Like it or not, healthcare reform has arrived. Whether you're a healthcare leader or consumer, things are going to change. Some of these changes we may welcome such as keeping children on your policy until age 26 (assuming you want your kids around that much!), and striking down pre-existing conditions as cause for denial of coverage.

However, in the world of healthcare administration things are heating up. For instance, pay for performance is going to ramp up significantly both in government payment and commercial insurance. If you've watched the news lately from Honolulu, you know that future contracts with commercial insurers have huge weights for quality. Whereas historical incentives were in the 1-2% range, this is now in the mid-teens. Therefore, there is no time like the present to become obsessed (yes, "obsessed") with your core measure scores, HCAHPS, never-event scores, readmissions, etc. Not only does the survival of your patients depend on this, but your organizational survival as well.

At the macro level things are a little more vague but nevertheless vital to our futures. What exactly is an "ACO?" How does this match up with a "Medical Home?" Should I plan to build my own ACO, hitch hike with another ACO, or pretend that none of these will actually get off the ground anyway -- and do nothing?! There are arguments for all of the above depending on your market and circumstances. The fact is that the discussion of ACOs only accounts for six pages of the 2,000+ page healthcare reform bill. The most important details will be delivered by the HHS Secretary some time in December. These "rules" will give us the first indications on how all of this is supposed to work.

So, what should we be doing as healthcare leaders to not be left behind? Tune in! Find reliable sources, such as ACHE and others you trust, to help clear the fog on what's going to happen. Have meaningful conversations with your boards and leadership teams to discover innovative responses to some of these obtuse issues.

In fact, this is a defining moment for healthcare leaders, which means that we have the privilege and responsibility to make sense of these new layers of bureaucracy and payment systems. We must protect our patients and our institutions from harm in the process. As with DRGs in the 80s and managed care in the 90s, we will likely survive these challenges; however, those who prepare the best will not only survive, they will thrive, and their communities will be the winners!

Kevin A. Roberts, FACHE, President and CEO, Castle Medical Center

(*this is a play on the phrase "denial - it's not just a river in Egypt")

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