Mindi Szumanski, Medical Journal – Houston: How is your system dealing with federal funding cuts and reimbursement reductions? How do you feel this will specifically impact healthcare overall?
Mark A. Wallace, Texas Children’s Hospital: Reimbursement pressure will likely have a wide range of outcomes on health care across organizations, and one of the most challenging will be protecting the research and education missions found in the academic medical centers. We continue to focus on increasing value based care, with appropriate emphasis on both improved outcomes and cost containment. We are constantly looking for new strategies to deliver great care at the lowest cost, and we feel fortunate to have many opportunities to improve on both.
Ronald A. DePinho, M.D., The University of Texas MD Anderson Cancer Center: The University of Texas MD Anderson Cancer Center, like many other academic health centers, hospitals and care providers across the country, is addressing the challenges of federal funding cuts in research and reimbursement of healthcare services through comprehensive internal assessment and evaluation of care delivery, costs and opportunities for changes to adjust to healthcare market pressures. Through a strategic planning process, the institution is considering strategies, tactics, short and long-term goals to enhance care quality, reduce costs, identify and implement efficiencies in care delivery and ensure that care always remains patient focused. MD Anderson’s Institute for Cancer Care Innovation is leading institutional efforts to examine costs, improve efficiency and identify innovative ideas for reimbursement reforms to demonstrate the value proposition of providing higher quality cancer care at lower costs. Through a partnership with the Harvard Business School, MD Anderson has been a leader and engaged in these efforts for the past 6 years, making significant progress and testing ideas across a variety of diseases and disciplines.
While MD Anderson is fortunate to be a beneficiary of grant funding through the state’s innovative and bold creation of the Cancer Prevention and Research Institute of Texas (CPRIT), which allocates $300 million per year for the support of cancer prevention and research projects at institutions across Texas, MD Anderson realizes that these and other funds to support research are not unlimited, and they are under constant pressure. This state resource has partially filled the gap in federal funding as a result of significant reductions in National Institutes of Health (NIH) support. However, through our strategic planning process, the institution is investigating creative ways to sustain the significant research mission of MD Anderson through: enhanced collaborations with the private sector; other institutions and research centers around the country; maximizing philanthropic opportunities; and prioritizing research programs to ensure we are making progress through the announcement, organization and implementation of the Cancer Moon Shots program.
Donna K. Sollenberger, University of Texas Medical Branch Health System: For health care providers that serve large populations of Medicare/Medicaid patients, like the University of Texas Medical Branch in Galveston (UTMB Health), many questions linger around how reform will impact both health care delivery models and affect health care providers’ bottom lines. Reform is designed to provide more affordable health care to Americans, improve population health, enhance the patient experience of care (including quality, access and reliability), and reduce or control the cost of care. But because of funding cuts and reimbursement reductions, hospitals like UTMB will need to find ways to meet their bottom line while serving these large populations for less reimbursement.
While the Affordable Care Act will help many Texans cover their health care expenses, many in the state will still be left uninsured, and these individuals will need access to health care systems already limited in their capacity to provide care. We must therefore become even more innovative and collaborative, and to be more creative as we develop new models of care delivery.
Efforts in the inpatient arena will be focused on “preventable” hospitalizations for acute and chronic conditions, preventable readmissions, emergency department use, efficient patient flow through our system, and unwarranted testing or care. It will be necessary to provide methods for patients to receive home-based disease management programs and outpatient care, instead of accessing hospital care. Expanding and coordinating outpatient services that include community settings and home services will provide an essential, more cost-effective means of health care delivery.
In addition, working to develop partnerships with referring physicians, long-term care hospitals, skilled nursing facilities and nursing homes will be key objectives. Health systems like UTMB will have to find ways to improve access and expand primary care, including the establishment of multiple Patient-Centered Medical Homes; and utilize telemedicine and secure webcam visits to extend care and provide educational session for chronic disease education and group visits.
Participation in programs such as the Texas 1115 Medicaid Transformation Waiver, designed to make up for reimbursement shortfalls, have resulted in the creation Regional Healthcare Partnerships (RHP) and will strive to improve population health, enhance the patient experience of care (including quality, access and reliability), and reduce or control the cost of care. UTMB is the anchor for the 16-county Region 2 partnership.
UTMB is proud of its long tradition of improving health in the communities it serves—locally, statewide, nationally and internationally. It remains committed to helping Texas and the nation determine the best way to ensure equitable access to quality care for all. Both now and long into the future, UTMB Health will strive to be a patient-centered, highly reliable, value-driven organization; the first choice in the region for patients, physicians and employees; and exceptional value to payers and businesses; and a state and national leader in health care delivery.
Mindi Szumanski, Medical Journal – Houston: How do you personally stay positive and then facilitate a positive work environment?
Mark A. Wallace, Texas Children’s Hospital: When you stay focused on your mission, staying positive and maintaining a positive work environment comes naturally. Business models, bottom lines and projections are all very important, but the most important thing is delivering great care to patients and families.
Ronald A. DePinho, M.D., The University of Texas MD Anderson Cancer Center: MD Anderson is uniquely positioned to accelerate the pace of converting scientific discoveries into clinical advances that reduce cancer deaths. I’m driven by the dedication and depth of our talent and unparalleled resources across the cancer care continuum. I’m proud to be a part of a community that includes more than 20,000 extraordinary faculty, staff, students and volunteers who are inspired by the hope and trust placed in us by our patients and their families. Frequently, I meet patients and caregivers and hear their stories of courage, faith and personal sacrifice. You can’t help but be moved and motivated by these stories and encouraged to keep advancing toward our mission to end cancer. That hope and inspiration is shared throughout our ranks – in clinics, laboratories and offices, and on all of our campuses. Everyone is connected by our mission.
Open communication is key to a positive work environment, and frequently we ask faculty and staff for feedback in both formal and informal programs. Recently, we completed our biennial opinion survey and action plans are underway based on an 82% response rate from of our engaged workforce. Strategies for our institution’s future call for input from many to deliver on our efforts to thrive in the changing health care environment, and to be there for the many people who need our expertise and compassionate care. Our employees have to know where the institution is going, what their role is and what resources we provide so we can work together to advance our mission.
Donna K. Sollenberger, University of Texas Medical Branch Health System: Embracing the challenges faced by the health care industry and looking at them as opportunities to lead and to succeed helps our teams at UTMB stay positive— we also realize we are on a journey and while we focus on the work that needs to be done today, we must also keep our eyes on the horizon and on our future goals. We continually strive to build a culture of safety and hold our values of compassion, integrity, respect, diversity and lifelong learning in the highest regard. We know it’s important to help our employees grow and develop, and we value their feedback on the initiatives currently underway and upcoming. We celebrate achievements and recognize our teams for the hard work they do, because we realize everyone works on a team that in some way, shape or form that impacts our patients’ and their families’ experiences, and we all have an important role to play in assuring that they receive the best possible care. Our individual contributions to the team on which we work are critical to achieving UTMB’s vision define the future of health care and strive to be the best in all endeavors. We always try to emphasize and abide by these philosophies, and this helps UTMB Health to maintain a positive work environment.
Mindi Szumanski, Medical Journal – Houston: What is your system doing to reduce readmissions?
Mark A. Wallace, Texas Children’s Hospital: Our solution is a multiple initiative approach. We are investing resources into coordination of care, both in the hospital and through our Health Plan. We are improving our information systems to better inform the decisions and support process improvement. We are increasing access to pediatric subspecialists who can help keep these patients well and out of the hospital by caring for them in an outpatient setting. There is not one single strategy that will solve this challenge; it will take a comprehensive approach.
Ronald A. DePinho, M.D., The University of Texas MD Anderson Cancer Center: Reducing readmissions has been and continues to be an important goal at MD Anderson. Patients and families prefer to be in the hospital only as long and as often as necessary. We recognize that readmission -- especially for those who have just recently been discharged -- represents an inconvenience in time, travel and cost for patients and families. Some readmissions are not preventable. Therefore, we need to focus on readmissions that are potentially preventable and address the causes.
On the surgical side, Dr. Thomas Aloia has been instrumental in the application of the National Surgical Quality Improvement Program (NSQIP) at our institution. The program targets risks that can lead to readmissions such as surgical site infections and urinary tract infections. Dr. Aloia has been responsible for the data monitoring program and the subsequent performance improvement efforts to reduce those risks.
There also have been significant efforts at MD Anderson in the area of hematological malignancies, which occur in a significant portion of our inpatient population. The development of outpatient, fast track clinics in Leukemia, Lymphoma and the Stem Cell Transplant services have led to the delivery of several services in the outpatient setting, thus not necessitating readmissions.
We continue to identify other areas amenable to improvement for other cancer-specific conditions, such as pain control and bowel symptoms, to further reduce the need for readmission. Again, these efforts will continue to ensure that only patients who absolutely have to be in the hospital are admitted.
Donna K. Sollenberger, University of Texas Medical Branch Health System: We have initiated the deployment of proven methods of risk assessment, interdisciplinary planning tools, patient “teach back”, and structured discharge preparation and followup to reduce unplanned readmissions overall. For patients with frequent hospitalizations, we are developing plans for a more intensive support outside the hospital environment in order to help this population establish a medical home and better understand what services and assistance may best help them self-manage disease. This will also allow us to better understand socioeconomic/ non-medical needs and to potentially help mobilize community resources for some patients.
For our elderly population, our Acute Care of the Elderly team has a project underway to close gaps in care associated with transitions between hospital and skilled nursing facilities. We will be supplementing clinical staff who have a formal presence in these facilities and taking advantage of our Epic EMR capability to exchange information electronically at discharge.
We will also be extending our community health care program to enlarge its case management in the community to a broader base of patients, and to focus on disease states with recurring readmission risk.
Maura Walsh, President, HCA Gulf Coast Division: HCA Gulf Coast Division’s commitment to excellence in patient care includes a major focus on the reduction of patient readmission. Our devoted caregivers apply evidence-based medicine to the individual needs of each patient, which produces outcomes that enhance patients’ lives. Through our patient portal, we provide ease of access to each patient’s medical records. Patients can be confident that their 24- hour connection to HCA Gulf Coast Division’s highly trained case management professionals gives them a real-time connection to address any needs they may have. Once discharged, patients have all the necessary support to ensure that readmission is avoided. Should readmission be necessary, our nurturing physicians and medical support personnel are dedicated to addressing patient concerns and returning them to an active life among family and friends.
David Koontz, Senior Vice President - CHI St. Luke’s Health: CHI St. Luke’s Health is embarking on a new era in healthcare by creating healthier communities through special alliances with other leading healthcare leaders to coordinate the care of their patients. Moreover, CHI St. Luke’s is committed to a dramatic expansion of current research, collaborating with Baylor College of Medicine and the Texas Heart® Institute in developing break-through technologies and interventions that will save lives.