John B. Chessare, new chief executive of Greater Baltimore… (Baltimore Sun photo by Algerina…)
The new chief executive of Greater Baltimore Medical Center, John B. Chessare, watched health care reform unfold in Massachusetts as a hospital executive, physician and consultant in that state.
Now, as hospitals across the country work to figure out the impact of the coming reform on a national scale, he hopes to bring his experience to bear at GBMC.
The 58-year-old former pediatrician was president of Caritas Norwood hospital outside Boston and later a hospital consultant, and he was practicing medicine as recently as five years ago. He thinks that will help him better understand both the financial and medical aspects of the business.
Chessare says he follows the teachings of his mentor, Donald M. Berwick, the recently appointed head of the Centers for Medicare and Medicaid in Baltimore, who has championed putting the patient first and health care provider second.
Hospitals can better serve patients while still finding ways to operate more efficiently, especially in preparation for federal health care reform, Chessare believes.
Chessare, who took the helm at GBMC last month, talked to The Baltimore Sun about reform and the changing industry.
Question: How do you think health care reform is going to affect GBMC, and are there any steps you're taking now to prepare for it?
Answer: We're not exactly sure because I don't think anyone is quite sure yet what health care reform will bring us. We're up to the challenge, and we are delighted that the United States is moving forward to ensure that Americans don't go without access to care.
We believe that, done well, reform should help us drive the waste out of our system. We spend about four times what they spend in Western Europe on health care, and unfortunately it is not fair to say that our system is the best in the world any longer. We are the best system in the world in some areas, but in other areas we have a lot to learn from other countries.
Q: You will probably get a lot of new patients coming into the hospital. Do you anticipate having to expand?
A: We believe that what we need to expand is a lot of outpatient opportunities, and we look forward to moving care upstream. There is a lot of discussion about whether we could have a system where the incentives are to keep people out of the hospital. Right now, quite frankly as a hospital executive, the incentives are for us to fill up the hospital because we stay open by making enough money to pay all our bills and get ready for the next piece of technology.
We are clearly not in business to make money per se, but we have to make some money to buy the next technology, and presently we make all our money, almost every penny of it, by waiting for people to get sick and then treating them. I would much rather be paid to figure out ways for everyone not to become [sick]. We're hoping that reform changes the focus.
Q: Maryland has a unique way of setting hospital rates that's designed to spread the cost of patient care; what do you think about that?
A: I am very happy to be in Maryland with the rate-setting because there is a group of people without an immediate vested interest that are looking to make sure that the hospitals have the resources that they need to serve the population.
In the state that I just came from, there is a tremendous unlevel playing field where you have a few hospitals getting exorbitant rates and most of the community hospitals are barely able to survive. The hospitals with the exorbitant rates then take the excess profit and build ventures on the doorsteps of the community hospitals to therefore take the remaining profit out of the community hospitals, which pretty much make the community hospitals on the verge of bankruptcy.
Q: What did you think about the 2 percent increase in hospital rates that was passed and opposed by some hospitals as too low?
A: The rate-setting commission has a very difficult job because they are trying to balance the expenditure of resources by individuals against the needs of the hospitals. And we will continue to work as hard as we can to drive the waste out of the system and make the payments be adequate. I do appreciate the fact that the commission will continually re-evaluate the status of hospitals to make sure we're not put at risk.
It's going to be particularly difficult in this transition period, when we're not quite sure what the federal government's rules will be. And we're not configured for a very fast switch from focusing totally on providing services to sick people to focusing on keeping people healthy. So we would like the rate-setting commission to understand that, to give us a little cushion as we make that switch.
Q: You were in Massachusetts during health care reform there. Was there anything you learned there?