October 21, 2010

Address highlights goals, performance of clinics

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David Posch, CEO of The Vanderbilt Clinic, updates faculty and staff on the performance of Vanderbilt’s clinics at Wednesday’s address. (photo by Susan Urmy)

Address highlights goals, performance of clinics

Across Vanderbilt's clinics a vital transformation is under way.

The many changes being wrought in the clinics are intended both to put Vanderbilt in position to succeed in a changing environment and to provide a model for health care in the nation.

“Reforming health care happens here where we actually provide care,” said David Posch, CEO of The Vanderbilt Clinic and executive director of Vanderbilt Medical Group.

The remark came at the top of Posch's annual State of the Clinics address, delivered Oct. 19-21 at locations in Williamson County, on the main campus, and at Vanderbilt Health One Hundred Oaks.

Posch briefly framed the national effort to improve health care in terms of four fundamental problems: disjointedness, that is, poor coordination from one care setting to the next and one episode of care to the next; widespread delays in absorbing new science into day to day medical practice; gross inconsistency of quality and cost; and failure to engage patients and families in the process of care.

“The cost and quality issues get solved by dealing with these four areas,” he said.

As Vanderbilt helps lead the way to improvement, outpatient teams will have to take careful account of certain trends, outlined by Posch as: a move away from fee for service; falling prices per unit of service; a need for providers to accept economic risk from payers; and sweeping new requirements for transparency in cost, quality and outcomes.

A year ago Posch rolled out a strategic plan for outpatient care, and this week he announced that the plan is now 36 percent complete. Another 41 percent of the projects are still under way, and 23 percent are just beginning.

“The central element of our strategic plan is quality,” he said. “It's essential that we have evidence based quality and safety, and to do that we want a culture that promotes both.”

Posch presented the results of a recent survey aimed at assessing how well the Vanderbilt Medical Group organizational culture supports safety; and with that he announced the establishment of the VMG Patient Safety and Quality Improvement Committee, headed by assistant vice-chancellors Paul Sternberg, M.D., and Jonathan Gitlin, M.D.

In addition to addressing the recent survey, the committee will look to expand house-wide quality/safety measurement and improvement efforts (currently focused on basic practices like hand washing and medication reconciliation).

Posch said that as Vanderbilt puts in place the capability to accept potential economic risk from health care payers, VMG and Clinic governance structures may have to be amended to better support coordination of care across inpatient and outpatient settings; also, partnership between primary care and specialty care will be even more essential than it is today.

The pilot of My Health Team at Vanderbilt has been a rousing success and the program is set to expand. My Health Team adds new support for patients with chronic disease, helping them stay in physiologic control and avoid acute episodes; it's expected that such prevention efforts will not only improve outcomes but will also increase capacity and cut overall cost.

Last year 56 percent of VMG patients received an appointment within 15 days, and this year the target is 62 percent. Having made steady progress in patient satisfaction in recent years, this year VMG will try to raise overall patient satisfaction by another three percentage points. VMG has greatly expanded orientation and training programs.

Posch announced that:

• the clinics will add new support for the integration of clinical care with clinical research activity;

• this year will see the implementation of outpatient electronic clinical decision support/outpatient order entry (now in pilot);

• while VMG's centrally supported clinic redesign efforts have mainly focused on patient access improvements, this year they're going to expand to include new support for clinical improvement;

• VMG will build new infrastructure for video conferencing, and this year leaders will be considering robust deployment of telemedicine.

Posch presented the first annual VMG Volunteer Leader Award to Edward Zavala, MBA, administrator for the Transplant Patient Care Center.
The first annual VMG Community Service Project Award went to Williamson County Clinics for their Red Cross blood drive.

Posch commended the medical group's top patient satisfaction performers in overall quality of care: two providers, Sandra Moutsios, M.D., and Rosemary Cope, LPC, have performed in the survey vendor's 100th percentile for two year's running; two clinics, Addiction and Pediatric Cardiology, achieved in the vendor's 100th percentile this year.