As we are watching the budget debate play out in Washington, how can we understand the impact of sequestration, followed by the continuing budget resolution, on St. Joseph's and the patients we serve?

For each of the last few years we have faced Medicare cuts to reimbursements. When those announcements come, we take two approaches. First we pull in our belts, delay capital investments and salary increases, and move needed investments into the future.

We also ask ourselves how we can improve processes of care, decrease repeat tests and generally improve quality. Quality improvements mean less time in the health system, better outcomes and often lower costs.

We all agree there are things we want to improve in health care, including better access to care, better communications and better quality. To do so we need to substantially change our systems by investing in more primary care, better technology and better management of care across different settings. These changes will take investments and time to achieve. 

Can we cut the costs of care and  make investments at the same time we are seeing more Medicare and Medicaid patients? The theory is that as more people have insurance coverage, we will see less uncompensated care. The  expanded coverage hasn't happened yet, the exchanges are just getting started, and no one is completely sure how these pieces will all work.

Yet, we are facing a minimum of $13.7 million in cuts for 2013, and projected cuts of $264 million over the next 10 years. It is likely the cuts will surpass the offsets, and in fact we will have less revenue for providing care to increased numbers of patients.

We are approaching this complex set of circumstances carefully, trying to explore cutting costs, and developing alternate resources to invest in our growth. 

If we could send three messages to our elected officials they might include:

1.  Invest in primary care growth. If millions of Americans will have health coverage, where will they access care? Our fear is they will access care in our already strained emergency rooms.

2. Slow down the speed you expect change to happen.We have incentivized  health systems across the country to implement electronic medical records. This will slow down providing care at the very time we need more care.  Productivity of health professionals will slow as we move towards meaningful use. 

3. Invest in more than health care. Managing care and population health is an admirable goal, but our communities have crises in jobs, education and housing. Moving from health care to health of communities requires investment in many areas and time to change systems.

St. Joseph's will continue to prepare for the future, and we are committed to our development of a system of high quality care, yet we remain concerned about the level of cuts and rapidity of change.