Hospital collaboration

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Hudson Health Partners provided this model of the continuum of care which seeks to explain the different roles of various kinds of health care providers.

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Beset by competitive pressures on all sides, some community hospitals are considering desperate measures. Used to struggling fiercely for local market share with each other and increasingly beset by other problems, hospital systems in the Hudson Valley are adopting strategies that a few years ago would have been unthinkable. In some cases, they’re even cooperating with each other.

Three mid-Hudson hospital systems last week announced the formation of a new collaboration through which they can work together to seek efficiencies of operation and to control costs. Hudson Health Partners LLC was described by its chairman, Allan Atzrott, also CEO of the two-campus St. Luke’s Cornwall Hospital, as “a true partnership.” It consists of St. Luke’s in Newburgh and Cornwall, St. Francis Hospital in Poughkeepsie and Beacon, and the Bon Secours hospital system, consisting of Bon Secours in Port Jervis, Good Samaritan in Suffern and St. Anthony’s in Warwick. The three systems have equal shares in the new corporation, said Atzrott.

The collaboration may grow to include other hospital systems. Atzrott said conversations have already been held with five additional potential partners.

The arrangement is a strategic alliance, not a merger. Each hospital will remain independent under the control of its own governing board.

A press release describing Hudson Health Partners delineated five broad areas for the collaboration. One focus was quality initiatives and best practices. Clinical collaboration, including wellness initiatives, pre- and post-hospital care, and expansion along the continuum of care, was a second. Physician services will include such significant items for collaboration as recruitment, medical education, integration of health records, and services for practice management. Cooperation in the areas of hospital services, employee benefits, pilot projects and support services will be encouraged. Finally, group purchasing and the sharing of general services will be pursued.

Jeanine Logan, spokesperson for the Northern Metropolitan Hospital Association (Normet), the regional hospital trade group, said the move would be a good thing. “Any collaboration that will help patient care, help improve physician recruitment, and do other such things could be helpful,” she said.

Fewer inpatient stays

Average in-hospital stays, said Atzrott, used to be nine days. Now it’s four — and dropping. Eighty-five percent of service used to be inpatient and 15 percent outpatient. Now the ratio is 60 percent to 40 percent, he continued, and shifting more to outpatient every year. Some 60 percent of ambulatory surgeries are now performed outside hospitals. “Forty percent of something is better than 100 percent of nothing,” noted Atzrott.

The direction of change is the same as that cited by HealthAlliance officials at the recent community forums in Ulster County. HealthAlliance CEO David Lundquist has said that he doesn’t expect the diminution of volume experienced by hospitals during the present recession ever fully to be reversed. New patterns of relationships, for instance one in which the hospital provides the space and other providers the services, are likely. In some cases, one hospital will provide specialized services for the communities of other hospitals.

“Integrating consolidations with other institutions is important,” Lundquist said at a recent forum at Benedictine Hospital. “We are fully integrated with other providers. We cannot be a standalone in this world.”

The state and regional health insurance exchanges created in New York State this year under federal legislation are intended to promote and measure patient-centered care. It is hoped they will provide a continuum-of-care scenario through which the different players will sort out their roles in a more cost-aware, efficient health care environment.

Change agents

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Fifteen people sat at a large conference table in a windowless room of a large office building in Fishkill later last Wednesday afternoon. The conferees, mainly doctors, health administrators and researchers, constituted the board of directors and staff of Thinc, the Taconic Health Information Network and Community. The Thinc board meets monthly to share information and research about the fast-paced changes in the healthcare industry, one-sixth of the gross national product.

“Welcome to Thinc,” says the organization’s website. “Thinc is the neutral, non-profit organization that convenes the community and articulates a collaborative vision for improving the quality, safety and efficiency of health care in the Hudson Valley. Thinc starts with the foundation of health information technology, then builds on that base for quality improvement that benefits the entire community.”

It was a geographically diverse group. Two of the participants, HealthAlliance Chief Financial Officer David Scarpino and Saugerties primary-care physician Dr. Eugene Heslin, are Ulster County residents. At least two more, St. Francis Hospital chief executive Bob Savage and information technologist and physician leader Dr. John Blair III, are from Dutchess.

A committee of the respected Institute of Medicine, a national doctors’ group, recently delivered the latest broadside emphasizing the urgent need for reform. “The costs of the system’s current inefficiency underscore the urgent need for a systemwide transformation,” it said. “The committee calculated that about 30 percent of health spending in 2009 — roughly $750 billion — was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best-performing state.”

Like any group used to handling specialized information, the people sitting in the chairs around the table in Fishkill tossed around jargon with which they all seem familiar, employing acronyms and other shorthand terminology in abundance.

Some of the arcane terminology they employed was medical, but most was bureaucratic: standards, programs, funding sources, government linkages. For a reporter attempting to absorb what they were saying, the experience might be likened to listening to a group of people who are constantly lapsing into a foreign language in order to express themselves.

The people around this table were cognizant that they were the de-facto coordinators in the Hudson Valley region of what is arguably the most ambitious effort at major social and economic change in American history. When it comes to leading the efforts for regional organizational development of health care, they’ve been doing the job that needs doing.

Health records are key

Five years ago, Thinc, working with MedAllies as its implementation agent, began a project to implement meaningful use of electronic health records (EHRs) at a thousand doctors’ offices in the Hudson Valley. Funded and incentivized by a $5 million state grant, the initiative has achieved its goal. The EHR adoption rate in the Hudson Valley is estimated to be 80 percent now, with Thinc’s initiative being directly responsible for about a third of those implementations.

Recently, 75 primary-care practices in the region were chosen for the next four-year effort at implementing the next phase of transformation. These practices will start delivering enhanced healthcare services this fall.

This federal program is part of a broader effort to find a new national model for the purchase and delivery of comprehensive primary care that will improve health and reduce costs throughout the country. Building on the foundation of what is called the patient-centered medical home concept, this initiative encourages multi-payer collaboration, aligning payment reform with practice transformation. Participating payers will reimburse participating practices for providing comprehensive primary care. The federal Center for Medicaid and Medicare Innovation will pay each participating practice $20 per month per fee-per-service beneficiary the first two years of the program, $15 per month the third and fourth years.

The selected primary practices will engage in systematic data-sharing and collaborative learning experiences. They will also have an opportunity to share savings achieved (at the market level). Such a collaborative effort, also involving a group of payers, has the potential to transform primary-care practices.

Tools for transformation

At the same time, the rules for meaningful use of information technology have this past month been raised to require increased technical interoperability among record systems and greater patient engagement. Medical practices and hospitals will need to be able to exchange records with each other. The government will be using its considerable market clout to push vendors toward standardization and unification of existing regional health records exchanges. Building on regional health information organizations such as Thinc, a statewide network of secure medical records is not quite around the corner. But it’s on the horizon, the Thinc participants said, and getting closer all the time.

You’d suppose that the community would want to know more about what we are doing, one board member at the table in Fishkill ventured. Other heads at the table nodded in agreement. So far, that supposition hasn’t often been translated into reality. Public involvement in this phase of health reform has been a rare commodity.

The Hudson Valley is now ready for the next phase in the long process of transformation of health information technology. A recent blogger, David Whitlinger of the New York eHealth Collaborative (NYeC), described the change succinctly as “moving from countless tons of paper files, containing life-saving data, which is trapped in file rooms across the state, toward a secure, Internet-enabled health information network that responsibly allows information to be shared across the care continuum to improve care.”