Ironically, the Medicare-dependent hospitals of today could have a leg up going forward. Hospitals with better payer mixes can afford to improve efficiency around the margins. But an organization like Providence Regional that exists on federal reimbursements doesn't have as many cost-shifting options and has to pay more attention to cost-cutting.
Hofheins is already trying to prepare for a future environment where utilization is going to have to be reduced across the board. In particular, imaging and testing levels will have to come down, so Providence is working on patient tracking and communication strategies that will help avoid duplicating tests and procedures now. He sees tighter integration with physicians and EHR connectivity across the continuum as first steps.
"That is going to be on my mind to be sustainable in the future. I don't have a lot of individual line items in mind. A lot of the work we're doing is to create a tighter community of care," he says. "There's no single way to do it. You have to look at lots of different ways of managing it."