Meeting explores health reform’s impact on VUMC
Health care reform, as signed into law in March by President Barack Obama, will introduce significant change and a number of specific challenges for health care providers, but on balance, Vanderbilt University Medical Center will fare favorably under this landmark legislation.
Larry Goldberg
That message was delivered Tuesday by Larry Goldberg, CEO of Vanderbilt University Hospital, to some 800 managers and faculty leaders at the quarterly VUMC Leadership Assembly at Langford Auditorium.
“I think we have to recognize that this is one of the most global pieces of legislation that has ever been passed. It's the first health care legislation that has actually tried to address cost, quality and access,” Goldberg said.
Among potential advantages and opportunities for VUMC, Goldberg lists far fewer patients without insurance and a bias in favor of VUMC-style integrated care delivery.
“I think most important is that we have a lot of credibility, we are a national resource, an authority, and when people have questions about medicine and the delivery of care we definitely have a voice,” he said.
Jeff Balser, M.D., Ph.D., reviews Vanderbilt’s flood relief efforts at Tuesday’s Leadership Assembly. (photo by Susan Urmy)
The reason that's relevant is that so many details are apparently left unspecified in the legislation.
“It's probably more of a guideline than an actual bill with rules and laws. There are a lot of things in it that actually aren't clear. There's also a lot of aspirational-type things in the bill,” Goldberg said.
Between Medicaid expansion, insurance subsidies for lower-income Americans and mandates for employers and individuals, the bill is expected to cover around 33 million of the 46 million U.S. residents who currently lack health insurance.
“The expansion of coverage will serve us fairly well,” Goldberg said, while also acknowledging that questions remain about whether more Tennesseans may be shopping for insurance on their own, which could lead to more people acquiring less comprehensive coverage.
Under quality provisions, by 2013 between 1 percent and 3 percent of VUMC Medicare revenue will be “at risk,” that is, dependent on whether the Medical Center meets or exceeds certain clinical quality indicators.
Delivery system provisions will begin to shift reimbursement away from fee-for-service and toward a more preventive approach.
Approximately 800 managers and faculty leaders took part in the Leadership Assembly in Langford Auditorium. (photo by Susan Urmy)
Under a system of bundled payments, providers will begin to accept a measure of financial risk for procedures such as joint replacement and heart surgery.
Under a model called “accountable care organizations,” hospitals and doctors across a region will sign on to coordinate their services, follow certain standards of care and share in any resulting cost savings.
The bill also sets aside billions of dollars for outcomes research and for demonstration projects to improve care delivery. Due to its strengths in informatics, health care services and outcomes research, VUMC is ideally positioned to lead in many of these efforts.
The delivery provisions “are really aimed at fundamentally changing the health care delivery system,” Goldberg said.
“We really are in a very strong position around health care reform,” said Jeff Balser, M.D., Ph.D., vice chancellor for Health Affairs and dean of the School of Medicine, during a question period.
“Some of the financial incentives I think are great, but we would do this anyway. This is the right way to take care of patients.”
Other provisions of the bill deal with rooting out regional utilization/cost aberrations, waste and fraud; improving transparency; and scrutinizing providers' non-profit tax status.
C. Wright Pinson, M.D., MBA, deputy vice chancellor for Health Affairs and senior associate dean for Clinical Affairs, delivered a quarterly progress report, much of which was centered on quality.
“As you walk out of this room there are two things I don't want you to forget: one is washing your hands, and two is supporting the work surrounding [prevention of] central line associated blood stream infections,” he said.
Balser started off the half-day session with a financial update, including the news that this year's pay-for-performance increase will average 2.5 percent this year across the University.
To see slides used in the presentations, including financial details, employees can log on at the elevate website: www.mc.vanderbilt.edu/elevate.