A time of transition

As I mentioned in my last post, I transitioned to the CEO Emeritus role at CHRISTUS Health on March 1, 2011. This is a time of many great changes, and my blog is one of them!

While I have truly enjoyed interacting with each of you in this forum, I’m moving to a new blog that will allow me more flexibility and an enhanced ability to share what I’m doing and learning in my new pursuits.

One of those pursuits includes a book I am writing, which I’ll be posting about on my new blog tomorrow! Please join me at http://thomascroyer.blogspot.com to continue the conversation.

Thanks to each of you for the time you’ve invested here in this blog and engaging with me. I’ve been blessed by my interactions with each of you.

Yes, This Was One of the Reasons: Some Final Reflections

As I transitioned to the CEO Emeritus role at CHRISTUS Health on March 1, 2011, I wanted to share with you some reflections in my final days as the team leader of the CHRISTUS Health ministry.

As a health system, in principle, we know what we need to do over the next decade to be successful. From the five strategic directions which emanated from our Futures Task Force II work and the proposals articulated in the health care reform law, we have a fairly clear itinerary. There is no question that the health care industry is about to go through transformational change.

With that said, while we all recognize that although our itinerary is extremely clear and well-planned, driven by both our successes and challenges over the last 12 years, an itinerary is not a roadmap. I explained this in a presentation given to CHRISTUS Health Associates over the past months:

Royer Transition Presentation March 2011

View more presentations from CHRISTUS Health

Just as we, together, created the roadmap to execute our learnings and recommendations from Futures Task Force I, which has driven us to a great place on our Journey to Excellence, Ernie Sadau, CHRISTUS’ new CEO and his senior leadership team, in collaboration with the entire CHRISTUS family—the Associates, physicians, volunteers, governance boards and committees and the sponsoring congregations—will have to create and communicate the CHRISTUS rules going forward. This will ensure that our vision of becoming a health and wellness delivery system which can manage and coordinate our patients’ and residents’ health across all care settings will become a reality. This level of organizational preparedness will require new or enhanced care competencies which we have identified for 2011, and have numerous initiatives in place to accomplish such.

As in the past, the future work of the entire CHRISTUS Health family will have to be transformational work. And as I have reiterated on many occasions and at many events this year throughout the system, transformational outcomes are facilitated by people who have been called to their work. For me, determining whether you have been called can be done by asking a question I have asked myself at various times in my life’s journey; “Could this be one of the reasons why God put me on this earth?”

My wife Jane and I know that we were called to CHRISTUS Health. And, yes, I know having the privilege of being the team leader for our Associates is one of the reasons I was put on this earth. Truly, walking with you has been a blessing. For this, I will be eternally grateful and extend my sincerest of thanks for all the contributions you have made to collectively help us to be successful on our 12-year Journey to Excellence.

Hopefully our paths might cross again as I serve as the CEO Emeritus of our great ministry. Each day, I will keep you in my prayers, knowing that Ernie and his Senior Leadership Team will be most successful in driving the transformational changes necessary to ensure our success in reaching the top of the excellence mountain. It is with special love for each Associate that I conclude with one more sincere thanks for your support—past, present and future.

Ernie Sadau
http://www.christushealth.org/body.cfm?id=118&fr=true

The Continuing IT Journey

I have said for many years—and health care reform is increasingly clarifying this fact—that if we are to increase the quality of our care and reduce our costs, we need to have efficient and effective technology systems in place that support consumer interaction and make it easier to implement evidence-based medical protocols.

At CHRISTUS, we have been focusing on:
• IT systems that are data-driven
• Our ongoing Unity Project to connect not only our existing acute care systems, but also connecting our U.S. operations to those in Mexico and our non-acute divisions
• A firm schedule for implementing these improvements and changes
• Physician involvement and supporting them as possible in these changes

I have said many times that physician alignment will be key to our future, and this includes alignment with our IT systems.

Physician usage and adoption of our current data system will also be critical to the overall success of our system-wide Computerized Physician Order Entry (CPOE) efforts. The move to electronic medical records and CPOE is closely aligned with quality patient care. Although the quality improvement benefits to automation will not occur overnight, we remain confident that positive results will be widely recognized.

Staying Connected in Haiti

Those of you who stop by my blog regularly probably remember our trip to Haiti last year and how it changed all of us. (To read the posts about Haiti, click here.)

In February 2010, I led a 20-member medical team who served for a week in Port-au-Prince, but we knew that was just a drop in the bucket of what the country and its people would need. That’s why CHRISTUS Health recently announced that we have committed $1 million to rebuild and reopen Hospital St. Francis de Sales, a Catholic hospital in Port-au-Prince that was heavily damaged during last year’s earthquake.

You can read more about the project on our Website here. Please consider joining us and other Catholic health systems around the country as we make ongoing investments in the health care infrastructure—and ultimately, the people--of Haiti.

Some Positive Aspects of Health Care Reform Already Making a Difference for CHRISTUS

Today, I’d like to share with you some newsletter articles from our system publications about how federal funds are supporting the work of CHRISTUS in our regions.

CHRISTUS St. Michael Awarded $1.8 Million Grant for Kids Care Collaborative

The Texas Health and Human Services Commission awarded CHRISTUS St. Michael a $1.8 million grant to implement a two-year health home (medical home) pilot program. The program, named Kids Care Collaborative, will involve a partnership between the University of Arkansas for Medical Sciences Area Health Education Center – Southwest, the All for Kids Clinic in Texarkana and Texarkana Community Clinic.

The Kids Care Collaborative is designed to develop best practices for many of the medical home strategies already in place at CHRISTUS St. Michael, in addition to those that it plans to implement in the future. Although intended to benefit children who are covered by Medicaid in the state of Texas, the collaborative will also serve other children and adults so that the vision of a medical home for all will be closer to becoming a reality. The pilot program will provide a medical home for participants that will also include dental and behavioral health services.

Immediate goals to be accomplished are hiring of staff, establishing collaborative relationships with medical professionals, securing office space and beginning the necessary training so that the foundation for a successful program is laid. Mike Finley, M.D., regional chief medical officer, will provide overall leadership and guidance. This is an exciting time for CHRISTUS St. Michael as it leads the effort to transform health care delivery in the Ark-La-Tex region.


$4.23 Million in Federal Incentive Funding for “Meaningful Use” Awarded to CHRISTUS Louisiana Acute Care Facilities

CHRISTUS Health received a payment of $4.23 million in federal incentive dollars for its Louisiana acute care facilities, an amount designated as a “down payment” in exchange for our commitment to meet the established criteria for “meaningful use” of electronic health records set forth in the Health Information Technology for Economic and Clinical Health (HITECH) Act enacted as part of the American Recovery and Reinvest Act of 2009. Our Texas facilities plan to follow the same protocol required to receive a down payment in the near future. Based on the payment formulas provided by the Centers for Medicare & Medicaid Services, CHRISTUS incentive payments over the next five years could potentially approach $109 million.

ACOs or Clinical Integration?

On numerous occasions you have read here that the high cost and low quality of some health care in the U.S. is due to overuse or misuse of many therapies and the lack of coordination of care among various delivery points, causing duplication of services. If ACOs do what they are supposed to do, they will hold providers truly accountable for a patient’s care through its entirety by creating meaningful clinical collaboration between physicians and hospitals, utilizing clinical evidence-based treatment plans proven to result in higher quality and lower care.

Although there are major challenges to overcome, including connecting hospitals and physicians with electronic data and determining how ACO reimbursement will be distributed, CHRISTUS Health recognizes opportunity and supports the concept of ACOs, but more importantly, the idea of clinical integration, which is the basis of our strategy. This position provides an aligned approach to care management that allows hospitals and physicians to collaborate to provide coordinated, lower cost and higher quality care. The significant differences between ACOs and the Clinical Integration model are:

• ACOs are Medicare-only and are still based on a fee-for-service model (which limits their effectiveness in the short term, but they will likely migrate to capitation);
• Clinical integration requires an alignment between physicians and hospitals based on the desire to improve the cost/quality equation. That is the primary focus of the alignment.
• Clinical integration requires a governance structure that holds all parties accountable for evidence-based protocols that will ensure high quality and minimal "waste" in the care delivery process.
• Clinical integration requires data integration across the continuum, but with little specificity about how that occurs. In fact, some of the greatest success stories in clinical integration have been operating with little more than a data repository for years, but have been able to achieve significant improvements in clinical outcomes and cost.

While the challenges outlined by some industry analysts are valid, the concept of ACOs is a sound one if all parties are truly committed to improving the cost/quality equation; however, current legislation does little to actually hold all parties accountable and responsible to each other. Clinical integration, on the other hand, is not legally mandated, but is more of a business management model designed to reduce utilization, standardize care, manage care (via a medical home) and improve quality - while at the same time lowering overall cost. The most important benefit of doing so is that physicians and hospitals can co-negotiate for managed care contracts and can command higher payments from private payers on the front end for demonstrated superior quality.

Reform Repeal Vote

As I’m sure you are aware, the U. S. House of Representatives will be holding a vote today on H.R.2, “Repealing the Job-Killing Health Care Law Act."

As a health care entity still subject to the requirements of the Accountable Care Act, CHRISTUS will move forward with implementing the provisions of health care reform in accordance with the law. We will also continue to advocate for additional legislative measures that expand access, reform payment mechanisms and address social justice issues. We are aggressively sharing knowledge and best practices across our ministry to reduce costs and speed implementation while improving quality and patient satisfaction.

CHRISTUS Health will continue our commitment to “Putting Care Within Reach” of all those who need us, and will remain focused on providing high quality, compassionate care each and every day.

A New Era for Hospital-Physician Alignment

There is no denying that we live in an era of rising health care costs. As a result, we have seen many strategies like health care reform to reduce these costs and ensure that everyone in our country has access to the care they need. It is clear that our shared goals of higher quality care at a lower cost can only be achieved through collaboration. This means collaboration between hospitals and physicians as well as providers across the continuum of care (long-term care, home care, clinics, etc.) and patients themselves.

I was recently interviewed for an educational report compiled and distributed by the healthcare financial management association on the topic of hospital-physician alignment, which covers why it is important now, and how health care systems can foster and support alignment with physicians (as well as the much-noted ACO model). I’m admittedly somewhat biased, but I believe it is a thorough, well-written report, and I suggest you pause to read it and share it with your teams.

Any Illness is Not Good Medicine!

I was overcome with disbelief when I saw an article yesterday morning in The Dallas Morning News claiming that flu cases are good medicine for hospitals. Why?

First and foremost, it’s hard to imagine that any illness could be good medicine for anyone, including hospitals. Yes, we know that the “good medicine” referred to in the headline was the “good financial outcome” for the hospital that an increased influx of flu cases would cause. However, that would be the ultimate cause of some of the poorest medicine delivered in the U.S. today: Do whatever you can as a provider, providing services that even may not be necessary, to increase revenue and bottom line profitability.

Second, having flu patients in a hospital is actually bad medicine for the inpatient setting, since it would make the spread of flu more likely and increase the likelihood of a patient flu “epidemic” within the hospital. Clearly, the goal of any health care team should be to keep as many flu patients and flu symptom visitors away from the hospital campus as possible.

Third, flu cases do not generate any operating income for hospitals, which the article got close to right; a hospital analyst reported that “Higher flu activity is likely to increase medical costs. . .However, unless the flu activity increases dramatically, we expect a limited impact on company earnings.”

Fourth, indicating that the absence of a flu season is the cause of flat year-over-year inpatient volumes holds little truth. We have had minimal flu season volume increases for multiple years, and there are many other more valid reasons to volume declines, including the global economic crisis, which caused more patients to cancel elective procedures, and new technologies permitting more procedures to be done safely in outpatient settings.

Fifth, and most importantly, preventing flu through prevention and education should be health care providers’ primary focus, not encouraging more flu cases so as to cause bad medicine for hospitals.