"In Manhattan, the cultural transformation we need to go through is immense," says Cracolici. "There are thousands of patients who have an inability to pay who don't have a primary care physician."
The developing network of primary care sites is one way to address that problem, but St. Luke's-Roosevelt has also partnered with two major federally qualified health centers, which the Patient Protection and Affordable Care Act makes possible. Such facilities are reimbursed at a higher rate than hospital clinics, which is one big reason for the partnership.
"We've made a decision to move the clinics out of the hospital, shut them down, and shift the work force to the FQHC partnership," Cracolici says. "Those centers get higher reimbursement, and the downstream positive for care is that they can expand hours, maintain quality of care and improve patient access, and provide it in a more appropriate setting than a hospital."
St. Luke's-Roosevelt physicians staff the FQHCs, so patients still feel as though they receive as good or better-quality care than at the hospital, Cracolici says.
"When they go to the William F. Ryan Community [Health] Center, which has four locations, they will see a doctor with a lab coat that says St. Luke's-Roosevelt."
Admission avoidance is a term that Cracolici likes to use when talking about the capital spending St. Luke's-Roosevelt is planning for and executing now. He says the most important aspect of dealing with this patient demographic is the prevention focus for diseases that "go with the territory," such as obesity, diabetes, hypertension, and cardiac disease.
"We're working on admission avoidance because there will be fiscal penalties associated with readmission," he says. "We're not eliminating services, but moving toward those that surround wellness and prevention."
IT investment becomes the top priority
Meanwhile, in California, Laurie Eberst is working diligently on the IT side in capital allocation. As CEO of the Catholic Healthcare West Ventura County service area and St. John's Regional Medical Center, Eberst is expecting another million patients in her community to move into the health insurance exchanges mandated in the healthcare reform act.