MBGH Update: Methodist Healthcare Quality Report Cards Now On-line

Memphis Business Group on Health (MBGH) applauds Methodist Le Bonheur Healthcare (Methodist) for making their quality of care report card public on their websites. Specifically, MBGH is pleased with this initiative for the following reasons:

• MBGH has been working with Memphis-area hospitals since 1997 to improve transparency. As advocates for our member employers, we’ve consistently pressured hospitals to measure and publicly report their performance and to use this information to improve the quality of care they provide.

• MBGH has been asking Methodist to report quality information separately for their adult hospitals since 2002. In response to our request for Methodist to participate in our Leapfrog initiative, they have responded to The Leapfrog Group Annual Hospital Survey separately for each adult hospital. Until now, other publicly available quality reports have only been at the system level, essentially reporting average performance across the system. System-level reporting has not been useful to employers as they try to educate their employees about selecting hospitals that provide higher quality care. In this new initiative, Methodist is reporting quality information by facility which is a significant advancement.

• MBGH has asked Memphis-area hospitals to report their performance on a regular basis, which allows employer purchasers and employees to track performance over time, including whether hospitals improve performance or if there is lack of improvement. Methodist has committed to reporting this information regardless of whether it shows they are providing quality care or if they need to improve, thereby providing the good news and the not-so-good news.

This initiative is an excellent first step in increasing transparency with area employer purchasers and employees/potential patients. MBGH asks that all Memphis-area hospitals look to this as a local transparency standard they should try to meet and exceed.

As this initiative takes root, MBGH asks all Memphis-area hospitals, including Methodist, to add additional critical information to their online information. Information on outcomes, such as survival rates/mortality rates; structure measures such as staffing in ICUs and computerized physician order entry; and hospital acquired conditions, such as falls, pressure ulcers, and infections is already available and would not require significant work to add to the reports.

Gary Shorb, President and CEO of Methodist Le Bonheur Healthcare, emphasizes their commitment to working with MBGH and purchaser employers to provide additional information that is useful to employers and their employees. MBGH is meeting with Gary and senior Methodist staff to work out the specifics and timeline. We will keep you up-to-date as details are finalized.

We welcome the opportunity to work with other Memphis-area hospitals, as well, as they develop their transparency strategies.

In the meantime, we encourage you to access and use the Methodist Healthcare information by clicking below:

Methodist Healthcare Adult Quality

Le Bohneur Children’s Hospital Quality

Pushing for Market-Level Health Plan Performance Reporting

I attended my first NCQA Purchaser Advisory Council today and it was a great meeting. NCQA is addressing the latest in health reform issues, including exchanges, accountable care organizations, relative resource use and furthering its work in wellness/health promotion and medical home. I am excited about the tools and information NCQA is working on, most of which measure and report performance at a plan or vendor level.

But I am struck by the fact that although reporting at the plan or vendor level often works for individual employers, those of us involved in community-level change need this valuable information cut in a different way. For example, health plans in TN report their HEDIS measures at a statewide level. Works for employers that have employees across the state, but does not work for those of us wondering how plans are peforming in Memphis specifically. Another example is the wealth of information that will become available through NCQA's relative resource use reports, which, once again, look at the plan's performance across the entire state.

It is great to know how health plans perform, in general across TN, but it would be even more powerful and actionable to know how they perform in each market in TN. That would tell us more about our own providers and their performance and help identify what we need to improve locally and may even give us hints about how to improve it. Because of contracting methods here in Memphis, where plans contract either with Baptist or Methodist, but generally not with both, we could even begin to understand if there are any real differences in the quality and resource use between our two major hospital systems and their affiliated physicians.

Understanding whether these differences exist between Baptist & Methodist is critical to local employers, and their employees, in knowing where to go for safe, high quality, efficient care.

NCQA is pushing itself to be relevant, vital, and address the current issues that are even more important due to health reform. The next challenge will be how to make this information relevant and usable by communities as well as individual employers. I hope I can bring this perspective to NCQA as I continue to serve on their Purchaser Advisory Council.

MBGH Celebrates the Spirit of Memphis

Get into the Spirit of Memphis!!! Our city, heritage, music, food, culture, people...our spirit...is what makes us great. Celebrate it!!

Employers: Focus on These Aspects of Health Reform NOW!!!

Click here to hear Steve Wojcik, vice president of public policy for the National Business Group on Health, offer his take on what employers should have top of mind between now and when the biggie components of the Patient Protection and Affordable Care Act take effect in 2014 and 2018.

Not Paying for Readmissions Spurs Improvements in Patient Care

It is estimated that 75% of the Medicare admissions readmitted to the hospital within 30 days of discharge were preventable. In total, the cost of readmissions to Medicare is approximately $17.4 billion annually.

Medicare's decision NOT to pay for preventable/avoidable readmissions to hospitals has gotten attention. Significant work is now being done by hospitals to put better discharge and/or transfer processes into place to better coordinate care, ensure patients have support systems at home and get needed followup services. A good example of how aligning payments with desired outcomes serves as the main "carrot or stick" to get action. And, a good example of how poor quality care drives high cost.

Click here to read the article. The clear connection between aligning payment with expected outcomes is in the last paragrah.

It's Coming Down to the Wire, Help Memphis Get Google Fiber!!

Show your support for Memphis to get Google Fiber. Go to http://www.google.com/appserve/fiberrfi/public/options to complete a nomination for Memphis; join Google Fiber for Memphis, TN's Facebook page

Cost Effective, Quality, Safe Care Must Be Part of the Med's Plan

Merely waiving co-pays and deductibles is not enough to accomplish what The Commercial Appeal's editorial says the Med must do: "The Med has to convince potential paying patients that it's a quality alternative for medical care."

Waiving co-pays and deductibles reduces financial barriers for patients, but in no way ensures that the care they receive is efficient, high quality, and safe. People should have information on the cost and quality of care at the Med to decide if the waived financial requirements are "worth it". But much of the cost and quality information that is available for all the other hospitals in Memphis is not available for the Med because the Med does not publicly report this information through The Leapfrog Group's Annual Hospital Survey (click here to get results for other Memphis hospitals).

Information that is publicly available on the Med's quality of care shows that significant opportunities for improvement exist. For example, recently released statistics on central line infections in ICUs shows that in 2008, the Med's rate of infection was approximately 238% above the average (click here to read Consumer Reports Health article and click here to get State of Tennessee report) . The Med indicates that they have been addressing this issue, but it would be good for us to know what progress they have made in bringing the infection rate down. If the Med reported to The Leapfrog Group survey, we would know how effective their improvement efforts have been and could track their progress.

In addition, the Med's scores on patient experience of care measures from Medicare's survey for the 12-months ending March 2009 show that only 56% of the patients would "definitely recommend" the hospital to others (compared to a national and statewide 68% average).

Finding a financial solution to the Med's situation is essential, but the Med owes us cost-effective, high quality, and safe care. They owe us this under all circumstances, but especially if they are going to offer us financial incentives to use their services. It is not right to ask people to make the decision to come to the Med based only on the fact that they will "save money". The Med should participate, as all other Memphis hospitals do, in the Leapfrog survey so people can decide if the quality of care they are likely to receive is worth saving money because there are no co-pays or deductibles.

Click here to read the latest Commerical Appeal editorial.

MBGH Leading Employer Contributions to Improving Health in Memphis

MBGH supports the Commercial Appeal's call for employers, churches, civic organizations, and government to get involved in improving health in Memphis..each group should work within their sphere of influence & responsibility to contribute to the overall improvement in our community's health...MBGH is taking leadership in working with employers by sharing solutions and providing employers tools includng health benefit design, worksite health-related programs, and building an overall culture of health to improve the health and productivity of their employees and to use their health benefit dollars efficiently.

Click here to read the editorial.

Bredesen's Budget Includes No Extra Funds for The Med

Looks like a "business as usual" proposal from The Med is a non-starter. Where is the creative plan that paints a different vision?

Click here to read more details.

A Thoughtful Commentary on Health Reform

I can't do this piece justice to summarize, so please just read. You (and/or I) may not agree with all he says, but he does lay the issues out in a thoughtful manner. Well worth the read..

Click here to read more.

2009 Was a Great Year for MBGH!!

2009 was great for MBGH..celebrating hospitals, health plans & physicians that are improving quality & efficiency of care in Memphis, holding our first annual conference, hosting the NBCH Board at Graceland & NBCH meetings in Memphis, and representing Memphis employers in Nashville, DC, Pittsburgh, Dallas, Phoenix, Philadpelphia and beyond..We look forward to 2010!!

We're Likely to Continue to See a Decline in Small Physician Practices

Atul Gawande's latest article in the New Yorker magazine compares the current health care quality and efficiency crisis to a similar crisis experienced in agriculture in the early 1990s. Gawande points out that improvements in agriculture, driven by scientific and technological advances and evidence-based efficiencies, resulted in farm consolidation and the rise of big "agribusiness". And, the small farmer suffered as they became less competitive with larger, consolidated farms.

Gawande postulates that small physician practices may face a similar situation. Pressures for physicians to consolidate will only increase with the emphasis on performance measurement and outcomes-based payment methologies.Given this direction, we are likely to see the number of small practices continue to decrease.

Click here to read a summary of the article's points on small physician practices.

Click here to read Atul Gawande's complete article.

No Memphis Hospitals on Leapfrog's Top Hospital List

No Memphis hospitals are on The Leapfrog Group's Top Hospital list for 2009. Only TN hospitals were Vanderbilt University Hospital and The Monroe Carell Jr. Children's Hospital at Vanderbilt. I'm challenging Memphis hospitals to have at least one of our hospitals on this list by 2011. Which hospital(s) want to help make this happen?

Click here to see the entire list of Top Hospitals.

MBGH Had a Full House at our Health Reform Update

Andy Webber, CEO and President of the National Business Coalition on Health, updated a capacity crowd at this morning's MBGH "Health Reform: How It Affects Employers" breakfast meeting at the Crescent Club.

Andy focused on the major provisions that impact employers:

• The employer mandate and "pay or play" proposals, including the federally mandated minimum benefit design
• The development of insurance exchanges and the public option
• Excise tax on "cadillac" plans and
• Workplace health promotion incentives.

Andy believes that there will be some type of health reform passed and signed into law by the first quarter 2010, perhaps as early as the President's State of the Union Address in January. According to Andy, there is just no other option for the Democrats but to pass SOMETHING. The exact shape of that "something" is still to be determined, especially the fate of the public option.

Click here for a copy of Andy's slides.

We Need a Holston Medical Group in Memphis!

We need a "Holston Medical Group" in Memphis!!! Blown away at the "Preparing for a New Healthcare Landscape" meeting by the clinical, administrative, & cost outcomes Holston Medical Group has achieved with their emphasis on electronic medical record, team approach to care, and general "accountable care organization" philosophy. Who is willing to do this in Memphis? Can't wait to get Dr. Jerry Miller to Memphis to share his knowledge & inspire change...

How Do We Save the Med?

The discussion on how to save the Regional Medical Center at Memphis (the Med) is heating up. The Med's Board has indicated that it will close the emergency room, 70 medical/surgical beds, and outpatient clinics if $32 million is not found by February 2010.

An idea floated by Shelby County Commissioner Mike Ritz is to add a 2% tax on all hospital services in Shelby County (click here). A letter to the editor from Gary Shorb, CEO of Methodist Healthcare calls for "public support" of the Med (click here), but is unclear as to what form that support should take. Gary Gunderson and Scott Morris, in a special Viewpoint column today (click here), call upon us to "pray with all of your might for the health of our city, for those who will be affected if The Med emergency room is closed. We also call on all to pray for the strength to make wise decisions that will lead Memphis to be a city where rich and poor alike have the benefit of being cared for when we are most vulnerable."

This last call by Gunderson & Morris is a call to action to make "wise decisions". But what is the wisest decision? To burden those who are paying the high cost of health care by adding an additional 2% tax to their already high bill could have dire unintended consequences. One of those consequences could be pricing health care services out of reach of even more people, adding to the community burden of the uninsured. The call for public support could possibly take the form of a broad-based strategy to raise revenue for the Med. After all, if it is indeed a community resource or "utility" then don't we all have a role to play in keeping it viable?

One last thought: as I wrote to the CA back in August 2008 (click here), the Med owes us something in return for our financial support. It owes us a well-run, efficient hospital offering our community the highest quality care for the services it provides. As Gary Shorb points out, the Med has made progress in these areas. However, the Med should make a commitment to be held publicly accountable for the cost and quality of their care by agreeing to publicly report their progress in implementing critical patient safety and quality improvements by reporting, like the other Memphis-area hospitals, to The Leapfrog Group Annual Hospital Survey (click here).

We are being asked to dig deep into our pockets as citizens to support the Med, and the Med should prioritize showing us that it is worthy of this support.

A Call I Can Finally Answer

A friend of mine called last week to ask for suggestions for a cardiologist and a cardiac surgeon. Her husband’s father had been admitted to the ICU and they determined that he needed a cardiac cath and possibly surgery. She reached out to me because she knows that Memphis Business Group on Health has been collecting information on the quality and efficiency of cardiac care in Memphis since 1997. She also knew that we had worked with physicians, including cardiologists, to help them evaluate the quality of care they gave their patients and to see if they met national standards. She knew that my father had practiced medicine in Memphis for 45 years and had referred me through the years to the physicians he knew would give me good care.

In the past, all I would have had to share with her was this “insider” information. Information that was not generally available to everyone in Memphis, but information I had because of my job and because of my family. One of the well-kept secrets in health care is that insiders know who the good doctors are but that information has only been available to those "in the know".

Well, today I am excited that we are beginning to “democratize” healthcare!!! No longer do you have to be an insider to get some credible information on our local physicians. I was able to refer her to www.healthymemphis.org and tell her to scroll down and click on “Patient Experience Survey” to go to the Consumer Checkbook survey results for over 400 Memphis-area physicians, including cardiologists. These results are based on perceptions of care gathered from thousands of Memphis-area residents about their physicians. I was also able to refer her to www.NCQA.org where she could click on the link “Recognition Programs” to see the list of cardiologists in Memphis that have voluntarily submitted information for evaluation and have been recognized for the quality of care they provide.

I am glad I can finally answer a call looking for a good physician by referring a friend to credible information. I hope my friend followed-up and used this information as well as information she gathered from her father-in-law’s primary care physician and other friends and family. Having this type of information publicly available to everyone, not just health care industry insiders, is a huge step in helping make quality care available to everyone in our community. But having this information will only help if we begin to use it. So, check the sites out yourself and let me know what you think.

Make Your Own Health Reform

In the midst of all of this health reform hubbub, I was struck by the simple message of an article by Rick Johnson for HealthLeaders Media, published July 28, 2009. He states:

"But whatever comes out of the other end of the health reform debate, insurers and employers should not count on the eventually watered down version of health reform - assuming some plan actually becomes law - to help change the direction of healthcare's cost curve. No, it is wiser to exhaust the tangible options at hand. A truly progressive employer is striving today for a mix of employee wellness efforts and contracts with health care organizations - both at home and abroad - that bring down the cost of some of the most pricey and common procedures....One day this health reform movement seems to gain momentum, and then the next day it loses traction..... So work today to bend your organization's cost curve. No one is going to do it for you tomorrow."

When we developed the theme for our recent August 26 conference, "Do It Yourself: Health Benefit Tools for Employers", we didn't know the twists and turns health reform would take. As it turned out, that was a perfect theme as the conference focused on what Memphis-area employers CAN do to bend their own cost curve. Actions around benefit design, vendor management, work site clinics, and activating your employees are all within your realm of control. You don't have to wait on Congress for changes in these areas. You don't have to wait for the health care delivery system to improve quality and become more efficient to take these steps.

Put these strategies that employers can do now together with local efforts to measure and report on provider performance, create systems to help providers improve the quality and efficiency of their care, and engage consumers across the whole community, and we have a recipe for our own local health reform.

Let's learn more together about ways we can bend our own cost curve and reform our own system and not wait for the federal government to make that happen. The more of us that take these types of actions, the faster we will see the difference.