February 27, 1998

Switch to patient care center system on the horizon

Switch to patient care center system on the horizon

Vanderbilt's move toward patient care centers is gathering steam.

By this summer, officials say, specific operational, financial and business plans for each of the 16 designated patient care centers should be finalized and information tracking and other necessary support systems should be in place.

Leadership teams, made up of physicians, administrators and financial officers, have been in place for 13 months and are in the process of fine-tuning these organizational plans in preparation for the change.

"This summer we will begin to see the execution of these plans," said Norman B. Urmy, executive director of Vanderbilt University Hospital. "We will be off and running, with the ability, as the months roll by, to test our performance and make adjustments as necessary."

All of the patient care centers have completed the process of defining their existing services and have finished mission and vision statements, providing a foundation for the organizational and business plans now being created, according to Marsha N. Casey, chief operating officer of VUH.

In the works for nearly four years, patient care centers represent a major restructuring for how patients are cared for both in the hospital and The Vanderbilt Clinic. Each of the 16 centers is made up of a team of related physicians, health care providers and resources that combines inpatient and outpatient services to treat a defined patient group.

Each center is led by one or more physician and administrative officers, who, along with directors of ancillary services form the Patient Care Council, led by Casey and Dr. John S. Sergent, professor of Medicine and chief medical officer of The Vanderbilt Medical Group.

By realigning care around defined patient bases, creating a stronger partnership among care teams and making decisions closer to the point of impact, VUMC's move toward patient care centers is expected to not only boost the quality of care provided but reduce the costs of providing that care.

"If you focus on specific types of patients, such as pediatrics, cancer or transplant patients, you are going to have focused expertise and collaboration of all the health care givers, which ultimately means you're going to have better quality," Urmy said. "Secondly, from a financial point of view, it is a very good model. Organizing care in this way means that the cost of care will be the lowest."

It will also enhance the teams' ability to care for patients, said Sergent.

"In the managed care world, the winners will be those physicians and hospitals which demonstrate that they add value, such as high quality at low cost. Patient care centers enable us to get all the players to the table to develop business plans and then to put them into operation ‹ the first step toward comprehensive cost-effective disease management," Sergent said.

The move will also allow care to be better tailored to the needs of differing patient bases, Casey said.

"It will create quicker response to patients needs and develop measurable goals from quality and cost perspectives," she said.

Another vital component of the patient care center system is that it allows for performance to be accurately measured. It creates a way for the physicians, administrators and managers of each individual center to unite and measure their performance, and to be held accountable for that performance along quality, cost, price and other lines, said Urmy.

From an institutional perspective, perhaps the most important result from the shift to patient care centers will be how it increases the medical center's ability to be flexible in today's competitive market, said Urmy.

"This model allows us to be adaptable to the needs of the population. You don't tie every center's progress to a single broad plan. This creates the ability for each different center to move at its own pace to take advantage of market opportunities without either being slowed down or dragged along by other centers, which may be at different stages of development," Urmy said.

While so-called product line organizations similar to VUMC's patient care center model have been around for some time, they haven't been frequently used in large academic medical centers.

"While there are some growing pains involved in this major transition, there is no question that we are doing the right thing, and we are already reaping some of the benefits," Sergent said. "The best part is that we are not only saving money, but we are demonstrating that the care is better as well."

VUMC's 16 identified patient care centers, and leadership teams, are as follows:

€ Cardiology ‹ Dr. Davis C. Drinkwater Jr., William S. Stoney Jr. Professor and Chair of Thoracic Surgery; Dr. F. Andrew Gaffney, professor of Medicine; Robin L. Steaban, administrator

€ Cancer ‹ Dr. R. Daniel Beauchamp, John > Sawyers Professor of Surgery; Dr. Russell F. DeVore III, assistant professor of Medicine; Carol Eck, administrator

€ Women's care ‹ Dr. Stephen S. Entman, professor and chair of Obstetrics and Gynecology; Lisa K. Mandeville, administrator

€ Emergency ‹ Dr. Corey M. Slovis, professor and chair of Emergency Medicine; Susan M. Erickson, administrator

€ Children's care ‹ Dr. Wallace W. Neblett III, professor and chair of Pediatric Surgery; Dr. Gerald B. Hickson, associate professor of Pediatrics; Dr. Ian M. Burr, James C. Overall Professor and Chair of Pediatrics; Greg Catt, administrator; Terrell Smith, administrator

€ Perioperative care ‹ Dr. Charles Beattie, professor and Chair of Anesthesiology; Dr. James A. O'Neill Jr., John Clinton Foshee Distinguished Professor and Director of the section of Surgical Sciences; Nancye R. Feistritzer, administrator

€ Trauma, Burn Unit, LifeFlight ‹ Dr. John A. Morris Jr., professor of Surgery; Sandra Greeno, clinical instructor in Nursing

€ Transplant, Vascular, General Surgery ‹ Dr. C. Wright Pinson, professor of Surgery; Wilma Heflin, administrator

€ Orthopaedics ‹ Dr. Gregory A. Mencio, assistant professor of Orthopaedics and Rehabilitation; Wilma Heflin, administrator; Carrie D. Warring, administrator

€ Plastic Surgery, Otolaryngology, Dermatology, Oral Surgery, Urology ‹ Dr. Brian B. Burkey, assistant professor of Otolaryngology; Lenys A. Biga, administrator

€ Neurology ‹ Dr. George S. Allen, William F. Meacham Professor and Chair of Neurological Surgery; Dr. Gerald M. Fenichel, professor and chair of Neurology; Lenys A. Biga, administrator

€ Behavioral Health ‹ Dr. George C. Bolian, associate professor of Psychiatry; Lee Fleisher, administrator

€ Ophthalmology ‹ Dr. James C. Tsai, assistant professor of Ophthalmology and Visual Sciences; Georgia R. McCray, administrator

€ Medicine ‹ Dr. Allen B. Kaiser, professor of Medicine; Dr. John H. Nadeau, professor of Medicine; Laurel Aldredge, administrator

€ Offsite Practices ‹ Dr. James P. Wilson, associate professor of Medicine; Roxane Spitzer, Ph.D., chief operating officer of VMG Networks

€ Primary Care ‹ Dr. James P. Wilson, associate professor of Medicine; Betty J. Akers, administrator.