• Leadership E-Bulletin: November 2012

    Nov 07, 2012

    The November 2012 e-bulletin highlights the Fall-Winter 2012 Leadership magazine, which showcases how hospitals and other providers are trying to dramatically reduce costs and improve quality through innovation and standardization.


    Building Effective Clinical Decision Support  

    None of the 93 cardiologists practicing at Cardiology Consultants of Philadelphia would fail to prescribe a beta-blocker to a heart attack patient, if appropriate-because their EHR system would not allow it. The system is embedded with quality-checking algorithms for nine indicators of good cardiac care. As physicians document in the EHR during a patient visit, they are flagged to address the indicators relevant to a patient's condition. The program will not advance to the next screen until the physician has either indicated compliance with the quality measure or explained the reason for not doing so.

    "These are absolute hard stops," said Scott E. Hessen, MD, the practice's chief medical information officer. "You cannot bypass them."

    Cardiology Consultants is among the leading providers that are using clinical decision support to standardize care, improve compliance with evidence-based protocols, reduce length of stay, and save lives.

    Promising Innovations for Complex Problems  

    Motivated by their missions and declining reimbursements, progressive providers are stepping up to the plate to identify and test new approaches?from service robots to easy-to-remember mnemonics?that stand to contribute to a less costly and safer healthcare system. For example, Centura Health at Home is about to join a small but growing cadre of providers that offer home-based acute care. Hospital at Home® patients appear to need less pain medicine and have a lower risk of complications, such as delirium and falls. Not surprisingly, patients really like the program.

    "There is no place that is more 'vulnerability making' than the hospital," says president & CEO Erin Denholm. Denholm aims to combine the Hospital at Home concept with a telehealth program at one Centura hospital, Penrose-St. Francis Health Services in Colorado Springs. "Our telehealth program will allow us to monitor patients' vital signs and conduct virtual exams through the telephone lines and respond rapidly, if need be."

    Sizing Up Economies of Scale  

    After acquiring three hospitals since June 2011, Mercy now includes 31 hospitals and more than 200 clinics. With no hint of slowing down, the St. Louis-based system last year announced a plan for expansion over the next eight years that could amount to more than $4 billion. The money will be spent to advance Mercy's central strategy: success via economies of scale.

    "Managing the cost of care is vital to future success," says Michael McCurry, Mercy's executive vice president and COO. "When you have a concentration of facilities in a given geographic area, it's much easier to leverage your administrative and back-office functions, such as billing and purchasing, for scale to serve those facilities."

    An Arizona Collaborative Shares in the Savings

    The leaders of Arizona Connected Care-which brings together more than 200 physicians, three federally qualified health centers, and Tucson Medical Center-believe that they are creating a model of care that will make them successful in any payment system that rewards improved quality and increased efficiency.

    The partnership puts physicians in charge of creating a new delivery model. "Physicians are able to take responsibility for the care of their patients and be held accountable for it-and that's the way it should be," says Jeffrey Selwyn, MD, chairman of Arizona Connected Care.

    More Inside Leadership

    The Fall-Winter 2012 Leadership magazine also contains profiles of two prominent healthcare leaders: Camden Coalition of Healthcare Providers' Jeffrey C. Brenner, MD, and Blue Shield of California's Bryce Williams. The issue also profiles caregiver Helen Kuryllo.

    In addition, the issue includes columns from performance improvement expert James L. Reinertsen, MD; Beth Israel Deaconess Medical Center's CIO John D. Halamka, MD; and HFMA's Todd Nelson.