JONATHAN PERLIN, M.D., takes the reins as chairman of the American Hospital Association’s board this month. Perlin, president of clinical services and chief medical officer of the Hospital Corp. of America in Nashville, Tenn., with 162 hospitals in 20 states, recently spoke with H&HN about his goals for 2015, the search for a new AHA chief executive, and how the association must continue evolving as the field rapidly transforms.
How might a divided government affect the AHA’s advocacy agenda?
PERLIN: There are some constants in the American Hospital Association’s advocacy agenda, and we have a long and strong history of bipartisan support and interaction. We also stand behind some pretty important themes. The mission of the AHA speaks to the highest potential for the health of individuals and their communities. That’s a constant. The AHA has long supported access to health care and that is a constant as well. Clearly, we’ll be working on many of the current near-term challenges that are linked to annual budgeting.
One of the most important things during the next couple of years will be working effectively with state hospital associations. There are any number of issues that can fragment us as an industry, and it’s important that our advocacy voice be strong and unified. We have critical partners in the allied health associations and their leadership and insight — state by state, metropolitan area by metropolitan area, rural area by rural area — will be critically important in terms of working parallel on all of the issues that may be driven at some level by federal policy, but play out at a state level.
So, maintaining field unity, especially as economic pressures continue to mount, is a concern?
PERLIN: Field unity is critically important to the AHA’s advocacy strength, and there are issues that are potentially divisive. We’ve experienced that with the area wage index and disproportionate share. Medicaid expansion has been implemented unevenly, and that creates tensions. But, as a board and as an organization that works closely and embraces relationships with allied health and hospital associations, our strength of advocacy and ability to meld improvements in quality and value are directly tied to our ability to work together. I’m compelled by Benjamin Franklin’s admonition, “We must all hang together or, surely, we will all hang separately.” It’s imperative that we hang together, and as chair, I will certainly do my part in working with the president of the AHA, board colleagues and staff to listen attentively, work diligently and develop consensus to address complex issues that inherently may affect individuals, states and hospitals differently.
Where are you in the process of seeking a new AHA president and CEO?
PERLIN: As you know, Rich Umbdenstock announced his intent to retire at the end of 2015. A search process is underway with Jim Skogsbergh, CEO of Advocate Health Care and AHA chair-elect, who is leading the search committee.
Candidates need to be bilingual. They need to be familiar with policy and the legislative process in Washington and across the country, and they also need to understand hospital and health system operations. In terms of personal characteristics, a candidate needs to be the lead spokesman or woman for American hospitals and health care. Each needs to be a tremendous advocate, a good listener and an extraordinary communicator. In short, he or she needs to demonstrate extraordinary statesmanship. Candidates need to understand the current environment, but also have the ability to see around corners. They need to be able to hear the differences of opinion, yet develop consensus and drive a shared agenda. Rich Umbdenstock is a hard act to follow because these are his characteristics.
What issues do you plan to home in on as chairman?
PERLIN: There are three areas that I want to highlight. One is access to care. There is no way that we can live the AHA’s mission of achieving the highest levels of health for individuals and communities without access, and certainly that ties into the advocacy agenda in terms of challenges to health insurance exchanges and the need for Medicaid expansion. Second, work that’s being done around Redefining the H and achieving the Triple Aim. Hospitals have been America’s leaders in high-quality care, but we need to push ourselves further in terms of improving the health of communities. The third is value and the great work that the Health Research & Educational Trust has done through the Hospital Engagement Network to demonstrate value by improving the clinical and social outcomes of care while simultaneously reducing the cost. Those three complementary arms — care, health and value — are really at the core of sustainability and possibility for an even more promising future for America’s health.
How can hospitals promote healthful lifestyles?
PERLIN: I love that question. I often think about how America’s hospitals would fare in terms of comparisons on health indicators if they were a country. How are we doing as we try to lead the country toward better health in terms of weight, tobacco use, substance use, exercise and diet? We not only have an obligation to demonstrate leadership and practice what we preach, but, if we do this well, we become an exemplar for the rest of the country. Too much of America’s health care and, frankly, too much of the country’s health care dollar, is directed toward salvage — salvage from the ravages of chronic diseases that are fundamentally preventable through diet, exercise, avoiding tobacco use, and addressing vulnerabilities like poverty, literacy and access to preventive health services. That’s hugely important.
How does the AHA need to change as the field evolves?
PERLIN: The AHA remains extraordinarily relevant. Its membership is changing in any number of ways. Certainly, there are some megatrends. There is increasing consolidation of hospitals and health systems and increased vertical integration with insurance. The most important thing that the AHA must continue to do is to provide a big tent that serves as a home for not only organizing advocacy in a manner that’s sensitive to all members’ needs, be they rural, frontier, critical access, vulnerable urban, academic, community, system or integrated health plan, and really focus on the big issues. Those issues include access to care, support for the AHA mission, improving the health of individuals and their communities, and the work that positions AHA and its membership to grapple with the challenges of the future — a changing population, changing financial circumstances of our country, changing threats to health care. Redefining the H is an important product of the AHA committees on research and performance improvement, because it squarely addresses just these issues. Hospitals have an extraordinary role in our society. They are part of the core of our ability to be successful as a population, as a just culture and as an economic power.
THE PERLIN FILE
What are you reading right now?
I’ve been reading a lot of Supreme Court blogs. I usually have a number of books open. A really terrific book by Doris Kearns Goodwin, Bully Pulpit, about the lives of Teddy Roosevelt and William Taft. It’s a great read and very relevant to the intersection of policy and media today.
Who has been the biggest influence on your career?
I’ve been fortunate to have a number of mentors. Certainly my father, who was a physician and embraced things like community mental health and community psychiatry, way before the concept was prominent. Our founder, Thomas Frist, M.D., and his father offered an extraordinary piece of advice: “Take care of the patient and everything else will follow.” That admonition is one that I have embraced from my very first administrative role.
What are your hobbies?
There are two. One is that I’m an avid photographer and the other is that I enjoy playing the guitar. One of the privileges of living in Nashville is that there is an extraordinary music scene.
To watch a video that H&HN recorded in December 2013 with Perlin discussing his agenda as AHA’s future chair-elect, go to http://bit.ly/16ftl0Y.