The most discouraging moment for me at the HFMA annual conference came during a question and answer session with Tuesday keynoter, Sen. Bill Frist, M.D., the former majority leader. It wasn’t how Frist all but pilloried the recently passed reform legislation. It was an aside about he would not encourage his son to enter medicine. Frist comes from a long line of physicians, and while his political ego shone brightly during his talk, his medical world-view came thru loud and clear. No longer in politics, Frist serves on the faculty at Vanderbilt, and his analysis of the current health care environment reeked of rambling academia (tempered, thankfully, by oratorical showmanship).

Yes, reimbursements will go down. Yes, the states are broke and will be strapped to run the insurance exchanges that are the heart of the legislation. Yes, Medicaid lacks the information systems infrastructure to support a sudden influx of new enrollees. Yes, health care spending as a portion of the GDP is on an unsustainable growth curve. None of this is particularly new news, and it took the honorable Senator way too long to make these points.

But his little aside about his son not entering medicine? Now that is telling, and troubling. We face some serious shortages of primary care physicians, and if the insurance expansion of the reform legislation is only partly successful, it will bring a wave of new demand for services unlike any other we’ve seen. Frist, a heart surgeon, spoke candidly about the excitement of his specialty, and how primary care often holds little appeal for the med students of today. Couple that with a profession, already highly regulated, that is confronting a dubious economic future, and it is no wonder our best and brightest students would think twice before going down this career path.

Frist’s sentiments about the poor prospects of success for the ObamaCare package surfaced time and time again during the vendor and provider meetings I participated in at HFMA. One executive from the Cleveland Clinic equated the bill with shifting chairs around on the Titanic.

But despite all the legitimate misgivings around the reform bill, all is not doom and gloom in the industry. If nothing else, the HFMA educational sessions testified to the industry’s ability to respond to crises. Executives from the Natividad Medical Center in Monterey County, California pulled off a major about-face.  The 172-bed public safety net hospital lost $25 million in 2005 and faced closure. They were on the hot seat of hot seats, but they got off. By 2009, the organization was in the black, with a net profit of just under $8 million. It shows what people can do when faced with a crisis. Jeff Bass, M.D., who was medical director in the emergency dept. during the transition, described the effort as cultural transformation that involved both firing laggard staff and renegotiating all managed care contracts (the organization had done little in the way of going after patient collections, nor had it updated its fee schedule in years). On the I.T. side, Natividad wrested management control from the county government, which had bogged down the hospital with its sluggish decision-making.

Of course, there is way more to this story than could ever be described at a 45-minute talk at HFMA (and reduced even more here). But the point is, far from the lofty academic arguments and the heated partisan squabbling, there is a core of dedicated administrators who will be the ones making viable transitions.

Dick Clarke, the ever-enthusiastic head of HFMA, captured the can-do spirit. “Be nimble,” he advised the thousands of CFOs in attendance, recounting how HFMA itself did a fast turnaround by moving its conference—on a dime—from Nashville to Las Vegas. Clarke revealed the results of HFMA’s “financial pulse,” its member survey. Some 40 percent of hospitals say they face a challenge getting capital, with a slightly higher number revising construction plans as a result. At the same time, half said they are going to increase their investment in clinical I.T.—the cornerstone of any quality improvement measure. For many, the recession is a prod to priority setting.

Other Thumbs Up/Thumbs Down from the Conference:

• Thumbs Down to George Will’s decision to ban the press from his keynote.

• Thumbs Up to HFMA for a thoughtful, easy to tote program guide.

• Thumbs Down to whoever dreamed up breaded deep-fried pickles paired with biscuits and gravy as appropriate food for a health care conference.

• Thumbs Up to Ian Morrison for a delightful, engaging opening talk that blended insight and humor.

• Thumbs Up to Garri Garrison at 3M who patiently fielded all my questions about ICD-10 for nearly an hour.

• Thumbs Down to Las Vegas for condoning smoking in indoor public spaces.



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