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Cheryl Clark, for HealthLeaders Media

An Institute of Medicine report released this month may give some cost-embattled healthcare executives just what they need, even if it’s not something they’re all ready for just yet.
It’s a 10-point “CEO Checklist for High-Value HealthCare,” a list of tips on how to keep their organizations alive, written by an all-star cast of leading hospital chiefs.
“We can’t afford the healthcare that we’re delivering today,” says Brent James, MD, executive director of the Intermountain Institute for Care Delivery Research in Ogden, UT. “If you’re not adapting right now,” James says, “you will die.”

He is among 11 well-known executives who believe that at its core, the healthcare delivery system must be radically transformed to improve quality and reduce cost.  And there are a lot of healthcare CEOs, he says, who really don’t understand that yet. Or if they do, they’re bewildered about how and where to begin.

In addition to James of Intermountain, efficiency/quality tips are shared by big-name leaders: George Halvorson of Kaiser Permanente; Gary Kaplan, MD, of Virginia Mason; Gary Gottlieb, MD, of Partners HealthCare System; Patricia Gabow, MD, of Denver Health; Michael Fisher of Cincinnati Children’s Hospital Medical Center; Delos Cosgrove, MD, of the Cleveland Clinic; Robert Petzel, MD, of the Department of Veterans Affairs; John Toussaint, MD, of ThedaCare Center for Healthcare Value; Glenn Steele, MD, of Geisinger Health System; and Jonathan Perlin, MD, of HCA, Inc.

Not a silver bullet
“We weren’t trying to give them the magic bean formula, you know, just do this and everything will be fine, a silver bullet,” James says. “It’s just that this transition is happening with increasing rapidity across the industry, so we wanted to help people be more successful in their transitions, and not step into the same holes that we stepped into in the past.”
The report says that extensive waste within the healthcare system, estimated at $750 billion or 30% of national healthcare expenditures, “do not improve health.” 

A chart in the report, however, shows that Geisinger, achieved a 67% decrease in elective mortality of patients undergoing coronary artery bypass grafts, while Kaiser cut HIV mortality in half and HCA saved 200 people who would have died from central line bloodstream infections, simply by delivering care better and smarter.

10 broad calls to action
The checklist’s 10 items are extremely broad. The top item calls for “visible and determined leadership by the CEO and Board.” The second item urges “a culture of continuous improvement, commitment to ongoing real-time learning.” And number three calls for “IT best practices – automated, reliable information to and from the point of care.”

The others are:
4. Evidence protocols: effective, efficient, and consistent care
5. Resource utilization: optimized use of personnel, physical space, and other resources
6. Integrated care: right care, right setting, right providers, right teamwork
7. Shared decision-making: patient/clinician collaboration on care plans
8. Targeted services: tailored community and clinic interventions for resource intensive patients
9. Embedded safeguards: supports and prompts to reduce injury and infection
10. Internal transparency: visible progress in performance, outcomes, and costs

Waste and cost-shrinking strategies
But the report also gives 32 specific examples of strategies hospitals have employed to reduce waste and spending, that over time, improved quality and appropriateness of care. And yes, they reduced cost, too.

At Intermountain Healthcare, when an obstetrician refers a pregnant woman for an elective induction, she must meet nine criteria before the procedure is allowed to proceed.

If she doesn’t, and there’s no medical necessity for the induction, she will be sent home. That practice has reduced the elective induction rate from 28% in 2001 to less than 2% today, saving the Ogden, UT healthcare system $50 million a year.

Decision rules
And at Virginia Mason Health System in Seattle, provider education failed to stop doctors from ordering unnecessary expensive advanced imaging tests, wasting lots of resources. So VM tried something else. It installed decision rules in the software used to order the tests, requiring the provider to specify the evidence justifying the scan.

Decision rules were installed in the software used to schedule studies. The MRI rate for headache decreased by 23.2%, the lumbar MRI dropped by 23.4% and the sinus CT rate declined by 26.8%, saving millions in costs.

For IT best practices, Geisinger has saved $1.7 million over the past years in reduced chart pulls, more than $600,000 in reduced printing and faxing and more than $500,000 per year from reduced nursing staff time and more than $1 million in reduced transcription time. They’ve done it through a health information exchange, an Electronic health record system, ePrescribing modules, a data warehouse, and document management.

Evidence protocols
For evidence protocols, Kaiser Permanente’s orthopedists developed the “Healthy Bones” program and reduced hip fracture rates for at-risk patients by 50%. The program uses systematic bone density tests, osteoporosis medications, education programs among efforts to better manage high-risk patients.

And under embedded safeguards, Cincinnati Children’s achieved an 85% reduction in ventilator-associated pneumonia and a 50% reduction in catheter-associated bloodstream infections and lowered costs by $5.6 million a year with a robust system that detects risks for hospital-acquired conditions.

For internal transparency, Denver Health nearly doubled breast cancer screening rates by developing registries for their community health center network, with real-time data and performance report cards. “An essential feature of the report cards has been non-blinded display of performance by site of primary care and by primary care provider, which drove reduced variation and improved overall performance,” the report says.

James says healthcare systems must do not necessarily these same things, but these kinds of things, if they are to remain viable. The transition to these kinds of strategies “will have to accelerate even more than it has been. The reason is because it produces better patient outcomes at lower cost.”

 

About Morgan Hunter HealthSearch
Morgan Hunter HealthSearch (MHHS) provides Executive Search and Interim Leadership solutions for hospitals and health systems throughout the United States.  Our services include executive healthcare recruiting, retained healthcare executive search, healthcare interim management, executive placement for hospitals

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