are not taking personal responsibility for their health, especially among the poor and immigrant populations.
Haralson said the key is getting patients to see their primary care physician before their condition worsens and they have to go to the hospital. If that happened more often, healthcare costs would plummet. Freudenberger said the problem is convincing those segments of the population to take personal responsibility.
“Those patients have to want to go see a primary care physician,” he said. “So, one of the biggest issues we have is that people are not accountable for their own care.”
He said they tracked the trend at OakBend and found that the poor and immigrant populations won’t follow through on their own care.
“We invited them to schedule a follow-up appointment post-discharge and what did we find in that process? One, the vast majority wouldn’t even schedule an appointment and two, 80 percent of those people we helped schedule and appointment for ended up not showing for their appointments,” he said.
He said that in order to fix the funding you must first fix the attitudes.
“Are patients willing to share their burden of the cost and their share of the accountability?” he asked.
Wes Garrison of St. Luke’s said he agreed with his colleagues, but also noted the county is seriously lacking care for mental health patients.
“There is no program at all in this county for those patients,” he said. “They go to Austin.”
He said 98 percent of the mental health patients at St. Luke’s come via emergency medical services. Once they are cleared medically, the problem becomes one of placement, especially on weekends when there are no judges in the county to sign orders.
“These patients are unfortunately housed at ERs and taking up valuable resources,” he said. “There are very few locations in Fort Bend County that will take our mental health patients once we have them in our facility. The only one psychiatric facility that will take our non-insured, which is the majority of them that we do see, is Texana.”