CEO Interview Series: Payment Reform and the Data Gap
June 5, 2011
Posted by chcablogadmin in : ACO Update
The following interview with Narendra Kini, M.D, President and CEO, Miami Children’s Hospital, is another in a series of CEO interviews with Jacqueline Kueser, CHCA Vice President, regarding children’s hospitals’ responses to the current and envisioned health care environment. Dr. Kini shares his thoughts on the basket approach to bundled payment, the urgency of implementing EMR across all children’s hospitals, and both independent and united paths to survive in an increasingly consolidated environment. This week’s Executive Dialogue will offer a facilitated discussion and visioning sessions on additional strategies. — JR
Interview with M. Narendra Kini, M.D., MHA, President and CEO, Miami Children’s Hospital
- Narendra Kini, M.D., MHA
Payment Reform
All hospitals are experiencing an evolution in payment reform in terms of how we manage cost and outcomes. The new payment scheme will be tied to diagnosis related groups (DRGs); the days of fee for service (FFS) are gone. This move toward basket payment for outcomes along with shifts in tort reform will drive significant changes in the provision of care and the investment required going forward.
Health Information Exchange
How will we achieve outcomes across a population? In terms of information exchange, it is a matter of numbers. Only 14 percent of hospitals are digitized. Where is the information that will fuel HIE? We will need a critical mass of at least 50 percent EMR adoption and thus HIE maturity is likely 5-10 years away.
Managing Population Health
In terms of population health, the trend to an accountable care model across the industry will require children’s hospitals to become centers of excellence and expand into primary care and secondary preventive care. We must have a footprint in prevention to have an impact in an accountable care environment. The challenge is the requirement to be extrinsically networked and digitized in order to intervene at the right time.
Independent and Merged Paths in a Consolidating Environment
Three necessary steps for children’s hospitals to become an independent accountable care model include:
- Create centers of excellence – including an extensive network of digitized information regardless of location;
- Outreach – moving to virtual outreach and telemedicine/ telepresence; and
- Knowledge transfer – providing knowledge to parents to make decisions early, e.g. home monitoring of diabetes patients. We need ways to scale these efforts.
If we don’t move in this direction, children’s hospitals risk being absorbed and we could end up with adult providers taking care of kids. The future consolidated landscape within 5-10 years means children’s hospitals must move quickly to ensure survival.
An alternative model is the creation of zones of pediatric systems for dominance via consolidation/merger. The risks of merging regionally include medical staff reaction, fiscal models of operation, payor mix, level of IT individualization (i.e. Epic, Cerner) and culture. It certainly seems necessary to consider the potential ideal environment for a merged model across children’s hospitals to ensure the best children’s care continues to be available in the Switzerland model.
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