February 23, 2001

Access is key: Jacobson

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Six-year-old Justin Lamar Washington is the 2001 March of Dimes National Ambassador. (photo by Dana Johnson)

Access is key: Jacobson

Dr. Harry R. Jacobson thanked staff and faculty for keeping Vanderbilt’s position as the premier health care facility in the region at this year’s State of the Medical Center address Thursday afternoon in Langford Auditorium.

Among the evidence cited by Jacobson:

•For the second year in a row Vanderbilt has been recognized as the top hospital in Nashville based on the National Research Corporation’s survey of 700 households.

•Vanderbilt was among the top 100 hospitals in the country selected by the HCIA-Sachs Institute.

•In the 2000 edition of the US News and World Report Annual Best Hospitals edition, Vanderbilt is ranked in 11 of 17 specialties; and in nine of 11 cases Vanderbilt’s rating improved.

•Vanderbilt is now the most preferred hospital in all of middle Tennessee, a change in public perception since 1996, when the “Hearts and Minds” advertising campaign began.

“This is a solid and continuing reminder to the community of the worth and value of this institution. We should all be proud,” Jacobson, vice chancellor for Health Affairs, said.

Jacobson encouraged the crowd at Langford to take a moment and reflect on the awards that have been won and the clear preference in the market. “It is impressive and stands as a clear recognition of the hard work, the dedication and the spirit you have brought to Vanderbilt,” he said. “I hope you are as proud as I am of our achievements – both clinical and academic.”

Jacobson also pointed to challenges facing VUMC in the coming year.

Outlining these challenges, Jacobson focused on the mounting losses from TennCare, the lack of access to the hospital caused by construction, and inefficient patient flow.

TennCare losses again exceeded $15 million last year. Still, Jacobson said seeing TennCare patients remains squarely within Vanderbilt’s role “It is our mission and it is our responsibility to heal people regardless of their ability to pay.”

A promising turn occurred this year as Vanderbilt received an $8.2 million essential provider payment awarded to facilities that saw a disproportionate share of TennCare patients. The state government is optimistic that additional funds may be distributed through a proposal called HELP. HELP would provide a one-time payment to the state’s teaching hospitals that provide care for the sickest TennCare patients. This could mean as much as $20 million to Vanderbilt.

“For too long Vanderbilt’s competitors have avoided providing care to TennCare families,” said Jacobson. “They have avoided the financial losses and have effectively passed those losses to us. The future of TennCare is still very much up in the air.”

Jacobson was calm and resolute in his message of improved access. “There is no question that we can’t meet our goals unless we can begin to solve a constellation of problems and barriers that we’ve collectively named ‘access’ issues,” Jacobson said.

Another major obstacle for Vanderbilt is physical in nature. Due to the construction of the Cancer Center and the Children’s Hospital, people can not gain access to the hospital. “We simply can’t find enough parking spaces for all of the patients who come here,” he said.

To remedy this problem, more shuttles will be offered to deliver patients to the hospital. Also, only employees who need to park in the hospital garage will be allowed to do so.

The increasing wait time of patients at the clinics is also hurting the parking situation. “If we could cut overall patient time by an hour, we can increase parking capacity by 25 percent,” he said.

A second major “access” barrier is to increase patient appointment opportunities. VUMC is working to bring on new staff physicians in areas like primary care where it has been difficult to get appointments. Occupancy rates are also a concern for the medical center. “We are forced to divert patients from our emergency department and cancel elective surgery when there are not enough beds to accommodate patients,” Jacobson explained. “Imagine if someone you loved needed a Vanderbilt doctor, but we couldn’t accommodate them. It is a problem we need to work on.”

Other access issues include streamlining improvements in the ED. Expansion of waiting space and the creation of a fast track program to treat patients with minor emergencies will help with patient flow. New and renovated surgical areas are also crucial in improving access to VUMC. A new OR is ready to open now and a space on 4 South is being renovated. Jacobson is calling for the addition of four new OR’s this year to meet VUMC’s surgical needs.

Rounding out access improvement is the need to simplify the structural complexity of the medical center. “This is a remarkably complex place – hard enough for those of us who work here to find our way – let alone the elderly couple from Bowling Green,” said Jacobson, who is proposing new signage and wayfinding to help with this problem.

“Access will remain a significant issue for the foreseeable future,” Jacobson added. “It will expand to include how we handle telephone calls and set appointments; how we register patients and collect information. There is much to be done.”