• Leadership e-Bulletin: January 2013 Issue

    Jan 31, 2013
    A Three-Legged ACO Gets Off to a Running Start
    The term “accountable care” was barely in use in 2007 when a California health system, payer, and physician association hammered out the basic model that many new ACOs are now adapting for their own use.

    The partners—Dignity Health, Blue Shield of California, and Hill Physicians Medical Group—started with a dual quality and cost agenda. They set a per-member-per-month global budget that required the three partners to collectively reduce costs by at least $15 million in 2010. However, they also agreed to maintain or improve the quality of health care provided: The partnership agreement stipulates that no cost-control initiative can be launched if it would hurt quality.

    Launched in January 2010, the ACO serves 41,000 California Public Employees Retirement System (CalPERS) beneficiaries in the Sacramento, Calif., area. At the end of 2011, the partnership had saved CalPERS a total of $37 million compared to what it would have paid without the ACO. And the three partners split $13 million, courtesy of a shared-savings contract.

    Keys to Successful Surgical Quality Improvement: An Interview with Scott J. Ellner, DO
    When asked what is critical to a successful surgical improvement program, Scott J. Ellner, DO, MPH, FACS, advises starting with trustworthy data and pinpointing variation. “The best way to get people to buy into a quality improvement program is to share clinical outcomes and data metrics that they will actually believe,” says Ellner, who is vice chairman of surgery and director of surgical quality, Saint Francis Hospital and Medical Center.

    The Connecticut hospital is currently standardizing how colon surgery patients are prepared for surgery. “As you limit unnecessary variation, you can minimize adverse events,” says Ellner. “After six months of implementing standardized approaches, we are seeing an improvement in our raw data showing a decrease in surgical site infections.”

    Staffing and Scheduling: Easing the Management Burden
    Unit/department managers at Champlain Valley Physicians Hospital (CVPH) in Plattsburgh, N.Y., used to spend an inordinate amount of time dealing with scheduling and staffing issues. This is a common and frustrating problem for hospital managers. In fact, staffing tasks can occupy 50 percent or more of a manager’s time, according to anecdotal reports.

    In 2010, the 381-bed CVPH moved to a centralized approach to staffing and scheduling. It also replaced manual and, at times, paper-based processes with automated scheduling solutions. A time study of inpatient nursing units revealed a return of 7 hours of work per manager for every pay period after the changes were implemented. Managers have been able to redirect their time from scheduling activities to patient care and staff mentoring.

    Small, Rural Hospitals Tackle the Challenge of Scale
    Small, rural hospitals face unique challenges as they move toward value-based payment models. For example, one obstacle is limited scale, which restricts their access to affordable capital and their ability to take advantage of population management initiatives. However, rural hospitals highlighted in the latest research report from HFMA’s Value Project are tackling the challenge of limited scale with certain strategies.

    For example, some small, rural hospitals are determining how many specialty services are realistic and appropriate for community needs and assessing how best to deliver those services. Others have opted to provide certain specialty services through telehealth partnerships. For example, Copper Queen Community Hospital, Bisbee, Ariz., has established telehealth arrangements for cardiology services and strokes and is working on a burn program.