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Finding The Future For Public Hospital Districts

AWPHD. Finding The Future For Public Hospital Districts. AWPHD Administrator Only Retreat May 22-24, 2011 Red Lion Hotel Hanford House. Finding The Future. In the beginning, hospitals were the end By early 20 th Century, most owned by doctors

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Finding The Future For Public Hospital Districts

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  1. AWPHD Finding The FutureFor Public Hospital Districts AWPHD Administrator Only Retreat May 22-24, 2011 Red Lion Hotel Hanford House

  2. Finding The Future • In the beginning, hospitals were the end • By early 20th Century, most owned by doctors • 1930s: more than half who go in come out alive! • 1940’s Hill Burton Act • In Washington, Public Hospital Districts are born • 1958-62 Fifteen rural hospitals in Washington transition from religious affiliation to PHD

  3. Finding The Future • 1963-4 Medicare and Medicaid • 1970’s Rate Setting and Health Planning • 1983 DRGs • 1988 Discounting and the end of rate setting

  4. Finding The Future • Cost Spiral is, really and truly, unsustainable… If $1 out of $6 isn’t enough, how much is? …and the cliff is under our feet! • There really won’t be enough doctors or nurses to meet demands of current system. One recent published survey estimates the shortage of primary care physicians in the US at 44,000 by 2016. A UW study suggests that there will be 5,000 RN vacancies in hospitals on any given day in 2014.

  5. Finding The Future • Affiliations, mergers and acquisitions are re-making the health/medical care landscape in Washington state. Only a handful of free standing community hospitals left; most PHDs are actively managing physician practices; a new deal every day. Also being driven by increasing complexity, especially complexity in information management. The message seems to be: “bigger is better.”

  6. Finding The Future • AWPHD intends to understand and respond to, not direct, the needs of members. • How to best do that in a time of such dynamism? • What might Public Hospital Districts look like in 2015? • Will more follow Stevens Healthcare approach? • Valley Medical Center approach? • Skagit Valley Hospital approach? • THE ANSWER IS ALMOST CERTAINLY YES!

  7. Finding The Future • Over the next year promote vision of rural hospitals in a reformed health care system • Emphasize value of local hospital to local community • Improve Commissioner understanding of trends and emerging role • Support You!

  8. Ambulance Assisted Living Behavioral Health Service Clinics Emergency Department Fitness Center/Programs Health Education/ Prevention Programs Health Resource Center Home Health Hospice Inpatient Outpatient Palliative care Pharmacy Skilled Nursing Facilities Wellness Centers Services Offered By PHD’s Today

  9. Finding The Future A Simple Question: • In the Healthcare Market Place Today-- • Whose “community,” “population,” or “market area” is more easily defined than a public hospital district’s?

  10. Finding The Future Our Answer: No One’s! • Legal authority and responsibility to assess, define and respond to a broad range of health and medical service needs • Accountable through elected boards and public votes • Defined boundaries and populations, taxing and bonding capacity.

  11. Finding The Future • ALSO: WE ARE NOT RARE!

  12. White Paper Review

  13. Finding The Future Neither are we alone: • Local Public Health Agenda For Change • Efforts to create a “Regional Health Authority” to bring people “with special needs” into Medical Home/Accountable Care Organization discussions

  14. Finding The Future • Emerging Concepts: • Medical Home • Accountable Care Organizations • Regional Systems • What do we like about these ideas? • What will it take to make them work?

  15. Finding The Future • It seems • likely that PHDs will grow in multiple ways– and that they will require representation and advocacy support to be successful. • likely that Commissioner Education will become increasingly important. • unlikely that the demands for transparency and issues related to OPMA and PRA will become less “noisy” over the next few years. • AWPHD, in some form, will be valuable!

  16. Finding The Future • How much support can PHD’s afford? • Growing pressure on dues: In 2011 AWPHD will spend about 1/2 what it spent in 2005. But the pressure to cut expenses has really just begun. • ?? Time to consider ??: • More independence from WSHA? • Stronger consolidation with WSHA? • Expanding membership beyond PHDs?

  17. Thank you! Jeff Mero, Executive Director jeffm@awphd.org 206.216.2519

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