NASHVILLE—Is your hospital future-proof? Given the uncertainty that lay ahead—at least in terms of financial sustainability—it's a tough, yet timely, question, and one that Premier healthcare alliance CEO Susan DeVore used to kick off this year's Premier Breakthroughs Conference in Tennessee.

"The reality of the unsustainability is really starting to kick in," DeVore told her audience. "Our debt will spiral out of control, reaching 90 percent of GDP by 2020. And 2020 is not that far away."

The tax rate for middle income Americans, DeVore said, would have to go from 35 to 66 percent to cover the projected rise in health care costs over the next few years, and that's not a likely rallying cry with the 2012 election season nearly upon us.
DeVore then asked a series of what ifs: What if the individual mandate holds? What if it doesn't? What if Rep. Paul Ryan's (R-Wis.) plan for Medicare becomes law?
She then made an interesting point that I haven't quite heard framed this way before: While Democrats attack the Ryan plan and Republicans go after the ACA, both approaches boil down to less reimbursement for hospitals and the end of fee-for-service health care.

"With all of these plans, the end results are basically the same," DeVore said. "It's a payment model that will be capped in some way."

Beyond the major financial questions facing the U.S. health care system, of course, are even more important questions about the care it provides, which DeVore illustrated with the story of her mother's tragic end-of-life care journey.

For the better part of two decades, DeVore's mother suffered from multiple chronic conditions. She eventually lost her ability to walk. DeVore and her siblings had been willing to put their mother into a skilled nursing facility, but couldn't find a SNF that would take her without at least a three-day acute care stay preceding it. Ultimately, her mother developed a pressure ulcer at another nursing facility and was hospitalized for five days, which made it possible for her to be placed into a SNF.

"Only in our health care system is a pressure ulcer considered good fortune," DeVore said.

Tragically, that pressure ulcer led to an infection and ultimately to sepsis, which claimed her mother's life. Devore's family members, aware of her health care background, asked her if the entire ordeal was preventable. While she couldn't pinpoint what part of the complex transition process was at fault, DeVore was sure of one thing—the overall care journey was costly and ineffective.

"The care for the last three weeks of her life cost Medicare and taxpayers $45,000 and didn't have good outcomes," she said.

Many Americans, including myself, could tell similar stories about a loved one's last days, where high-cost interventions piled up but didn't ultimately change anything.

But DeVore's talk wasn't all doom and gloom. She described a vision for cheaper, coordinated care, which would leverage the aggregation and economies of scale offered by clinical integration and provider partnerships with incentives for clinical innovation. Only by working together and looking for better ways to provide care, DeVore argued, will providers be able to create a better, safer and more cost-effective health care system—the so-called "future proof" Utopia she began her talk with. But it will have to happen while the current system lurches onward, she noted wryly.

"Wouldn't it be great to put up a sign that says 'Closed for transformation, we'll be back in 10 years?' " she concluded.