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34 2012-2013 Jacksonville & Northeast Florida Healthcare GuideTM

FLORIDA HOSPITAL ASSOCIATION CHAIRBy Laura Hampton

President and CEO of BaptistHealth in Jacksonville, HughGreene holds a master’s degree

in health administration from the Medical College of Virginiaand a Master of Divinity from Southern Baptist TheologicalSeminary in Louisville, Ky.

Greene has served as board chair for the JacksonvilleChamber of Commerce; JaxCare, which provided programs forthe working uninsured; and the Sulzbacher Center, where hereceived the Excellence in Healthcare Award for efforts inproviding health care to the homeless.

The Jacksonville Business Journal named Greene one of thearea’s 12 “Ultimate CEOs” in 2007, and in that same year, hewas inducted into the First Coast Business Hall of Fame.

As Florida Hospital Association (FHA) chair, Greene advocateson behalf of Florida hospitals in relevant state legislation andsupports the organization’s initiatives to provide the highestpossible care to the patients its members serve.

We sat down with Mr. Greene to talk about his work with FHA,challenges in the current system and the future of the healthcare industry.

What will be the biggest challenges in the health careindustry in the next year?

The biggest challenge we’re facing right now is majorreimbursement cuts. Over the last five years there have been$500 million in Medicaid cuts to Florida hospitals. This year thecut was 5.64 percent—so about $300 million.

Then turn to Medicare. I don’t care if Romney’s elected orObama’s re-elected—it doesn’t matter to me. We all knowMedicare cuts are on the other side of this election. So, whenyou start adding Medicare cuts on top of Medicaid cuts, wereally do face a future in which we’re going to be paid less. Whatdo hospitals do? What do physicians do?

We’ve reached this crisis, so what do we eliminate? Thechoices are obvious. Do you eliminate employees? I hope not.Do you eliminate programs like mental health, which is alreadygrossly underfunded? When you suddenly have all theseadditional cuts and you have programs that are losing money,do you pull back from those programs?

It’s like any other business. If you are losing money, you haveto do something different. When you are continually paiddramatically less year after year for what you’re doing,something gives. It just cannot, not give.

What would you like to accomplish this year as chairof the Florida Hospital Association board?

FHA is primarily an advocacy group in the industry. We’vebeen spending all of our time, up to this point, trying to holdback these Medicaid cuts and then also to advocate on behalfof Florida hospitals on other things that are deemed to bedetrimental to the welfare of hospitals.

On the other hand, one of the things I am most proud of withFHA is major quality initiatives. We have several surgical careimprovement initiatives among the Florida hospitals, in concertwith the American College of Surgeons, to improve surgicaloutcomes—in particular, reducing surgical infections. I don’tknow the number of hospitals in the state involved, but it’s big.We’ve really been spending our effort and energy to betterinvolve hospitals and to learn from each other via best practices.

How is technology changing the patient/physicianinteraction and how hospitals do business?

Well, you can drop technology into three buckets—clinical,pharmaceutical and information technology.

The traditional bucket that people think about is clinicaltechnology. Five years ago, we didn’t own any kind of surgicalrobot, now we own three. We didn’t own high speed MRIs,where you can do the scan of an entire child in four seconds.There’s a continued explosion of that kind of clinical technology,which improves patient care.

There is a reason why you would have a gynecologicalprocedure done with a robot as opposed to someone going inwith their hands and doing it. The robot allows you to do veryfine surgery with less blood loss, less destruction of relatedtissue, and, therefore, recovery is much faster.

The other thing that continues to explode in our industry ispharmaceutical technology. Think of various conditions, ratherit be Lipitor related to cholesterol, whether it be the antiviraldrugs related to HIV—huge continued progress every year. That’sa big driver in health care costs as well. Before these thingscome off patents, they’re very expensive. But, none the less, allof us want it. I mean, why wouldn’t you?

The third area of technology is information technology. Wejust completed the conversion of our final hospital fully toelectronic medical record. In all of our hospitals, there’s nopaper being used at all in a clinical patient record anymore. Weare also rapidly converting our doctor’s offices to an electronicrecord, and then we’re connecting them, so that your record willfollow you or information will be transmitted electronically. It’shuge. There’s great opportunity for patient care improvement.

If you’re in a hospital bed now, and the nurse is going to giveyou a medication, they swipe their badge, they swipe the barcode on the medication, and they swipe the bar code on yourwrist band. We know who gave what to whom, when—and thenthe computer has the incredible ability, given the explosion inpharmaceutical technology, to say, whoa! Do you realize thisdosage is not compatible to this patient’s weight? Or even, didyou know this particular medicine is counteractive with anothermedication this patient is taking? So, the computer hastremendous potential.

How does the push to decrease wait times inemergency rooms impact patient care?

The whole emergency room issue is kind of a complicatedone. The contradiction that’s always there for the patient is, theleast sick person is often the one that ends up having to wait

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Heritage Publishing, Inc. © 2012 Q&A WITH HUGH GREENE, FLORIDA HOSPITAL ASSOCIATION CHAIR

the longest, and they can’t understand. They think, you can getme in and out in a hurry; I don’t have much wrong with me.But, in a true emergency room, they’re the least priority. So everytime that ambulance rolls in, they’re in the back of the line.

I’m very hesitant to tell anybody, “You’re going to come to ouremergency room and get in and out in 30 minutes,” if they’vejust got a cut finger or something. I think it’s an interestingmarketing thing that people are doing, but I don’t want to createunrealistic expectations.

How will the changes outlined in the Patient Protectionand Affordable Care Act (PPACA) impact physicians,hospitals and patients in Florida?

Health care reform impacts everything. It’s transformational.The law is so complicated. It has a lot of stuff in it, and I’veargued all along it has a lot of good stuff in it. The good part forphysicians and hospitals is, when you move 32 million of the50 million uninsured from being completely uninsured tohaving some level of coverage, that’s really a positive thing.

Now, on the other hand, what is occurring in part of the law,are simply big reductions. There’s a $500 million cut in Medicarepayments contained with this law, but it’s somewhat offset bythe uninsured having the ability to pay something.

There are a whole series of things that affect the insuranceindustry, specifically, and there are major delivery systemreforms contained in the law that changes, potentially, the wayhospitals and physicians are compensated going forward.

You’ve heard many things like bundle payment contained inthe law. The goal of bundle payment is to avoid hospitalreadmissions. Any time anybody does anything to anybody, ifthey’ve got insurance, we get paid. We’re paid by encounter—volume. So the more you do, the more you make. The law says,maybe the incentives are not correctly aligned here.

A patient that’s admitted with congestive heart failure that’sdischarged and then returns to the hospital six days later and isreadmitted—guess what—we get paid again. If they getdischarged a second time and get readmitted, we get paidagain. Every time they come, we get paid. There’s really noincentive in the system, historically, for doctors and hospitals totry and manage care more effectively. It’s not like we’re tryingto readmit them, but we just aren’t particularly incentivized.

If you suddenly get paid a bundle payment for a 30-dayepisode, and by the way, if they’re readmitted you don’t get paidany more, that changes the whole nature of what we do. Thenwe start assigning case managers, following up with patients athome, etc. We’re incentivized to keep them out of what’s themost expensive aspect of the health care delivery system—theemergency rooms and hospitals. So, I actually think that changeof incentivization is a positive thing.

Critics would say, “Are we moving toward national healthcare?” We really are not moving toward more governmentcontrol. The law, as it’s currently put forth, actually solidifies theprivate employer insurance model in this country. It’s notsocialized medicine in the traditional government sense. Peoplekeep wanting to turn it into that. When people do that to me, Isay, “Have you read this thing?” That’s not what it does. But, itcertainly is giving government a more active role—in terms ofhow Medicare’s going to pay in the future, particularly.

My point is—even though it takes us down a very differenttransformational path around health care delivery in thiscountry, it has enough other things in it including expandingcoverage that makes it, in the long run, more palatable for thoseof us in the delivery system.

On the other hand, it’s not perfect. There was a lot of politicaljockeying, so there are things about it that are just not good.But, generally, it’s not a bad start.

What’s your opinion about the Supreme Court hearingtestimony on the Patient Protection and AffordableCare Act (PPACA)? Do you think aspects of the healthcare reform legislation are going to be overturned?

I don’t have the expertise from a legal standpoint to saywhether this thing is or is not constitutional, and so much of itseems to revolve around the political.

The more important question to ask is—what is the effect if itis not deemed to be constitutional? And that has two parts.There really is a difference between the individual mandatebeing deemed unconstitutional—striking down that piece andallowing the rest of the law—and the entire law being thrownout. Clearly the mandate is very important to the expandedcoverage piece. So, most people believe that if you take awaythis mandate, it does significantly undermine the coverageexpansion that’s so important in this law that will reportedlyresult in about 30 million people becoming covered.

This is a conviction I have. We have so started down this pathnow that I’m convinced if the health care reform law is repealed,we’re going to still see reform march forward. The commercialinsurers have already begun implementing the very kinds ofthings that the government was talking about implementing. So,when I meet with [insurance companies], they’re talking aboutbundle payment; they’re talking about pay for performance.

I guess what I’m saying is, I think the train’s kind of left thestation.