Five Hard Things

I read a piece this a.m. from the Governance Institute on Moving Forward Together.  Ken Kaufman of Kaufman Hall, a renowned health care consultant, laid out five disruptive steps, as he calls them, that organizations must take to prosper in the difficult health care environment ahead.  I like to compare our progress against such suggestions as I read them.  His five steps are:

·         Downsize the Delivery System - Stop offering services where the volume of patients is inadequate or where there are financial losses.  Easier said than done with the volume issue.  In our community, we have to offer services in a number of areas even if we are losing money because we are the only game in town.  We are constantly assessing and reassessing those services that we deliver; and if something changes in the industry that will allow that service to be changed, we will do so.

·         Reduce Unwarranted Variations in Care - Use data to evaluate physician performance and where individual physicians rank poorly, work with them on changing how they practice.  We have seen a great deal of success in this area, but there are a handful of docs with whom we are working more closely.  They have been informed that if you don't change then you won't be practicing at WMHS.

·         Eliminate Unnecessary Tests and Procedures - We are no longer paid on the volume of tests performed.  As a result, we have been reducing our ancillary use rates considerably.  We have a ways to go, but we have made great headway.

·         Address the Crushing Cost of Medicare - We need to better manage the care of all of our patients, especially the frail and elderly.  Five percent of the Medicare patients account for thirty percent of the cost.  At WMHS, we have a number of initiatives in place to better care for these patients as well as those who have multiple illnesses and who frequently return to the hospital.

·         Improve End of Life Care - In the late stages of life, many patients receive unnecessary care that drives up the cost of care.  At WMHS, we have done a great deal in expanding our palliative care programs.  Dr. George Garrow, our Chief Medical Officer, has brought his expertise as an Oncologist to this program, which has both been improved upon and expanded.

As Ken Kaufman puts it, the health care industry has been given permission to change.  At WMHS, we took advantage of that permission given to us by the Health Services Cost Review Commission and we have done so very well.  As I have described in the past, but not without many challenges.  We have improved the quality of care, the overall patient experience, the cost of care and the health of our community.  We have become THE health care company of our community.  We have taken on risk and provide services along the continuum of care through WMHS or through the many partnerships that we have developed over the last three years.  At WMHS, we are moving forward.