Fee-for-service rules impede new care delivery models, says AHA trustee Walsh
The Class of 2018 profiles the women and men who joined the AHA board this year.
As hospitals and post-acute care providers (PAC) partner in the transition toward a more integrated, value-based delivery system, they need the Centers for Medicare & Medicaid Services (CMS) to remove regulatory barriers that stand in the way of getting patients the best possible care across the care continuum, says Mary Beth Walsh, M.D., CEO and executive medical director of Burke Rehabilitation Hospital in White Plains, N.Y.
In a world of bundled payments, accountable care organizations and other alternative payment and delivery models, providers still must comply with many regulations designed for a fee-for-service system that restrict their ability to craft and test innovations that depart from that structure, Walsh observes.
“You can’t meaningfully alter the pattern of care in a patient-focused way that enables you to get a good outcome and lower costs because you run up against those regulations,” she says.
Walsh and other hospital leaders urge House lawmakers to get behind an effort on Capitol Hill – led by Reps. Pat Tiberi, R-Ohio, and Ron Kind, D-Wis. – to encourage CMS to provide regulatory relief for acute-care hospital and PAC providers. They will call for more flexibility for providers participating in alternative payment models in a letter expected to be delivered soon to the agency.
Walsh also contends that the proliferation of quality measures increases providers’ burden and blurs their ability to focus on issues most important to providing better patient care. “None of these efforts are going to work out well for the health of our communities if we don’t get the quality outcomes measures right,” says Walsh, who joined the AHA board in January.
She says the pace of change in health care is occurring more rapidly than many in the field anticipated, and is causing “angst” among hospitals that “simply don’t have the infrastructure or the analytics to meaningfully participate in risk contracts. There is concern that this is moving faster than some hospitals can manage.”
Walsh says the AHA board’s discussions around redefining the ‘H – she likes to call it “clarifying the ‘H’” – is designed to help hospitals continue to keep their promise of help, hope and healing, but in ways that explore what it means to be a provider in a rapidly transforming health care environment.
“The traditional hospital will continue to be there,” she says. “The building that people go to when they turn dramatically and suddenly and unexpectedly ill. That is the blue and white H sign that dots our roads and that role is not going away.”
But she says hospital need to build on that traditional role by partnering with other types of providers and experimenting with new ways to provide care where people live and work – not just at the local hospital.
“Our niche in the continuum of care is critical,” Walsh says of rehabilitation hospitals. “We focus on patients achieving their functional potential to enable their best quality of life and fullest participation with family and community.”
Walsh joined Burke Rehabilitation Hospital 37 years ago and has led the organization since 1995. The hospital specializes in neurological, orthopedic and cardiopulmonary rehabilitation. Last year, it became part of Bronx, N.Y.-based Montefiore Health System – an alignment intended to provide more value to patients, including better care coordination, patient navigation and oversight.
As an AHA trustee, Walsh serves on the association’s Committee for Process Improvement and is a delegate to Regional Policy Board (RPB) 2, which includes New Jersey, New York and Pennsylvania. The AHA’s nine RPBs provide input on public policy issues considered by the board.
Walsh wishes the public was more aware of the mission behind the AHA’s advocacy. “The association doesn’t exist just to save us from a rate cut or to prevent further harm or to get my outpatient department properly reimbursed,” she says. “It is equally committed to achieving a society of healthy communities where all individuals can reach their highest potential for health. I wish the public could see more clearly how the advocacy pieces are tied to the mission.”