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Put the Whole UH Team to Work for Our Patients

Coordinated care is more convenient care – and, more importantly, leads to better health outcomes

UH Clinical Update - November 2018

By Cliff Megerian, MD, President, UH Physician Network

It’s good medicine, it’s good for our patients and it’s good business.

I am writing about keeping patients within the University Hospitals system. We know that we can best meet our patients’ needs when we keep them within the exceptional health care system we have built, which now touches more than 1.3 million patients each year

This concept contributes to UH as a whole, as it allows us to be successful in the new world of ACOs and population health and also can provide compensation benefits to our physicians.

But the focus on keeping our patients’ care within one system is not unique to UH. It is being mandated by the national evolution of care from the traditional fee-for-service model to population health, whereby physicians and hospitals are rewarded or penalized based on the success of providing safe, appropriate lifelong care in a cost-effective manner to large populations of patients. In fact, we are already there.

Managing referrals and the resulting quality of care will now play a key role in determining a provider’s success under the Medicare Access and CHIP Re-authorization Act of 2015 (MACRA), influencing performance on numerous measures.

This change is being phased in over the next couple of years. In addition, all Medicare and commercial ACO programs also follow a similar paradigm of measuring quality, safety and overall costs in the cohort of patients attributed to a particular ACO arrangement. This is of the highest importance to us as physicians here, because UH has the fifth largest ACO in the country with more than 500,000 lives.

You will recall that shared savings was the hallmark of the first generation of the Medicare ACO program – a reward for doing well, from which a number of UH physicians benefited. The second generation Medicare ACOs, as of this writing, may start as early as 2019. They will bring financial penalties, both in terms of physicians' professional fees and to our system if costs are deemed higher than those of our peers, and/or if other metrics such as quality and safety are below targets.

But, as in the past, it will bring significant rewards if we perform well.

We know from our experience in the early generation of the Medicare shared savings programs that our yearly costs per member per year within the UH system are significantly lower than those of our local competitors. When patients leak out of our system, our doctors are attributed the costs charged by the outside hospital, and usually these costs are higher -- even for the same procedures. From a safety and quality standpoint, we also know that our ability to track the activity of our patients who are seeing specialists, and the communication regarding care, are both enhanced if patients stay within the system.

If that wasn’t reason enough, beginning in 2019, regardless of whether a Medicare patient is in an ACO of ours, that patient and reimbursement for rendered services will be subject to MACRA, which rewards many of the above-mentioned targets.

In fact, starting next year, up to 4 percent of a physician’s revenue from Medicare fee-for-service reimbursement will vary up or down based on the MACRA measures. We were able to achieve for 2019 approximately a 1.5 percent increase in reimbursement, but we can do better.

Currently, we keep 65 percent of our referrals within the system – a low figure compared to national benchmarks for an integrated delivery system. A recent study shows that one percent of keepage can translate to about $16 million dollars in additional revenue for a system with a cohort of patients as large as ours. Doing the math, a 10 percent increase is $160 million in additional revenue. That would go a long way in providing enhanced services for our patients and our physicians and nurses. In addition, it would help us perform better on our ACO and population health strategies, as well as MACRA, bringing value to our patients and our physicians.

You’ve confirmed for us several times in surveys your confidence in the care we provide at University Hospitals. And we all know that when care is coordinated, it leads to better patient outcomes. It is tremendously easier to coordinate care through a common EMR platform with providers whom we know and trust and with people who are on the same team.

That is always the priority for all of us here at UH.

We know it hasn’t always been easy to accomplish this. But in recent years, we have created many tools to help you provide more integrated care and to make the referral process easier and more efficient.

One is the UH Provider mobile app, which showcases the clinical expertise available at UH medical centers and health centers. The app allows referring clinicians to quickly and efficiently locate UH physicians by name or specialty. It also provides our UH Urgent Care locations and phone contact numbers for direct admission to UH hospitals by site.

Another is our Schedule Me Now system, which allows you or your staff to simply and easily schedule your patients’ referral appointments before they leave your office. You can use it to make appointments with specialists -- and our specialists can use the technology to refer to sub-specialists in their own department.

Having a patient’s appointment scheduled at the time of service and before they leave the office makes a huge difference in whether the patient will receive the follow-up care he or she needs. And because we are all on the same EMR, you will know not only whether your patient went to the appointment, but you’ll also see clinical results or other critical information about the patient’s care.

If your office staff is not familiar with Schedule Me Now, please have them reach out to for assistance. You can also contact your physician liaison for any help you need with the UH Provider mobile app. Your liaison also can provide a current snapshot of your alignment within the UH system.

These are the tools that make the referral process simpler and faster.

Coordinating all of a patient’s care under the UH umbrella is how we achieve success as a system. There are four pillars by which we measure this success: quality, safety, patient satisfaction and cost.

We know we offer safe, high-quality care, and our surveys show high patient satisfaction. We also know that it is cost-efficient for our patients to stay within our system, often simply because there is no duplication of tests and treatment.

We have improved access to available appointments with specialists – so that a primary care provider, for example, will be able to schedule a timely appointment for his or her patient.

We also are creating a mechanism to identify where physicians need encouragement to use our colleagues in the system for referring, especially for such specialties as cardiac and spine surgery. We want to remove all the variables in care, which is impossible to do when that care is provided outside the system.

Again, the quality of the care we provide is paramount. We have furthered our commitment to continuous quality improvement and high-value care delivery with the appointment of Peter J. Pronovost, MD, PhD, as Chief Clinical Transformation Officer for UH.

Dr. Pronovost, a world-renowned patient safety champion, innovator and critical care physician, will develop and lead strategic initiatives to improve value across the health system. He will be the clinical lead for population health and lead high-reliability medicine, with direct responsibility for the UH employee accountable care organization. He will create cross-functional teams to engage UH providers (and employees) in care models leading to improved outcomes and reduced costs of care.

We have built a great health care system. Now is the time to put the entire UH team to work for our patients, unleashing our system’s efficiencies and effectiveness.