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Clinical enterprise braced for shifting health landscape

Nov. 14, 2013, 8:43 AM

David Posch, CEO of Vanderbilt University Hospital and Clinics, delivers last week’s State of the Adult Clinical Enterprise address. (photo by Anne Rayner)

Vanderbilt University Medical Center staff and faculty are preparing for a new health care landscape, one shaped by a lowered payment regime, greater outside scrutiny of health care quality, new rewards and penalties for hospital and provider safety and quality, and the transfer of financial risk for health outcomes from payers to newly affiliated hospitals and providers.

The greater part of the 2013 State of the Adult Clinical Enterprise address, delivered last week by David Posch, CEO of Vanderbilt University Hospital and Clinics and executive director of Vanderbilt Medical Group, was devoted to reviewing these preparations. Posch summed up the new landscape as a shift from volume-based reimbursement for health care services to reimbursement based on value and population-based care. He delivered numerous examples of improvements to the system of Vanderbilt health care delivery.

At the start he asked, “Can anyone here recall a time that has been as turbulent in health care as what we’ve experienced this last year? I’m in my 40th year in health care and I can’t recall anything to compare with what we’re experiencing right now.”

Wrapping up an hour later, he said, “It’s an exciting time. We are at the forefront of redesigning health care — that’s where Vanderbilt should be.”

Posch quickly reviewed recent quality and safety efforts, which augment a longstanding focus on reducing hospital-acquired infections at VUMC. Leaders have begun routine safety rounds in the hospital and clinic. New measures are reducing surgical site infections, improving medication safety, improving the safety of continuous positive airway pressure for treatment of sleep apnea, and improving safety and quality of care for women undergoing normal delivery.

Hospital and clinic processes are changing, becoming more standardized:

• The hospital charge nurse role is being redesigned to allow greater interaction with staff at the bedside.

• The efficiency and timeliness of hospital medication administration is receiving greater scrutiny and standardization.

• The supply utilization review process conducted by the Medical Economic Outcome Committee achieved $11.7 million in savings in fiscal 2013.

• Standardization is improving the timeliness and quality of nursing handovers from the adult emergency department to inpatient units.

• Daily multidisciplinary team “huddles” on a number of hospital units are supporting smoother patient transitions to post-acute care.

• The clinics are rolling out a standard operating model that integrates information systems technology to improve quality and safety, lower costs, improve efficiency and boost patient satisfaction.

A number of additional improvement initiatives will roll out in the coming months. Inpatient nurse workflow redesign will reduce the time nurses spend on documentation, freeing them to devote more time to direct patient care. Hospital equipment will be fitted with inexpensive computer chips for wireless location tracking, saving time for caregivers. Providers will use a voice recognition system for transcription of clinical notes, saving up to $3 million per year.

“All of this is about liberating time, improving the quality of care and improving the quality of work for our caregiving teams,” he said.

The talk included a review of recent performance in terms of hospital and clinic cost, quality and service. As ever, when he gives these talks, Posch made value his watchword.

He offered a quick analysis of the main challenges that health care providers must solve — disjointed care coordination, failure to provide evidence-based medicine and failure to engage patients and families.

He devoted a good portion of his talk to a six-part health care “value agenda” (conceived by Michael Porter of Harvard Business School): organize into integrated practice units; measure costs and outcomes for every patient; move to bundled payments for care cycles; integrate care delivery across separate facilities; expand excellent services across geography; and, to support it all, build an enabling information technology platform.

Outlining Vanderbilt efforts to advance this agenda, Posch touched on new disease management capabilities, growth of the Vanderbilt Health Affiliated Network, new patient satisfaction initiatives, and a range of new strategies for improving care coordination and coping with financial risk for health care outcomes.

“Our role is to be at the lead of this,” he said in conclusion. “Change is hard, we know that, but we’ve achieved remarkable things by working as a team. Our best improvement ideas have come from our care teams, and that’s where we’re going to get our success going forward, by continuing to work as a team.”

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