Freas is looking down the road at healthcare reform with some trepidation.
"Our ability to throw off the kinds of margins we need to reinvest are going to be significantly impacted [by healthcare reform]," she says. All of their financial models, including costs around labor, are planning for the levels of reimbursements to decline.
"The 'offset' of the Medicaid expansion doesn't cover the direct cost of providing care," says Freas. With labor being half of the cost structure, she argues, you have to examine it.
For Southwest General, layoffs are a last resort. It evaluates hires with a focus on specialized labor pools that can deliver a high quality of care. It also measure current employees against national benchmarks and targets to operate at a LEAN staffing model.
Hospitals and health systems like Southwest General aren't expecting to 'kill' jobs, but they are uncertain about the future. The twitchy and reactive hospital shares market reflects that.
And although healthcare's job creation rates are still ahead of the rest of the economy, its plateau over the past few months seems to reflect hesitancy about what's coming in November.
"Right now we are trying to guess at what the impact will be," says Freas.