Texas med­i­cal cen­ter keeps its fo­cus on process im­prove­ment

Modern Healthcare - - Q & A -

The UT South­west­ern Med­i­cal Cen­ter is on a roll. Last year, it ex­panded its pres­ence in the fast­grow­ing Dal­las mar­ket by open­ing an $800 mil­lion hos­pi­tal com­plex.

It re­cently won des­ig­na­tion from the Na­tional Can­cer In­sti­tute as a com­pre­hen­sive can­cer cen­ter and opened new brain and bioin­for­mat­ics in­sti­tutes. Since 2008, Dr. Daniel Podol­sky has led the $2.3 bil­lion teach­ing in­sti­tu­tion, whose 13,800 em­ploy­ees serve about 92,000 hos­pi­tal­ized pa­tients a year. Mod­ern Healthcare Nashville bureau chief Beth Kutscher re­cently asked Podol­sky about the strat­egy be­hind the aca­demic med­i­cal cen­ter’s re­cent moves. This is an edited tran­script.

Mod­ern Healthcare: What were your goals for build­ing the new fa­cil­ity?

Dr. Daniel Podol­sky: Build­ing a whole new fa­cil­ity for in­pa­tient care was in the con­text of a health sys­tem that was grow­ing at a pace greater than the lo­cal mar­ket, and on rel­a­tive terms, greater than most univer­sity-based health sys­tems.

The fa­cil­ity we were us­ing, the St. Paul Univer­sity Hos­pi­tal, was built nearly 60 years ago. It re­ally did not have the ca­pac­ity to sup­port the tech­nol­ogy that we saw as be­ing an im­por­tant part of the fu­ture of clin­i­cal care.

MH: What made you think tech­nol­ogy was where your fo­cus should be?

Podol­sky: We went through ev­ery as­pect of the hos­pi­tal’s func­tion and asked the ques­tion: How can we make the care a bet­ter ex­pe­ri­ence for our pa­tients and sup­port their fam­i­lies? In ad­di­tion, we wanted to build a hos­pi­tal that had in its DNA an op­por­tu­nity to fa­cil­i­tate our mis­sions of teach­ing and train­ing stu­dents and res­i­dents and sup­port­ing clin­i­cal re­search. So we set out to de­sign a fa­cil­ity which would be ef­fi­cient in the need to in­cor­po­rate new tech­nolo­gies in the fu­ture, and fi­nally, in be­ing wired that en­abled us to ap­proach in a rig­or­ous way an as­sess­ment of qual­ity and the im­ple­men­ta­tion of process-im­prove­ment ca­pa­bil­i­ties.

There are a num­ber of in­no­va­tive uses that have been in­cor­po­rated into the hos­pi­tal that both im­prove care and the qual­ity of ex­pe­ri­ence. For ex­am­ple, one that has proved ex­tremely pop­u­lar with our pa­tients as well as our staff and fac­ulty is a very large, high-def­i­ni­tion med­i­cal Skype ca­pa­bil­ity in ev­ery pa­tient room.

Pa­tients may have been re­ferred by a pri­mary-care doc­tor who is across the city or in another part of the state or another part of the coun­try. (Those physi­cians) can be brought into the dis­cus­sion with the team here when re­view­ing imag­ing find­ings and dis­cussing po­ten­tial treat­ment plans. It’s cre­ated the abil­ity of a spouse to say good­night face to face with some­one in the hos­pi­tal or to join rounds, as it were, and ask the physi­cian or the nurse a ques­tion when they can’t be there in per­son. It’s al­lowed us an ef­fi­ciency of get­ting in­put from our col­leagues who might not oth­er­wise pro­vide con­sul­ta­tion un­til the end of the day, to get their in­put when they are across cam­pus in an out­pa­tient set­ting.

MH: Aca­demic med­i­cal cen­ters are very high-cost sys­tems be­cause of their train­ing and re­search mis­sions. Are there ways in which this new fa­cil­ity helps you meet some of the goals of value-based care?

Podol­sky: It’s cer­tainly enor­mously more ef­fi­cient than our old fa­cil­ity. Some of that’s bricks-and-mor­tar stuff in terms of up­graded util­i­ties and energy-ef­fi­cient ways of con­struct­ing the build­ing. But things like the (com­mu­ni­ca­tions) tech­nol­ogy I’ve just de­scribed do have a sig­nif­i­cant im­pact on the ef­fi­ciency of care.

We have some of the same tech­nol­ogy in all of our pro­ce­dural spa­ces, es­pe­cially the op­er­at­ing rooms. So sur­geons op­er­at­ing who may come upon an un­ex­pected find­ing can have ac­cess to the ex­per­tise of another sur­gi­cal dis­ci­pline as the pro­ce­dure is pro­ceed­ing. They can in­ter­act di­rectly with our pathol­ogy depart­ment if ap­pro­pri­ate when a pro­ce­dure for re­moval of some sort of ma­lig­nancy is un­der­way. That higher-qual­ity in­ter­ac­tion among the pro­fes­sion­als (brings) a higher de­gree of

com­mu­ni­ca­tion and a higher de­gree of ef­fi­ciency. All of that helps us in a value-based world.

MH: You’ve been on a fundrais­ing tear re­cently with a new brain in­sti­tute and an in­sti­tute for bioin­for­mat­ics. How do you do it, es­pe­cially com­ing off the tough years we’ve had eco­nom­i­cally?

Podol­sky: We are for­tu­nate to be in Dal­las, where there is both a com­mu­nity with the means to sup­port im­por­tant in­sti­tu­tions and a will to do so. We are not the only in­sti­tu­tion that ben­e­fits from that civic-mind­ed­ness and that gen­eros­ity.

MH: How com­pet­i­tive is the Dal­las mar­ket, and what’s the niche that you’ve carved out for your­self?

Podol­sky: There are a lot of ex­cel­lent med­i­cal in­sti­tu­tions in Dal­las. But we are re­ally the only aca­demic med­i­cal cen­ter in the city, the only med­i­cal school and the only one with the kind of re­search foot­print that is a cou­ple of or­ders of mag­ni­tude be­yond oth­ers in the city. Fifty per­cent of the doc­tors in this whole re­gion re­ceived ei­ther their un­der­grad­u­ate med­i­cal ed­u­ca­tion or their grad­u­ate med­i­cal ed­u­ca­tion res­i­dency train­ing or both here.

We are very sub­stan­tially skewed to­ward more com­plex care. When we look at our case mix in­dex, it’s pretty high by any na­tional bench­mark with two-thirds of our in­pa­tient care within the bound­aries of ter­tiary and qua­ter­nary care. And I think that that’s not only high for Dal­las, but even com­pared to peer aca­demic med­i­cal cen­ters around the coun­try.

MH: You’re see­ing a lot of con­sol­i­da­tion in North Texas. What is your part­ner­ship strat­egy?

Podol­sky: We have over the past few years de­vel­oped some very im­por­tant part­ner­ships in the form of a net­work of com­mu­nity pri­mary-care physi­cians. The net­work is called the UT South­west­ern Com­mu­nity Af­fil­i­ated Physi­cians. These are physi­cians who are not em­ployed by us, but we con­tract with them right along­side our fac­ulty and our fa­cil­i­ties where they agree to make a real com­mit­ment to in­te­gra­tion.

So their EMR is com­pat­i­ble with our EMR. They help de­velop our care path­ways and also re­ceive on a very reg­u­lar ba­sis sig­nif­i­cant amounts of data about their prac­tice out­comes, their prac­tice ef­fi­ciency, the to­tal cost of care for their pa­tients and re­source uti­liza­tion.

That has been our most sig­nif­i­cant ini­tia­tive as con­sol­i­da­tion hap­pens. Rec­og­niz­ing our strengths be­ing in ter­tiary and qua­ter­nary care and be­ing rel­a­tively smaller in pri­mary care, we de­cided that rather than grow that foun­da­tion, we would part­ner with com­mu­nity physi­cians who are will­ing to sign on to that set of com­mit­ments.

“When we look at our case mix in­dex, it’s pretty high by any na­tional bench­mark.”

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