Although they may have been preaching to the choir, five leaders of area hospitals spoke about the state of healthcare during an annual healthcare luncheon hosted by the Fort Bend Chamber of Commerce May 31 at Safari Texas Ranch.
The five panelists – Rob Heifner of CHI St. Luke’s Health Sugar Land Hospital, Richard Ehlers of MD Anderson Cancer Center, Greg Haralson of Memorial Hermann Sugar Land and Southwest hospitals, Joe Freudenberger of OakBend Medical Center, and Chris Siebenaler of Houston Methodist Sugar Land Hospital – were each given a topic to address and also answered questions at the end of the presentation.
The topics were given by Fort Bend Chamber of Commerce Chair Malisha Patel, who is also replacing Haralson on Aug. 1 as CEO of the two Memorial Hermann hospitals. Haralson is being promoted to CEO of the Texas Medical Center campus.
Heifner of St. Luke’s went first and was asked to discuss generational impacts on healthcare. That led him to talking about the baby boomers.
“An interesting thing demographically is their life expectancy is longer than what their parents were. However, when you look at relative healthcare, relatively speaking, they’re sicker and have more issues,” he said, noting that the health issues relate from lifestyle choices made decades ago.
“They have more diabetes, more heart disease and they’re living longer, so that actually is potentially a disaster because we don’t have the resources to take care of this population,” he said. “Then on the other side of the equation, are the providers. When you look at the average age of nurses, they’re on the tail end of that demographic, so as they start to exit the workforce we’re starting to see a deficit of providers to take care of a cohort that now is growing exponentially. As a system we need to determine how are we going to have these hard discussions about how to take care of these people.”
Ehlers from MD Anderson was asked about healthcare reform.
“We’re moving toward an era of value-based healthcare,” he said.
Ehlers said there are two parts to consider. The first is the political one of funding health care and providing for the uninsured. The second was the quality of care, as the public demands more and newer services even though they may not be medically necessary. He said some of the technologies hospitals have, “may not add value to healthcare but that’s what’s being marketed.”
He said the United States could consider a method used in Europe called bundle care.
“A classic example would be hip replacement surgery,” he said. “Instead of fees for every service along the way there’s a single fee, that’s it. And whether it’s government pay or private pay … you can see real competition in the market because you can compare one provider’s cost to another’s, one’s outcomes to another’s.”
Haralson of Memorial Hermann was asked about state and federal mandates.
“I also feel that there’s so much more work to do,” he said. “As it relates to our healthcare system I think its an important context to learn that as the ACA (Affordable Care Act) was passed, hospitals negotiated with the Obama Administration and worked to find $555 billion in Medicare cost reductions, reimbursement reductions essentially for hospitals, cost reductions for the federal government, with the expectation that those dollars would be picked back up from the providers with the expanded coverage for the uninsured – those who are not accessing healthcare in a more cost-effective manner.”
Haralson, like his counterparts, noted that current levels of funding healthcare in the country are unsustainable. That means working with lawmakers to find solutions to very complicated problems.
“It is very, very important that we stay connected with our elected officials so they understand what our needs are so that we can provide the sustainability to provide care for the citizens of Texas,” he said.
Freudenberger of OakBend was asked to talk about the cost of healthcare.
“We also hear about it from the press routinely in terms of how much the U.S. is spending in terms of gross domestic product on the healthcare services we receive compared to how much they’re spending in Europe,” he said.
He said consumerism is driving the cost of healthcare up.
“That is what is driving us to dedicate over 17 percent of our GDP to healthcare services, so we consider that to be an unsustainable level,” he said. “And I believe it is unsustainable … as our baby boomer population ages they bring with them all the lifestyle decisions they made, all the healthcare issues they have, and all their consumer-driven attitudes they have and say ‘hey, I want to fix what’s broken. Fix it so I can go out and play golf again,’ or whatever the activity of choice is.”
As an example, he said his father was diagnosed with leukemia in his late 80s and was immediately referred to a chemotherapy program.
“I had to go through a whole process with the oncologist to understand would this lengthen his life or do anything that would benefit him, and ultimately the answer was no,” Freudenberger said. “Fortunately he lived past his expiration date. The doctor said he was going to expire at 92 and he lived to 95. I don’t think if we had invested all the resources that we would have gotten that out of him… That’s a lot of money to spend to treat somebody without the necessary benefit.”
Freudenberger said the country must start aligning incentives within the healthcare industry with the care of patients.
“Right now, the more you pay, the more we can do for you, so we have an incentive to do more. But what we really should be doing is keeping you as healthy as possible,” he said. “If you shifted our reimbursements to focusing more on the health of the community that we serve … then you’ll get doctors and hospitals and other healthcare providers investing a whole lot more time and energy in doing various things such as educating the communities they serve to better maintain their health and investing in technology that provides advance notice when a patient with chronic pulmonary disease, for example, is experiencing a fluid overload. With wearable technology now we can identify a lot of conditions before they become so acute the patient has to be hospitalized.”
He said Americans need to think about a system similar to the one used in Europe that places more emphasis on the patient’s behavior.
“In Europe it’s called refunded healthcare. If you made the decision to drink yourself to the point where you got cirrhosis, that’s not necessarily going to lead to the government paying for you to get a new liver,” he said. “In the U.S. healthcare system you don’t have that distinction. It doesn’t matter what’s wrong, Medicare is going to pay for it, regardless if you’re a candidate for that particular procedure.
“That’s a tough one to wrestle with as well as, how do we get away from doing everything without specific consideration as to whether it’s going to generate the best outcome?” he said. “There’s lots of issues, but when it’s all said and done, in my opinion the ultimate challenge is how do we change our consumer-driven model to being one that focuses more on health as opposed to getting what you want when you want it.”
Siebenaler of Houston Methodist was asked to talk about the impact of technology on healthcare.
“Technology is an enabler of disruptive influences in our market and we all are here dealing with those disruptions as healthcare providers,” he said.
Siebenaler said advancements in technology both give consumers more options but also drive up healthcare costs.
“Technology is the great enabler of most of that disruption, whether it be increased use of robotics, nanotechnology, implants … When you start thinking through what sort of information we’re getting, Big Data is kind of underpinning all of the things that are happening,” he said.
He said the latest trend in healthcare is the use of artificial intelligence. He said he doesn’t understand it, but he frequently hears it as a topic of discussion within the industry.
As an example of how technology is disrupting the healthcare marketplace, Siebenaler talked about cellular phones.
“Just look at your phone. Your expectation as a consumer is I have options right now and it cost me X. And if I want my services to be X-plus, then I will pay up for that access,” he said. “Isn’t that what we do right now from a consumer standpoint? We’re willing to pay that extra 20 bucks for something, well that’s a model in healthcare that we might see more of as we move forward, but I think the consumers end up driving it with technology being part of the disruption. In other words, if there are various technological platforms that better allow us to better engage in our healthcare consuming I think the opportunity is for us to do that more.”
Siebenaler said he is looking forward to seeing what advances in technology bring to the healthcare profession.
“It’s a fascinating time. The next 10 years for us as healthcare workers, as caregivers, will be the most challenging and dynamic years of our careers,” he said.