Rady Demonstrates Improved Patient Outcomes, Culture Shift and Financial Savings with Winning Project
May 15, 2011
Posted by chcablogadmin in : Cost Reduction, Innovation, Quality
Your dedicated staff and their participation in RACE for Results are great examples of how we drive each other to excellence every day. We’d like to congratulate not only the top awardees listed here, but the 10 finalists and all 30 hospitals who submitted entries in the RACE for Results program this year. They are truly “the best children’s hospitals with the brightest ideas.” We’ll profile several of these proven improvements for you in upcoming blog issues. One of these improvement programs might be just what your hospital is looking for. — JR
CHCA’s RACE for Results award recognizes exceptional clinical and business improvements in children’s hospitals. This year, Owner Hospitals submitted 30 entries in important areas such as bloodstream infections, waste reduction, electronic medical records, throughput and rapid response teams. Selected by hospital peers and international health care experts, the winners will be featured in educational webcasts and publications for all Owner Hospitals to access for their own improvement work. CHCA honors the winning hospitals May 19 in St. Petersburg, FL.
Rady Children’s Reduces Surgical Site Infections
Rady Children’s Hospital (San Diego, CA) is the 2011 RACE for Results award winner. After launching an aggressive evidence-based response to prevent surgical site infections (SSIs), the Rady team achieved an 80 percent decrease in costly orthopedic spine SSIs in just one year while maintaining surgical volume. They identified 10 patient safety interventions that are now part of surgical procedures at the hospital.
High Cost of Treating SSIs
National statistics estimate surgical site infections affect 50,000 patients each year, leading to additional procedures and longer hospital stays. In October 2008, CMS stopped reimbursing hospitals for the extra care required to treat all surgical site infections. Estimates of increased costs of SSIs are $153,871 in charges per affected patient with an average length of stay of 16.1 days, which calculates to about $10,000 in charges per day. Applying that amount to the12 orthopedic spine program patients identified in 2008 and 2009 at Rady Children’s shows estimated charges of $1,538,710 for 10 SSIs in 2008 and $307,742 for the two in 2009.
The 12 SSI patients required a total of 30 additional surgical procedures, 15 additional readmissions, and numerous office visits. The cost of an orthopedic spine SSI not only poses a great risk to the patient’s outcome and length of stay, but also increases hospital expenses.
Reducing SSIs at Rady
Impressively, in 2010, the volume of spine surgeries increased without additional infections. The 2010 monthly volume rose 33% (January-October) to an average of 17.7 surgeries a month from the 2009 average of 13.3 surgeries a month.
Engaged, informed multidisciplinary health care providers used evidence-based knowledge to promote crucial change. These interventions not only became part of policy at Rady Children’s, but led to an increased culture of safety within surgical services.
2011 Winner:
Rady Children’s Hospital (San Diego, CA)
“An Evidence-Based Response to a Cluster of Surgical Site Infections Involving Pediatric Orthopedic Spine Patients”
Honorable Mention – Clinical Care Projects Category:
Cook Children’s Health Care System (Fort Worth, TX)
“Bundled Interventions and Pareto Principle Result in a Culture Change and Reduce Healthcare Associated Infection in the NICU”
Honorable Mention – Clinical Care Projects Category:
Phoenix Children’s Hospital (Phoenix, AZ)
“Children’s Asthma Care Collaborative”
Honorable Mention – Waste Reduction Category:
Nationwide Children’s Hospital (Columbus, Ohio)
“Neonatal Care Collaborative to Decrease Length of Stay”
add a commentACO Update: Issue #4
May 15, 2011
Posted by chcablogadmin in : Financial Viability, Healthcare Reform
Regardless of where ACO legislation lands, many of you are still moving in the direction of managing health populations, assuming risk, aligning with physicians and looking at strategies to partner with other providers. In this edition of ACO Update we talk to Alan Goldbloom, M.D., President and CEO, Children’s Hospitals and Clinics of Minnesota. Alan candidly shares their three main strategies and the challenge for all children’s hospitals in developing an ACO model. Over the next few weeks, we’ll deliver several more CEO interviews leading up to a session at the Executive Dialogue.
We also profile the state scenario in North Carolina and the partnership with North Carolina Children’s Hospital. They’ve had a statewide medical home program for Medicaid patients (mainly children) for 20 years along with an accountable care-like program for the past 13 years. The state/local partnership brings together providers to cooperatively plan for meeting patient need and strengthening the health care delivery infrastructure. Along with impressive cost savings intitiatives involving chronic care, asthma and other conditions, the arrangement has stablized Medicaid care payment and improved care.
I welcome your comments and suggestions as well as your questions. Please feel free to contact me directly.
Jacqueline Kueser, Vice President, CHCA
Jacqueline.kueser@chca.com
- CEO Interview Series: The Fundamental Challenges of an ACO
- Operating in a Statewide Accountable Care Environment from Within a Health Care Sytem
CEO Interview Series: The Fundamental Challenges of an ACO
May 15, 2011
Posted by chcablogadmin in : ACO Update
Alan Goldbloom, M.D., President and CEO, Children’s Hospitals and Clinics of Minnesota, presents the distinct challenge for children’s hospitals in creating an ACO model. Jacqueline Kueser, CHCA Vice President, recently interviewed Alan as part of a series of CEO interviews about post reform strategies. As a former pediatrician and hospital administrator in Canada, his experience on both sides of the universal, government-funded health care debate brings unique perspective. Read or re-read Alan’s blog posted last year with his insightful comparison of the two national systems. — JR
Interview with Alan Goldbloom, M.D., President and CEO, Children’s Hospitals and Clinics of Minnesota
Alan Goldbloom, M.D.
“Accountable care” is built on the premise of assuming responsibility for broad-based care ranging from primary to tertiary. Children’s hospitals have a fundamental problem adapting to this model of care. The majority of freestanding children’s hospitals function as tertiary, regional providers, and not necessarily as integrated delivery systems. With increasing numbers of beds (often 30 – 50%) devoted to intensive care, and with admissions coming from all over a region, we may have little or no involvement in their primary, long-term care. Moreover, many of the outpatients who come for specialty care may be seen only for a single episode of illness, with subsequent care provided by primary care practitioners dispersed across the hospital’s catchment area. The prospect of having formal relationships with all referring physicians in a region is difficult to imagine, even though such relationships are the underpinning of many payment reform models. This is in sharp contrast to some of the large adult integrated delivery networks who own regional medical centers, smaller outlying hospitals and primary care practices.
At Children’s of Minnesota, we are implementing three strategies to help us move closer to an accountable care framework:
1.) Physician alignment—we are forming a Clinically Integrated Network (CIN) with primary care and specialty practices throughout the Twin Cities. The CIN will replace our current Physician Hospital Organization, will set quality and performance standards, will be connected by information technology, and will allow for collective contracting arrangements with payors (including bundled payments). We have also begun to purchase some smaller primary care practices, and are developing Professional Services Agreements with others, whereby we would purchase their assets, contract on their behalf, and contract with the physicians to provide the care. We have learned in our region that one size cannot fit all. Therefore, the goal is to offer a variety of arrangements that would ultimately advance care integration in the metro area, and establish a framework for accountable care.
We have learned in our region that one size cannot fit all. Therefore, the goal is to offer a variety of arrangements that would ultimately advance care integration in the metro area, and establish a framework for accountable care. — Alan Goldbloom, M.D.
2.) Hospital alignment—we are in discussions with regional hospitals to help staff their pediatric units, provide subspecialty support, and share pediatric protocols and standards. This would allow us to leverage our brand more broadly in a market that is highly competitive for tertiary/quaternary pediatric care; by enhancing the pediatric care in these regional hospitals, we would enhance and grow the relationships that ultimate result in our hospital being their first choice for more complex services.
3.) Maternal-fetal medicine—we are creating partnerships for joint mother/baby facilities to enable the neonates and their families to take advantage of services on the children’s hospital campus. At our Minneapolis campus, this will involve a new Mother-Baby Pavilion built in partnership with the largest adult system in the state (Allina), who would move all of their obstetrics from their flagship hospital, Abbott Northwestern, onto the Children’s campus. In addition to providing a home base for our joint fetal diagnostics and intervention program, it will be both a normal and high-risk maternity center with 4,000 deliveries per year. Moreover, it will be adjacent to our NICU so the sickest newborns will no longer be separated from their mothers. The second component of the program is to extend the partnership into the other adult hospitals in the Allina network, thereby developing a single standard of neonatal care.
Our future efforts will need to focus on ambulatory networks and data exchange with other physician and hospital providers. We will also evaluate the feasibility of owning a managed care plan to enable us to assume more risk. The concept of assuming total risk is not foreign to me, since I worked previously (in Toronto) in a system where we had a global budget for the hospital. We knew on January 1 each year what our revenue would be for the next 12 months, and had to meet our mandate to provide care. I actually don’t recall it was any more challenging than trying to deal with the ongoing uncertainties of Medicaid funding in the U.S. today, especially now that we are in an era when most states are facing budget deficits. I am therefore open to the option of having both the risk and the responsibility for care, with the qualifier that we need to carefully model such a plan around the reality of decreased resources in the future.
add a commentOperating in a Statewide Accountable Care Environment from Within a Health Care System
May 15, 2011
Posted by chcablogadmin in : ACO Update
To learn more about North Carolina’s state programs in the evolving accountable care environment, as well as operating a children’s hospital as part of a large, adult-oriented health care system, we spoke with Alan Stiles, M.D., Brewer Distinguished Professor and Chair, North Carolina Children’s Hospital (part of the University of North Carolina’s UNC Health Care). Here is what we learned.
Community Care of North Carolina (CCNC) was established in July, 1998, and designed to build on the state’s existing Medicaid primary care case management program, which essentially created medical homes for Medicaid beneficiaries. The goal is to work with leadership throughout the state to improve quality and access to affordable care for North Carolinians with special attention to underserved and low income populations.
Fourteen participating networks of community physicians, hospitals and health departments, covering the entire state address overall status of enrollees by proactively managing their care through risk stratification and disease and case management, as well as providing enhanced access to care. The networks work with the state in defining, tracking and reporting performance measures that help gauge effectiveness of participating networks in achieving quality, utilization and cost objectives.
Participation is optional for the state’s approximately 1.4 million Medicaid eligibles. About 945,000 of those eligible participate in the primary care case management program. Of those, about 875,000 participate also in CCNC. CCNC’s quality/cost-saving initiatives have focused on asthma disease management, chronic care (deals with Medicare/Medicaid dual eligibles), diabetes disease management, emergency room use reduction, pharmacy (primarily focused on long term care facilities), high cost/high risk patients and heart failure. Results have been impressive — $147 million saved in fiscal year 2007 according to a William Mercer (actuarial firm) study; a 34 percent lower hospital admission rate for asthma patients under age 21; eight percent lower use of ERs by asthma patients; 24 percent lower episode costs for asthma patients; seven percent increase in referrals for diabetic eye exams, and 23 percent increase in biannual foot exams for diabetics.
Dr. Stiles credits CCNC with stabilizing Medicaid payment for care and spurring care improvement.
As the environment changed with payment reform and with the probability of ACO formation on the horizon, the Hospital has focused on cost reduction, not only in its operations, but in helping to reduce the cost of care and is doing so in concert with the other children’s programs in the state. Five percent of children on Medicaid account for 50 percent of pediatric Medicaid costs (30 percent of adults in Medicaid account for 50 percent of Medicaid adult program costs). Dr. Stiles is confident quite a lot can still be done to reduce the cost of caring for these high cost patients. He thinks costs for the high cost group of children can be reduced by 25 percent. He would partner with practices to help them change work processes and the primary care physicians’ skill set regarding care of children with chronic illness. Other issues to address are those associated with transition to adulthood as parents often stay heavily engaged with the care of these patients as the patients grow up.
Each of the N.C. program chairs was asked to look at the top 50-100 high “cost” children their institutions treated last year. A key finding was that many were “geographically challenged” (i.e., they are not near a children’s hospital and do not generally “trust” local primary care providers to care for them). This group incurred enormous emergency department costs. As a result, effort is under way to get primary care medical homes better trained and enabled to do more on their own. One area being explored is the possibility of changing payment incentives so primary care physicians can provide longer visits. The group is also exploring the use of telemedicine.
While North Carolina is well ahead of others in managing care quality and cost, and NC Children’s Hospital has been a leader in that regard, there is more yet to do. The changes on the horizon create both opportunities and challenges. Being part of a system affords certain opportunities, but it also creates complications and challenges at the same time. And there are still questions about how to best relate to primary care practices outside of the system that refer large percentages of inpatients to the Hospital for care.
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