Bill DowneyThe U.S. Supreme Court decision regarding the Patient Protection and Affordable Care Act (PPACA) will be announced within the next week.  Regardless of the outcome, Riverside has long established its course of action to provide valued-based health care as described in the following position statement.

I think it is important that health systems remain accountable to their patients, local communities, physicians and staff.

Bill Downey
President and CEO 
Riverside Health System

Many people have asked my opinion on what I thought the Supreme Court’s decision was going to be regarding the Patient Protection and Affordable Care Act (ACA).  My answer is, regardless of the Supreme Court decision on the ACA, Riverside Health System (Riverside) is committed to pursuing initiatives that promote measurable value in the healthcare process.  The evolution of Riverside has aligned closely with significant tenets of the ACA.  We are addressing three of these significant tenets: information technology advancements, physician leadership in the clinical delivery process and the current national trend of creating an organization that is accountable (along with the individuals in our care) for improving the care we provide.

Over the past 25 years, Riverside has led the region in the implementation of information technologies that have enhanced the care delivery in our hospitals, outpatient settings, long-term care facilities and physician offices.  In 2011, Riverside was the first in Virginia and one of the first in the nation to receive Federal designation for meeting the “meaningful use” guidelines in deploying technology in the care of their patients. Riverside has also been recognized as one of the nation’s Top 100 Most Wired Health Systems by Hospital & Health Networks for seven consecutive years.  Additionally, Riverside continues to develop the integration capabilities of its technology to enable continued delivery of best practices, evidence-based medicine and preparedness for population health management and was named as the 23rd most integrated health system this year based on a report released by IMS Health.

While ACA has raised the visibility of health information technology, one shortfall of the act in regards to technology is the limited funding which contributes to only a fraction of the cost that health systems bear in developing truly compatible systems.  In addition, the government needs to more clearly define interoperability standards for the sharing of health information.  Until this is done, health systems will be limited in sharing appropriate patient data among providers.

The second tenet of the ACA is related to physician leadership in the healthcare delivery process.  Riverside is a leader in engaging physicians throughout the system.  In the early 1990’s, Riverside started to engage physicians into leadership roles and also began employing physicians.  Today, Riverside is almost 500 providers strong -- 400 physicians and 100 advanced practice providers.  Further, Riverside engages physicians in all aspects of care to include leadership in service lines (e.g. cardiac, cancer, primary care, etc.) and administrative oversight of our acute care facilities.  We operate the largest group of geriatricians in the region who oversee the care in our long term care facilities and community-based senior programs such as PACE (Program for All-Inclusive Care of the Elderly) and we continue to accept new Medicare patients.

A second shortfall of the act is the continued under-investment and incentives by Federal and State governments to expand the supply of primary care physicians and advanced practice providers where needed.  This exacerbates the access to care resulting in patients using expensive emergency room services for primary care needs.  In response to the need to educate more primary care physicians, Riverside has operated one of the oldest family medicine residencies in the country.  Established in 1971 in partnership with Virginia Commonwealth University, Riverside graduates more than a dozen residents per year with 70% remaining in our region after graduation. 

The third tenet that resonates with Riverside’s vision is the drive to create a system in which the providers and patients are accountable for the care of all Americans.  Accountable Care Organizations (ACOs), while still evolving, are expected to connect providers who are willing and able to take responsibility for improving the health status, efficiency and experience of care of a defined population.  Riverside is engaged in developing its model in collaboration with national experts who are guiding some of the 32 pioneer health systems selected by the Centers for Medicare & Medicaid’s Innovation Center in the past year.

The shortfall of ACA is how to transition from the current reimbursement model which compensates health systems for procedures using a fee-for-service system to a prevention-based model in a way that is fair to all involved.  In addition, the level in which the government incents patients to be engaged in their care falls short in multiple areas to include advanced care planning for end-of-life decisions, and overall individual responsibility such as managing chronic illnesses through preventive services and compliance with medication regimens.

Along with the legislation from the ACA, one longstanding issue for the healthcare system is who should bear the responsibility for uncompensated care.  As a not-for-profit health system, Riverside treats all patients regardless of their ability to pay. In 2011, Riverside Health System provided $25M in charity care to individuals who fell below the federal poverty level.  This is in addition to another $35M in quantifiable benefits for indigent patients. While we do not know the direction that the Supreme Court will take and how it will impact this issue, we believe there are solutions such as expanding the Medicaid program or growing Medicaid managed care for the uninsured.

Riverside’s vision is to develop meaningful and trusting relationships with its patient-customers enabling them to make value-based healthcare choices and to engage all Riverside providers to improve the value of care in the communities we serve by promoting the practice of evidence-based medicine.  Regardless of the legal interpretation of the ACA, we remain committed to our vision.