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The Big Story: Hospitals test the goodwill of Congress on Medicare cuts

For decades, ‘the hospitals have told me they’re going to shutter, they are broke, and that Medicare reforms will essentially impoverish them. And they’re still there and doing incredibly well.’ –  Gerard Anderson, a health policy professor at Johns Hopkins.

What It Means for You

Health systems have enjoyed the benefit of the doubt for a long time.
That time may be ending.

Consider the dissonance in two different takes on our industry from last week.

  • Health Affairs tells us that hospitals are “on track for their worst financial year in decades” and “will be forced to take drastic measures to reduce costs…including service line closures if not closing altogether.” In sum, things are bad and going to get worse.
  • Axios says “hospitals test the goodwill of Congress” as they endlessly ask for more federal dollars, even though “the industry has not been scrutinized as much as other health groups, despite being the primary driver of rising medical costs.” In fact, Axios writes, “some facilities would be just fine without lawmakers’ help,” shrugging off the sound and fury. In sum, crying wolf.

Yes, there are nuances in both articles and, for healthcare’s inside baseball crowd, the points are well scored.

But, friends, all of us involved in advancing the mission of delivering care need a new story and a new approach to telling it.

This week’s articles are beacons of more to come.

Our industry’s consistent inability or refusal to talk about money, to candidly address the concerns that hound healthcare – the extraordinary cost of care, the fog of price transparency, the definition and distribution of charity care — is exhausting the extraordinary goodwill afforded us because of the care we deliver.

Avoiding the questions or failing to translate the exceptionally complex issues for lay audiences doesn’t stop the hard conversations from happening.

Silence (or tiptoeing obfuscations) eliminates the ability to shape the story. Into this vacuum step other voices with other agendas and solutions that may or may not be accurate or helpful. We can’t win if we don’t play.

Uneasy being labeled as the “primary driver of rising medical costs,” as Axios wrote? It’ll be the common knowledge until we replace it.

This is not to suggest the solution is an easy one. On the contrary.

  • It takes your time, of which you have none to spare.
  • It takes your focused attention, and there’s little left in that supply chain.
  • It takes a rich understanding of how the gears of our business mesh in general and how they turn in your market.
  • It takes the hard work of decoding healthcare’s quantum-physics-level intricacies for your lay audience.
  • It takes the discipline of telling that story over and over, piece by piece, so it eventually penetrates and sticks.

No, not easily done. But urgently necessary. The cost of failing to to do it well could be high in DC, at your state capitol and within your zip codes.

The Health Affairs article is not wrong when the authors write “the manner in which hospitals respond [to the challenging financial forecasts] will have long-term implications for cost, quality, and access to care, especially within historically underserved communities.”

And Axios, in yet another article last week: “All signs point to a crushing surge in health care costs for patients and employers next year — and that means health care industry groups are about to brawl over who pays the price.”

See that? “Brawl.”

You know where this goes.

The media will call. Scrutiny is their job. The stories will contrast the big dollars being generated against struggling families in need.

Lawmakers will opine. Attorneys General will ponder whether you’re earning your tax-exempt status. Analysts will, well, analyze.

A win won’t come with a message that healthcare is hard or complex or broken (although it certainly is all those things) and, so therefore cannot be appreciated without an MBA.

We cannot win if our message is merely a version of “trust us.”

Trust is not what it used to be.

This reframing is our collective task in 2023.

Consider the great goodwill that your health system enjoys in your market not as a shield, but as a stage that you’ve built over the years, set before the very people you serve. They have some questions.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

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