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Editor's notes

Yeah, More Uncertainty

10.01.11 by Mary Grayson

Executive leaders know that the future will demand that we excel at designing and implementing a variety of patient-centered, integrated models of care at the individual local level.

Just kidding. I am on your side. But seriously, no one in health care has witnessed times like we are living in now.

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Far from succumbing to the paralysis that uncertainty can cause, an equally remarkable degree of self-initiated positive activity is happening in health care. Podcast Running Time: 3:17.

The last major period of upheaval in terms of quantum change was probably the switch to DRGs in the early 1980s. But even then, after all the stomping and shouting died down and the last note of outrage sounded, everyone pretty much understood what the new landscape looked like and what the rules were. It was a question of learning how to lead, manage and adapt in order to succeed under a totally different reimbursement system moving from cost to set price. Viewed from the safe vantage point of some 30 years, it sounds deceptively simple.

Today, the big U-word rules the leadership and management waves — and that would be uncertainty. There is simply so much that we don't know or frankly that we can even control. Think about the totality of today's situation.

As of this deadline, we don't know how much Medicare might be cut as part of deficit reduction or how much deeper Medicaid cuts will go on top of existing state cuts. And, as state and municipal governments become more desperate for revenue over time, we don't know if we will find ourselves the unwelcome center of attention.

Will the recession double-dip or will the economy just continue to drag along? Either way, unfortunately, we can count on more U-words, such as uncompensated care, and uninsured or underinsured patients, all leading to more bad debt. And we have absolutely no idea how long it will take the economy to recover nor at what pace.

Oh, and we're not really sure how health care reform will play out. Fainter flowers might wilt.

The good news is that rather than wilting or succumbing to the paralysis that uncertainty can cause, an equally remarkable degree of self-initiated positive activity is happening in the health care system. While pundits and other so-called knowledgeable observers delve deeper and deeper into all the theoretical details of health care reform and opine and argue about what will work and what won't, many executives see an outline of the future — albeit a vague one — and are moving toward a value-based scenario.

Regardless of how all the final fine print reads and whether the economy evolves, devolves or dissolves, a very high bar for quality and patient safety is now a "given." Care coordination, performance improvement and expense control (see our cover story launching a new Fiscal Fitness series) are top of mind as well.

None of this is easy, but executive leaders know that the future will demand that we excel at designing and implementing a variety of patient-centered, integrated models of care at the individual local level.

For leaders who want to make a difference, that's a pretty exciting proposition. Hats off to how far we've come and how far we might go.

See, I told you I was on your side.

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The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association