Kansas hospitals have one foot on the boat and one foot on the dock, creating a distinctly wobbly environment that leaves leaders looking for stability, a Kansas hospital spokesman said.
"I think the biggest challenge facing hospitals, and frankly anybody in health care, is to try to understand where this system is moving," said Tom Bell, president and CEO of the Kansas Hospital Association. "Look at the way Washington and Topeka policymakers have dealt with health care. Especially in Washington, there is absolutely zero confidence from a provider's point of view that you know what the rules are going to be next year and sometimes even next month."
Multiple factors are changing in the health care world, from incorporating population health management into the work hospitals do to taking a deep dive into how social determinants like poverty and race affect health. As this shift is occurring, hospitals continue to be paid based on more traditional measurements, which often fails to incentivize them for trying to make changes being demanded, Bell said.
For Kansas facilities like Holton Community Hospital, the challenges are plenty.
Any conversation with hospital officials turns to behavioral health, Bell said.
"Whether or not you are delivering behavioral health care specifically, you're affected by it because you see patients who have behavioral health issues in your ER," he said. "You see them in your clinics. The inability of our society to put the right emphasis on the places that they need to be has been very frustrating for hospitals. I think a lot of people would agree that right now, a big part, if not a majority, of behavioral health care takes place in hospital emergency rooms and jails. That's a situation that I don't think any of us think we should tolerate."
Krista Eylar, director of nursing for Holton Community Hospital, said the lack of behavioral health services was what led her facility to launch the Senior Life Solutions program, a contracted service to get mental health services to the elderly, who frequently suffer from depression, grief and loss. This program reaches out to patients in their home setting, offering support that maximizes health outside the hospital.
"I think it's a huge change probably for all of us that are used to working in the hospital setting — to really change our mindsets," Eylar said. "We have always focused on how do we provide the best care in this hospital setting. Suddenly, we're being challenged to think how do we continue that once they leave here."
Bell said the behavioral health issue won't be going away.
"I've been at KHA for over 30 years now, but it feels like to me that right now, we're paying for decades of neglect of that issue," he said. "We thought we could ignore it and do some things that we thought maybe were going to keep people in communities. And we didn't need these state hospitals as much as we did in the past. I think we fooled ourselves that we had the solution."
Add in the fact that behavioral health issues are more common, and the issue of how to make sure people get help will stay relevant for some time.
Bell highlighted other top issues for hospitals:
Telemedicine/telehealth. The Kansas Legislature this session is tackling the insurance issues around the topic, working to determine if insurance companies should have to pay for telemedicine visits as they would if the provider had seen the patient in the office. "We've got a large, large majority, about 80 percent, of our hospitals that are already providing telemedicine services," Bell said. "I think that's going to increase."
Workforce challenges. Hospitals face recruiting challenges, lack of a talent pool to even recruit from and current employees who are worried about their day-to-day jobs and personal safety, the latter "arguably part of the behavioral health discussion," Bell said. Safety concerns often center around patient behavioral health, including substance abuse issues.
Opioid epidemic. KHA formed a joint working committee with the Kansas Medical Society to discuss opioid and substance abuse issues. "What we always heard as we would talk with our members it hat yes, opioids are a big issue in our state and an increasing problem, but in many cases, they're not as big a problems as things like meth. And alcoholism is still right up with those substance abuse kinds of issues."
Expanding Medicaid. It is impossible to talk with hospital administrators without discussing Kansas' lack of Medicaid expansion, Bell said. "We're running out of excuses for the people that have said they're against it," he said. "There's not many left."
More collaboration. KHA is seeing more collaborative health-care efforts among members, and sometimes that collaboration results in consolidation. Networks and joint efforts help especially small hospitals offer more services.
Regulatory requirements. Health care providers want more clarity and work on the number of regulatory requirements at the state and federal level "that in the providers' minds have very little to do with actually taking care of patients," Bell said.