29 November 2011

Midwest Edition
Calendar
December 4-7
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Transparency Matters, Study Shows

Wisconsin Medical Practices Publish Quality Data
Its been known for many years that the fastest We very denitely showed that members way to improve medical quality in hospitals is of the collaborative improved on every to make the results of the quality metrics measure that we had been publicly reporting public. That is, publish them, so that for at least two years, Lamb said. Second, a everybody can see how well the institution is large portion, a majority, did specically doing compared to its peers. tackle improvement efforts because of the Researchers have wondered whether the reports. same principle holds for physicians practices. This has major implications for improving Theyre a lot harder to measure. In the rst quality of care nationwide, he added. Public place, how would you get the data? reporting and being able to compare yourself Nevertheless, the Wisconsin Collaborative to others really does drive improvement. for Healthcare Quality The Wisconsin project got off the decided to try to nd out. ground in the early 2000s, recalled Starting in 2003, it tracked the Don Logan, M.D., who practiced as progress of 409 clinics across an interventional cardiologist and the state against 12 standardlater became chief medical ofcer ized metrics of quality. Refor the Dean Health System, with searchers, led by Geoffrey 500 physicians based around Lamb, M.D., an internal Madison. medicine specialist at the After the famous Institute of Medical College of Medicine report came out in the late Wisconsin, looked at such 1990s, showing the indifferent state data points as results of LDL of quality in U.S. healthcare, cholesterol testing, physician leaders in Wisconsin hemoglobin A1c control, got together and decided to start Geoffrey Lamb, M.D. and common population measuring quality of care in Medical College screening measures, such as their state. At that time, there of Wisconsin pneumococcal vaccinations were no good measures of and tests for colorectal, quality performance at the cervical and breast cancers.
Continued on Next Page

January 6-8
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March 6,7
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Wednesday, December 9, 2011

Noon CST

Midwest Healthcare: A 2012 Business Preview

E-Mail info@payersandproviders.com with the details of your event, or call (877) 248-2360, ext. 3. It will be published in the Calendar section, space permitting.

Please join Michael Millenson, president of Health Quality Advisors, Jay Warden, senior vice president of The Camden Group and William M. Dwyer, president of Dwyer HC Strategies, to discuss the trends that will shape the Midwest!s healthcare business environment in 2012:

http://www.healthwebsummit.com/ppmidwest120911.htm
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NEWS
Wisconsin (Continued from Page One)
clinical level. We had to start from zero, Logan said from his retirement home on Florida. They had to start by establishing a baseline from which subsequent improvement could be tracked. Our premise was if we told physicians where they were on the curve of performance, all physicians being achievers, they would do the right thing, Logan said. We would publish them internally, then publicly. We thought public exposure would help us. The notion that publication of comparative quality results could inuence behavior was already established also through a study situated in Wisconsin. In 2003 Health Affairs published a research study by Judith Hibbard showing that hospital performance went up as soon as comparative results became publicly available. That study made clear that clear that there is some improvement if it is privately shared info, but more improvement if it is publicly shared, said Irene Fraser, director of the Center for Delivery, Organization, and Markets at the Agency for Healthcare Research and Quality. There are two theories about why it works that way, she said: One, going through the consumer vector, consumers see the information and act on it, and that changes the market. The other theory is that providers see it, and dont like to look bad as professionals, so they act on it at that point. It has been harder to study physicians practices than hospitals, because most physicians are in small practices, where the cost and disruption of data gathering would make a research project prohibitive. Wisconsin, however, has a somewhat unusual medical landscape. Most doctors work in large multispecialty group practices, such as those afliated with the Dean Clinic, the Marsheld Clinic, or Aurora Health Care. On a state level, Wisconsin has one of the highest rates of electronic medical recordkeeping in the country, partly because these large aggregations of physicians have the capital and the will to invest in these expensive systems. In 2004 at Dean we spent $40 million in the rst year on electronic medical records, none of which came back to the physicians in income, Logan said. The benets all accrued to patients in improved care. This underlying electronic infrastructure is one of the reasons this study could be undertaken more easily in Wisconsin than in

Page 2

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In Brief
Two Northern Indiana Hospitals Sign Accord to Combine Operations
The boards of two northern Indiana hospitals have agreed to merge into a single operating entity. Memorial Hospital and Health System of South Bend, with 325 beds, will combine with Elkhart General Health System, with 297 beds. Both are near the University of Notre Dame. Conversations regarding a merger began in March. The hospitals will commence discussions in December around what form the new healthcare organizations parent company will take. The afliation follows years of successful collaboration between the two organizations and as a proactive response to dramatic changes pending in the healthcare industry around healthcare reform, the hospitals said in a joint statement.

New Physician Web Site in Illinois Receives Heavy Volume of Hits

In a little more than ve weeks, the physician proles posted by the Illinois Department of Financial and Professional Regulation have posted more than 750,000 hits, the department said in late November. The database was published after the legislature passed the Patients Right to Know Act, following an investigative series by the Chicago Tribune that revealed many doctors continued to practice even after convictions for sex crimes. About 85% of all Illinois physicians and chiropractors with active licenses have approved their public information, the department said.

Continued on Page 3

other states (with the possible exceptions of Minnesota and Massachusetts). And indeed there are other regional quality organizations, such as Minnesota Community Measurement and Quality Quest in Peoria, Ill., that do much the same kind of work. Chris Queram, the chief executive of the Wisconsin Collaborative, said the decisive factor was the willingness of the states physicians to get behind this project. Electronic record is part of it. Political will trumps that, he said. The 2003 landmark hospital study was pushed through by a business coalition using discharge data available through the state division of health, he said. That sent a signal to providers, both hospitals and physicians, that this stuff is coming, and wed like to have a say in how measures are selected, how theyre dened, where the data comes from. Physician leaders of the major groups saw the accountability imperative is not going away, and chose to embrace it instead of keep it from happening, Queram said. I give them a lot of credit. In the beginning it was scary, Logan said. It meant opening up the underwear drawer and saying, Im not doing so well on this measure, what are you guys doing that works better? There is that certain element of, Gee, I dont look as good as my peers, so maybe we should put some effort into this. Lambs study, which has been submitted to a medical journal, was paid for through a grant of $295,889 from the Commonwealth Fund. The foundation supported the study because it wants to build the case that public reporting of quality indicators makes a difference in patient outcomes, said AnneMarie Audet, M.D., who oversees the program in health system quality and efciency. Reporting this data costs money. People say, if you want me to invest in this, show me that value. The project was designed to compare Wisconsins performance to that of two states that didnt have public reporting, Iowa and North Dakota, as well as the rest of the United States. Those states didnt see the improvement that was seen in Wisconsin. In surveys, physicians groups were asked to what extent they paid attention to the published results. The researchers found that many of the clinics were paying a lot of attention to how they scored on these measures, then implementing clinical guidelines, patient reminders, and educational tools for patients.

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NEWS

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FTC Takes Aim at Rockford Merger

Files Injunction to Halt OSF, Rockford Health Combo
The Federal Trade Commission is going to take a second run at the proposed merger of two major hospitals in Rockford, Ill. The agency, responsible for policing anticompetitive behavior in the hospital industry, announced in mid-November it would challenge the acquisition of Rockford Health System by OSF Healthcare System. OSF, based in Peoria, Ill., controls nine hospitals, including OSF St. Anthony Medical Center in Rockford, with 235 beds. Rockford Health System owns the 293-bed Rockford Memorial Hospital. The FTC requested a preliminary injunction to halt the deal, saying the two hospitals together would exercise control over 64% of the market for acute care services and 37% of the market for primary-care physician services. The only remaining independent competitor would be 312-bed SwedishAmerican Hospital. SwedishAmerican and Rockford Memorial tried to combine in 1988 but that deal was thwarted by a federal judge. In 1997 SwedishAmerican considered a merger with OSF, but it did not go through. In a news release the FTC said that if the combination of OSF St. Anthony and Rockford Health were allowed to happen, OSF would have license to raise its rates. The merger would increase the incentives and ability for the two remaining hospitals in Rockford to engage in coordinated anticompetitive behavior, including sharing condential information, deferring competitive initiatives, or aligning managed-care contracting strategies, the FTC argued. In a statement, the two hospitals declared they were extremely disappointed. They said they were committed to pursuing all legal options and would oppose the request for a preliminary injunction.

In Brief
Were really pleased with all the interest, a spokeswoman for the agency said. Medical malpractice insurers are required to report any payments they make on cases involving doctors they insure. Hospitals, likewise, have to report actions against physicians on their staff. Criminal convictions must also be reported, but it is more difcult to gather independent data from the states 102 county courts. Physicians are supposed to self-report their convictions. However, few of them do. The physician proles can be found at www.idfpr.com.

St. Lukes Kansas City Unveils $330 Million New Patient Tower
St. Lukes Hospital of Kansas City opened a new $330 million patient tower that is designed to house the hospitals Mid America Heart Institute. The new tower showcases the latest medical technology and patient amenities. Our commitment to excellence is reected in every detail of the beautiful new structure, from expanded patient care space to improved accessibility, said Julie Quirin, CEO of St. Lukes Hospital, in a statement. The new home of the heart institute includes surgical suites, catheterization labs, and electrophysiology suites. Patient rooms have private showers and bathrooms. Family members will have a place to sit and sleep. Nearby nursing stations are intended to make staff more accessible to patients and visitors. Physicians are able to meet with family members after procedures in special private consultation rooms. Patients and families will have access to an acre of new green space, including a healing garden, courtyard garden, and rooftop garden.

Beaumont, Blues at Loggerheads

New Payment Model Halts Negotiations in Mich.
Beaumont Health System and Blue Cross and Blue Shield of Michigan are taking their contract dispute down to the wire. Beaumont said it would end its contract with Blue Care Network, the HMO run by the Blues, by Jan. 12 unless the Blues come to terms by Dec. 31. The heart of the argument is a value-based incentive plan that Blue Cross wants to institute in hospitals across Michigan, starting with Beaumont. Under that system, the hospital would be required to collaborate with physicians to pull back on expensive treatments and volume of treatments, and to put more emphasis on preventive care and patient outcomes. Beaumont is requesting a 6% increase in 2012, then 1.5% in 2013 and 1.5% in 2014. Blue Cross is countering with less than 5% for 2012, and no increases in 2013 or 2014. With all hospitals in the state, Beaumont will already receive a 2.6% raise in 2012 as a member of the participating hospital agreement. Other hospitals in Michigan are paying close attention to the Beaumont/Blue Cross situation.

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OPINION

Page 4

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Manage Health Benefits for Value

Employers Cant Afford Not to Insist on Accountability
Healthcare is like no other U.S. industry. surveys and seminars I have led for over 15 years, Employers do not manage their health costs employers often tell me that less than 10% or like they do every other supplier or vendor; even 20% of their targeted population is engaged youd be hard pressed to nd another example in these programs. where companies pay millions of dollars for Translated to common purchases, bananas are services without requiring quality or even sold at about $1 a pound and there are typically results, for that matter. As one of the largest four bananas in a pound. If you pay $1, you purchasers of healthcare, employers must take expect four bananas. What if you only received responsibility to combat rising costs and poor one banana? Would you want a refund? Would quality by demanding and measuring quality you want the grocer to go at risk to guarantee and value for every dollar spent with their you get the bananas? Why is this not the case for vendors (i.e. health plans and providers). healthcare? According to recent research released by the Even acknowledging that some folks will never non-prot Center for Health Value Innovation engage, you might expect 75% engagement in the (CHVI), healthcare benets are underprograms. Perhaps we could be comfortable with managed. A focus on outcomes missing from three of the four bananas. But today employers most benet programs -- could produce better are often settling for a return of only one or two results. bananas. CHVIs efforts over the past ve years have This lack of oversight leads to signicant waste. conrmed that engagement and Employers are worn down from accountability are sorely lacking the past several years of across all of the stakeholders in economic turmoil, the fear of the health supply chain, changing insurance plans or including consumers, employers, benets advisers during the health providers and health plans. reform ramp up, and the Payment reform has been downsizing of benets staff at promoted to manage the rising many companies. costs of inpatient and outpatient Employers must begin to take services, and outcomes-based a more active and disciplined risk contracting (aligning incentives management approach for health across all stakeholders) has benets. Employee health taken a major step forward to screenings should be their rst align payment with metrics that step. After that, employers should matter (adherence to safety and offer guidance to employees on clinical guidelines, for example). the goal-setting and tracking of By Cyndy Nayer Outcomes-based contracting puts a prescribed treatment; build part of a service agreement at risk and then uses benet design incentives to drive patients to the higher-performing service providers, improving engagement and accountability. Many employers spend millions of dollars on healthcare without understanding their engagement and outcomes patterns. In these all-too-common scenarios, healthcare services are purchased on a rate per employee. For instance, medication coaching may be purchased for $10 per diagnosed employee for management of diabetes. (Numbers here are used only for illustration and not related to actual costs.) If there are 100 diagnosed diabetics in the population, then the employers pay 100 times $10, or $1,000. Yet who is managing the deliverables? In accountability through outcomesbased contracting by creating a prototype contract for services, data and measures; and identify and implement best practices that improve accountability for outcomes. We must treat employee benets and healthcare expenses like any other business practice. We need to align responsibilities to control healthcare and absence costs in a way that encourages good performance and good health. We can no longer afford excuses for underperformance, as the health of our businesses and communities is at stake.
Cyndy Nayer is president and chief executive of the Center for Health Value Innovation.

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MARKETPLACE/EMPLOYMENT

Page 5

CHIEF EXECUTIVE OFFICER

Governed by a ve-member board, Girard Medical Center is a district, critical access hospital (CAH) licensed for 25 acute care beds with a 10 bed DPU, providing comprehensive health care for its patients .! The hospital has 15 physicians on staff with another 32 courtesy physicians.! Girard Medical Center offers health care services for children, adolescents, adults, and geriatric patients The hospital services the town of Girard, KS (population 2,800) and Crawford County (population 44,000) with net revenues of $17.5M and an ADC of 20.! They have a Senior Behavioral Health Unit and 5 clinics. The hospital website is www.girardmedicalcenter.com

ABOUT THE OPPORTUNITY

The Chief Executive Ofcer is responsible for all day-to-day operations of the Hospital. This position is accountable for planning, organizing, and directing the hospital to ensure that quality patient care is provided and that the nancial integrity of the hospital is maintained. The CEO ensures compliance with applicable laws and regulations as well as all policies and procedures set forth by the Governing Board and Medical Staff, and those required by Medicare Survey Standards.!! The CEO is responsible for creating an environment and culture that enables the hospital to fulll its mission by meeting or exceeding its goals, conveying the hospital mission to all staff, holding staff accountable for their performance, motivating staff to improve performance and being responsible for the measurement, assessment and continuous improvement of the hospital's performance.

POSITION REQUIREMENTS
MHA or MBA Preferred. 5 plus years progressive experience in hospital operations as hospital CEO or equivalent. Previous Critical Access Hospital (CAH) experience preferred. Strong physician relations and understanding of physician practice management. Managed care experience, experience and knowledge in quality initiatives.

BENEFITS AND COMPENSATION Salary is commensurate with experience. To attract!and retain the best professionals, we offer a comprehensive and competitive benets package that includes medical, dental, vision, 401(k), employee assistance program, and much more. Contact: Mary Ann Holloway, Director, Human Resources (620) 724-5142 maholloway@girardmedicalcenter.com

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MARKETPLACE/EMPLOYMENT

Page 6

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*New England Journal of Medicine, 2004.

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