Sharing Your Voice

Last week I was in Washington for the public policy council of the Children's Hospital Association. We heard from national experts giving their thoughts about what was going to happen with the Supreme Court on their ruling of the Healthcare Law, and the outlook of the Presidential campaign. While the experts offered many different views, what struck me was one common theme.

All agreed that regardless of who is elected President, or who controls the Congress, the federal deficit will be addressed in 2013. Cuts will be made in all federal programs and they will be severe. No if’s, and’s, or but’s about it - severe cost cutting will happen. This means that Medicaid, the program so many of our children rely on will be cut. The question is not if it will be cut - but by how much.

Staff from Congress came to speak to us. They reminded us that when Medicaid was created, it was intended to support the healthcare needs of the poor - not what it has evolved into, it is now the program covering the massive long term care expenses for the elderly. (In NJ most of the $6 billion spent in Medicaid is spent on the elderly in nursing homes.) They said we must be able to have an honest, thoughtful conversation about how to restructure the program or else the program will be cut irrationally, and arbitrarily.

My gut wrenched. It is time to sit down and be an adult. Not just an advocate who says, “you can’t cut me; go look somewhere else,” but instead asking for real solutions.

It took me immediately back to what we have been talking about over the last 2 years. I have told you that we are not going to get paid anymore in reimbursements. The president of the American Hospital Association said last week when he spoke at a private meeting of NJ Hospital CEO's, "What you get paid today, is the most you will ever be paid. You have to do more with less, and if you don’t figure it out, someone else will."

This wasn’t news to me, and shouldn’t be to you because it’s something I’ve been discussing over and over again. But just like a recent conversation I had with a staffer who shared their concerns, “How do we have the courage to put ideas and real changes on the table that might hurt for a short time, but protect our entire program for years to come?”

I thought about examples of changes we made personally or professionally and wondered if we had the benefit of hindsight, we might have personally done things differently. There is no argument that whether you call what we have been through since the crash of the stock market in 2008 a recession or a depression, we know that 1 in 10 people are unemployed and the numbers of those underemployed are 1 in 19. People are hurting. Some have lost their homes, or are working two jobs. Some of you have shared the challenges your spouses and family members have faced and are still facing. Your children have moved home or you are helping support other loved ones who have fallen on hard times.

At some level, we knew that the "good times" couldn't last forever - right? Our houses were worth twice what we paid for them, by doing no additional improvements; we were getting salary increases every year, even though we were losing money and we were consuming. Consuming products and stuff (iPad’s, computers, houses …who would ever pay more than $50 for a purse in 2000?). We were buying bigger houses and as a people, Americans were running up huge debt. And then it happened. The bottom fell out. What would you have done differently if you knew then what you know now?

And that is how I am looking at the conversation last week in Washington. The experts tell us “it” is coming. Congressional staffers, off the record have said, you have to give us something to restructure the programs you depend on or you are going to end up having people who don’t understand what you do as well as you do, restructuring the program for you. I am now talking to my colleagues about putting tough questions out there and trying to give them the hard medicine but at least we can prepare for how to live with it.

That is what the 100 day work outs are about and why we continue to ask you for your ideas on restructuring our business and becoming more efficient. We have to change. We will not get paid any more for the services we deliver, and in some cases we will get HALF of what we get today. We can be mad that we are in this financial time or we can use this time before the cuts happen, to figure it out and be ready.

If you don’t engage in this process and give ideas to your supervisors and directors, then the cuts will come and we may not make the "best" decisions, or the ones you think we should but I am asking you now - get engaged.

Even if it is in other departments - often it is hard to see how to change when you are in the middle of it. Right, that is why we go to personal trainers or counselors, we need people to help us think through and work through. We hired consultants who helped us get started on the 100 day work out process, but now it is on us. What should we do? How can we make changes? We had this discussion during the employee meetings but most of the conversation was about doing more, spending more money, which is ok but it does not get us ready for what is certainly coming.

So I ask you - what is that our senior leadership is not doing that we can do better to get you engaged in this process, of putting real ideas on the table for significant change? Because it is coming, and changes have to be made. If you want to be part of what the change looks like, now is the time.

You have a voice in this. Make it heard.