• The same problems remain - many Americans don't have insurance; state and federal costs continue to go up; how can we pay for it?
• Should health reform be a direction, not a solution?
• America has always been an incremental nation - change can't be rushed, it needs some consensus
• Is the solution a state and community effort?
• If the delivery system doesn't change, the providers will change – radically
• Reform must come from providers and insurers
• Will someone pay for what providers want to do OR must providers do what someone will pay for?
• TOUGH CHOICES ARE HERE!

An exclusive report from the Estes Park Institute. We take seriously our responsibility to help health care leaders like you stay current with the critical challenges facing today's health care industry.

We’ve surveyed hundreds of hospital executives, trustees, and physicians from all across the country. We asked them to share their opinions and concerns about the issues facing their hospital. And we’d like to share our findings with you.

In addition to the Top Issues in Health Care Report, be sure to download the companion Workbook. Designed by the Fellows of the Estes Park Institute, the workbook may be used at board meetings or retreats to discuss the top issues facing your hospital.

Click here to view the Top Issues Online Toolkit.

Although the President’s recent speech gave some specifics of the proposed slimmed-down bill, a lot is still indefinite. Many changes will occur. On September 29, Estes Park Institute held a follow-up to the July 15 Health Reform 2009 audio conference. John Kitzhaber and John Horty hosted a lively discussion to bring board members, physicians and management up to speed on the status of the health reform effort, including:

• The effect of the President’s speech to Congress
• What is likely to happen between now and Thanksgiving?
• Analysis & effect of the Baucus Bill
• How much can the White House affect events?
• What should hospitals prepare to do to protect their ability to serve their community?
• What will happen after 2009?
• Has health care reform become continuous?
• Community hospitals in the post-reform era

It looked simple. Cover the 46 million uninsured and pay for it by cutting the cost of care and improving quality.  Though some had another goal, not talked about – transition to a single payor system.  But, it isn't simple. To pay for coverage and cut costs, everything has to be examined, no matter how small or weird or unusual.

And so, "the genie is out of the bottle"!

Everything is in play, public insurance plans, wellness, nonprofit medical co-ops, less pay for hospitals, major criticism of fee-for-service reimbursement, fraud and abuse waste, cutting physician fees, comparative treatment effectiveness and new bureaucracies.

And much in the final bill won't work as intended.  2009 reform won't end even if the President signs a bill in October, or November, or December.  It will go on and on and on – affecting all of us and requiring change – for years to come.

On July 15, Estes Park held its first-ever audio conference to discuss these timely health reform issues.  Healthcare leaders from around the country listened in as healthcare experts John Kitzhaber and John Horty presented 30 minutes of information, insight, and advice for dealing with ongoing healthcare reforms.  A 30-minute discussion period followed.