Chief Healthcare Executive Roundtable: Patients are getting squeezed

Hospitals are facing more problems in getting adequate reimbursements from insurers, and patients are paying the price.

That was the overwhelming sentiment of healthcare leaders who came together for the Chief Healthcare Executive Roundtable. In the latest video from that conversation, healthcare leaders say they are facing more problems in dealing with payers, and it’s hurting patient care.

These leaders participated in our roundtable.

• Robert Garrett, CEO, Hackensack Meridian Health
• Benjamin P. Levy, M.D., clinical director of medical oncology, Johns Hopkins Sidney Kimmel Cancer Center
• Kevin Beiner, chief operating officer, Northwell Health
• Deepak L. Bhatt, M.D., M.P.H., M.B.A, director, Mount Sinai Fuster Heart Hospital, Icahn School of Medicine
• Stephanie Wierwille, moderator; EVP, strategy and innovation, BPD

Check out the video for the full discussion. Here are some highlights from perhaps the most passionate segment of the conversation.

Jeopardizing the mission

Levy says Johns Hopkins has been struggling with more delays and denials in payments, including battles over authorizations for treatment.

“It's the patients who are getting squeezed,” Levy says. “We're feeling this front and center at our organization.”

Northwell Health is facing more pressures from inadequate reimbursements, Beiner says. The New York health system maintains modest operating margins because it’s aiming to invest more in services for patients.

But Beiner says it’s becoming more difficult.

“We're living on a 1% margin by choice, because the choice is to do the right thing for our communities,” Beiner says. “I reflect on the platform, the mandate, and what we as providers have to jealously guard, which is that we're the ones here for our communities and our patients, and those top-line pressures are jeopardizing that. We can't be shy about it.”

The hospital executives said they are assessing the impact of H.R. 1, the sweeping tax and spending legislation President Trump signed last year. Analysts project Medicaid spending is projected to be cut by about $1 trillion over previous projections in the coming decade, and millions of Americans are expected to lose coverage. Hospitals are bracing for less support even as they expect to see more patients without any insurance.

Garrett says Hackensack Meridian is anticipating more challenges with Medicaid cuts.

“We take care of 20% of Medicaid patients throughout New Jersey already,” Garrett says. “Every time we see a Medicaid patient it's a significant loss, but it's part of the mission.”

Beiner said health systems are already facing challenges with Medicaid reimbursements falling short of covering the cost of care.

“We as providers have a role in affordability, but again, what we're spending on is giving care to people who need care, and the economic equation is that we lose money delivering that care,” Beiner says.

Advances aren’t rewarded

In some cases, health systems deal with problems when they try to find ways to deliver more effective treatments at lower costs.

Bhatt of Mount Sinai cites advances in atrial fibrillation ablation to treat a common heart rhythm disturbance in older patients. New advances are allowing the procedure to be done more quickly, enabling patients in some cases to be discharged on the same day. But Bhatt says the reimbursement is less compared to prior procedures.

“You've got a procedure that's actually better, but a hospital is going to make less money as it gets adopted,” Bhatt says.

Garrett expressed similar frustration, as health systems try to expand ambulatory services and hospital-at-home programs to help reduce costs.

“There should be some recognition of that in the reimbursement structure, and I haven't seen it,” Garrett says.

You can see all of the videos from our series on the Roundtable page. Our first videos debuted last week. We divided the wide-ranging roundtable into smaller videos designed for busy healthcare leaders.

The videos are free to watch, but you will be asked to fill out some information to access the videos. Join the conversation.

• Read more: The Chief Healthcare Executive Roundtable: Wrestling with costs, change, and the need for innovation