TCT.14: Hospitals' future combines closures, opportunities

WASHINGTON, D.C.—The current climate of healthcare reform has many cardiovascular clinicians and administrators asking what the future holds. American hospitals need to learn to do business differently, but, will it help them survive? This was one of the Leadership Considerations in the Cath Lab topics presented Sept. 14 at the Transcatheter Cardiovascular Therapeutics scientific sessions.

Michael Guiry, PA-C, MBA, assistant vice president of cardiovascular services at North Shore-LIJ Health System in New York,   said change was happening whether hospitals are ready or not. In 2012, the amount spent on healthcare in the U.S. is about $2.8 trillion, nearly 18 percent of the U.S. gross domestic product.

While much of this burden is on patients and their employers, the U.S. government pays for approximately 45 percent of costs. And, due to the aging population, these numbers are expected to grow rapidly in the next few years.

Healthcare reform promises hope for many Americans who cannot afford the cost, however, some hospitals are already feeling a crunch in their operating costs as they move away from the fee-for-service model. Some have found they already can’t compete.

Value-based measures have been difficult to achieve and with each year, new goals are applied. Hospitals that fail to achieve success in improving to those measures find that they are paid less and less. This year, Guiry reminded the audience, reimbursement cuts to institutions that fail to meet expectations could be as much as 5.5 percent from Medicaid and Medicare.

Coupled with the fact that profit margins on most hospitals is about 1 to 3 percent a year, “This puts many institutions in the red, which means they’re nonsustainable,” Guiry said.

“What we’ve seen in the New York City region is that, due to many of these financial challenges over the last 15 years, we’ve seen more than 15 hospital closures. And throughout the country we’re seeing more and more.” One in five hospitals was expected to close by 2020, according to an estimate from White House council.

Cardiovascular care must evolve to survive. Some areas already provide growth opportunities and costs can be streamlined by utilizing less expensive methods. In addition, services can be expanded and increased utilization of outpatient services can help. Digital and virtual care will become a greater portion of care over inpatient services.

Guiry pointed to the aging population to remind cardiovascular specialists that the need for these services isn’t going to go away. In fact, in the coming years, more services will be needed. Predicted areas of growth included cardiac surgery, electrophysiology and vascular medicine, by as much as 20 to 25 percent.

“Unfortunately, interventional cardiology on the inpatient side will not be growing,” Guiry said, predicting a decline in the volume of catheterizations and flat growth for PCIs.

In Guiry’s hospital, savings success has come by bringing clinicians into the discussion about cost, showing them options and providing them with cost-benefit analysis of procedures has helped.

Guiry concluded by mentioning that there are expanding opportunities for the cardiovascular field, through service offerings, strengthening condition-specific clinics and reducing operating costs.

A follow-up speaker, Leo Nelson Hopkins, MD, of the Gates Vascular Institute in Buffalo, N.Y., offered another opportunity in the cardiovascular healthcare market: growth through the creation of multidisciplinary cardiovascular centers, bringing together members of different disciplines with solutions to perform a more safely at lower cost.