St. Joseph Partners in Leadership, Graduation Future of Healthcare Nationally

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St. Joseph Partners in Leadership,
GraduationFuture of Healthcare Nationally
Locally

• Wednesday, June 1, 2005
• Nancy W. Dickey, MD
• President, AM Health Science Center
• Vice Chancellor for Health Affairs, Texas AM
  University System

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Future of Healthcare Nationally Locally

• Five Issues That Will Drive Healthcare
• Technology Advancement
• Evidence Based Medicine
• Pay for Performance
• Involved Consumer
• The Uninsured

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Technological Advances

• Is is widely accepted that technological change
  has accounted for the bulk of medical care costs
  over time.
• When costs and benefits are weighed together,
  technological advances have proved to be worth
  far more than their costs.
• The average newborn in 1950 could expect to spend
  8,000 in present value on medical care over
  his/her lifetime. The comparable amount in 1990
  is 45,000.

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Technology Advancement Examples of how different
perspectives pay off

• Improved breast imaging leads to identifying
  smaller tumorssurgeons challenged to find
  effective, aesthetically pleasing treatment
  laser destruction in place of traditional scalpel
• Improved imaging identifies aneurysms in arteries
  in people who are poor surgical risksurgeons
  partner with catheter-savy cardiologists stent
  treatment of aneurysm (a dacron tube replaces the
  defective pipe with a new one)

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More examples

• Mother of autistic child (psycholgical and
  behavioral problems) notes improvement when
  antibiotics usedpediatric researcher
  investigates possible bacterial etiology to
  behavioral problem

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Evidence based medicine

• Protocols (cookbooks) vs. trained judgment
• A new culture, environment

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Hospital Quality Alliance (HQA) Hospital
Quality Measures Acute Myocardial Infarction
(AMI) Aspirin at arrival Aspirin prescribed
at discharge ACE inhibitor for left ventricular
systolic dysfunction Beta blocker at arrival
Beta blocker prescribed at discharge
Thrombolytic agent received within 30 minutes of
hospital arrival PTCA received within 90
minutes of hospital arrival (effective for 3Q2004
discharges, measure becomes PCI received within
120 minutes of hospital arrival) Adult
smoking cessation advice/counseling ?? ??
Heart Failure (HF) Left ventricular
function assessment ACE inhibitor for left
ventricular systolic dysfunction Discharge
instructions Adult smoking cessation
advice/counseling
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Pneumonia (PNE) Initial antibiotic received
within 4 hours of hospital arrival Oxygenation
assessment Pneumococcal vaccination status
Blood culture performed before first antibiotic
received in hospital Adult smoking cessation
advice/counseling Initial antibiotic selection
for community-acquired pneumonia (CAP) in
immunocompetent patients Influenza vaccination
?? Surgical Infection Prevention (SIP)
Prophylactic antibiotic received within 1 hour
prior to surgical incision Prophylactic
antibiotic selection for surgical patients
Prophylactic antibiotics discontinued within 24
hours after surgery end time ?? TOTALS 10
17 22
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Quality Measures

• Heart Attack Care Quality Measures - Higher
  Percentages Are Better(some of the recommended
  care given to patients if appropriate) Quality
  MeasureClick on a measure name to compare all
  hospitals in a graph PERCENTAGE FOR ST JOSEPH
  REGIONAL HEALTH CENTER Percent of Heart Attack
  Patients Given ACE Inhibitor for LVSD  if
  appropriate89 of 55 patients
• 2 Percent of Heart Attack Patients Given Adult
  Smoking Cessation Advice/Counseling  if
  appropriate79 of 14 patients1,2 Percent of
  Heart Attack Patients Given Aspirin at Arrival
   if appropriate99 of 97 patients2 Percent of
  Heart Attack Patients Given Aspirin at Discharge
   if appropriate99 of 134 patients2 Percent of
  Heart Attack Patients Given Beta Blocker at
  Arrival  if appropriate93 of 73 patients2
  Percent of Heart Attack Patients Given Beta
  Blocker at Discharge  if appropriate88 of
  113 patients2 Percent of Heart Attack Patients
  Given PTCA Received Within 90 Minutes Of Arrival
   if appropriate30 of 10 patients1,2 Percent of
  Heart Attack Patients Given Thrombolytic Agent
  Received Within 30 Minutes Of Arrival  if
  appropriate0 patients 2

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Quality Measures

• Percent of Heart Attack Patients Given ACE
  Inhibitor for LVSD Top Hospitals 100
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE UNITED
  STATES - 75
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE STATE
  OF TEXAS - EASTERN SOUTHERN 71
• ST JOSEPH REGIONAL HEALTH CENTER - 89      
• Top Hospitals represents the top 10 of
  hospitals nationwide. Top hospitals achieved a
  100 rate or better.

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Quality Measures

• Percent of Heart Attack Patients Given Aspirin at
  Arrival Top Hospitals 100 
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE UNITED
  STATES 91 
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE STATE
  OF TEXAS - EASTERN SOUTHERN 90 
• ST JOSEPH REGIONAL HEALTH CENTER 99     

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Quality Measures

• Percent of Heart Attack Patients Given Beta
  Blocker at Discharge Top Hospitals 100 
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE UNITED
  STATES 84 
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE STATE
  OF TEXAS - EASTERN SOUTHERN 81 
• ST JOSEPH REGIONAL HEALTH CENTER 88     

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Quality Measures

• Percent of Pneumonia Patients Given Initial
  Antibiotic Timing
•  Top Hospitals 89 
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE UNITED
  STATES 72 
• AVERAGE FOR ALL REPORTING HOSPITALS IN THE STATE
  OF TEXAS - EASTERN SOUTHERN 70 ST JOSEPH
  REGIONAL HEALTH CENTER 71      
• Top Hospitals represents the top 10 of
  hospitals nationwide. Top hospitals achieved a
  89 rate or better.?

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Pay for Performance

• Physicians
• Hospitals
• Others?

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Involved Consumer

• Available information
• Physician training to embrace a partnership
  approach
• Possible incentives in payment mechanisms like
  insurance

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The Uninsured

• 44 million Americans
• 1 in 7 Americans
• Nearly 15 of the population

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The Uninsured

• 80 working Americans or dependents of working
  Americans
• 1 in 4 a new immigrant

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Insuredbut decreased access

• Medicare no longer accepted in many practices
• Managed care plans boot millions
• Medicaid is a barrier to access
• Multiple plans decreased service

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Uninsured increasing dollars decreasing

• Poor economy
• State reductions in Medicaid and CHIPS
• Medicare facing federal budget reductions as baby
  boomers, technology increase the strain

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The Future of Healthcare

• Improved knowledge and therefore cures,
  treatments
• Improved information with subsequent improved
  deicison making
• Commitment to improved quality and safety

• Potential shortages of highly trained people
• Cost, cost, cost
• Ethical dilemmas created by pushing the
  boundaries