Leaders from Catholic Healthcare West, Intermountain Healthcare, and Harborview Medical Center told a rapt audience at HFMA's final conference keynote how they are making key quality changes and improving access to care while struggling with rising costs, climbing charity care numbers, and occupancies that are stretched to 100% at times.
While the crowds are usually halved by the last day of most conferences, the room was packed—more proof that with so many new financial challenges, healthcare leaders are looking to their peers for new information.
At San Francisco-based Catholic Healthcare West, Barbara Pelletreau, vice president of patient safety and clinical risk management, said the system, with more than 40 hospitals, has set aggressive metrics to improve quality. That includes implementing a sepsis prevention program in the last few years that has reduced mortality rates by 52%, saved more than 700 lives, and created $15 million in savings. "Quality, safety, and financial are coming together," she said.
Pelletreau said the system has drilled down to 60 key metrics on which hospitals focus. Another strategy has been to share a sentinel event report across all clinical areas that tells patient stories. "Every month, CMOs, chiefs of nursing, and patient safety officers go through the real stories and help facilities present the stories," she said. "This is the most effective strategy after doing the metrics approach."
Meanwhile, Lori Mitchell, CFO of Harborview Medical Center in Seattle, which is part of the University of Washington, said the system, which does $2.4 billion net revenue on an annual basis, had $150 million in charity care this year, up from $120 million last year. "We are focusing on areas that are the same—putting the patient first is what this is all about," said Mitchell.
She acknowledged there is work to be done in customer service. "While it shouldn't be that hard to be nice, we run 100% occupancy and when people are running that fast, our service indicators are not as good as they could be."
Like CHW, Harbor View is working to find the right way to talk about patient safety. "We have adopted a way of talking about adverse events at the hospital that is personal. We are forcing ourselves to use words like 'last month four patients were harmed at Harbor View when they shouldn't have been.'"
At the same time, the hospital is also working with physicians to improve key quality indicators by taking advantage of their natural desire to be A students. Reporting indicators by individual service areas, such as orthopedics, creates competition among the chiefs to be the best, she says. Harbor View also reports by unit. "We are observing hand hygiene, which is posted up on the units and that has helped us improve our scores."
Gregory Poulson, senior vice president at Intermountain Healthcare in Salt Lake City, said the 21-hospital system serves as a safety net for Utah and covers 80% of the uninsured that receive hospital care in the state. Intermountain also has seen a big increase in charity care costs, climbing to $200 million last year, up from $140 million the prior year.
He said Intermountain is focused on providing care the same way across all of its facilities. This approach has "yielded improvements in quality and cost," he said.
Intermountain's history in electronic medical record technology has set the stage for improvements across the system. "We started one of the first electronic medical records in 1967," said Poulson.
Karen Davis, PhD, president of The Commonwealth Fund, who moderated the forum, asked how the group is addressing access to care, the uninsured, and underinsured while waiting for healthcare reform.
"For many of our hospitals, we have found it is more cost effective to offer free clinics than to figure out how to go after all of the insurance," said Pelletreau, with Catholic Healthcare West, noting that hospitals can also put in a request for seed money for special projects through the system's community benefit fund. For example, she said, one project offers diabetes education in largely Hispanic areas.
Harbor View, meanwhile, has taken a unique approach to the uninsured, said Mitchell, explaining that the issue is not so much about access, but rather helping patients move into financial assistance programs, such as Medicaid.
A few years ago, Harbor View began having workers who process Medicaid applications for the state of Washington set up shop at the hospital with nurses and social workers. "We get them processed quickly and we get paid for services we are providing, and it helps as they are discharged and need other assistance," said Mitchell.