Hospitals and other providers have been doing a good job controlling costs, and growth in health care spending has moderated in recent years. However, overall costs are expected to continue to rise as the baby boomers age, the incidence of chronic illness increases, and advances are made in medical technologies and the structure of our health care system.

Over the past year, the American Hospital Association board of trustees has sought answers to the question of how to make a large-scale impact on health care spending and determined that policymakers should focus on two interconnected strategies to improve the health care system and to ensure the financial viability of our nation's health care programs while we tackle the federal debt and deficit.

First, promote and reward accountability. We need to re-structure the system in a way that promotes and rewards accountability — to patients, their families and their communities. This includes engaging individuals in their health and health care.

Second, use limited health care dollars wisely. We must focus on using them in ways that eliminate inefficiency and improve the quality of care for patients. Recommended changes are laid out in the latest board report, "Ensuring a Healthier Tomorrow: Actions to Strengthen Our Health Care System and Our Nation's Finances," available at www.aha.org/healthiertomorrow.

I urge you to take a look at this important report and discuss its recommendations at a future board meeting. It provides an important roadmap for how we can focus our efforts and take responsibility for those things we can control, and challenge others to do their part. There are many things providers need to do, but hospitals cannot do it alone. Others — government, insurers, employers and individuals — also must do their part.

The time to act is now. Further cuts to provider payment will not put us on a sustainable path for the future, nor improve care; we need real targeted reforms.

Katherine Keene (klinnkeene@comcast.net) is COG chair and a trustee of Salem (Ore.) Hospital.