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Quality: Toward Unity

Janice Simmons, for HealthLeaders Magazine, August 12, 2009
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The initiatives are continually improving—and evolving, according the MHI President Kevin Graham, MD. For instance, on receiving timely treatments for a myocardial infarction (MI)—the Level I heart attack program rolled out in 2003—mortality has been reduced during that period by 50%. In addition, mortalities related to aortic dissections have declined by 50%.

These results were obtained not using any of the new technologies available today, Graham said. "[It's] just getting people to work together" along the continuum of care.

But it's not a static program. In evaluating whether patients get the right treatments at the right time, quarterly meetings are conducted to hear from providers, including primary care physicians, paramedics, and emergency medical technicians. "It's all about giving the optimum patient experience."

In determining if that physician-hospital relationship is paying off, Bent cites the contribution of the MHI cardiology program to the hospital.

Last year, for instance, MHI grew its contribution margin by 11%, which was a combination of topline growth through new development and expense management programs.

"I think we've been able at every point to demonstrate how we've advanced our quality agenda, our patient satisfaction scores, while tracking our employment engagement scores," Bent said.

"On the growth side, we actually increased our market share by 1% in the last year, which may not seem like a lot, but it's a pretty saturated market and that's a big deal," Bent said.

Addressing antitrust issues with the FTC
One of the concerns about aligning a physician practice with a hospital has been possible antitrust issues or questions by the Federal Trade Commission about the structure of the new organization.

Three years ago, the 3,000-physician Memorial Hermann Health Network Providers was seeking an alignment with Memorial Hermann Hospital in Houston; the providers met the issue head on by meeting with the FTC in Washington, DC, according to Doug Ardoin, MD, who is physician-in-chief at the hospital system, which includes 11 hospitals and 3,514 licensed beds.

The hospital and physicians since have been involved with various initiatives—including reducing hospital-acquired infections; improving MI, coronary, and heart failure care; and detecting false blood cultures—which has made a difference on the inpatient side, where the mortality ratio has dropped during the past two years, Ardoin said.

In describing alignment, Ardoin said that it means achieving the outcomes "that are going to be beneficial to the patients and the payers and all providers—including physicians."

For those pursuing clinical integration, he emphasizes that it is not about contracting integration.

"It's not a gimmick. It's not a bunch of doctors just using electronic medical records. Everybody's got to be involved in this."


Janice Simmons is senior quality editor for HealthLeaders Media. She can be contacted at jsimmons@healthleadersmedica.com.

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