Hospitals will shrink, said Shure, but they will not go away completely. "The goal is to reduce avoidable re-admissions by 25 percent. The actual amount of re-admissions for Medicaid populations is already 20 percent of all admissions," she said. "That means a 5 percent reduction overall, so that's a real reduction."

Shure echoed Finnegan's concerns about making sure the workforce is stable and adequately compensated. She hopes the displaced workers will be able to transition into ambulatory settings or population health initiatives.

She also addressed the necessity for hospitals who previously thought of each other as competitors to work together in the interest of meaningful PPS development, but thinks there will be more than one working model for how those groups come together. Shure thinks those groups will inform essential details to the development of payment reform.

"In recent years, Medicare and Medicaid payment rates have eroded to the point that we think institutions without a commercial base are increasingly unsustainable," said Shure, "So comprehensive payment reform will have to look at that underlying issue, and that has to be addressed at all levels of government if we're going to be successful."

There was an air of excitement in the Sheraton as attendees learned about DSRIP. According to Shure, that hopeful feeling is shared among the physicians who may be personally affected by the new legislation.

"I worked on a few waivers over the years and I do get the sense that this one is different," said Shure, "In my conversations with hospitals around the city, they're very engaged in this process; they really believe it is transformative."

Although it's hard to know if that belief stems from the level of funding or the overall push for health reform, Shure thinks meaningful change is happening and DSRIP can play a historic part.

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