Download Finding The Future For Public Hospital Districts

AWPHD
FINDING THE FUTURE
FOR PUBLIC HOSPITAL DISTRICTS
AWPHD Administrator Only Retreat
May 22-24, 2011
Red Lion Hotel Hanford House
FINDING THE FUTURE
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In the beginning, hospitals were the end
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By early 20th Century, most owned by doctors
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1930s: more than half who go in come out alive!
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1940’s Hill Burton Act
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In Washington, Public Hospital Districts are born
1958-62 Fifteen rural hospitals in Washington
transition from religious affiliation to PHD
FINDING THE FUTURE
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1963-4 Medicare and Medicaid
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1970’s Rate Setting and Health Planning
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1983 DRGs
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1988 Discounting and the end of rate setting
FINDING THE FUTURE
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Cost Spiral is, really and truly, unsustainable…
If $1 out of $6 isn’t enough, how much is?
…and the cliff is under our feet!
There really won’t be enough doctors or nurses to
meet demands of current system.
One recent published survey estimates
the shortage of primary care physicians
in the US at 44,000 by 2016.
A UW study suggests that there will be
5,000 RN vacancies in hospitals on any
given day in 2014.
FINDING THE FUTURE
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Affiliations, mergers and acquisitions are re-making the
health/medical care landscape in Washington state.
Only a handful of free standing community
hospitals left; most PHDs are actively
managing physician practices; a new deal
every day.
Also being driven by increasing complexity,
especially complexity in information
management.
The message seems to be: “bigger is better.”
FINDING THE FUTURE
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AWPHD intends to understand and respond to,
not direct, the needs of members.
How to best do that in a time of such dynamism?
What might Public Hospital Districts look like in
2015?
Will more follow Stevens Healthcare approach?
 Valley Medical Center approach?
 Skagit Valley Hospital approach?
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THE ANSWER IS ALMOST CERTAINLY YES!
FINDING THE FUTURE
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Over the next year promote vision of rural
hospitals in a reformed health care system
Emphasize value of local hospital to local
community
Improve Commissioner understanding of
trends and emerging role
Support You!
SERVICES OFFERED BY PHD’S TODAY
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Ambulance
Assisted Living
Behavioral Health
Service
Clinics
Emergency Department
Fitness Center/Programs
Health Education/
Prevention Programs
Health Resource Center
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Home Health
Hospice
Inpatient
Outpatient
Palliative care
Pharmacy
Skilled Nursing
Facilities
Wellness Centers
FINDING THE FUTURE
A Simple Question:
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In the Healthcare Market Place Today-
Whose “community,” “population,”
or “market area” is more easily
defined than a public hospital
district’s?
FINDING THE FUTURE
Our Answer: No One’s!
o
Legal authority and responsibility to
assess, define and respond to a broad
range of health and medical service
needs
o
Accountable through elected boards
and public votes
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Defined boundaries and populations,
taxing and bonding capacity.
FINDING THE FUTURE
ALSO:
WE ARE NOT
RARE!
WHITE PAPER REVIEW
FINDING THE FUTURE
Neither are we alone:
 Local
Public Health Agenda For Change
 Efforts
to create a “Regional Health
Authority” to bring people “with special
needs” into Medical Home/Accountable
Care Organization discussions
FINDING THE FUTURE
 Emerging
Concepts:
Medical Home
 Accountable Care Organizations
 Regional Systems
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What do we like about these ideas?
 What will it take to make them work?
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FINDING THE FUTURE
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It seems
likely that PHDs will grow in multiple ways–
and that they will require representation and
advocacy support to be successful.
 likely that Commissioner Education will
become increasingly important.
 unlikely that the demands for transparency
and issues related to OPMA and PRA will
become less “noisy” over the next few years.
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AWPHD, in some form, will be valuable!
FINDING THE FUTURE
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How much support can PHD’s afford?
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Growing pressure on dues: In 2011 AWPHD will
spend about 1/2 what it spent in 2005. But the
pressure to cut expenses has really just begun.
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?? Time to consider ??:
More independence from WSHA?
Stronger consolidation with WSHA?
Expanding membership beyond
PHDs?
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THANK YOU!
Jeff Mero, Executive Director
[email protected]
206.216.2519