Dennis Barts, CEO at Valley Hospital & Medical Center: In January, the Centers for Medicare & Medicaid Services (CMS) released their Hospital Inpatient Value-Based Purchasing (VBP) proposal. The proposal outlines the agency's first large scale pay-for-performance initiative, a program that would empower Medicare to financially reward facilities that provide high-quality patient care.

According to CMS, value-based purchasing is an important driver in revamping care toward rewarding better value, outcomes, and innovations instead of volume. The value-based purchasing model redistributes inpatient reimbursement funds from lower-performing hospitals to those that score higher on certain care-quality and patient-satisfaction metrics.

Essentially, for hospitals, this means: Provide higher quality care and patient satisfaction, get rewarded for it; provide lower quality care, get penalized.

This change marks a significant cultural shift for the hospital industry, and it will have a marked effect on hospital operations over the next 10 years. Though CMS has long monitored hospital quality outcomes and patient experiences, and required hospitals to report them, now the agency will reward hospitals not just for reporting data, but for the results of the data.

The VBP model has been long-anticipated, and at Valley Hospital, we've been working to continuously improve quality outcomes and patient satisfaction scores—not just to prepare for VBP, but because it's the right thing to do. However, it's expected that when the program goes into effect in October 2012, roughly half of the 3,100 hospitals in the VBP program will experience up to a 1percent reduction in inpatient payments (and up to 2 percent by 2017). There's no question that the pressure is on for all hospitals to continuously improve to compete on the national level.

Last year, about 30 percent of Valley Hospital's patients were Medicare patients and another 18 percent were Medicaid patients. We don't anticipate these numbers changing much over the next 10 years. With nearly half of our patients' reimbursement coming from a government source, our attention to the outcomes measured under VBP will represent a huge operational focus for us. That starts now. At Valley Hospital, we will be focused on implementing new initiatives and hard-wiring those that we know work already, such as clinical hourly patient rounding and standardized order sets to enhance quality outcomes and our patients' experience. We've seen significant improvement in these areas over the past two years, pushing us into higher national percentiles in many categories.

VBP is an exciting phase in the evolution of the delivery of and payment for care. Sure, it's also a little intimidating and expected to be a major challenge for hospital executives across the country. But ultimately, it represents a measured way to reward hospitals that provide the best care. Increasingly, 'best care' means integrated care—the right care, in the right place, at the right time—with enhanced communication between all of a patient's health-care providers. We are fortunate to be aligned with many excellent local physicians, Rockwood Clinic, Deaconess Medical Center, and Inland Cardiology in developing an integrated delivery system.



Elaine Couture, RN and chief executive for Providence Sacred Heart Medical Center & Children's Hospital and Providence Holy Family Hospital: We, as caregivers, will continue to see extraordinary challenges in the future as the baby boom generation ages and requires more health-care services, and chronic diseases like diabetes, obesity, and heart disease become more prevalent among younger populations. This, combined with continued limitations to both financial and human resources, will require us to do more with less in the future.

Today's medical advances are keeping people with chronic diseases alive much longer and as a result, patients needing hospital care in the future will have much more complex health-care needs. Hospitals such as Sacred Heart will require more critical-care beds resembling today's intensive care units in order meet the increased demand and complexity of patients.

To address these challenges, hospitals and health-care providers will work together more closely than ever to bring greater operational efficiencies both in the inpatient and outpatient environment. Not surprising, technology will play a major role in the future as innovations such as telemedicine and advanced wireless technologies become common place and more user friendly.

In the future, patients will have direct access to their medical information and health-care providers via centralized medical-record databases using smart phone technology, including real-time scheduling, access to test results, and monitoring health conditions. These advancements will allow patients greater connectivity and interaction with all health-care providers throughout their care experience at all points of their life.

One of the most significant technological changes will be the use of advanced telemedicine in the inpatient setting. In the future, patients may not always have to travel great distances to access highly specialized care. Advancements in virtual medicine also may play a proactive role in the care for elderly patients. Individuals will be able to be treated at home more often, or receive hospital inpatient care while remaining in other ancillary care settings like a skilled-nursing facility, further decreasing readmission and transfer rates for chronic diseases like congestive heart failure.

The role of nurses will change dramatically, too. Practitioners at every level will provide a wider range of advanced care, as we experience a diminishing population of family practice physicians. Nurses working in the hospital setting likely will have more defined and specialized roles providing much more of the primary and mid-level care for patients. This will mean more advanced training for nurses allowing for both an improved coordinated team approach and greater autonomy in decision making at the bedside.

From an operational perspective, we expect to see decreased hospital lengths of stay as newer treatments and drug modalities become more readily available. Many interventional treatments and drug regimens will most likely be specifically tailored to the genetic fingerprint of each patient resulting in dramatically increased efficacy and improved outcomes for patients.

We are confident that health-care delivered in 2031 will feature a level of personalized care that is difficult to comprehend today, as new breakthroughs in information technology, medical devices, genomics, preventive care and pharmacology come together to provide a level of care that will be transformative.



William L. Gilbert, CEO at Deaconess Medical Center: The health-care industry has always been marked by rapid change. From the time I took my first hospital job as a transporter in the radiology department during high school, to my current role as CEO at Deaconess Medical Center, innovation and adaption to change have been paramount to providing a quality health-care experience for every patient. With new treatments, medications, and equipment available regularly, health-care providers have increased expectations for providing the highest possible level of care with the newest technologies and treatments available. In return, patients and their families have high expectations as well. Acknowledging the tension between higher customer expectations and the impact of health-care reform, an unstable economy and decreased government reimbursements for hospitals ensures that we will have to make significant operational changes in the coming years.

While increasingly sophisticated consumers become more involved in health-care decision making with their providers, hospitals and physicians are working hard to provide a greater range of comprehensive and integrated services. With the fallout from constantly changing nationwide health-care reform, hospitals across the country are facing many challenges. However, those difficulties promote opportunities for increasing efficiency, service and quality of care.

At Deaconess, we have partnered with Valley Hospital, Rockwood Clinic, and Inland Cardiology Associates of Spokane to create our region's first integrated delivery system (IDS). Though it may sound complicated, the benefit to patients is simple. Consolidated care allows for a higher level of individualized care, including coordination of an office visit with a family physician, consultation with a specialist, hospitalization for surgery, physical therapy, and follow-up care. In an IDS, seamless care and improved communication among health-care providers will help ensure that each patient receives a whole team of experts dedicated to making their experiences more efficient and convenient.

More partnerships among physician groups, hospitals and ancillary services will form as the market continues to consolidate. In addition, changes will be made on hospital campuses that will include further development of a medical plaza model. In addition to housing physician offices, our Deaconess Health and Education Center (DHEC) medical plaza soon will include additional specialized outpatient services. Construction is underway on the top three floors of DHEC to include several diagnostic and procedural labs. By integrating the location of physician offices and outpatient procedural labs in our plaza, we increase the level of convenience for patients who come to the Deaconess campus for their health care needs. We can better utilize existing hospital operating room capacity and have direct access to other clinical needs, including hospital-based anesthesiologists, radiologists and pathologists.

While the IDS operational model isn't new to the health-care industry, it's new to Spokane. Several respected hospital systems around the country including the famed Mayo Clinic, in Rochester, Minn., have demonstrated effectively that the IDS model can work.

With an integrated network of health-care providers and services, patients will benefit from increased efficiency and communication among their caregivers. Above all, patients will receive a level of care that is tailored specifically to them and their needs, with an increasing focus on improved quality and patient satisfaction.



Jon Ness, CEO of Kootenai Health: We know a patient's environment influences his state of mind and even his ability to heal. As we look at the hospital experience from the patient's perspective, everything will become more patient-centric.

In 20 years, hospitals will look and feel more like hotels. At Kootenai Medical Center, we have already started to move in that direction. We offer room service for our patients and recently hired an executive chef. Many patient rooms are designed so a family member or friend can comfortably stay in the room overnight if they wish.

Another change will be the number of beds you'll see at the hospital. New technology such as robotic surgery already has improved our ability to offer minimally invasive alternatives to traditional surgery. These procedures mean less pain and faster recovery times for patients so they don't need to be in the hospital as long. More technology enhancements will allow patients to be treated and to return home on the same day.

We'll also see more clinics to help manage conditions such as diabetes and high blood pressure.

Emphasizing preventive care will help patients maintain and improve their health so they won't need to come to the hospital.

Increasingly, hospitals and physicians will be working together as one. Patients will have one electronic medical record, with their health history and records of the care they have received no matter where they receive it. This integration will simplify and align patient care.

The new model will involve care navigators as well. It's common for patients with complex illnesses to have three or four physicians and a variety of specialists working on different aspects of their care at any given time. Care navigators will help coordinate each piece of the patient's care throughout his or her course of treatment.

And in 10 or 20 years, there's bound to be a smart-phone app connecting it all.