Former Speaker of the House Newt Gingrich and former Senator Bill Bradley kicked off the AMGA annual conference in Orlando with 30,000-foot discussion of the healthcare system that was characterized for the most part by compromise and bipartisanship--traits politicians tend to develop when they are no longer running for office.
The two agreed about the importance of insuring every American--though they disagreed about how to reach that goal--and emphasized personal responsibility as well as government oversight in revamping the healthcare system. One surprising twist: The Democrat on stage, Bradley, was unwilling to take a firm position on individual mandates, but Republican Gingrich surprised moderator Cici Connolly and some audience members by saying his views had evolved during the past 10 years and he now supports mandates for wealthy individuals who forgo health insurance to purchase luxury items. I caught up with Gingrich after the session to talk about the details of this mandate program.
Other topics discussed included:
EMRs. There isn't a single physician in the country who couldn't afford an EMR system if they had to purchase the equipment, and the government should step up its role in encouraging physicians to move in that direction, Bradley said. Gingrich said part of the problem was that government views spending on information technology as a cost rather than an investment that will pay off and improve the health system.
Medical errors. The key to reducing medical errors is providing incentives for providers to report errors when they occur so that healthcare leaders and government officials can identify patterns, Bradley said. He called for greater transparency, and said sometimes malpractice fears prevented physicians from being open about mistakes. Gingrich added that the industry could learn from the handful of innovators who have identified best practices and significantly reduced errors in their facilities.
Personal responsibility. Both Gingrich and Bradley said healthcare reform would depend on patients taking greater personal responsibility for their health and suggested the government could play a role in changing the culture by mandating physical education in schools or rewarding food stamp recipients who use the government funds to purchase healthy foods, for example.
Neither really addressed how the remaining presidential candidates would address the problems, or implement the solutions, they talked about. Though the session was billed as "how your vote will influence the future of American healthcare," the focus was on Bradley's and Gingrich's views, rather than McCain's, Clinton's, or Obama's.
But the two closed out the session by discussing the current race and by making predictions about the outcome. We may hear a lot more about some of the topics discussed today, particularly Gingrich's ideas, if one of Bradley's predictions turns out true: He thinks Republican nominee John McCain will pick the former Speaker as a running mate.
Tampa Bay's newest emergency room has opened miles from any hospital campus. The $9 million Morton Plant Mease Bardmoor Emergency Center in Largo is the first free-standing hospital emergency room in the seven-county Tampa Bay region, and just the fourth in Florida. The 15-bed facility will serve some of the estimated 84,000 central Pinellas County residents who visit hospital emergency rooms each year.
The good people in the Office of the Actuary at the Centers for Medicare and Medicaid Services take great pains every year to summarize and explain their health spending forecast without spin or exaggeration. The editors of Health Affairs are perennially grateful to them for taking an approach that helps the journal fulfill its mission of providing clear and objective analysis to inform debates on health policy. Thus, it is perennially disappointing to see how casually the careful CMS analysis is inevitably overlooked to fit the doomsday scenarios anticipated by pundits and politicos, and how quickly the policy discourse prompted by the forecast deteriorates into the rote repetition of preconceived interpretations.
Hospital leaders and their boards generally recognize that the board's role is shifting. Boards no longer swoop in quarterly to check financial status and go on their merry way. They are involved in patient-safety rounds. They review quality scores. And they are hospital spokespeople in the community.
For leaders, this means putting another hat on your already crowded head. Your job as board relationship manager extends far beyond the occasional dinner out.
Hospital boards must intimately understand the workings of your hospital and the emerging trends in healthcare. To this end, your role has expanded to include board education and coordination. And although they are more involved, board members aren't clinicians. They rely on you to tell them what they should pay attention to and what they can safely leave to others.
Some organizations have created the Chief Governance Officer position solely to handle their boards. Although this board-centric position sounds good in theory, not all CEOs agree with it.
"The CEO is hired by the board to be the board's agent. In return, one of the fundamental roles that the CEO should be playing is the Chief Governance Officer. When I look at allocation of my time, the care, feeding, nurturing, and maintaining of the board is a significant amount of what I do, and I think that should be it," says Robert Kiely, CEO and President of Middlesex Hospital in Middletown, CT.
So, how do you effectively do all that care and feeding?
Orientate. It's not enough to give new board members a bunch of reading material and send them to conferences. Board education requires hands-on teaching--both about industry trends and your organization itself. Some hospitals hold half-day orientation sessions, taught by their senior management teams, during the first month of new board members' appointment. Whatever your orientation process, make sure you have one.
Educate. Board education shouldn't end with orientation. Increasingly, board members must be able to speak to your organization's quality and patient safety performance--topics that won't come naturally to most board members. They don't need a clinical degree but they have to understand quality measures and hospital performance on an ongoing basis.
While teaching infection rates to bankers may not come naturally, it's essential to board effectiveness. That's why some organizations make quality and patient safety education a part of every board meeting. Sinai Hospital of Baltimore produces a monthly executive report card to show the board where they stand on quality indicators and how that has changed over time.
Evaluate. You've oriented new board members and educated the old, but how do you know if your board's really working? A 2007 Top Leadership Teams winner, Cary Medical in northern Maine, uses an annual Board Effectiveness Survey to evaluate individual board members and the board as a whole on each of the hospital's strategic categories. This four-page survey goes well beyond the typical board self-evaluation done at many organizations, and Cary's CEO uses the survey results over time to predict training needs for new and future board members.
As organizations like the IHI and The Joint Commission put more emphasis on the importance of governance, board members will continue to take a bigger role in your organization. And, as Kiely told me, "The fish stinks from its head"--if an organization's board and senior leaders are out of sync, so too is the organization. Your job as leader is to make sure your board truly is on board.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
One of your hospital's most significant payors has just notified you that, starting next year, it plans to withhold $1 million annually in reimbursement. The hospital may have a chance to regain some of that money, but only if you hit certain quality benchmarks and can demonstrate performance that exceeds that of your competition.
This isn't a pie-in-the-sky scheme concocted by the insurance industry to boost revenue and please Wall Street. Welcome to the reality of the federal government's proposed Value-Based Purchasing (VBP) program.
In this election year, much uncertainty surrounds the future of U.S. healthcare. But one thing is clear: Any and all health reforms, no matter the political party behind them, are certain to underscore quality and efficiency, rewarding top performers and potentially punishing poor ones.
In this environment of change, it is imperative that hospital leaders begin now to prepare for the changing reimbursement landscape ahead. Value-based purchasing (VBP) demonstrates just how high the stakes can be.
The proposed changes
Under the VBP proposal currently being considered by CMS and Congress, "a percentage of the hospital's base operating payment for each discharge or DRG payment would be contingent on the hospital's actual performance on a specific set of measures."
The idea is to try to move away from a hospital payment system based primarily on volume of procedures and instead reward hospitals for delivering on evidence-based quality measures and improved patient outcomes. The new program would move hospitals to a system "that rewards the best performers."
One possible implementation of the new program envisions taking a withheld amount from all hospitals and returning some or all of that money only to the top performers, effectively "grading on the curve" and guaranteeing that some percentage of hospitals will not get all or perhaps any of their withheld money back.
However, CMS also included provisions to pay hospitals not only for meeting or exceeding certain quality benchmarks, which would favor top-performing hospitals, but bonus payments to hospitals that show substantial improvement. The intention was to ensure funding for poorer-performing programs that are striving to make progress.
Needless to say, this amorphous formula could pose substantial challenges for hospital leaders laying out strategies for maximizing reimbursement under VBP.
For forward-thinking executives who want to maximize financial success under quality-based reimbursement systems, the time for action is now. Quality should be a top strategic focus for hospital boards and administrators as 2008 begins and resources need to be appropriately allocated. If there was any doubt that quality performance was going to drive payment, this should be settled now.
Anticipating VBP
To get and stay ahead of the VBP curve, it is vital for hospital leaders to understand that this isn't simply about how you are doing on processes (like Core Measures), but also about how CMS sees your mortality rates and how your scores compare to other hospitals nationwide.
According to a study of nearly 5,000 non-federal hospitals released in January by HealthGrades, the nation's best hospitals not only had mortality rates 27 percent lower across the board than all other hospitals, but they also improved at a faster rate, reducing mortality by an average of 15 percent from 2004 to 2006 compared to 11.4 percent for all others.
Hospital executives anticipating VBP should ensure that they are measuring and then monitoring the most effective clinical quality measures. After all, the whole intent of transparency is to help consumers make value-based decisions and purchases.
The first step is to identify and understand what CMS has proposed be reported in its VBP. Assess which of those quality metrics are already being measured, tracked and reported and how does your organization stack up? How do you think you will stack up against all other hospitals?
Some of the quality measures being considered won't be new to most hospitals. At least half are essentially "Core Measures" or "SCIP" measures (Surgical Care Improvement). However, even the hospitals that are doing satisfactorily on these measures may not know how they stack up in other areas such as mortality and complications related to Acute MI and Congestive Heart Failure.
Second, it is important to identify what part of VBP is currently not being measured, tracked and reported by your hospital. If these metrics are important enough to be in the VBP, they should also be evaluated by your organization.
Third, discuss the findings with your board's quality committee and review how decisions are made on which metrics to incorporate into quality reporting.
Fourth, make it a point to drop the same number of metrics that you add, eliminating measures that don't have the same impact.
The challenge for senior leaders is that the best hospitals are running faster and faster and, as a result, everyone else must work harder to catch up. But the good news is that the consistent clinical performance and rate of improvement HealthGrades research has identified among top-performing hospitals demonstrates that better is possible for all hospitals and many are working successfully to achieve this.
About Samantha Collier, MD, MBA Dr. Collier's role as a senior vice president and HealthGrades' chief medical officer has allowed her the opportunity to lead consulting teams that have helped more than 100 hospital organizations throughout the country develop and implement quality improvement initiatives that have improved their quality of care and public profiling positions. Dr. Collier, who continues to practice part time as a hospitalist, is frequently called to speak about quality improvement, the important impact of consumerism and healthcare ratings, public profiling and patient safety to the news media and at major conferences that have included the Harvard Quality Colloquium, CMS National Customer Service conference, the American College of Healthcare Executives and the National Association for Healthcare Quality.
The unsafe medical procedures that spread hepatitis C among patients at a large Las Vegas surgical clinic may be more widespread than first believed, health officials said. Health inspections at 13 other outpatient surgical centers in the Las Vegas area found several violations of standard practices.