Benjamin Chu, M.D., says hospitals are pushing forward with efforts to transform care delivery, but it will take time for the changes to take hold. Chu, the American Hospital Association's new board chairman, urges lawmakers to take a long-term view, rather than seek short-term fixes. | Interviewed by Matthew Weinstock
What's your message to lawmakers in Washington, D.C., as they continue to do battle over the budget and propose further provider payment cuts?
Chu: The key message is that things are really changing in health care delivery. Some of the core incentives that we've had for many years are changing with the Affordable Care Act, and I think changing for the better. We are moving from volume-based payment to value-based; the hospital engagement networks are absolutely working hard to transform the care that we deliver to be safer and much more efficient. The message to lawmakers is that we have to give time for those changes to take hold. A premature focus on the budget with the idea of just slashing payments could undermine those efforts.
You are a self-described political junkie and understand how Washington works. Do you think that a message of patience will actually resonate?
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Chu: You never know in Washington, but I'm hoping that people will listen. One data point is never an accurate gauge of what's going to happen long term, but if you look at the last year, the Medicare per capita increase in spending was 0.4 percent, virtually flat. Really, the problem with the federal budget is that the demographic explosion is going to accelerate the federal share of health care spending. We are adding 10,000 net new Medicare members a day and by 2030 there will be 75 million new beneficiaries.
That's the issue that people are struggling with. It would be premature to rush over the next year or two to slash the budgets, thinking that we have to do it now to get the savings 10 to 20 years from now.
Hospitals are vibrant parts of the communities that we serve and we are changing. I'd like to see the federal government give the hospital world and the health care world a chance to show that [we can eliminate] the 20 to 30 percent inefficiencies that people are talking about.
So you feel as though transformation is really beginning to take hold, right?
Chu: Absolutely. We are just in the first year of the value-based readmission policy and bundled payments and we are already seeing a 40 percent drop in central-line blood stream infections in the ICU. I'm sure we are going to see large drops in readmissions in the next year or two. The hospital world is focusing on transitions in care and putting in place principles and protocols that others have shown can actually be better for our patients. Giving it time is not just throwing up a hope and a prayer; it is allowing things that we actually know can work to take hold.
Do you think the focus on penalties for readmissions is having a positive effect?
Chu: You never want it to be just a penalty. You want to provide an incentive for people to do the right thing rather than just beating them up for being laggards. I think the focus is the right thing. What should the readmission rate be? How can we actually maximize your function so that you don't have to come back in the hospital? The problem, of course, is that hospitals and doctors are not always on the same page. We've been fragmented. With bundled payments and the incentive for the doctors and hospitals to work together, coordination of care is actually beginning to happen. The result of that is going to be better care for our patients, which will translate into fewer hospitalizations and fewer rehospitalizations.
What role do clinical leaders play in transformation?
Chu: Clinical leaders have to be part of the solution. The separation of the doctors and hospitals has always been artificial. If you think about the coordination that's necessary to do the best job we can for our patients, it has to be a collective effort. An individual doctor can't provide all of the resources necessary to coordinate all of that care. Hospitals can't do it alone, but hospitals have resources that can complement what a doctor can do.
Do you think there's enough training happening now to help clinicians move into leadership positions?
Chu: The biggest challenge facing hospitals today is leadership development. Whether you are a doctor or an administrator, the tools that have to be brought to bear are different. It used to be easy to be a hospital administrator when the reimbursement system was solely built on fee for service. All you had to do was keep your hospital full. The idea that you're taking responsibility for a population, whether it is a fully capitated model or a shared savings model, it's a larger responsibility for an individual's health over a longer period of time. You need to be able to work with other people. You have to be able to get doctors on board. You have to get community resources on board. Communication is a key ingredient and the ability to leverage relationships has to be a more focused part of leadership training. You can't be part of team if you are a sole agent.
You are the first physician to chair the AHA in 40 years. What kind of statement does that make?
Chu: The distinction between physician leadership and hospital leadership is blurring, and it has to blur. We have to work together. I don't think that this means that the AHA should be led by doctors from now until whenever, but physician leadership and hospital leadership have to speak the same language and we have to bring to bear the same skills to develop the systems that will let us do the best job we can for our patients.
Can you talk about patient engagement?
Chu: Patient and family engagement is something that I am very passionate about. It goes back to my clinical days. You are always trying to figure out how to get your patients and their families to help keep that person as healthy as possible. It is always a dynamic. It is never one-sided.
Figuring out how to engage patients, understanding where patients live and what circumstances they're in are really integral parts of getting the interaction to optimize the patient's health. As clinicians, we have to understand that. We are not simply experts that people come to so that we can parcel out advice that they should listen to just because of our training.
We have to understand that it really is a dynamic because the larger goal is to have a healthier person and a healthier community.
The Benjamin Chu File
• Bachelor of Arts, 1974, Yale University
• Doctor of Medicine, 1978, New York University School of Medicine
• Master of Public Health, 1989, Columbia School of Public Health
A primary care physician by training, Chu started his career in public health, running emergency services at Kings County Hospital Center in New York City. During his 20-plus-year career, he also has run outpatient clinics and entire health systems. He's moved between public health, academia and integrated delivery systems.
Being in the hospital as a 3-year-old battling rheumatic fever. "The first toy I remember having was a stethoscope. My pediatrician gave me one to keep me occupied."