November Update
At our semiannual Medical/Dental Staff meeting, we focused on the environment of healthcare today and looked a bit into the future. Jody Lomeo and 
Dr. David Hughes gave us insights into Kaleida Health’s plans and goals, and Laura Alfredo from GNYHA spoke about the political and regulatory landscape. If you missed the dinner, click HERE to watch a recording of the event.
We are facing many pressures, some of which will be disruptive. I think of these pressures as falling into three themes: financial, technological and cultural.
Many of the financial pressures are familiar: downward pressure on revenue (from decreasing reimbursements, increasing denials, etc.) along with ever-increasing expenses (especially technology). In addition, there is the uncertainty around the transition from fee-for-service reimbursement to pay-for-outcome (which comes in many forms). This method of reimbursement is a new paradigm whose effects still need to be seen. It adds a great deal of complexity as outcomes are much harder to measure than simple CPT coding. Outcome measurement and reporting is very data-heavy and therefore requires more technology. The timing and impact of this transition is very uncertain, making it difficult to plan ahead.
The technology required to support health care is becoming increasingly complex, as well. Electronic health records are doing much more than simply recording encounters; they are becoming integral to how we practice medicine. Unlike the old paper charts, EHRs are ever-changing, requiring ongoing training. We are relying on technology to support our pay-for-outcome transition. Technology may hold disruptions, as well. Some health care may transition from face-to-face encounters to telehealth encounters. New technologies may begin to perform functions currently done by providers (for an example, look at https://www.eyediagnosis.net/). On a positive note, there is a great deal of work being done on using technology to improve the provider experience of EHRs (for example https://hitconsultant.net/2019/02/11/cerner-chart-assist-ai/).
It is important not to underestimate the cultural challenges we face. Patients (especially millennials) will want full-time (24/7/365) remote access to health care. They are looking for transparency in pricing and quality, along with portability of their healthcare information. It is not clear how we can best provide this. In addition, the younger members of our provider workforce are looking for a different work-life balance than was common in the past. We must adjust to this in order to successfully recruit and retain the next generation of providers. Finally, burnout continues to take a heavy toll on providers. We must work to reduce the administrative burdens we face, improve our technology and technology training, and provide non-stigmatizing ways to support each other.
In my opinion, we can only meet these challenges with partnership among the Medical/Dental Staff, Administration and the Board of Directors. We need a trusting relationship among these entities, which comes from a shared vision and shared decision making. I ask of Administration: include us in decision making. I ask of the Staff: be good partners. We must go forward together, or we cannot go forward at all.
We are stewards of health care for our community. We must ensure there is excellent health care today, and we must ensure there will be excellent health care into the future. We must work for our community of today and of tomorrow.
Peter Winkelstein, MD, MS, MBA, FAAP
Medical/Dental Staff President
Kaleida Health