For some people, being the new CIO means making a splash by setting big goals and implementing sweeping changes. But when Tressa Springmann assumed the CIO role at LifeBridge in the fall of 2012, it was more of a ripple. Although she was a seasoned veteran, having served the role for 13 years at Greater Baltimore Medical Center, Springmann opted for a “listen and learn” approach at her new organization, and it has served her well. In this interview, she talks about the change management hurdles she had to overcome at LifeBridge, the deliberate strategy her team is employing to get physician practices on one EHR system, and what she does to stay energized.
- About LifeBridge
- Cerner in hospitals & practices, best-of-breed in ambulatory
- Maryland’s fixed payment system
- “Forced population health without attrition”
- Shared best practices through CRISP
- Strategy in rolling out Cerner to practices — “There’s a lot of credence to sitting on the sidelines for a few years.”
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It’s totally forced population health with no attribution. You’re attributed to whoever walks in your door.
We are in this very interesting place not knowing. We have negotiated what our base rates are going to be, but beyond that, the rest of the story is still in play.
The majority of us are just hunkered down trying to survive all the regulatory mandates on us and waiting for enough concreteness around the change in the waivers so that we can begin planning.
Many of them moved over to an EMR two years ago. They’re barely to a place where they feel they’re finding value, and so it’s a very emotional proposition to say, ‘you’re going to have to change.’
Gamble: Hi Tressa, thanks so much for taking the time to speak with us today.
Springmann: Thanks for having me. I appreciate it.
Gamble: To get us started, why don’t you give us a little bit of background information about LifeBridge Health — what you have in the way of hospitals and ambulatory, things like that?
Springmann: I’d be happy to. LifeBridge Health has two acute care hospitals: Sinai Hospital and Northwest Hospital and a long-term care facility, Levindale, which is both sub-acute and 120 chronic hospital beds, so it’s known as an LTAC hospital. We also have a very broad commercial division, and in that division, which is largely joint-ownership entities, we have a robust home healthcare company and we have urgent care centers. Also, certainly not on the commercial side but as part of LifeBridge Health, we’ve got many employed physicians, over 200 at this point.
We also have a tight relationship with a hospice organization. Going back to the commercial division, we have a physiotherapy relationship and retail pharmacy relationships. Although one might suggest we are small from an acute care presence, we certainly have a very broad offering across the care continuum.
Gamble: Okay. Looking first on the acute care side, what do you have in terms of the clinical application environment?
Springmann: For our core hospitals and for the majority of our physician practice sites, we’re using Cerner Millennium for our EMR.
Gamble: And that’s been in place a while?
Springmann: We are actively rolling the ambulatory tool across our practices. I’ve only been here 15 months, but certainly LifeBridge Health has been a Cerner partner for many years, and was, I believe, one of the first organizations to do CPOE in the early 2000s.
Gamble: Okay. And you said you’re in the process of rolling it across ambulatory practices right now?
Gamble: I would assume that’s for the owned practices.
Springmann: Yes, for our employed docs. We actually employ more than 430 physicians across the region, many of whom are specialists. We have both faculty employed and community employed.
Gamble: What about the commercial division you talked about, like urgent care — what’s in place at those facilities, and what kind of information exchange do you have?
Springmann: Many of them are relatively new joint ventures. They all have different platforms. Our home care company is on the Cerner HomeWorks product. Our urgent care centers are on eClinicalWorks and our retail pharmacies are on a product called Rx30, so we have very unique, independent blended systems. At this point, most of our data sharing is through interfaces, but we are pursuing the selection of a private HIE tool for LifeBridge this year. There have been a lot of regulatory changes that have happened in the past four weeks in Maryland that are really the catalyst for this type of behavior here in the state.
Gamble: As far as continuing to form partnerships?
Springmann: Sure. Maryland has been the only state recently on a waiver from Medicare. We have an all-payer system, which means it doesn’t matter what insurance you have, we get paid the same, whether it’s Medicare, Aetna or United. There’s a rate-setting commission that establishes all of the rates for each of the hospitals in Maryland, which is very different than the rest of the country. We’ve just modernized the waiver and the new rules under which we will be operating to try and maintain the waiver and require many of the hospitals in Maryland to go to a global budget.
Basically, the hospitals were given two choices: a variable or a global budget, but as a state, we need to keep our Medicare spend to a certain level over the next five years, and part of that is that many of our health systems, including LifeBridge, moved to a global budget. No matter what we do, we will get a fixed amount of payment. And so it’s incumbent upon us to really encourage care to happen in the right setting and to ensure that any additional capacity that that might create in our inpatient domain is back-filled with relevant cases and with appropriate acute cases, because we’re going to get a fixed payment.
That’s pretty dramatic, and it’s retro for some of our hospitals, but I don’t know the particulars. Not all of the hospitals have finalized their agreements with our rate-setting commission yet. It’s totally forced population health with no attribution. You’re attributed to whoever walks in your door.
Gamble: Wow. That really does, like you say, force population health. And then there’s of course on the national level there’s more motivation for that too. I can see why your organization has been really busy developing these partnerships and getting all of this into place.
Springmann: I actually came from an organization that was part of the MSSP — not the pioneer but the early for the Medicare Shared Savings ACO. I’m very familiar with the primary care attribution model. In Maryland, they’ve decided that we’re going to keep our Medicare expenses down in a very interesting way, so it will be a little bit crazy for the next few years here while we figure it all out. It could end up being a very, very good thing.
Gamble: Right. Now you said a lot of this stuff has come out in the last couple of weeks. In your organization, do you have any kind of system in place for who translates all of these regulatory rules into this is what we need to do or is that something that is kind of divided among the leadership team?
Springmann: It’s still in process. Aside from the regular fixed revenue, they’re still negotiating the quality incentives and penalty structure. So very similar to what you’re seeing in the regular world where there are incentives and penalties tied to things like readmission or nosocomial infections, the same is true in Maryland. They’re still working through what are those domains going to be and what is the incentive and penalty structure going to look like.
We are, in some ways, in this very interesting place not knowing. We have negotiated what our base rates are going to be, but beyond that, the rest of the story is still in play. There are a lot of committees at the state level, very interdisciplinary, including the payers and the hospital organizations, having those discussions as we speak.
Springmann: It’s like, here’s your fixed piggy bank but we can’t yet really get into the details on how you’re going to be measured.
Gamble: So you’re really moving toward that goal of population health and keeping readmissions down. You just have an added motivation compared to organizations in different states.
Springmann: In Maryland we call them PAVs, potentially avoidable volumes. Keep in mind, that’s just the hospitals. Nobody else is on this fixed payment model.
Gamble: Are you in contact pretty regularly with other CIOs in the state to see what other people are doing to make sure that they’re staying on top of this?
Springmann: I think there’s been a lot of good discussion. Many of the state CIOs are actively engaged in CRISP, our state health information exchange, and I think that’s where a lot of the dialogue is taking place to ensure that we jointly aren’t trying to reinvent the wheel, but are leveraging the partners that CRISP represents in helping us all come up with some standard methods of measurement.
A lot of these discussions have happened there, and thankfully, they’ve worked both with the state and with the healthcare systems in Maryland to put together some reporting tools for all of us on things like readmissions — not just to our own hospital, but to any hospital in Maryland.
Gamble: That makes sense to reach out to the other hospitals and health systems to share best practices as far as the best strategies to deal with things like having fixed piggy banks.
Springmann: Right, but as I said, it’s not all the health systems. We had two options. One was a variable model that was partially fixed and partially variable, and the other was a fixed model, and not all the hospitals have taken their position yet and finalized their contract. That’s kind of all over the map. I honestly think that the majority of us are just hunkered down trying to survive all the regulatory mandates on us and waiting for enough concreteness around the change in the waivers so that we can begin planning. There’s just so much required of us now from a regulatory perspective, especially this next year. We are thinking about, but don’t really have the time to worry about things that don’t yet have requirements to it.
Gamble: There are enough resources you need to dedicate for the deadlines that are definitely in place. As far as rolling out Cerner across the practices, what is the timeline for that? What stage is that in at this point?
Springmann: We’re trying to have them all finalized by the end of this calendar year, but we’ve been acquiring a lot of practices, so as quickly as we’re bringing them up, we’re filling the pipeline.
Gamble: I saw that there was a partnership with Potomac Physicians. That’s a pretty good sized group, right?
Springmann: Yeah, we’re very excited about that relationship.They are very progressive in terms of understanding population health and understanding wellness. Right now, we are transitioning all of their sites to the LifeBridge registration scheduling and billing platforms and then once that’s stabilized, we’ll begin discussions regarding an EMR migration.
Gamble: When you’re talking about expanding out and getting more practices under your purview, I imagine you really have to be strategic about it. You want to pick a group that’s going to be able to get on to your system or at least will be able to do that in a decent amount of time.
Springmann: I couldn’t agree more. I do think we’re also benefiting by work consolidation around standards of data exchange and by physician pressure for Meaningful Use. Because with a lot of these physicians, it’s good news, bad news. The good news is they’re already on an EMR. The bad news is they’re already on an EMR. And so it’s really critical once we become partners to navigate what the most effective strategic transition plan might be. In some cases, because of Meaningful Use payments across their physician base and the possibility of interrupting those, there’s a lot of credence to sitting on the sidelines for a few years and letting that play out, but making sure that they’re aggressively implementing the CCDR and the ability to use direct for exchange so that you’re not standing in the way of effective care coordination, but you’re being very sensitive to their investment and where they are on their own Meaningful Use curve.
Unfortunately a lot of these practices — and Potomac’s not one of them — have had their EMR for quite some time, but many of them moved over to an EMR two years ago. They’re barely to a place where they feel they’re finding value, and so it’s a very emotional proposition to say, ‘you’re going to have to change.’ So we’ve really taken it on a case by case basis.
Chapter 2 Coming Soon…