Wednesday, December 29, 2010

Happy New Year

Like in years past, as 2011 unfolds, the CHRISTUS family will again experience many blessings and face numerous challenges. As we prepare to celebrate the 12th birthday of the CHRISTUS Health ministry on Feb. 1, 2011, we should all pause not only to reflect on our accomplishments, but also embrace the clear action plans which will be necessary to address and hopefully mitigate future challenges.

Truly, our blessings have been many:
• Our culture is alive and well, seen in the lived experiences of our Associates, physicians, and volunteers, who daily are driven by our mission, vision and values.
• Our brand is strong and well-recognized, both internally and externally, built around our 4 directions on our Journey to Excellence.
• Our business literacy has achieved the highest performance metrics in our history, including days in cash, operating margin, investment income, labor and supply costs, and accounts receivable.
• Our community benefit contributions continue to maintain a leadership position among Catholic and not-for-profit health care providers, both in the U.S. and Mexico.
• Our futures planning process, including Futures Task Force II, which completed its work in 2009, has positioned us well for health care reform based on the identification of 3 strategic drivers, 5 strategic directions and 8 strategic enablers to guide us through the next decade.
• Our support and learnings from important improvement initiatives begun in 2010 which will continue in 2011, including: Medicare profitability, labor productivity, asset sales, physician integration, evidence-based clinical protocol development, stringent capital review process, revenue cycle enhancement, supply chain improvements, clinical information upgrades, refinement of continuing care and non-acute strategies, and clarification of international strategies.

Yes, with all of these blessings and accomplishments resulting from much hard work and effort from all members of the CHRISTUS family, we are positioned well for the continuation of our Journey to Excellence in the new year. But because of the complexity of health care, which only seems to increase, we will also have to face again some significant challenges. Because it is the right thing to do, we must embrace the positive innovations embedded in health care reform and transform CHRISTUS Health totally from a claims/payer system mentality which drives fragmented care, to a value-added partner mentality, with our patients and residents supporting seamless coordination of care. Fortunately, the initiatives articulated above, which are well under way, should address or significantly minimize the challenges which clearly are forthcoming. However, to be successful, we will have to embrace even more change and do everything possible to accelerate our Journey to Excellence for the continued success of our ministries.

Based on our effective team effort, we are strong today so as to be able to stand alone as a sustainable health care business model into the future. In addition, because of our significant growth over the last 12 years, we have the size and scale to create and finance further growth plans that can thrive in each of our ministries in our acute, non-acute and international divisions.

Facing and addressing challenges is nothing new for us. For the last 12 years of CHRISTUS Health--and for the entire 144 years since the founding congregations answered Bishop Dubuis’ call in 1865--we have faced fires, floods, epidemics and hurricanes. Although they have occasionally slowed our journey, we have been able to overcome each of them, learning from these experiences and renewing our energy and enthusiasm to continue our forward momentum. Such will be the case also in 2011.

Each of us is truly blessed to have answered the call and to continue to serve in our sacred ministry, CHRISTUS Health. In this new year, the successes will even be greater, and the challenges will be different, but most importantly, the call will remain the same: to carry out the healing ministry of Jesus.

So as we travel toward a new year, let us pray that it will be filled with much peace and happiness for all who enter our doors, for all members of the CHRISTUS family and their loved ones, and for those throughout the world who suffer hardships and pain. Let us ask for the strength necessary to use our hands and hearts effectively, to replace as much of these sufferings with our miracle moments. Happy New Year to you all.

Wednesday, December 22, 2010

Happy Holidays

When we first think of the Christmas season, many images initially pass through our minds – presents, decorations and parties. But as Christmas Eve approaches and some of the flurry of holiday activities subside, the image of the Christmas miracle – the birth of Jesus – becomes clearer. It is that miracle centuries ago that set the stage for the CHRISTUS Health mission – to carry out the healing ministry of Jesus.

With all the major challenges that health care systems face each day, including global challenges, it is important to remember that it is the miracle moments, however small, which happen in our ministry each day that truly make the difference in people’s lives. Although we may wish to believe it is our technologies and facilities that drive our outcomes, the positive results we all hope for only occur when CHRISTUS is filled with person-to-person interactions – assessing and treating an injury, offering words of encouragement, extending a warm hand, a big hug, or quickly saying a prayer.

We must always remind ourselves that the broader picture of sustained improvement would never get painted without the strokes of many artists, including our Associates, our physicians, Sisters, volunteers, board members and many others. These miracles are the true expressions of our incarnational spirituality. This is who we are. This is how we are seen. Whatever our role is in the ministry, we are the healing hands. We are CHRISTUS Health.

On behalf of the entire senior leadership team, I wish each of you many blessings for peace, hope, prosperity and happiness at the holiday season and throughout the New Year.

Monday, December 20, 2010

My Thoughts About Tort Reform in Texas

Many of you have probably read an article published this weekend in the New York Times about tort reform in Texas which featured a story from a patient at CHRISTUS Santa Rosa in San Antonio, Texas.

In an effort to protect Americans and their personal information, federal privacy laws (like HIPAA) threaten us with legal action if we comment on the care of any patient. Therefore, I can’t discuss Ms. Spears’ medical condition or treatment at our facility in detail. I can, however, extend to her my deepest consideration and compassion for what must be an extremely difficult situation for her and her family.

I can say that I have reviewed the documentation related to the incident described in the article, and it is my opinion that we provided care that was entirely complete and appropriate.

Because I can’t provide any further details, I would like to take this opportunity to add my voice to the dialogue regarding the focus of the article, tort reform in Texas.

Let me be clear: if an error occurs in our delivery processes, the patient and his or her family should be told the truth and should be financially reimbursed for the costs which have been caused by the error. In all my years as a practicing physician and even now as the president and CEO of an international health care system, I understand the great responsibility we are given by our patients and their families when they choose to place their lives and the lives of their loved ones in our hands. This is why I have always said that for CHRISTUS Health, excellence is a necessity, not a luxury.

Tort reform in Texas does not do away with financial awards to patients who have been wrongfully harmed by inappropriate treatment. It merely caps noneconomic damages at $250,000 per health care provider, with a maximum award of $750,000. Since tort reform was passed in 2003, these suits have continued to be filed, including against Emergency Room physicians, and damages have continued to be awarded.

We have known for years that the legal system put into place to deal with less-than-favorable quality outcomes in health care were necessary, but inappropriate as long as the potential settlements were uncapped and limitless. Support for tort reform does not mean refusing to accept responsibility, nor does it mean that providers are held to a lower quality standard. Instead, it means supporting paying what is due, admitting what was done incorrectly and doing everything possible to mitigate negative outcomes and create a positive solution for patients and their families.

Since the passage of tort reform, physicians have also begun to see Texas as a more attractive environment in which to practice medicine, and some studies show that our physician population has increased 31 percent. As we contemplate a current and worsening primary physician shortage, this is good news for Texans, who have more access to health care than they did before.

Specifically in CHRISTUS Health, since tort reform was passed, our expenses for litigation have been reduced dramatically. We have used these savings to further improve our quality and patient safety by reinvesting them in programs and projects throughout our entire health system. And as a result, we believe both the number of claims and the size of the claims have been even reduced further than as a result of tort reform alone.

Each of our 13 regions can submit projects which they believe, if implemented, would accelerate improvements in their quality of care. Based on competitive reviews, several of these are funded each year from these savings. Programs in the past which have received such support include providing standardized competency testing for all nurses, and providing the latest and safest way to lift heavy patients from one location to another. These programs were designed, funded and piloted and are now being universally implemented across the entire system.

The first program funded this way involved certifying all nurses and re-educating physicians in the appropriate use of fetal monitors. This was because, as many of you are aware, catastrophic events for the baby during the delivery process account for the largest number of lawsuits past and present in most hospitals and health systems. This signaled to us that improving “fetal monitor literacy” in our caregivers would result in an even higher level of safety for our youngest patients. After requiring this higher level of proven clinical competence in applying and reading fetal monitor strips during the labor and delivery process, CHRISTUS Health has successfully, in the last 12 months, delivered consecutively 17,000 healthy babies without any fetal abnormalities.

In the end, when we talk to patients who have had less-than-favorable outcomes, we believe that they truly want to be treated fairly and to do whatever is necessary to make sure the error does not recur. Tort reform makes both of these goals possible and creates a win-win situation for both the health care providers and the patients who receive our care.

I, along with the CHRISTUS family of 30,000 Associates, am dedicated to our mission of extending the healing ministry of Jesus Christ every day. We understand and take very seriously the awesome responsibility of caring for the health and lives of our friends and neighbors, and will continue to provide high quality, compassionate care at our facilities across the U.S. and Mexico.

Wednesday, December 15, 2010

Critical Success Factors for Accountable Care

As health care reform is seeking to restructure how care is delivered and reimbursed, the Accountable Care Organization (ACO) has come forth as a preferred model. A myriad of articles and conferences have appeared in response to the direction from the federal government in the hopes of educating both providers and insurers of not only what will constitute an ACO, but how they must operate to be successful.

Although many of the articles have little value, one written recently on behalf of the Advisory Board Company provides a wealth of knowledge in a well-organized fashion on this proposed model. Entitled “Health Care’s ‘Accountability Movement,' ” this article identifies and expands upon the 15 imperatives for success under accountable care. These 15 are organized into four categories:
• Physician alignment,
• Clinical transformation,
• Payment transformation and
• Information-powered health care.

As conversations about reforming how care is delivered continue and ACOs receive more and more focus, these considerations will become increasingly important.

Wednesday, December 8, 2010

The Importance of Our Cultural Competency

Since CHRISTUS Health began Feb. 1, 1999, its Senior Leadership Team has had performance goals to enhance diversity focus in our health care ministry. In 2000 when we embarked on our journey across the border to work with the Muguerza family in Mexico, we knew we would have to develop a culture competency as we worked with and developed health care delivery processes for the people who lived in another country. Although we have been extremely successful in our initial international effort, the senior team, in collaboration with the board, is increasing our focus on diversity by implementing multiple initiatives, including the formation of a system-wide diversity council and our hiring of a System Director of Diversity and Inclusion.

We are all in agreement that a diverse organization that develops a wide range of cultural competencies is best positioned for success. The various positive outcomes and competitive advantages of such organizations are articulated an article which appeared in the September-October 2010 edition of the Physician Executive Journal of Medical Management. Entitled, “Cultural Competency in Health Care Organizations: Why & How?,” this article describes the important strategies that are necessary to implement in creating a cultural competent workforce which ultimately helps patients in various ways, including reducing the risks for medical errors and malpractice claims. The article stresses that, “race and ethnicity concordance alone do not make cultural competence. Providers need specific knowledge and skill sets to provide culturally competent care.” As always, we are hopeful this information will be helpful as we continue our commitment to enhancing our cultural competency.

Thursday, December 2, 2010

Renewed Focus on the Determinants of Health

The U.S. Department of Health and Human Services today unveiled Healthy People 2020, the nation’s new 10-year goals and objectives for health promotion and disease prevention, and “myHealthyPeople,” a new challenge for technology application developers.

The Healthy People program aims is to improve the quality of our nation’s health by producing a framework for public health prevention priorities and actions. The Healthy People 2020 program includes new topics of focus, including:
• Adolescent Health
• Blood Disorders and Blood Safety
• Dementias, including Alzheimer’s Disease
• Early and Middle Childhood
• Genomics
• Global Health
• Health-Related Quality of Life and Well-Being
• Healthcare-Associated Infections
• Lesbian, Gay, Bisexual and Transgender Health
• Older Adults
• Preparedness
• Sleep Health
• Social Determinants of Health

Part of this program will examine what makes some people healthy and others unhealthy, and how we can create a society in which everyone has a chance to live long, happy lives. They recognize that solutions must address a broad range of personal, social, economic, and environmental factors that influence health status, which are known as determinants of health.

I have written many times on my blog about Canada’s seven determinants of health, and still firmly believe that if health care reform in the U.S. is to be successful, we have to address all the issues that affect overall health, not just hospitals/primary care. Therefore, I am glad to see this focus on all the factors that influence health besides health care providers, since it is clear that sectors such as education, housing, transportation, agriculture, and environment can be important allies in improving population health.