Friday, February 3, 2017

HCCA

Published in VC's Notes on February 03, 2017

Mississippi's Health Care Crossroads

Good morning!

A few weeks ago, I mentioned that the state Legislature had begun its 2017 session and we would be “on call” for the next three months to respond to questions from legislators. 

It's not uncommon for the Medical Center to have five or six initiatives in front of the Legislature each session, in addition to a request for bond funding and our general state appropriation.

This year, however, we are focused on one bill that I believe is crucial to the future of UMMC and our quest to achieve a healthier Mississippi - the Health Care Collaboration Act of 2017.  In fact, I think if of it as our state's health care crossroads.

You may have heard about it in the media, but today I want to share an overview of what the HCCA, as it's called, is all about.

MS_Crossroads_state.jpgIn simplest terms, the bill provides UMMC the tools it needs to conduct the business of health care effectively and efficiently in today's dynamic marketplace.  This is all the more important as we attempt to enhance that value equation we often talk about - lowering health care costs while improving quality.  In turn, strong, vibrant clinical programs are essential to high quality research and education programs and our ability to produce nearly 1,000 new health professionals for our state each year.

I will pause a minute to take you back to 1950, when the Legislature passed the law that created UMMC as a “department” of the University of Mississippi.  That was before Medicare and Medicaid, before DRGs and ICD-10, before group purchasing organizations and integrated care networks.  All this and so much more has come to pass, and yet our health care enterprise still must operate as if it were the legal equivalent of the geography department of a state university!

We have known about this handicap for years, of course, as we labor to purchase medical equipment under state procurement laws that are not well-suited to the needs of a modern academic medical center.  To be blunt about it, it is exceedingly difficult to properly equip our clinical faculty and staff or optimally serve our patients under our existing state procurement system.   

But it's only been in the last few years - as the financial status of many community hospitals in Mississippi has become more tenuous - that UMMC's inflexibility in conducting business has become so apparent.  When county supervisors in Grenada reached out to us for assistance with their hospital, our range of options to help that community was severely limited.  It took more than a year to work out a lease arrangement that was beneficial to both sides.

After Grenada, we began receiving numerous requests from other communities in all corners of the state - from boards of supervisors, hospital CEOs, physicians, legislators and concerned citizens.  That prompted us to begin looking at public academic medical centers in other states that had similar profiles to ours to see how they managed such requests.  We made trips and had numerous conversations and telephone calls.  It was in Alabama that we saw a model that allowed their state-supported AMCs to form partnerships or collaborations on an as-needed basis.  That was the inspiration for Mississippi's HCCA. 

The HCCA will allow us to form “health care collaboratives” - a type of public corporation - with hospitals and other health care entities in Mississippi for limited, specific purposes.  A particular focus will be to bolster or sustain the presence of some form of health care in rural communities.  Each collaborative will be governed by a board of directors, ultimately answerable to the state Institutions of Higher Learning board.

A good example for what a collaborative might look like is occurring in Belzoni.  The local hospital closed a few years ago.  Although the town still has physicians, it is essentially uncovered on evenings and weekends.  After months of discussions, we are working to establish an after-hours urgent care center in partnership with community leaders.  The clinic will rely heavily on our Center for Telehealth for specialty consultation.  This outcome could have been achieved much more easily if the HCCA had been in place.

The HCCA provides other relief, such as exempting the clinical enterprise from state procurement rules.  Before I get lost in the details, though, let me offer some disclaimers.

The HCCA is not a license for us to go out and make bad business decisions.  It just enlarges our toolbox to find a solution that fits the problem.  As I've said before, there are some communities in Mississippi where having a full-service hospital may no longer be economically feasible.  But that doesn't mean we have to abandon a health care presence for that community.

None of what the HCCA proposes is novel or unusual.  In fact, community hospitals, whatever their ownership status, already are able to form business partnerships as envisioned in the HCCA. The HCCA would provide limited antitrust protection for a collaborative created with UMMC, but only if it is determined that the public good is served by the arrangement.

It is not the intent of the HCCA to enable UMMC to take over health care in Mississippi.  The intent is to support our need to conduct business in a nimble and efficient manner and to provide a mechanism for us to partner with others to enhance health care in the state, particularly in response to requests for help from communities where traditional health care institutions are in transition.  Our goal is to have vibrant health care communities throughout the state, regardless of whether they have a formal connection to UMMC.

The HCCA does not require additional state funds.  In fact, if used properly, it can lessen financial risk to UMMC, the IHL and the state, and be an economic catalyst for our smaller communities.

I would add that UMMC is not the only academic medical center challenged to reinvent itself for a new era of health care.  The Association of American Medical Colleges, in a 2014 report, noted that “academic medical centers must evolve rapidly or risk becoming high-priced, anachronistic institutions in a landscape of highly organized health systems.”

In all candor, we cannot continue to function as if the world hasn't changed in the last 67 years without experiencing a gradual decline in all of our programs.  If UMMC is to lead the charge to better health status for our people - and who else can or will? - then it should be free to carry out that mission with tools that are available to every other health system operating in the state, including those from beyond our borders.

I appreciate your interest in this issue and your steadfast dedication to achieving A Healthier Mississippi.



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