In 2019 Fontenotes dealt with multiple issues that could change the fabric of health care in this country: following the progress of Azar v. United States (currently in the 5th Circuit Court) that could result in the eradication of the Affordable Care Act [“Obamacare”], looking at “Medicare for All” beyond its slogans, and addressing the realities of health care in Rural America to name just a few.
I don’t often bring you cheery topics in this E-Newsletter.
But I just completed my 23rd year as an Adjunct Professor in the Masters in Health Care Administration program at Trinity University, and I am happy to tell you I am filled with hope and optimism about the future of health care in America.
It Happens Every Year
As the Adjunct Professor for Health Law, I am responsible for teaching our students about multiple legal issues- from criminal liabilities associated with billing and kickbacks to patient rights regarding consent, end-of-life choices and privacy; medical malpractice to Medicare/Medicaid; state regulation v. federal initiatives such as the ACA and beyond. It is a chock-full semester.
As we approach the end of our time together, I assign a brief memo so each student can describe their vision of the future of the field they are entering.
Every year they astound me with their enthusiasm that is inspiring in equal measure to the difficulty of the field they have chosen.
The Role of a Hospital Administrator
To understand why the optimism of my students impresses me, I must explain the role of a hospital administrator for those of you in other sectors of the economy.
Being a Health Care Executive is a career of stress and change.
A hospital represents the worst fears and the highest hopes of your community. You need to be ready every day to face the intolerable tragedy of the death of a car accident victim on one floor- while celebrating small steps (literally) on the stroke unit, or another day lived in your Oncology clinic. An administrator must manage the non-technology/homey ambiance in Labor & Delivery favored by young parents, while also supporting the cockpit-like machinery of the ICU next door.
As the face associated with the entire enterprise- especially in a smaller community- you know that you embody all these intensely human moments every time you are seen in a restaurant or are addressing your local civic organization.
As a health care executive, you are a huge employer– in rural America, second only to the public-school system. You must care for your caregivers from your professional staff to those who maintain your physical plant at the highest standard of cleanliness and safety.
As a hospital executive you are running a city: issues regarding power (keeping the respirators alive if the electric grid fails), transportation (how to safely and compassionately roll patients through miles of hallways), traffic and access (can you take more ambulances in your ER or do you need to divert trauma to other hospitals?), public health (controlling infectious diseases), communication (continually updating and protecting digital records that allow all members of the team to understand each patient’s needs), and law enforcement (are you ready for the combative patient in drug withdrawal or an active shooter in your ER?).
Increasingly the public expects you to do all this while maintaining a facility with delicious food options and a lobby plucked from a high-end hotel.
You invest in technology that is quickly made obsolete in an environment where the physicians you depend on to care for your patients can be lured away by a shiny new toy at another radiology or surgical suite. And you can’t fight back with offers of any financial benefit to those same physicians- that would be illegal.
Speaking of which- the number of laws on both the state and federal level that dictate how you perform most of your processes would shock other business executives. Compliance with all is critical. Many of those you employ will never touch a patient- they exist to keep your facility within legal bounds to avoid all the penalties- both civil and criminal.
Those penalties could close your doors permanently because you are running your enterprise with a trajectory of decreasing revenue and tighter profit margins (I use the term “profit” lightly when referring to publicly owned and community hospitals).
To be a leader of a hospital requires inordinate skill in managing finances and budget.
What you charge is never what you are paid. Both government programs and private insurance companies are continually changing your reimbursement (always lower) without the negotiation standard in other industries.
And in this world, health care executives face each day’s list of priorities knowing that invariably there will be a crisis waiting to sabotage all other essential duties– loss of internet service because a road repair team nearby cut your cable, a sheriff serving your hospital with a Medical Malpractice complaint, a surprise visit from an auditor or Medicare-required compliance review (the unscheduled accreditation team from The Joint Commission will be on-site at least three days).
Then, of course, there is always the possibility of mass casualties streaming in from the explosion of a nearby plant, responding to an environmental hazard from a chemical spill at a local train crash- or transporting your patients from an incoming weather disaster such as a hurricane or tornado.
And all this time, 46% of surveyed physicians don’t trust you, you must address accusations that you don’t sufficiently appreciate your nursing staff (nurses are increasingly joining unions in the USA), and the majority of the public has no idea what you actually do.
This is the career my students have decided to enter.
What My Students Say
Understanding all of what I have said about being a health care executive, these are samples of what my students say when asked about the future of American health care:
1) They are excited about technology that can make health care more humane- not less so:
“Healthcare in the US is notorious for being clunky and confusing… The only way that these problems can truly be solved is through utilizing data in a thoughtful manner and pairing it with technology that works for patients, rather than for administrators.”
“The expansion of technology in medicine has created more access to healthcare and, therefore, to information… as our consumers become more informed, our care delivery will have to adapt to become more patient-centered.”
2) They view their role as administrators as facilitators for the greater good:
“To stay relevant, health systems will need to adapt to fit the patient’s experience and convenience, rather than the provider’s schedule.”
“Healthcare in the U.S. may be fragmented and siloed, but now is the time to fix it. I believe aligning incentives and controlling costs are the key components to solving this problem.”
3) They demonstrate compassion for the patients who are the reason why:
“We need to move back to a time where physicians, patients, and their families were responsible for making important medical decisions, not the individuals taking and giving money for that care to be administered.”
“I believe that quality of life and conversations about what patients value are going to be more common… I see people being more comfortable with having these conversations and more forward in asking for them. I think it will be a shift in both physician training and patient culture that will help move us forward in this area.”
4) They see themselves as Guardians of the future
“For me personally, beginning my career at this time in the scheme of health care in America, I am excited and anxious to be a part of the changes we will experience over the next 10-20 years… How will we, as new MHA students, be able to affect such a large complex system? I believe it will come through the support we offer to new ideas, and the new ideas we will bring to our companies during residency.”
“I believe that healthcare will have vast changes midway through our careers in 2040 and towards the end of our careers in 2060. The way we mine and utilize data, improvements to technology and changes to patient and provider behaviors will drive the outlook of our health care delivery system over the next 50 years.”
The positivity, professionalism, and commitment demonstrated by my class at large (and each student therein) leave me every December with a smile on my face and a confident outlook for American medicine.
My Goal is to Leave You with Hope
Annually I get to meet the people who will be the trailblazers of the health care system I (40 years their senior) will rely on increasingly as they mature.
If they are the future of health care- and they are- the rest of us are in capable hands.
With that good news, I leave you until next year.
I dedicate this Fontenotes to my Dad, John Gordon Freymann M.D. (1922 – 2018)
1965-1969: General Director of the Boston Hospital for Women
(now part of Brigham and Women’s Hospital)
1969-1975: Director of Education at Hartford Hospital
Want to Know More?
1. It would be possible to attribute the brightness of my students’ visions to their youth– but that wouldn’t be fair to the army of administrators in America already meeting the challenges I described above.
For the past seven years, I have served on the Board of Directors of Peterson Health in Kerrville, Texas. The vantage point I have on our own C-Suite and management team demonstrates the same professionalism, determination, and caring I see in my students.
At Peterson Health we have earned multiple national awards in recent years– but the glass case of trophies in our lobby does not represent hardware to us- each award is a testament to our staff and management team and their commitment to our community- and the patients and their loved ones who we serve.
2. My exposure to excellence in health care leadership extends beyond my students and my community- as a faculty member for the American College of Healthcare Executives [ACHE] since 2007, I have had the opportunity to interact with thousands of Healthcare Executives at all stages of their careers.
As stated on the ACHE website, the more than 48,000 members “are committed to integrity, lifelong learning, leadership and diversity, and inclusion.” That sums up my experience “from the front of the room” precisely.
Many of you may have noticed the designation FACHE ® by your own hospital administrator’s name- to learn more about this prestigious credential, which signifies board certification in healthcare management, go here.
3. If my description of the role of a hospital administrator sounds complex, challenging, and exciting to you- I invite you to consider it as a (new?) career.
If you would like to know more about the field of Health Care Administration, the process of earning an MHA, and about the MHA program at Trinity University, in particular, there is an excellent description by our Chair Ed Schumacher, Ph.D., here. You can also contact Ms. Sharon Hubenak, Director of Recruitment & Residencies, at firstname.lastname@example.org or call (210)999-8141.