Hospital CEO Survey

How do you anticipate the Patient Protection and Affordable Care Act will impact your system and what are you doing to prepare?

Ronald DePinho, M.D. President, The University of Texas MD Anderson Cancer Center:
The University of Texas MD Anderson Cancer Center, as a specialized cancer hospital, and 10 other comprehensive cancer centers, are now required to report outcomes in several domains. Through our Institute for Cancer Care Innovation as well as the Clinical Operations team, we’ve worked with CMS and its contracted agencies (including the National Quality Forum, Mathmatica and the National Committee for Quality Assurance) as well as other cancer centers to develop meaningful ways to measure outcomes for cancer patients. We have several physicians and staff engaged on several committees that have been working almost exclusively on this issue since the bill was passed, and we’re actively testing how to track, measure and report outcomes to ensure we can meet CMS requirements on deadline.

As for reimbursement, there is little question that the net effect of the Patient Protection and Affordable Care Act will be to decrease reimbursements for health care. With that in mind, we are working to understand and reduce our costs of care delivery, improve our efficiency and optimize the outcomes of the care we provide and actively evaluating both new care-delivery and reimbursement models.

Maura Walsh, President, HCA Gulf Coast Division:
The Patient Protection and Affordable Care Act (PPACA) has already ushered in many changes to health care. The initial stages of implementation focused on re-engineering existing insurance coverage such as allowing adult children to stay on their parents’ insurance plan until they turn 26, free preventive care and prohibiting insurance companies from rescinding coverage. The next significant milestone in the implementation of PPACA will come in 2014 with the launch of insurance exchanges and the expansion of Medicaid in those states that so choose.

It is important to note, Texas will not expand Medicaid as envisioned in PPACA nor will it create a state-run insurance exchange. The federal government will run and operate the insurance exchange for Texans who will need to purchase health insurance. Needless to say, we are preparing for the continuation of a high number of uninsured patients and will stay focused on quality, efficiency and clinical integration.

Donna K. Sollenberger, executive vice president and CEO, UTMB Health System:
As an academic medical center we are studying several ways to help patients and health systems achieve better health outcomes. For example, we are in the process of converting all of our primary care practices to patient-centered medical homes and will be seeking certification for them. We believe that by providing a medical home, we can produce better health outcomes for our patients, one of the stated goals of health reform. And, for years, UTMB has had community health and information programs meant to keep some of our most vulnerable patients out of our emergency rooms. We were early adopters of Community Health Workers, individuals who visit patients in their home and assure they have the prescriptions, follow-up appointments, transportation and in-home care that will be vital to their full recovery or to the management of their chronic disease. All of our Community Health Workers became certified last year. Another program teaches diabetic patients the importance of a good diet, how to buy the right foods for themselves and their family and how to best prepare those foods. As an industry, hospitals and health systems will need to be developing and piloting programs and delivery systems that will better manage the patient’s health and their care outside of the hospital with the goal of minimizing inpatient admissions.

Trevor Fetter, CEO, Tenet Healthcare Corporation:
Providing coverage to the uninsured is an integral component of improving our nation’s healthcare. Through our national perspective of health care in the U.S., we believe the longer term trends – such as the movement towards reimbursement based on quality and value – will continue, and we are strategically positioned to further the growth we have achieved over the last several years. Our hospitals are focused on the critical mission to provide quality care to all of our patients and we are continuously working to improve that high-quality of care through collaborating with physicians, other providers and insurers to reduce costs by increasing care coordination, deploying advanced health IT systems and using evidence-based standards to ensure every patient receives the best care possible. PPACA will also be implemented or not implemented in different ways in each state and will impact hospitals in unique and varying ways. Communicating with hospital leaders and providing them with resources to provide quality and value is highly important.

What are your thoughts or concerns regarding the transition to Healthcare Information Exchange (HIE) systems?

Ronald DePinho, M.D., President, The University of Texas MD Anderson Cancer Center:
A robust Health Information Exchange is essential for patient with cancer who travel great distances for care, so this is a tool that will impact a large number of our patients and others across the nation. MD Anderson’s Institute for Cancer Care Innovation has a subcontract through RTI International and the Office of the National Coordinator for Health Information Technology to develop a plan to work through the technical and policy challenges of sending structured patient data from our patients to direct-enabled personal health records. We’re looking at how patients could potentially take their medical records from their MD Anderson patient portal, called myMDAnderson, to their personal health records, where patients can also collect other health information online, like records from other doctors’ appointments or lab results or data from blood pressure monitors and glucose monitors. MD Anderson will be conducting a test in a development environment to create a work plan that outlines best methods, any technical issues, and proposed solutions. The work plan can then be used by RTI and the ONC to help guide other institutions that are also making the transition to healthcare information exchange systems, and it will also give us important information about how best to move forward as we better our own electronic medical record systems.

Maura Walsh, President, HCA Gulf Coast Division:
HCA supports the exchange of data between providers to manage the health of our shared patients. HCA is investing in several technologies across the company and in Houston to accomplish this objective.

Donna K. Sollenberger, executive vice president and CEO, UTMB Health System:
UTMB is a member of Houston Healthconnect that will enable us, through electronic medical records, to “talk to” another hospital or medical care provider, reducing duplicate or unnecessary tests, as well as saving patients and systems time, effort and money. We will be joining a Houston area pilot project that focuses specifically on uninsured and Medicaid patients this summer. The health information exchanges will have a particular benefit to patients as they will be able to share their healthcare information to multiple care providers, even if they are not in the same system. This will result in better and safer patient care. UTMB is hopeful that other area health systems join Healthconnect to share information and costs to operate the system.

Trevor Fetter, CEO, Tenet Healthcare Corporation:
Tenet is an early adopter of health information technology, having first begun laying the ground work in 2005 for its health information technology initiative, IMPACT (Improving Patient Care through Technology) – well before others in the industry began to embrace health IT. Tenet’s goal is to use the data the technology generates to streamline processes and produce new insights and intelligence for continual improvements in healthcare quality at lower costs.

Tenet’s IMPACT program aims to install an electronic health record and a personal health record in each of Tenet’s 49 hospitals by 2015, providing the right information when and where it’s needed to improve the care of every patient who seeks treatment at all of the company’s facilities. To date, 26 hospitals have satisfied federal criteria for meaningful use and have qualified for incentive payments under the American Recovery and Reinvestment Act. All of the remaining hospitals are on target to complete core implementation by mid- 2014, with ongoing implementation of components of EHRs for many years to come. As an early adopter of health IT, Tenet’s goal is to use the data the technology generates to streamline processes and produce new insights and intelligence for continual improvements in healthcare quality at lower costs. Through Tenet’s health IT efforts and through the secure use and sharing of health information, hospitals across its network already are seeing results, including:

• More complete and accurate patient health information and improved care delivery in both in-patient and ambulatory settings.
• Better coordination across the entire continuum of care.
• Improved and secure information sharing with patients and other caregivers. This aligns with national goals to empower patients, making them more responsible for their own health.
• Use of innovative technologies and shared protected health information (PHI) to help physicians, nurses and other clinicians combat chronic disease with informed, preventive care delivery. Improvements will include earlier diagnoses, reduced medical errors and lower costs.
• Reduced paperwork and improved workflows.

As part of its HIT initiative, Tenet is in the initial stages of establishing an HIE. Thus far, roughly one-third of Tenet’s hospitals are connected. As more connections are in place with third-party EHRs, Tenet expects the numbers to increase significantly in the coming years. to increase significantly in the coming years.