Leading a major hospital in an era where health care is a political hot button means having to deal with constant change and uncertainty, the presidents of Baltimore’s two major medical centers told business leaders Wednesday.

Dr. Mohan Suntha, speaking to members of the Greater Baltimore Committee, said that just that morning, he awoke to texts asking what he thought about tax reform efforts moving through Congress. Senate Republicans now want to include an amendment in their tax bill that would repeal the so-called individual mandate, the Affordable Care Act’s requirement that most people have health insurance.

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Suntha said the frequent talk about making changes to the landmark health law makes it difficult to plan and communicate with doctors.

“Many of our physicians are wired in a way where they say, ‘Tell us the rules of the game, and we will figure out how to win.’ And their win definition is saving lives,” Suntha said. “If we are constantly changing the rules or telling them we think the rules are going to change, that can be very challenging.”

Dr. Redonda Miller, president of Johns Hopkins Hospital, said talk about taking away health insurance coverage or making changes to the Medicaid program are just two of the things she is watching.

“We do worry about the federal level,” Miller said. “There are certain issues at the federal level that make us stay up at night.”

Miller and Suntha talked about a wide range of health issues, including drug prices, the unique way Maryland charges for hospital services and how the opioid epidemic has changed the way hospitals prescribe painkillers.

“There is absolutely now more process associated with how we prescribe, purposely to try and drive down the inadvertent overuse,” Suntha said.

Both Miller and Suntha have worked for their medical institutions for years, but they have been heads of the hospitals for just more than a year.

One of the challenges of the job has been operating under a new revenue system adopted by the state where hospitals have to stay within yearly global budgets, they said. Sometimes new, more expensive treatments are introduced they didn’t anticipate when setting the budgets, and they have to find ways to pay for them.

Both Johns Hopkins and the University of Maryland Medical Center are partnering more with community groups as they work to address health issues by working outside the walls of the hospital. Miller and Suntha said businesses also can play a role in improving health.

“In reality, the biggest thing we could do to help population health is increase the socioeconomic status of these communities — and that means more than disease management,” Miller said. “That means providing jobs, providing training, providing education."

“We just to the core feel that if we can provide gainful employment then the destitution, the blight that we see would improve,” she said. “I think the business community could help.”

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