Hospitals are being challenged like never before to rein in runaway healthcare costs, which now approach $2.6 trillion a year in the U.S.

From the Patient Protection and Affordable Care Act (or Obamacare, as it's become known) to pay-for-performance reimbursements from Medicare and Medicaid, healthcare reform hospital administrators are faced with holding down costs without compromising quality of care.
Bring it on, says the chief executive northern Mecklenburg's largest healthcare provider.
"We have a lot of cost and a lot of waste in healthcare," Tanya Blackmon, president of Presbyterian Hospital Huntersville, told a gathering of business, community and political leaders Aug. 24 in a forum at the Lake Norman Chamber of Commerce.

The U.S. spends more on healthcare than any other nation, yet ranks behind 18 other industrialized countries in medically preventable deaths, Blackmon noted.

Nearly one of every four Americans is covered by Medicare or Medicaid, making the federal programs covering elderly and low-income patients the most-influential force in controlling what healthcare providers can charge (or, at least, how much they are reimbursed) for their services.
"Medicare and Medicaid are telling us, 'You are charging too much for healthcare,'" Blackmon said. "They are also telling us we must put patients at the center of our decision-making."

Patient-centered care might sound like a no-brainer, but factors outside the patients' control — such as ability to pay or availability of particular treatments, for example — often can affect the level of care that patients receive. That's why Medicare and Medicaid no longer stick to predetermined payments for some procedures.

"We are actually measured on the quality of care we provide," Blackmon said.

That quality is measured in several ways. Patient outcomes are one gauge, of course. But Medicare and Medicaid also look at very specific elements of treatment, such as whether a patient believed to be having a heart attack is

Patient satisfaction has become another key factor in how much hospitals are reimbursed. That's why hospital walls are peppered with signs promising "excellent care." They are designed to plant that word, "perfect," in the brains of patients and their families, who might be surveyed about their hospital experience.

But that's all good, Blackmon insisted.

"We have to be looked at," she said. "We have to be accountable for what we do."

Other challenges loom, though.

"We have a shortage of physicians in the Lake Norman area already," Blackmon reported.
That likely came as no surprise to anyone who has spent an hour in the waiting room for a scheduled doctor's appointment. But, Blackmon added, things could get worse.

If no new doctors were hired locally, by 2014, the Lake Norman area would have a shortage of more than 20 internists and two-dozen general practitioners, Blackmon said.

That's why growing Presbyterian's stable of primary care physicians is near the top of Blackmon's to-do list. Other initiatives aimed at controlling cost and improving care include:
• The use of "patient navigators" to help guide patients through the hospitalization process.

• "Rightsizing" the workforce to make sure employees aren't taking on tasks that someone less qualified could — or should — be doing. For example, a registered nurse shouldn't be changing sheets, and a physician shouldn't be drawing blood.

• Renegotiating with vendors on costs for medical supplies, orthopedic implants, medications, food, etc.

• Implementation of electronic health records.

• "Alternate care" models, which involve treating patients outside the hospital.

• Prevention services.

• Efficiency and "payer neutral" revenue, meaning charges don't exceed what insurance will cover.

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