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 SATURDAY, NOVEMBER 21, 2009 5:36 am |
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Local News 
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As nation debates health reform, Everett models a system that works well EVERETT — Dave Brooks listened to the voice mail, but it was too late to get back to the caller on the East Coast.The chief executive at Providence Regional Medical Center Everett would have to wait until morning. That late June night, the man who oversees a $550 million annual budget and 3,500 employees, including 850 medical staff, would feel the eagerness of a child on Christmas Eve. The message was from Thomas Nolan of the nonprofit Institute of Healthcare Improvement in Cambridge, Mass. Nolan explained that Everett was one of 10 regions in the country chosen to participate in a conference exploring what's going right in health care based on an analysis of national studies. Each region was found to be providing better than average care at below average cost. During a summer when the debate over health care has boiled over, drawing thousands of people to town hall meetings from coast to coast to bend the ears of their congressmen, Everett found itself on a national stage as a model for keeping costs down and quality up. To Brooks, the invitation wasn't some kind of superficial pat on the back. He has long viewed the Institute of Healthcare Improvement as an organization respected by doctors, hospital administrators and insurance carriers. Nolan explained the invitation for Everett was not just about the hospital, which has 25,000 admissions a year and the busiest emergency room in the state with 110,000 annual visits. The choice was a reflection on the medical community in and around Everett. Joining him at the July conference in Washington, D.C., were Dr. Harold Dash, a cardiologist and The Everett Clinic's president and board chairman; and Richard Maturi, a senior vice president for Premera Blue Cross, a health insurance provider. Dash said he long felt the region fared well compared to other parts of the country, but was surprised someone from the outside noticed. “It was just like 2001 when the Mariners won 116 games and you didn't hear much about it on TV,” he said. “I think a lot of people don't understand what's going on out here.” The symposium wasn't aimed at tackling everything wrong with health care. It wouldn't, for instance, find a way to provide coverage for the estimated 50 million Americans without insurance. Mainly, the discussion was on how other regions could spend less while providing better care. It was an effort to get “public, political and professional traction on cost and quality based on successful examples,” said Dr. Donald Berwick, president of the Institute of Healthcare Improvement. Berwick cautioned that no region's performance was “anywhere near an optimum.” “They generally think, and we certainly do, that their costs could be still lower, their rates of increase slower and their quality of care higher than they are today,” he told the gathering. “They are instructive, but neither we nor they are claiming that they are ideal.” That certainly was Brooks' take. “No one I think came into that room thinking that we had all the answers and that we had minimal room for improvement,” he said. “There is so much more we need to do.” In figuring out who to invite, researchers examined 306 regions across the country with low or declining per capita Medicare costs that have above average patient quality. Seventy regions were identified as performing well. The final 10 were picked based on geography and demographic mix. Researchers used a Dartmouth University study, which uses Medicare data to provide comprehensive information and analysis about national, regional and local markets, as well as individual hospitals and their affiliated physicians. They scoured other databases, public reports and studies comparing hospitals. The study called the Dartmouth Atlas found that hospitals in top-performing areas had 14 percent fewer medical admissions, 17 percent fewer days in the hospital, one-third fewer visits to specialists and spent up to 21 percent less on medical imaging. There is no single reason Everett fared better than much of the nation. Local officials suggest many contributing factors, including greater use of generic drugs, a tighter rein on costly advanced imaging such as magnetic resonance imaging, a reduction in the need for blood transfusions and greater and faster sharing of information. Why Everett? Officials at The Everett Clinic say they are saving money without sacrificing quality by switching to generic drugs more often. The clinic has increased generic prescriptions from 41 percent in 2001 to 80 percent this year. It estimates it's saving between $30 million and $35 million a year by prescribing generic drugs and using other interventions. For example, using generic medicines for acid reflux, which are as safe and effective as brand-name drugs, saves about $15 per prescription, said clinic spokeswoman April Zepeda. Over-the-counter medication for the treatment of allergies can reduce costs by more than 80 percent. The clinic's goal for this year is to increase use of generic drugs to 82 percent, but it will continue to prescribe name-brand drugs if they are documented to have better results, said Dash of The Everett Clinic, which has $290 million budget and aims for 5 percent profit each year. Local health care agencies say electronic medical records play a critical role in documenting and achieving better results for their patients. Such health information technology provides doctors with more complete and timely patient data, which can be used to better coordinate services including preventative care, disease management and monitoring between visits. At The Everett Clinic, there has been a more rigorous checklist of conditions reviewed before a advanced medical imaging is approved. The result has been a 14 percent drop in the per capita the number of patients with back pain having an MRI procedure over the past two years and a 64 percent dip in patients needing an MRI for brain and other neurological problems during the same span. Fewer such scans cut into the clinic's bottom line, but also reduces health care spending. “Advanced imaging is very, very profitable,” said Dash, the clinic's president. “That comes off the top of our profit line, but that's best for our patients and it lowers the cost of care.” The clinic also has one of its registered nurses make the rounds at Providence each day. Karen Nardinger is called a Medicare coach, visiting patients and working with the hospital's discharge planners. The clinic cares for more than 28,000 Medicare patients and, on average, loses about $460 per patient a year. The clinic expects to lose about $11.7 million treating Medicare patients this year. With more baby boomers qualifying for the senior citizen government health insurance, that number could swell in the years ahead. Nardinger's position is aimed at helping hospitalized Medicare patients transition home or to another care facility and to get follow-up care. A timely visit with their primary doctors helps reduce the likelihood of those patients needing to be checked into an emergency room later. After the first year of the program, 60 percent of the hospitalized seniors had a doctor's appointment within 10 days of leaving the hospital, a significant jump from 38 percent who had scheduled appointments before the program began. “We would like to see them not have to come back to the hospital again for the same thing,” Nardinger said. The hospital coach program saved $294,000 in Medicare costs during its second year, according to clinic records. In a similar program emphasizing prevention, Providence has nurses make hourly rounds from 4 a.m. to 10 p.m. and every two hours after that without waiting for patients to use their call lights. They check to see if patients need help using the bathroom, walking, sitting, eating or with other needs. While the pilot program aims to improve patient satisfaction and quality of care, it also reduces falls, saving more money. The hospital has reduced the need for transfusions for patients needing surgeries. The use of transfusions for hip replacements fell from 48 percent in 2002 to 16 percent in 2008 and is on pace to dip to 14 percent this year. The drop in transfusions is even more dramatic for knee replacements, from 59 percent in 2002 to 9 percent last year. It is 5 percent so far this year. Registered nurse Trudi Gallagher heads up the hospital's blood management and conservation efforts. It takes planning and working closely with patients ahead of time and the goal is to conserve and use their own blood instead someone else's. Different techniques are used to conserve blood, control bleeding or promote the growth of new blood cells. Those strategies include vitamins, medications and micro-sampling where only a minimum amount of blood is taken for testing. Recovery time is quicker and there is less chance of infection. “I was amazed they could do something like that,” said Virginia Young, 69, a Lake Stevens resident who was recovering from knee replacement surgery in the hospital Thursday after spending weeks strengthening her own blood before the procedure. Quicker recovery From the third-floor cardiac surgery single-stay unit at Providence, Daren Barstad was feeling fortunate to be alive Thursday, let alone preparing to leave later that afternoon. Eight days earlier, the 61-year-old Snohomish man had shoulder surgery. While at home two days later, he felt pain in his leg and numbness and fluid in his foot. He was checked for blood clots in the leg and doctors determined he was OK. By early Sunday morning, he was feeling dizzy, short of breath and reported pressure across his chest. By Monday, doctors were removing a pulmonary embolism, a large blood clot in his lungs. Rather than shuffling them from critical care to recovery units as their conditions improve one or two days after surgery, Barstad and other patients in the cardiac care unit stay in the same room. The result is shorter hospital stays and quicker recoveries. “Every one day is a big cash saver,” said Laura Ouelette, a registered nurse in the cardiac care unit. “It was very important not to have to be shuttled from room to room,” said Barstad's wife, Barbara. “We're so thankful he had the same doctors and nurses and respiratory therapist. It was all very important to his recovery. We just give our thanks and praise to God and the hospital staff.” Next year, The Everett Clinic and Premera plan to try a new approach with some diabetic patients who choose a different coverage option. Instead of the traditional fee-for-service payment plan, the clinic will be compensated by how well patients fare. It's a small step into the thicket of health care financing that both sides will monitor closely. Maturi, the Premera vice president, said the conference in Washington drove home to him an important point in the health care debate — much of the success boiled down to decisions and working relationships at the local level. “What kept coming home to me is it's about leadership,” Maturi said. “Whether you are in a competitive market or a noncompetitive market, do you have leaders who don't just compete to be a successful business but are working to improve the health and affordability of health care within their community?” Eric Stevick: 425-339-3446, stevick@heraldnet.com. |
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