Joe FiferThe mid-term elections are over. Can we get back to business?


Setting aside the election results (because HFMA is a nonpartisan organization), the good news is that this was the first midterm in history to exceed 100 million votes. Nearly half of eligible voters exercised their civic rights, a midterm participation level not seen in decades.

The bad news is that uncertainty surrounding the elections led to financial market jitters, deferred business decisions, and seemingly endless speculation on election outcomes (i.e., lost productivity). And the political news cycle hasn’t slowed down for a nanosecond. Public attention has already shifted to the next turn of the political wheel.

Back when the country was waiting for the 2016 election results, HFMA’s message to members was simple: Don’t get distracted by political theater. The forces driving change in health care are fundamental, structural forces that won’t be derailed by whatever may be going on in Washington at any given moment. Our message now is basically the same as it was in 2016—but it carries greater urgency. Why does health care need your undivided attention now? Several reasons.

For one, value-based payment (VBP) methodologies need work. Based on research we conducted this year, early experiments with these methodologies are not curbing growth in total cost of care. Yet common sense and emerging results (i.e., from more recent activity) tell us that VBP shows promise. We must focus on developing VBP models that make a dent in healthcare spending, and that means incorporating social determinants of health and behavioral health—in other words, spending the time and making the effort to move beyond our acute care comfort zone.

Second, amid increasing merger and acquisition activity, we now have evidence that achieving the size required for population health management, or even just achieving economies of scale, comes at a cost. A research project HFMA conducted in partnership with the Deloitte Center for Health Solutions found that acquired hospitals are likely to lose money in the first two years after a merger unless they pay close attention to integration planning and execution. Mergers may be common, but successful mergers are far from routine.

And third, consumerism should move up on the priority list for healthcare organizations. Although many healthcare leaders recognize that consumerism is important, too often, it isn’t viewed as urgent. As a result, the industry has experienced slowly and steadily diminishing levels of public trust. Improving price transparency and adopting best practices for patient financial communications can go a long way toward rebuilding that trust.

With enough time, energy, and enthusiasm, I’m confident that we will be able to meet these challenges. Breaking the cycle of waiting for the results of the next election—or for someone else to solve our issues—is a good start.

Publication Date: Saturday, December 01, 2018