In This Issue
Paul A. Jeffrey
Wesley Long Community Hospital – Moses Cone Health System
Pamela M. Sinclair, FACHE
Advanced Home Care
Samuel B. Seifert
Wake Forest University Baptist Medical Center
Robert E. Byrd, FACHE
Alamance Regional Medical Center
Wendy P. Hicks
Novant Health – Forsythe Medical Center
Message from the Regent - Winter 2010|
Regent’s Message, Winter 2010
Fred T. Brown, Jr., FACHE
Regent for North Carolina
I would like to work at least until 2014. I probably could retire earlier than that but I really want to see what we do with health reform and try to be a small part of the positive change that will be required. Since I started as a community hospital CEO in 1973 (before many of you were born) amazing breakthroughs have taken place in healthcare but I am not sure that our population is that much healthier. I went to England to study the British National Health Service in 1978 and at the time there were more CT scanners in North Carolina than in the whole United Kingdom. I also saw my first hospice (which did not exist in our state at the time) which has become such a positive serve across our country. Although there were significant differences in the demographics of North Carolina and the United Kingdom, I really could not positively state that our healthcare system was significantly better. In the US since then we have built remarkable hospitals, implemented amazing technology, trained world class physicians , nurses, and even healthcare executives but to what end? Are we spending enough on prevention? Can we sustain the cost of what our population needs and demands? Will we “baby boomers” break the bank?
Our healthcare system has consolidated and will consolidate more. This has helped in some ways to improve efficiency and control costs. Consider, however, that a third of the hospitals in our state lose money from operations, that the federal plan to implement electronic health records is only funded at a level where 50% of hospitals and medical staffs will be successful at achieving meaningful use. Does this portend that the other 50% of hospitals and providers become irrelevant? Is the intent of Federal Reform to reduce the number of hospitals and drive transformation of care delivery to something very different than exists now?
I have been at this career for over 37 years and really thought when I first started out that we as a nation would have had all this figured out by now. I admit to being naïve but you would think that spending 20% of our GNP would have us at more advanced state than where we are in terms of the health status of Americans. Why are we ranked, depending on the study, as being anywhere from the 20th to 30th most unhealthy population of developed countries around the world? The awful truth came to me years ago. Healthcare delivery has little to do with health status in the US.
I have been asked why the healthcare system does not do more prevention and education for the populations served. It may sound cynical but the truth is hospitals and physicians do not get paid to do this now, but that is about to change. My suggestion is that we get ahead of the curve and work on population health improvement now. We know how to prevent diabetics from getting to a state of health where they have to be hospitalized. We know that calling patients seven days after discharge has no effect on readmission rates and these calls need to take place within twenty-four hours of discharge. Coaching and teaching patients and the community about healthy living, eating, and exercise can be accomplished in so many ways. Hospitals and doctors are not in this alone. We need to build coalitions of business, local and state government, public health, YMCAs, school systems and senior centers to name a few. To not undertake the initiative now is to continue to put our nations healthcare costs on those big state and federal credit cards with no spending limit (until we cannot make the interest payments).
Health Reform will not be repealed, but we do have a chance to make it into something that will better solve our health status and healthcare delivery problems. Now is an exciting time. I heard a professor last week at the Gillings School of Global Public Health at UNC say that we no longer could afford to “think outside the box. We had to start thinking outside the building!” As healthcare leaders we have never had such an opportunity to affect change that will be so meaningful to our communities, state and nation. My thought is we start now, keep an eye on Washington, but not wait until thousands of pages of policy has been written. Our consumers are getting older, our population consuming more care and we have to turn the tide now or our children and my grandchildren will pay for our inaction.
Doing what we always have done is like trying to drive a car by looking in the rear view window. Now is the time for innovation, new community initiatives and for thinking “outside the building.”
I am proud to be your Regent.
Fred T. Brown, Jr., MPH, FACHE
Regent for North Carolina