Aca­demic docs see­ing the need to stan­dard­ize and cre­ate more value

Modern Healthcare - - Q & A -

Dr. C. Wright Pin­son is CEO of the Van­der­bilt Health Sys­tem in Nashville and deputy vice chan­cel­lor for health af­fairs and as­so­ciate dean for clin­i­cal af­fairs at the Van­der­bilt Univer­sity Med­i­cal Cen­ter.

Pin­son, a hep­a­to­bil­iary and liver trans­plant sur­geon, over­sees 1,500 physi­cians, four hos­pi­tals, 100 out­pa­tient clin­ics and a bud­get of $2.6 bil­lion. He co­founded and co-di­rects the Masters in Man­age­ment in Health Care pro­gram. As a side­light, Pin­son plays drums in a rhythm and blues band with other Van­der­bilt col­leagues that has shared the stage with stars such as Charlie Daniels and Del­bert McClin­ton. Mod­ern Health­care ed­i­tor Mer­rill Goozner re­cently spoke with Pin­son about fed­eral fund­ing cuts for aca­demic cen­ters, qual­ity-im­prove­ment ef­forts and Van­der­bilt’s ef­forts to build a broader in­te­grated net­work. This is an edited tran­script.

Mod­ern Health­care: How is the fed­eral freeze on fund­ing for grad­u­ate med­i­cal ed­u­ca­tion and Na­tional In­sti­tutes of Health re­search grants af­fect­ing your in­sti­tu­tion?

Dr. Wright Pin­son: So far, we’re weath­er­ing the storm sat­is­fac­to­rily. Our grants amaz­ingly are up 5%. But the dif­fi­culty comes in cre­at­ing enough bot­tom line to support (our mis­sion). Our out­pa­tient growth has been near 10% for years and that con­tin­ues. The in­pa­tient growth is less, though we still have growth. The bot­tom line, though, con­tin­ues to get com­pressed. Serv­ing the un­der­served, med­i­cal ed­u­ca­tion and bio­med­i­cal re­search do not have bot­tom lines. They re­quire some trans­fer from clin­i­cal­care rev­enue. The shrink­ing bot­tom line cre­ates ten­sion for those pro­grams.

MH: Why is Van­der­bilt do­ing bet­ter than other aca­demic cen­ters?

Pin­son: We have a tremen­dous cadre of ex­cep­tional in­ves­ti­ga­tors who have con­tin­ued to be suc­cess­ful and very com­pet­i­tive in the grant world.

MH: What is the re­la­tion­ship be­tween the for-profit health­care in­dus­try cen­tered in Nashville and your in­sti­tu­tion?

Pin­son: We have many fo­rums like the Nashville Area Health­care Coun­cil where we have the op­por­tu­nity to in­ter­act on a reg­u­lar ba­sis, and that has been very ben­e­fi­cial in both di­rec­tions. We im­port ex­per­tise from the in­dus­try in man­age­ment of our op­er­a­tions.

MH: Where does Van­der­bilt stand on im­prov­ing qual­ity of care and pa­tient out­comes?

Pin­son: We have re­or­ga­nized our whole qual­ity, safety and risk man­age­ment ef­fort and have tried to in­te­grate that with the op­er­at­ing teams in a more ro­bust way. We are be­gin­ning to make more rapid progress on qual­ity and safety mea­sures. We are look­ing at our core in­pa­tient op­er­at­ing mod­els, as well as our core out­pa­tient clinic op­er­at­ing mod­els, and we are re-en­gi­neer­ing those mod­els, stan­dard­iz­ing them and mak­ing sure they are re­li­able. We’re look­ing at our billing and col­lec­tion op­er­a­tions, and we’re up­grad­ing the soft­ware and pro­ce­dures and get­ting per­son­nel who can drive us to a higher level of ef­fi­ciency. And we are set­ting our stan­dards higher in terms of meet­ing pa­tient ex­pec­ta­tions of qual­ity, safety and ser­vice.

MH: Is it harder to get physi­cian buy-in on clin­i­cal stan­dard­iza­tion in an aca­demic med­i­cal cen­ter?

Pin­son: His­tor­i­cally, that would have been the case. But physi­cians at our in­sti­tu­tion are see­ing the ur­gency to per­form to higher stan­dards and the need to cre­ate more value. So there is a will­ing­ness to take on stan­dard­iza­tion and set­ting per­for­mance cri­te­ria that I have not seen in the past. We are a learn­ing or­ga­ni­za­tion and this idea of tak­ing in new ideas and ap­ply­ing them is ac­tu­ally quite well re­ceived.

MH: Can you talk about any im­prove­ment ini­tia­tives that are un­der­way?

Pin­son: We have de­vel­oped a va­ri­ety of project teams. We try to take on half a dozen 100-day projects and bring them to an end point, then work off of a list and take down the next most sig­nif­i­cant projects. Inside a large or­ga­ni­za­tion, it’s very hard in some ways be­cause of its size. Th­ese project man­age­ment teams bring ap­pro­pri­ate fo­cus with a spe­cific end point that drives us to con­clu­sions in a mean­ing­ful time frame.

MH: Is Van­der­bilt con­sid­er­ing forg­ing al­liances and ex­tend­ing its brand the way Duke and the Cleve­land Clinic have done?

Pin­son: Since 2011, we have de­vel­oped the Van­der­bilt Health Af­fil­i­ated Net­work. We have found in­sti­tu­tions that have rel­a­tively sim­i­lar value sys­tems, of­ten in­de­pen­dent not-for-prof­its, and we have co­a­lesced into a net­work of

“We are set­ting our stan­dards higher in terms of meet­ing ex­pec­ta­tions of qual­ity, safety and ser­vice.”

about 45 af­fil­i­ates across Ten­nessee. We should be clin­i­cally in­te­grated for­mally by the end of this year. Through that net­work, we will push out ev­i­dence-based stan­dards of care, col­lect­ing qual­ity data, driv­ing ef­fi­ciency and low­er­ing cost all across this net­work. It’s start­ing to spill over to some of our neigh­bor­ing states.

MH: Is there a long-term vi­sion of meld­ing this into a net­work and tak­ing on risk con­tracts?

Pin­son: I think it could evolve to that. Our first task, though, is to meet the re­quire­ments for clin­i­cal in­te­gra­tion and demon­strate that we can pro­vide value and sav­ings in the net­work as it stands now. We can be­gin to think about how we cre­ate more value over time.

MH: Is Van­der­bilt mov­ing to­ward form­ing an ac­count­able care or­ga­ni­za­tion and tak­ing on pop­u­la­tion health man­age­ment?

Pin­son: We are def­i­nitely learn­ing how to man­age pop­u­la­tions. We look at this net­work as cov­er­ing a large enough ge­o­graphic foot­print that we could rea­son­ably take on a pop­u­la­tion.

MH: What is Van­der­bilt do­ing to pro­duce more pri­mary-care physi­cians?

Pin­son: Van­der­bilt has tra­di­tion­ally been far more fo­cused on spe­cialty care and re­search in its med­i­cal school, and I don’t think we are likely to be­come a sig­nif­i­cant force in pri­mary care, although we have a cur­ricu­lum that al­lows peo­ple to fo­cus on pri­mary care if they want to.

MH: Some of your peers, such as the Cleve­land Clinic, put a huge em­pha­sis on their tech­nol­ogy trans­fers. What is Van­der­bilt do­ing in that arena?

Pin­son: We have set up a tech­nol­ogy trans­fer of­fice over the past decade, and we are trans­fer­ring a num­ber of ideas through con­tracts. It’s now hun­dreds a year. It is be­gin­ning to bring in sig­nif­i­cant dol­lars.

Our phar­ma­col­ogy depart­ment is fan­tas­tic, and their abil­ity to push out po­ten­tial ideas has been su­perb. Those ideas have been gen­er­ated in the ar­eas of di­a­betes treat­ment, erec­tile dys­func­tion, hyper­ten­sion and the neu­ro­sciences.

MH: As a liver trans­plant sur­geon, what do you think about the de­bate on when to treat peo­ple who test pos­i­tive for the hep­ati­tis C virus? With limited bud­gets for Med­i­caid and prison pop­u­la­tions, do you support just mon­i­tor­ing pa­tients’ liver func­tion and wait­ing to pro­vide treat­ment?

Pin­son: It makes ab­so­lute sense. It is not clear that there’s any big ben­e­fit in try­ing to treat peo­ple pro­phy­lac­ti­cally. It makes a lot more med­i­cal and fi­nan­cial sense to mon­i­tor peo­ple un­til they get to a point where it looks like they’re de­vel­op­ing some fi­bro­sis or other ev­i­dence of dis­ease pro­gres­sion be­fore you treat. Every­body that you iden­tify who has hep­ati­tis C prob­a­bly does not re­quire treat­ment.

Newspapers in English

Newspapers from USA

© PressReader. All rights reserved.