ObamaCare hits home in San Francisco

ObamaCare hits home in San Francisco<https://theruggedindividualist.wordpress.com/2013/06/03/obamacare-hits-home-in-san-francisco/>
Posted on June 3, 2013<https://theruggedindividualist.wordpress.com/2013/06/03/obamacare-hits-home-in-san-francisco/> by Roy Filly<https://theruggedindividualist.wordpress.com/author/sonodoc/>

Dear Readers,

I have railed against ObamaCare in many posts. I have said that it will be a disaster and I stand by that opinion.

UCSF, my base of operations, has a CEO that I greatly admire. I could tell you many things that would, I am confident, cause you to agree with my opinion. I rank him in the top three of CEOs I have dealt with in my long career. Recently he sent a letter to the UCSF Community regarding the impacts of ObamaCare on our beloved institution. I am reproducing an edited (only because it was quite long and detailed) version. I think you will be astounded at the impact of the health care law. It could bankrupt the institution or greatly curtail the types of services it has been providing. The quality of medical care in the entire Bay Area is highly dependent on the top-of-the-line students we train every day and send into our community after their education is complete.

Roy Filly

Dear Colleagues:

This week, we will begin a painful, but necessary process to reduce our UCSF Medical Center workforce of more than 7,000 individuals... by 300. In this email, I will outline the reasons why we need to take these actions now...

UCSF Medical Center, including the UCSF Benioff Children's Hospital, has enjoyed an unprecedented period of growth and strong financial performance for more than a decade. The most important hallmark of this period are the hundreds of thousands of patients from the Bay Area, California and the world whose lives we have saved or changed for the better as a result of the care we provided at UCSF.

But as you are well aware, society is demanding major changes of all healthcare providers. Simply put, society's expectation is that we will provide care to more people, improve the quality and safety of that care - and do it at dramatically lower cost.

In pragmatic terms, we see this in intensified regulatory oversight from The Joint Commission, the State of California and the federal Center for Medicare/Medicaid Services (CMS). We see programs like "value based purchasing" where our Medicare payments are cut unless we achieve quality and patient experience targets. We see it in the Affordable Care Act that has already begun to shrink our payments. We see it with employers - including the University of California - demanding changes in what they pay health plans and providers. And we see it in the new Covered California Health Benefit Exchange, which will begin enrolling members this year - and which has committed to lowering healthcare costs (meaning lowering payments to hospitals and physicians)...

Compared to this year, by 2016, UCSF Medical Center will face reduced reimbursement of approximately $75 million annually associated with healthcare reform; and simultaneously face increased costs of $175 million from higher employer pension contributions and the operation of the new Mission Bay hospitals. This means that a $100 million operating gain at UCSF Medical Center this year would become an unacceptable $170 million operating loss in 2016 - absent our taking actions today...

... It will be difficult to achieve society's aims for us in healthcare - cover more people, do it better and do it at lower cost - without rethinking how we carry out our work. So rather than seeing a challenge and thinking that we need more staff to address it, we need to see a challenge and find new, novel ways to meet it. Perhaps the answer lies in using new technology, or in new partnerships with others inside or outside UCSF; or in work redesign using the Lean process improvement principles we are adapting across the organization. If any organization can find the right answers, it is UCSF.

My management team and I will have office hours and will be rounding on units across all shifts over the next few weeks to answer questions. Medical Center managers will be holding staff meetings to review the effects of the reductions in individual areas. And as always, if you have comments or concerns, feel free to address them to me or any member of my management team.

I thank you for your support of UCSF Medical Center and UCSF Benioff Children's Hospital, and the patients we serve.


Mark R. Laret, CEO

UCSF Medical Center and UCSF Benioff Children's Hospital


According to the Congressional Budget Office (CBO), Obamacare will reduce Medicare reimbursements by $716 billion over 10 years. These cuts will hit Part A providers such as hospitals, nursing homes, skilled nursing facilities, and hospices, along with Medicare Advantage plans. The trustees predict that if Congress allows these cuts to go into effect, 15 percent of Medicare providers would go in the red by 2019, 25 percent by 2030, and 40 percent by 2050.

UCSF benefits the entire San Francisco Bay Area, generating more than 39,000 jobs and producing an estimated $6.2 billion economic impact when including operations, construction, salaries, and local purchases by employees, students and visitors, according to a new economic impact report.