Lead­ers’ top con­cern: Im­ple­ment­ing re­form

In Nashville, how to im­ple­ment health care re­form is top of mind for in­dus­try lead­ers. Is­sues re­lated to the re­cently up­held Pa­tient Af­ford­able Care Act, in­clud­ing how med­i­cal ex­penses will be re­im­bursed, tech­nol­ogy’s role in health care de­liv­ery and pati

Modern Healthcare - - NASHVILLE HEALTH CARE COUNCIL -

Those con­cerns are also among the ma­jor is­sues that have emerged un­der health care re­form: ac­count­able care, re­im­burse­ment, “mean­ing­ful use” of elec­tronic health records and re­duc­ing clin­i­cal costs while im­prov­ing qual­ity. Sur­vey re­spon­dents rep­re­sent var­i­ous sec­tors of Nashville’s health care in­dus­try, in­clud­ing hos­pi­tals and other care providers, pro­fes­sional ser­vices, con­sult­ing ser­vices and in­for­ma­tion tech­nol­ogy. The busi­nesses range in size from fewer than 100 em­ploy­ees to more than 10,000.

Re­gard­less of how health care leg­is­la­tion plays out over the short haul, Nashville’s health care lead­ers are pre­par­ing for health care re­form in the same way they continue to po­si­tion them­selves as in­no­va­tors and change agents open to new op­por­tu­ni­ties.

Re­gard­less of how health care leg­is­la­tion plays out over the short haul, Nashville’s health care lead­ers are pre­par­ing for health care re­form in the same way they continue to po­si­tion them­selves as in­no­va­tors and change agents open to new op­por­tu­ni­ties.

Saint Thomas Health — a mem­ber of As­cen­sion Health, a Catholic health min­istry that is the largest non­profit health care sys­tem in the United States — be­gan the process of trans­form­ing health care de­liv­ery two years ago, said its Pres­i­dent and Chief Ex­ec­u­tive Of­fi­cer Dr. Mike Schat­zlein. Saint Thomas Health Ser­vices con­sists of nine hos­pi­tals, four in con­junc­tion with Capella Health­care, and sev­eral other health ser­vice providers that serve Mid­dle Ten­nessee, South­west­ern Ken­tucky and North­ern Alabama.

“Not so much be­cause of ex­ter­nal pres­sures, but rather be­cause it is the right thing to do, ser­vice de­liv­ery must be more per­son-cen­tered, far less frag­mented and much less ex­pen­sive,” said Schat­zlein, who is also mar­ket leader for As­cen­sion Health Min­istry for Nashville and Birm­ing­ham.

Saint Thomas has chan­neled its ef­forts into three ma­jor ar­eas: ac­cept­ing re­spon­si­bil­ity for the con­tin­uum of care for in­di­vid­u­als and pop­u­la­tions, in­for­ma­tion sys­tems in­te­gra­tion and process im­prove­ment to pro­vide con­sis­tent qual­ity and safety at lower cost, Schat­zlein said. A year ago, it launched an ac­count­able care or­ga­ni­za­tion, Mis­sionPoint Health Part­ners. The in­creas­ingly pop­u­lar ac­count­able care model

con­sists of net­works of hos­pi­tals, doc­tors and other providers co­or­di­nat­ing — and be­ing held ac­count­able for — pa­tient care.

Mis­sionPoint now has more than 1,400 doc­tors and nine hos­pi­tals, and is re­spon­si­ble for all or part of the con­tin­u­ing care of nearly 30,000 mem­bers. It is one of the first in­sti­tu­tions sanc­tioned as an ac­count­able care or­ga­ni­za­tion for Medi­care pa­tients by the Cen­ters for Medi­care Ser­vices, Schat­zlein said, adding that he ex­pects Mis­sionPoint will en­roll more than 21,000 Medi­care pa­tients in 2012. With health care re­form expected to in­tro­duce tens of mil­lions of pre­vi­ously unin­sured pa­tients into the man­aged care sys­tem, it is not sur­pris­ing that nearly a third of the sur­vey’s re­spon­dents ranked med­i­cal re­im­burse­ment as their No. 1 con­cern.

Scott Mer­tie, pres­i­dent of Kraft Health­care Con­sult­ing, which spe­cial­izes in all as­pects of re­im­burse­ment and com­pli­ance re­lated to Medi­care and Med­i­caid, said he has

“We are al­ways look­ing for­ward to make ac­cess­ing health care eas­ier for pa­tients and to help providers achieve the nec­es­sary pay­ment cer­tainty.” SCOTT MACKEN­ZIE CEO Pass­port Health Com­mu­ni­ca­tions, Inc.

al­ready been work­ing with clients ea­ger to un­der­stand how health care re­form laws will im­pact their fa­cil­i­ties.

“Due to RAC’s (re­cov­ery au­dit con­trac­tors) and other forms of gov­ern­men­tal claims au­dits, our com­pli­ance prac­tice has seen a large in­crease in pro­vid­ing ex­ter­nal cod­ing and doc­u­men­ta­tion au­dits and other risk as­sess­ments to iden­tify ar­eas of ex­po­sure for our clients,” Mer­tie said.

Lat­ti­more, Black, Mor­gan & Cain, P.C., the largest re­gional ac­count­ing and fi­nan­cial ser­vices fam­ily of com­pa­nies based in Ten­nessee has been proac­tive in health care re­form.

“We be­gan im­ple­ment­ing an ac­tive cam­paign to ad­dress the health care re­form bill years ago when it was merely a pos­si­bil­ity,” said An­drew Bis­son­nette, health care part­ner at the firm.

With a team of more than 40 health care pro­fes­sion­als, the firm has ex­per­tise in na­tional ac­count­ing firms as well as di­rect in­dus­try ex­pe­ri­ence, Bis­son­nette said. “Hav­ing these pro­fes­sion­als with ex­ten­sive fi­nan­cial and prac­ti­cal ex­pe­ri­ence en­ables us to dis­sect this bill, and what it means to our clients quickly and ef­fi­ciently.”

Mak­ing cer­tain that providers re­ceive pay­ment for ev­ery pa­tient will be in­creas­ingly com­plex as the vol­ume of new pa­tients in­creases.

Pass­port Health Com­mu­ni­ca­tions, which spe­cial­izes in soft­ware and busi­ness so­lu­tions for health care com­pa­nies, an­tic­i­pates 30 mil­lion peo­ple will ac­cess health care in the United States as a re­sult of health care re­form. The com­pany has de­vel­oped prod­ucts that track lo­gis­tics and pa­tient risk

from out­pa­tient, to in­pa­tient, to post-acute care to man­age the pa­tient’s en­tire episode of care across health care en­ter­prises. It has also de­vel­oped soft­ware to de­ter­mine el­i­gi­bil­ity, fa­cil­i­tate en­roll­ment and iden­tify fi­nan­cial as­sis­tance for needy pa­tients.

“We are al­ways look­ing for­ward to make ac­cess­ing health care eas­ier for pa­tients and to help providers achieve the nec­es­sary pay­ment cer­tainty in or­der to continue de­liv­er­ing the high level of care Amer­i­cans en­joy and de­mand,” said Scott MacKen­zie, chief ex­ec­u­tive of­fi­cer of Pass­port Health Com­mu­ni­ca­tions, Inc.

In terms of im­pact to the health care busi­ness, more than half of those sur­veyed ranked tech­nol­ogy high. Health IT and man­age­ment plays a huge role in health re­form, specif­i­cally in mean­ing­ful use of elec­tronic health records tech­nol­ogy (EHR). (The re­cent Supreme Court de­ci­sion does not af­fect mean­ing­ful use, which was es­tab­lished un­der ear­lier leg­is­la­tion. Health care providers must prove mean­ing­ful use of cer­ti­fied elec­tronic health sys­tems to qual­ify for Med­i­caid and Medi­care in­cen­tive pay­ments.)

As two of the big­gest na­tional providers among the Nashville health care community, Hospi­tal Cor­po­ra­tion of Amer­ica (HCA) and Community Health Sys­tems (CHS) are fo­cused on es­tab­lish­ing mean­ing­ful use best prac­tices.

“Whether it’s work­ing to­ward the re­quire­ments of health re­form or suc­cess­ful im­ple­men­ta­tion of elec­tronic health records to achieve mean­ing­ful use, our scale al­lows us to ad­dress mul­ti­ple is­sues si­mul­ta­ne­ously, in­no­vate, per­fect ap­proaches and then repli­cate suc­cess­ful strate­gies,” said Dr. Jonathan B. Per­lin, HCA pres­i­dent, Clin­i­cal and Physi­cian Ser­vices Group and chief med­i­cal of­fi­cer. HCA is the largest pri­vate op­er­a­tor of health care fa­cil­i­ties in the world.

Per­lin said he is proud that most of HCA’s hos­pi­tals at­tested for mean­ing­ful use last year, but stresses that it is not an “end point.”

“We see the EHR as a ve­hi­cle for de­liv­er­ing bet­ter pa­tient care, with greater con­ti­nu­ity, more per­son­al­iza­tion and im­proved ef­fi­ciency,” he said.

At CHS, clin­i­cal ex­cel­lence has al­ways been a top pri­or­ity, said Dr. Lynn Si­mon, the com­pany’s se­nior vice pres­i­dent and chief qual­ity of­fi­cer.

Si­mon said that like other hos­pi­tals and health sys­tems, CHS has his­tor­i­cally ex­am­ined clin­i­cal mea­sures sep­a­rately from dayto-day op­er­a­tions. But with the fo­cus shift­ing to value based pur­chas­ing, qual­ity ef­forts and op­er­a­tions need to be in­te­grated more closely, she said.

“We’re look­ing at qual­ity met­rics in real time — not just at the his­tor­i­cal data— and that is a good thing for our pa­tients,”

“We see the EHR as a ve­hi­cle for de­liv­er­ing bet­ter pa­tient care, with greater con­ti­nu­ity, more per­son­al­iza­tion and im­proved ef­fi­ciency.” JONATHAN B. PER­LIN, MD HCA pres­i­dent, Clin­i­cal and Physi­cian Ser­vices Group and chief med­i­cal of­fi­cer

Si­mon said. “The en­tire in­dus­try has to re­main fo­cused on ways to re­duce med­i­cal er­rors. Pa­tient safety is a pri­or­ity for us – as it should be for all health care providers.”

CHS has em­barked on ef­forts to make its af­fil­i­ated hos­pi­tals highly re­li­able, Si­mon said. It is shift­ing its fo­cus from process of care mea­sures to im­prov­ing out­comes, in­clud­ing im­prov­ing mor­tal­ity rates and re­duc­ing read­mis­sions and hospi­tal ac­quired con­di­tions.

One ex­am­ple she points to is a sys­temwide de­vel­op­ment of stan­dard­ized or­der sets. Lo­cal med­i­cal staffs ap­prove them, but with an or­ga­ni­za­tion­wide stan­dard­ized and con­sis­tent ap­proach to qual­ity, CHS can drive higher qual­ity, re­duced costs, the abil­ity to track re­source con­sump­tion and or­ga­ni­za­tion-wide ef­fi­ciency, Si­mon ex­plained.

Suc­cess­ful health care re­form de­pends on keep­ing costs down

“Based on the suc­cess of our med­i­cal home pi­lot, fi­nan­cial mod­el­ing projects, we can cre­ate sig­nif­i­cant sav­ings while also greatly im­prov­ing out­comes for these pa­tients.” C. WRIGHT PIN­SON, MD Deputy vice chan­cel­lor for health af­fairs, Van­der­bilt Univer­sity and CEO Van­der­bilt Health Sys­tem

while im­prov­ing qual­ity. That is es­pe­cially true for providers of Med­i­caid and Medi­care ser­vices.

Van­der­bilt Health Sys­tem is Ten­nessee’s largest provider of Med­i­caid ser­vices and ad­dresses a sig­nif­i­cant vol­ume of Ten­nessee’s Medi­care pop­u­la­tion.

“Al­ready, we know we will be fac­ing de­clin­ing re­im­burse­ments as we continue to treat these pop­u­la­tions,” said Dr. C. Wright Pin­son, deputy vice chan­cel­lor for health af­fairs, Van­der­bilt Univer­sity and chief ex­ec­u­tive of­fi­cer of the Van­der­bilt Health Sys­tem.

In or­der to meet that chal­lenge, last year Van­der­bilt Health Sys­tem be­gan a com­pre­hen­sive op­er­a­tional im­prove­ment process to cre­ate sav­ings and re­align its cost struc­ture. The or­ga­ni­za­tion met its ini­tial goal to save $50 mil­lion and con­tin­ued to work to­ward even greater ef­fi­cien­cies, Pin­son said.

Van­der­bilt also re­cently re­ceived an $18.8 mil­lion fed­eral grant it will use in part­ner­ship with its af­fil­i­ate med­i­cal cen­ters — Maury Re­gional Med­i­cal Cen­ter, NorthCrest Med­i­cal Cen­ter and Wil­liamson Med­i­cal Cen­ter — to es­tab­lish a med­i­cal home model.

Pin­son said all par­ties will be able to bet­ter man­age pa­tient pop­u­la­tions with costly and epi­demic chronic ill­nesses, such as di­a­betes, heart dis­ease and hy­per­ten­sion.

“Based on the suc­cess of our med­i­cal home pi­lot, fi­nan­cial mod­el­ing projects, we can cre­ate sig­nif­i­cant sav­ings while also greatly im­prov­ing out­comes for these pa­tients,” he said.

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