Mission recognized in Washington for low-cost, high-quality care
How do they do that? That was the question on the minds of legislators and health policy experts on Tuesday, July 21, when representatives from 10 communities, including Asheville, traveled to Washington, D.C., to participate in a one-day symposium entitled "How Do They Do That? Low-Cost, High-Quality Health Care in America.
The symposium was moderated by four of the country's most celebrated health care improvement experts: Donald M. Berwick, MD, President and CEO, Institute for Healthcare Improvement; Elliott Fisher, MD, Director, Population Health and Policy, The Dartmouth Institute for Health Policy and Clinical Practice; Atul Gawande, MD, Director, Brigham and Women's Hospital Center for Surgery and Public Health and Associate Professor, Harvard School of Public Health and Mark McClellan, MD, PhD, Director, Engelberg Center for Health Care Reform at Brookings and former Director of Health and Human Services during the Bush Administration.
Representing Asheville and Mission were Joseph Damore, former President & CEO of Mission Health System and Mission Hospital; George Renfro, Managing General Partner of Nash Renfro Investments and Chairman of the Mission Health System Board; Alan Baumgarten, MD, a family practice physician and Mission Hospital's Chief of Staff; William Hathaway, MD, a cardiologist and Mission Hospital's Vice Chief of Staff; and Kris Hoce, CEO of Pardee Hospital in Hendersonville. Joining them were hospital and community representatives from Cedar Rapids, Iowa; Everett, Washington; LaCrosse, Wisconsin; Portland, Maine; Richmond, Virginia; Sacramento, California; Sayre, Pennsylvania; Tallahassee, Florida; and Temple, Texas.
Why now and why these communities? In a March, 2009, speech at the White House, President Barack Obama said, "The greatest threat to America's fiscal health is not Social Security. It's not the investments that we've made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation's balance sheet is the skyrocketing cost of health care."
Then on June 1, Harvard surgeon Dr. Atul Gawande published an article in The New Yorker magazine entitled "The Healthcare Conundrum," that examined the underlying reasons behind the cost of health care in different communities, even some within the same state. In the midst of the current debate over health care reform, it got the attention of politicians, health care providers and policy experts. The result was the July 21 symposium, which provided a forum for communities with high quality, low cost health care to share their experiences.
There are many opinions as to why healthcare costs vary so much and why high cost doesn't necessarily produce the best clinical outcomes. Some cite an unhealthy populace, big government, different treatment protocols, unnecessary tests, and the cost of malpractice insurance. Clearly, there are many contributing factors, some of which can be quantified and some that cannot.
Which brings us to The Dartmouth Atlas of Health Care, widely regarded as one of the most valuable and reliable tools in assessing healthcare cost and quality. It examines patterns of health care delivery and practice nationwide using Medicare billing and utilization data for 306 Hospital Referral Regions (HRRs).
In ranking the 306 HRRs, the Dartmouth Atlas takes into account age, sex and price-adjusted Medicare spending per enrollee and the intensity of hospital and physician services provided to seriously ill Medicare beneficiaries during their last two weeks of life (according to the Hospital Care Intensity Index).
It also analyzes the CMS Hospital Compare Survey that measures quality of care against a standardized set of core measures for three common clinical conditions: acute Myocardial Infarction, heart failure, and pneumonia. When outcomes were combined, Mission scored 94.6 out of 100. When all factors were taken into account, Mission ranked 24th among the 306 HRRs measured by the Dartmouth Atlas, making is one of the nation's top performing hospitals.
So how DOES Mission do it?
In presenting Asheville's experience, Joe Damore began by citing the region's long history and culture of medical excellence. He pointed out that Asheville is a community that is attractive to high quality physicians.
- Has a strong culture of physician and hospital collaboration that is patient-focused.
- Has a large primary care base that is complemented by MAHEC's Family Practice Residency Program.
- Is home to a high number of integrative medicine providers.
- Has relatively low demand for health services, despite the fact that it is a retirement center.
- Has strong hospice care and palliative care programs.
- Has physicians and clinicians with 10 years or more of experience developing and implementing clinical pathways, order sets and chronic disease management.
- Has a culture of healthcare innovation, particularly in providing care for the uninsured, providing disease management programs for people with chronic diseases like diabetes, and community wellness.
The symposium didn't focus on the Congressional health care reform debate and the various bills being constructed in the House of Representatives and the Senate. Instead, the attendees stressed the need for changes in Medicare's payment system in ways that incentivize and reward providers who are providing low cost, high quality care. Other common themes that emerged from the 10 communities included:
The need for strong leadership, particularly from physicians, to improve and standardize health care.
- The importance of creating a strong base of primary care physicians.
- The importance of coordinating care among all providers.
- Improved accountability by using health care data to measure the performance of providers and to share with purchasers of care and the public.
For his part, Dr. Gawande, the Harvard surgeon and author whose article created such a buzz in Washington, D.C. and beyond, the symposium's results were clear. All better-performing communities have a culture of putting the needs of patients ahead of business models. "These are communities we want to protect and spread, but they are threatened," he said.
