Wednesday, August 15, 2007

The CHRISTUS Portfolio

As I have mentioned several times, health care is extremely complex. Therefore, it requires much time, effort, and focus on daily operations—particularly in light of the constant changes occurring in the regulatory environment.

However, an additional complexity of health care is that the trends we are seeing today are causing such radical changes in the delivery of care that if we don’t pause now to give sufficient time to envisioning the future, it is a very good possibility that when we reach the future, we will be inadequately prepared.

Consequently, since its inception in 1999, CHRISTUS Health has committed a significant amount of time and effort to monitoring health care trends and planning for the years ahead. After completing our first round of future planning (Futures Task Force I utilizing scenario planning) we recognized that the two major drivers of health care change for both CHRISTUS Health and all of U.S. health care would be:
1) the declining reimbursement under the control of both the federal and state governments, and
2) the rapid introduction of technology that would move a significant amount of health care from an inpatient setting to the non-acute arena. At CHRISTUS, we define non-acute care as “care and services that do not require an inpatient acute care hospital stay” (i.e., outpatient sites, clinics, continuing care retirement communities, long-term care, etc.).

In fact, when we began future planning, we believed—and have subsequently proven—that this introduction of non-invasive technology would be so rapid that it would be disruptive. In fact, it is so disruptive we could not respond rapidly enough to its introduction and were burdened with the question, “Should we purchase the first generation of the technology, or wait to purchase the second generation?” Technology is changing so rapidly that with limited financial resources, this question needs constantly to be asked, and then, as objectively as possible, be answered using data as rationale.

A living example of this dilemma which occurred in the last 10 years, was the introduction of lithotripsy. If you are as old as I am, you can recall that this technology was first introduced by requiring that patients be immersed in a water bath. It was clear to me as a practicing physician that this technology would not be long-lived, particularly because
1) If patients coded in the tub, how could they be revived without significant movement?
2) It would eliminate a large number of obese patients who were unable to be placed in the tank.
3) And it would eliminate a large number of patients who were afraid of water.

However, I was bombarded by requests from Urologists to purchase this technology as quickly as possible. Those of us who owned the first generation of lithotripsy devices soon realized when the second generation of dry lithotripsy was developed in response to all of the concerns outlined above, that we had indeed wasted $1.5 million and had to find another use for the small swimming pool we now owned.

With all of this learning, CHRISTUS Health has utilized these drivers to recognize that acute care will be significantly changing in the future, and that a much greater emphasis needs to be placed on the non-acute product lines. In addition, CHRISTUS is somewhat unique because of our strong international presence, predominately in Mexico.

Because of this, we have begun the transformation of our portfolio to one-third acute, one-third non-acute, and one-third international. I will cover each of these thirds in more detail in future blogs.

However, today, it would be appropriate to discuss two more drivers of this transformation, those being:
1) the senior aging process and
2) the large number of baby boomers who are reaching 65 years of age.

With regard to the former, it has been our observation while studying the seniors on our senior campuses (independent living, assisted living and long-term care), that these people—often with average ages between 85 and 90—are not aging like our parents. They are staying healthy for a prolonged period of time, have a strong desire to stay in the most independent living situation possible, and in their final weeks, are often facing an acute illness such as a heart attack or stroke, which cause them to request hospice care for a shorter period of time.

This is verified by our data that indicates that people stayed approximately three-and-a-half years in our long-term care facilities in 1999. Now, they spend less than 9 months on average there, instead spending most of their time in the independent living or assisted living locations.

It is important to note, also, the findings of an ongoing study in the United States of over 4,000 people who are over 100 years of age. These people have no common characteristics related to avoiding common health risks, i.e., obesity, smoking, alcoholism, etc. This population includes all of these health-risk factors. Instead, surprisingly, the four things they have in common are:
1) They are optimistic people; they always see the glass as half full.
2) They have learned to accept loss and move on. Most of these people have buried their spouses and all of their children.
3) They stay on a relatively routine schedule each day, meaning they get up at pretty much the same time each morning, eat their meals at the same time, and go to bed at the same time.
4) They all have an avocation. It may be as simple as meeting at Starbucks or the local diner for their morning coffee, or as complex as a daily golf round or a bridge session.

For me, this data indicates that if you live beyond 65 to 70 with a chronic illness, you have reached a stable relationship with that illness and will probably not die early because of it, or one of its major complications. For example, we do not find a large number diabetics in their 70s or 80s who develop gangrene or blindness, because they have learned to manage their disease. Consequently, when their final demise occurs, it is rather related to a short-lived acute episode as mentioned above. Therefore, this population of people—rather than requiring extensive inpatient stays and therefore new hospital beds—will want their care in non-acute settings accompanied with outpatient hospice support.

The baby boomers, on the other hand, are a population of people who want their care as rapidly as possible, as affordable as possible and with the highest quality possible. They are also being burdened with increasingly larger co-payments and therefore are much more focused on where, when and from whom they are going to get their care.

By doing a survey of this population, we have learned that they will much prefer to have their care in a patient-centered urgent center, mini-clinic, or other outpatient facility. They will only opt for inpatient beds which when absolutely necessary. And if it is necessary, they will want a room that is far different than our present hospital rooms. They will want them to be large enough to accommodate families at all times—much like we have in Mexico—and they will want full access to all the internet technologies so their communications, either from themselves or from their family members, will never be disrupted.

So our transformation has been driven by a clear understanding of the present complexities, the future vision and the major drivers of health care in the future. Transformation, we believe, is required if this future is going parallel with what patients and their families will desire and demand in the next 10 years.

3 comments:

Anonymous said...

Dr.Tom,
What an informative sight. Patient-centered urgent care? I have not heard of this but it sounds like something special. As someone who has visited all three of your hospitals,(yes I am currently poor, but thats just a temporary sympton)Spohn Shoreline and Spohn South are wonderful and clean. All Healthcare workers seem happy and patients well cared for. Both of these hospitals radiate health, peacefulness, and a sunny disposition. You can't walk through them without feeling at least a little happy. I think the ambience of happiness and cleanliness is a positive thing for the workers and patients. Yet Spohn Memorial looks dirty, drab, and desperation is in the air. I know its old but the walls and floors in the exam rooms in the ER and the ER Waiting room are just dirty looking. There is definitely less respect and sunny attitudes toward the poor in the ER but the Dr.Offices and waiting rooms and patient rooms seem clean. I know miracles are happening every day there because of the God Given Talent and hard work of Doctors and Nurses. You just don't feel the sun or healthy outlook that seems to promote healing. The ER looks dirty. Well that's fixable. There is a problem many are worried about when it comes to getting their prescriptions when there is a hurricane. I think it's 3 prescriptions a month and they cannot be given to patients a day earlier than a month. I have not been there in a while so I do not know if you have come up with a plan to help those get their prescritions in case of evacuations or bad storms that would knock out roads. Is there a sister pharmacy or clinic located in cities people might need to relocate to that would be able to help the Nueces County Clinic Patients receive medication refills? If not is there a way during hurrican warnings they can get a prescription earlier than waiting a whole month? They advise people to have at least a months worth of any medication they might need, because nobody knows how long a disaster can last. I know you have emergency procedures for patients that are admitted but if there is a plan for Clinic patients getting a perscription refilled early please make sure the information gets to the patients. I know you have many headaches to deal with. Getting the government to pay your hospitals and doctors must make you feel like a dentist. I recently found your blog and find it quite interesting. Are staph and MRSA infections a problem here like they are in other cities? Boston claims they are winning that war. Well I will bore you no longer. I am a CMA. Not as educated or as impressive as a Doctor and CEO. Have a nice week.

Sincerely,
Kim Dees (not so anonymous)
p.s. Corpus Christi is a beautiful city, just don't drink the water.

Craig said...

8-20-07

Dr Royer:

I was intrigued by your employment video and by your wireside chat while viewing the Christus Health web site. Impressed with your leadership, I wanted to inquire with you directly about a couple of questions at it relates to Catholic health care. The first has to do with the locations of your hospitals. I live in the Dallas-Fort Worth area and there are not currently any Catholic hospitals. I have seen several hospitals built over the past few years in the area and I know there are plans to build more. Has there been any discussion about bringing a Christus Facility to the DFW area?
My second question has to do with women’s health in general but reproductive health specifically. Even though I have been a Catholic all my life, I never paid much attention to the teachings of Humanae Vitae. So ignorant of the teaching, I trained to become a reproductive physiologist (Ph.D.) and went on to become director of an infertility laboratory. There I performed all the modern laboratory procedures including IVF, embryo freezing, ICSI, etc. I left my position as embryologist and assistant professor of Ob-Gyn 8 years ago after progressively struggling with the aggressive use of this technology. Since then I have been working for an orthopedic medical device company but have also received training on the natural methods to regulate fertility. I am curious why a distinctively Catholic health organization like Christus would not more assertively offer teaching and treatment using natural methods?
There is a strong need for a different type of women’s health center that would focus on reproductive health from menarche to menopause and also extend into geriatric care. Endocrine problems and osteoporosis are two areas that preventive medicine can have a major impact on. Having a laboratory and medical education program that focused on the natural family planning methods would be effective for this and would stand out as unique. I personally know at least 3 ObGyn’s in the DFW area that have NFP practices only. The need would only increase as more in the medical and scientific community embrace, study and legitimize this health science. I personally would be willing to devote the rest of my career to such an endeavor. Is it possible that Christus Health is the organization to do this?
I thank you so much for your time and look forward to your comments.

Sincerely,

Craig Turczynski, Ph.D., HCLD.
turczdad@aol.com.

Dr. Tom said...

Dear Dr. Turczynski,

Thank you for visiting the CHRISTUS Health Web site and for your positive feedback on our health system’s employment video and Wireside Chat. As we strive to achieve transparency in all that we do, we believe it is important for both existing employees, as well as those who may be considering job opportunities within CHRISTUS, to be familiar with our mission, vision and values, as well as the latest news and information impacting the health care industry as a whole and CHRISTUS, in particular.

To address your first question relative to CHRISTUS Health’s presence in the Greater Dallas-Ft. Worth area, current market assessments confirm an overall lack of need for additional acute care beds in the area at this time; however, CHRISTUS is pleased to partner with Catholic Charities in Grand Prarie, Texas, to fund a clinic designed to improve access to needed health care services. In addition, CHRISTUS operates a non-profit retirement community founded in the Catholic faith, CHRISTUS St. Joseph Village, which is located in Coppell, Texas, just a short distance west of Dallas.

As for your second question regarding reproductive health services, many CHRISTUS regions offer comprehensive women’s health programs and our system intends to continue its strategic focus on women’s health services, both now and in the long term.

Again, thank you for your interest in CHRISTUS Health and for your thought-provoking dialogue.