Health care execs discuss challenges amid evolving laws, demographic changes

Healthcare is changing as hospitals modify services away from fee-based compensation to an outcome-based system in compliance with the Affordable Care Act. That, and workforce shortages were two of the challenges discussed Wednesday (April 6) at the Northwest Arkansas Council’s Health Care Summit in Rogers.

Changing the entire mindset of the health care sector and the patients it serves is taking place in accordance with the Affordable Health Care Act, said Dr. Bill Bradley, president and CEO of Washington Regional Medical System.

“All of us are trying to improve the quality of the care we provide, but being paid on the outcome is a new challenge along with cost,” Bradley said.

Marcy Doderer, CEO of Arkansas Children’s Hospital, said under the present treatment guidelines a child with chronic asthma would have one inhaler to help him manage his condition. He would be required to keep it with him at all times, which means he takes it to school, the sitter’s and also gets home with it at night. Doderer said inevitably the child forgets it at school and ends up the emergency room during the night with an episode.

Under the new model a better way to treat this condition would be to give him three inhalers, one at each place so he is never without it. She said everyone agrees three inhalers provide for better outcomes, but ArkKids, Medicaid, nor private insurers will cover it.

STILL NEED ‘HUMAN CONNECTIONS’
Eric Pianalto, president of Mercy Hospital Northwest, said the outcome-based standard of care is the right solution and said Mercy has been working on this changing dynamic for more than a year. But it’s difficult to do long range planning when the revenue can change overnight, he said.

Not all care has to be done in a hospital, which is something on which Northwest Health System President Sharif Omar said his hospital group is working. He said a community approach to health care makes more sense given it comes with a lower cost than standard hospital stays. Omar said Northwest Health recently launched the NWA Sparks Alliance where seven hospitals from in the system including Sparks Medical Center in Fort Smith and Van Buren each share data to seek better overall patient outcomes.

Bradley said assimilating and analyzing data is great but it will never completely replace the needs for humans. He said patients with congestive heart failure who end up in the emergency room when fluid builds up in the body can stay in intensive care and regular care for several days at a cost of about $25,000. Under the new guidelines, these patients are now sent home with electronic scales to weigh themselves daily and record any weight gain.

“We have found out that about 40% of patients won’t weight themselves. So we have sent … medical students out to check on these patients in their homes to make sure they are weighted and in the process we are able to intervene before a hospital stay is necessary. The technology is great but it doesn’t replace the human connections,” he added.

THE WORKFORCE ISSUE
All of the health care executive on the panel agreed that workforce restraints are a huge hindrance to the future growth.

“We need to hire 200 doctors this year alone,” Bradley said.

While health care jobs compromise 8.7%  of the national labor force they are only 6.5% of the local job base, according to the Bureau of Labor Statistics.

“We are all chasing demand here in Northwest Arkansas and could grow faster if we had the workforce in place to facilitate that expansion,” Pinalto said. “I don’t think the nursing shortage will be filled in my lifetime.”

Omar said they all recruit fairly successfully but they can’t get enough as fast as they need them. He has already seen one hospital built with no patients, just a team of doctors who offer telemedicine in certain specialties. He expects there will be more centralization of speciality care in the future as demand outpaces supply.

The sector has seen tremendous growth. Arkansas’ education and health services sector employed an estimated 179,100 in February, up 8.74% compared to February 2010, and up 20% compared to February 2006. In the Northwest Arkansas metro, the education and health services sector employed an estimated 25,000 in February, up 54.3% in the past 10 years. In the Fort Smith metro, February employment in the sector was 16,800, up 19.1% in the previous 10 years.

HEALTHCARE GROWTH POTENTIAL
The potential to grow the Northwest Arkansas health care sector hinges on its ability to attract and retain health care professionals.

Mike Malone, president of the Northwest Arkansas Council, said the local economy has a gross domestic product worth $25.3 billion, which is bigger than El Salvador. He said on a national scale, health care spending compromises about 17% of GPD. He couldn’t say exactly how much health care spending contributes to the local economy, but at 17% that would be $4.4 billion in Northwest Arkansas.

Thompson said about $1 out of every $5 spent in the state goes toward health care. He said demands on the state’s health care sector will increase as two-thirds of the state’s population are obese and 12% of them are diagnosed diabetics.

Doderer said the $160 million investment Arkansas Children’s Hospital is making in Northwest Arkansas is underway with dirt moving on the building site in west Springdale. She said this new hospital will create 300 more health care jobs that must be filled in an already tight workforce.

“We have wanted to expand our services in Northwest Arkansas for about 10 years. It’s not be a disruptor to the region’s health care sector, but be a partner in helping compliment the care that is already here,” she said.