As told to Matthew Weinstock

Truly transforming the health care delivery system will take a team effort, says Teri Fontenot, president and CEO of Woman's Hospital in Baton Rouge, La. The chair-elect of the American Hospital Association says hospitals, physicians, other providers, insurers and patients need to work together to improve care, reduce costs and create healthy communities.

My first health care position was the director of accounting at St. Francis Medical Center in Monroe, La., in 1982. I never really envisioned a health care career; it sort of found me. I had an accounting degree and was comptroller for a local building supply company when I learned of an opening at St. Francis.

The hospital had an excellent reputation, and it seemed like a really good opportunity to work in an organization that had strong values and helped people.

The CEO, Sister Anne Marie Twohig, was wonderful. Although I didn't have any health care experience, she was very pleased to have a professional accountant on staff because Medicare was moving from cost-based reimbursement to a prospective payment system.

I think the fact that I didn't have prior health care experience was beneficial because I could learn the reimbursement system without being shackled by the way care had been paid. She understood that changing to a risk-based model was going to require a higher level of accounting skills and said she would teach me the health care part. I was at St. Francis for five years and consider her my mentor.

I left St. Francis Medical Center to work as the chief financial officer for Southwest Florida Regional Medical Center in Fort Myers. I had the privilege of working for Herb Dorsett, who was a gifted motivator and strategic thinker. He showed me how hospital administrators can be visionary and how they motivate others to lead. He was very team-focused, which was not the typical management style in 1987. He relied on his management team as advisers. Decisions were always made collectively. He saw the CEO position as more externally focused and understood how important it was to be involved in the community.

I didn't stay there very long because I got homesick and wanted to get back to Louisiana, but he was a mentor to me as well. I make very few decisions today without consulting my administrative team. I have a great deal of confidence in the talents that they bring to the table. They embrace our mission and vision and do whatever is best for the organization, even though someone may have to compromise.

Bracing for Reform

I've worked in health care for 28 years. It is constantly evolving, and we have the opportunity to participate in the changes in a positive way. I find that very rewarding and can't imagine being in any other field, because it's so dynamic. Some may need to have a mock funeral or a mourning session so they can move on to new ways of doing things.

There are a lot of good things about our health care system. Lifespans are now the longest ever, due to hospitals, technology and other developments. We must make sure that we are doing everything we can so that patients and our community are as healthy as possible, not just from the standpoint of medical care, but all the other things that make a person healthy.

A healthy person is someone who exercises regularly, eats right, understands nutrition, is mentally alert, and educated. These are things hospitals have tried to promote to improve health in their community; now with value-based purchasing, there's more of an incentive to help patients manage chronic conditions, for example. That's not been the incentive in the past.

Doing More With Less

Public reporting and comparisons with other providers will help all hospitals perform better. When we improve care, ultimately, we'll have better outcomes at lower cost. It's hard to convince people that, as [AHA President and CEO] Rich [Umbdenstock] likes to say, we can do better with less. We've seen it over and over at Woman's.

Since the payments will be bundled and reimbursement will be shared with physicians, I think it's going to be extremely important, whether you employ your medical staff or you have the more traditional relationship with them, to get everyone educated as soon as possible about the new model. Hospital executives shouldn't assume they're going to get the biggest share. I think that's absolutely the wrong way to go about it.

There's a lot to learn about the way physicians provide care in their offices, and how it won't be just about physicians and hospitals; there are many other providers as well. Everyone needs to be at the table and everyone needs to have some skin in the game. We also need to hone our listening skills to make sure that we understand the implications and opportunities for everyone so that the patient can have the best possible outcome.

Information is King

Access to information across the care continuum is vital. To be successful with value-based purchasing, outcomes reporting and care that is integrated and aligned with other providers, we have to be able to access each others' information in a way that is timely and meaningful. It can't just be data. It's got to be true information that we can use on a real-time basis to provide patients with the care that they need in an affordable manner.

At Woman's, our primary medical staff are obstetricians in private practice, and we are implementing an electronic prenatal records system so that when a patient arrives in labor on a weekend or after hours, her latest medical information is immediately available. That's just one example of how care can be improved.

Duplicate testing can also be minimized. A patient may arrive at the hospital with a problem relating to diabetes. If a test was run in a physician's office, most hospitals don't have access to it, which results in financial waste.

Talking From the Heart

When I was on the AHA board from 2005 to 2007, Health for Life, the AHA's health reform initiative, was created, and I was impressed with the consensus-building that occurred. Other trade associations, physician groups, insurers and consumer groups helped to figure out the best way to improve health in America.

There are a lot of components to the health care reform law that aren't finalized. There are some things that will be changed, I'm certain of that. We will continue to listen to our membership about areas of grave concern or, once implemented, are not working. Because of the relationship the AHA team has with our federal leadership, I believe we're in a good position to communicate unintended consequences and move forward to create a healthier population.

As chair-elect of the American Hospital Association, I intend to be available, open-minded and listen so that the AHA can best serve the members.

Important roles for the AHA are education, communication and engaging the membership. One example is Hospitals in Pursuit of Excellence. The tools and resources that the AHA team have already provided and will continue to provide are critical.

If hospitals have to make some unpopular decisions that affect patients, trustees have an opportunity and an obligation to help communicate why those decisions were made and why; ultimately, it's in the best interest of their community. They also need to be engaged in advocacy at the state and federal level with elected and appointed government officials.

Although our board has been fairly active in that regard, many trustees are nervous about advocacy. By talking from their heart about what they know, they are sincere in expressing what most elected and appointed officials really want to hear.

Preaching Patience

It's unrealistic to think that every member of the American Hospital Association will agree on every aspect of health care reform. I don't myself. For example, I don't think that the patients have enough responsibility, but I'm also optimistic. Once we move into the next phases of reform, hopefully patients will be held more accountable.

Right now, the main responsibility or penalty that patients have is whether or not they enroll in an insurance program. Not smoking, wearing a seat belt, eating healthy and exercising will go a long way toward personal patient accountability and health improvement.

Hospitals and physicians can't do it alone. Working together and taking it to the next level where patients are more involved in their care will prove that this was the right thing to do in the long run. People need to be patient, which is hard for me to say because I'm not a patient person, but this situation didn't occur overnight, either.

Matthew Weinstock is senior editor of Hospitals & Health Networks.

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