“Expect more!” 

I learned what that meant when as a third grader my mother moved me to a private Catholic school from an economically depressed inner-city public school where 70 percent of the students never made it to high school graduation and where the majority of those who did were sub-literate. 

 The nuns who ran the school could not care less about my socioeconomic status, the environment in which I was being raised, or any of the other reasons one might use to justify my failure to excel and become a productive member of society.  Though I arrived unable to read or write, by the end of my first year there, I was as literate as a sixth grader in every subject I studied.  The use of steel-edged rulers had something to do with the pace at which my learning quickened, but it was the expectations the nuns had for me that changed my destiny.

I am reminded of this early childhood experience as I think about how in 2013 I will approach the challenges of my job representing hospitals and the interests of the communities they serve.  My thoughts are focused on the circumstances that present hospitals with uncertain futures:

• The preliminaries for implementing the 2014 provisions of the federal health care reform laws enacted in 2010 move into high gear this year. 
• The last election gave us a state where the majority party controls all state offices and our state legislature with a two-thirds voting margin in both houses—a challenging circumstance at best. 
• Congress opened the year by cutting another $1.5 billion in Medicare payments to California hospitals so that payment cuts to doctors could be delayed.  This is on top of the $17-billion cut hospitals took to help pay the cost of health care reform and another 2 percent cut looming as part of the budget sequester enacted by Congress. 
• What’s happening to Medi-Cal is worse.  This severely underfunded and underpaying program was dealt another death blow as the year ended with a court decision that allows draconian rate cuts to be made that will destroy sub-acute care provided by hospitals. 
• Add to this already-full agenda moving the remaining fee-for-service Medi-Cal program from selective provider contracting to an APR-DRG payment model; the Medicare/Medi-Cal dual-eligibles conversion; and the looming cuts to the disproportionate share hospital program, and you should begin to understand my anxiety. 
• Also, and perhaps most importantly, we have lost the public’s trust over the use of hospital charge masters for billing self-pay patients; we have zero credibility with consumers on this issue.  And that fact will have a negative halo effect on our overall image and advocacy efforts at every level of government and with consumers until this billing practice is shelved.

So what’s a body to do?  “Expect more!”  My lesson from childhood is the answer.  We cannot allow our destinies to be made by our circumstances.  If we are true to our calling as stewards of high-quality, affordable medical care, then we need to step up our game.   We need to figure out how to get our organizations in sync and on board with the new paradigm—moving from volume to value—served up by the health care reform laws.   Moreover, we need to “Expect more!” from our state and federal policy makers … and ourselves.

Your thoughts?