One of the biggest challenges for health systems is to be aggressive and stay ahead of the curve while also maintaining a healthy bottom line. And although there is no magic bullet to achieving that balance, one key ingredient, according to Tom Pacek, is having a board that’s committed to excellence and is willing to take risks. In this interview, he talks about his top priorities, including migrating ambulatory onto a single EHR platform, sustaining Inspira’s Medicare ACO, and creating an infrastructure to ensure redundancy as the organization continues to grow. Pacek also discusses the blurring of lines when it comes to data ownership, how he deals with physician trust issues, his team’s strong focus on care coordination, and his strategy for keeping the staff engaged.
- Selling ACOs to the board
- Gathering data — “If you can’t measure it, you can’t improve it.”
- Physician trust factor — “The lines are blurred now.”
- South NJ’s “robust” HIE
- Merger with Underwood Memorial
- Working with Comcast to enable “complete redundancy”
- Importance of board support
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We’re trying to get ahead of that curve and learn from it. We believe that in working very closely with our physicians and our patient population, we can actually bend the cost curve and maybe share some savings.
Physicians would say, ‘I don’t want anyone to see my data,’ because they’re afraid somebody’s going to steal patients from them. It’s not about that anymore. It’s about collaborating on the patient population that we all have.
We’re bringing our practices left and right. We’re acquiring practices or we’re just doing leasing arrangements for services with physician practice, but that requires us to share data back and forth. So we need to have connectivity to every single office that we connect to.
99.9 percent of the time they’re right behind me saying, ‘this makes sense, let’s go for it.’ That gives you a lot of personal job satisfaction as well, and keeps the staff happy. They know if we need to get something done, we’re going to be able to do it without a lot of difficulty.
Gamble: You touched a little bit on population health, which is a nice little segue to talk about your strategy there. But actually, first I wanted to ask you about the ACO, Inspira Connect.
Pacek: That’s our Medicare ACO. We’ve partnered with physicians in our community to deliver reduced costs and improve the quality of care that we provide to our Medicare patient population. We’re serving about 11,000 members; that number changes. Attribution is a funny thing, when we start to dive into what our attribution is versus what CMS may think our attribution is. It doesn’t always see eye to eye, and we have to do that justification and qualification, and it’s interesting. It’s interesting when you start to see payer data against your own data, and how it differs. That creates some challenges and some new opportunities for us to be able to engage with the payers in a different way. We all think we have the same data, but it certainly is not. We hold the key to the care — the clinical care documentation; the real details of what goes on with the patient, whereas the payers have the claims and it’s more statistical in nature and a whole lot less about the details of what really goes on when treating a patient. In this care management population health world, they’re coming together and it’s definitely going to improve the overall care we deliver to our patients.
As far as reducing cost, we’ll see. Time will tell. The fear of the whole process is that it doesn’t have a very good track record so far. I think that less than 30 percent and probably closer to 20 percent of the organizations that are doing MSSP eventually reach the thresholds of where they can actually share savings with their physicians. Our executive committee and our board actually challenged us as to why do we want to do this. We think it’s the right thing to do. Obviously, CMS is saying we’re heading in that direction and that by 2018, 50 percent of reimbursement will be based on these types of criteria and the ability to manage patients and reduce cost. So we’re trying to get ahead of that curve and learn from it. We do believe that in working very closely with our physicians and our patient population, we can actually bend the cost curve and maybe share some savings. In our opinion, we will share some savings.
But this is our first year, so it’s really our trial year. We’re gathering data. We’re learning a lot about the data. We have a saying that if you can’t measure it, you can’t improve it. We wanted to engage in this process and give us this year to really look at the data, work with our docs, share the information about how they’re delivering care to their patients, what they’re doing well, what they’re not doing well, share the outcomes, and also talk about the costs. We want to try to get on board so that by next year, when it counts as far as reimbursement goes, that we’re ready to really share in the savings and bend that cost curve and improve care as well.
Gamble: Right. And as things progress more, it gets into really reaching that true level of engagement with patients and getting them to be more invested in their care and make changes. That’s something where I guess the whole relationship with the physician really comes into play.
Pacek: It does, because we can’t do it alone. We can talk about it from a hospital perspective. When you get discharged from our hospitals, we do the discharge instructions, we engage with you about educating you. We’re taking that a step further, so whatever education we provided you with here in the hospital, we’re going to make that available to you in your home, so you can get that over the internet securely. You can access it. You can watch the videos again. We’re trying to do everything we can to make sure the patient is completely informed of what their responsibilities are to keep themselves healthy once we’ve discharged them. But the fact of the matter is, they go back to their physician, and if the physician is not on the same page with us, we could be steering them in different directions. And so we really have to coordinate that care and coordinate the education with the physician and make sure we’re on board with the care planning of that patient once they’re discharged here. We’re taking a very active approach with that and partnering with our physicians.
We do it not only through these programs, but even through our physician hospital organization, where we talk about how we care for these patients going forward. Whether we’re in an MSSP program or whether we’re just caring for our Inspira employee population, or whether we’re doing any other kind of payer population, or just high-risk patients. We have initiatives of our own to manage our high-risk patients and our high-cost patients. We can’t do that alone. You have to do it with the physicians, so we engage with them to look at data and look at the patients and manage the information.
That’s a huge step forward, and it’s a huge trust factor with the physicians. Now we’re asking them to share common data on a patient. Let’s face it, HIM departments in hospitals don’t want the information from the physician offices — ‘That’s not part of my legal record. I can’t control what the physician did in their office, I don’t want to take responsibility for it.’ Guess what? Those lines are blurred now. We’re all accountable for that patient record going forward. We might not call it a legal-medical record, but that definition is really blurring. I’m not sure right now what the true definition of legal-medical record is anymore, so I make sure I keep risk management and corporate compliance in line with us as we make decisions to share data. They’re always involved in the decision-making process and policies and procedures to keep us legal, but that is a blurred line, and it’s not until we’re able to do that that we can actually impact, in a good way, patient care and reduce costs.
Gamble: It’s interesting what you brought up about the trust factor. That’s becoming so much more of a big thing now that really wasn’t there before.
Pacek: It wasn’t. Physicians would say, ‘I don’t want anyone to see my data,’ because they’re afraid somebody’s going to steal patients from them. It’s not about that anymore. It’s about collaborating on the patient population that we all have, doing appropriate referrals to the appropriate physicians, and for everybody to be working on the patient in the most cost effective, but also the most effective ways, using evidence-based medicine and things like that.
I think they’re coming to learn that it takes money to do this. Everyone’s realizing that it takes a lot of money to be able to do this from a technology perspective. Hence, the Meaningful Use dollars that the government has thrown out there — because it does take technology. It does take a lot of money to do this. They can’t afford to do it on their own. Honestly, they need to partner up, and we can bring that to the table. From an information system perspective, we can help them with their EMR and with their EMR vendor to engage in those conversations and engage on the interfaces to make sure that we’re sharing the appropriate data with the appropriate safeguards in place, to achieve the results that we’re all looking for.
Gamble: And of course hospitals have to do that as well with other hospitals when you’re talking about the HIEs
Pacek: You are correct. We have a very robust HIE here that we do participate in with a couple other hospital providers in the area, and we do it very successfully. Right now we’re starting to engage with even some of the more local hospitals to us — what we would call the competition — where we’re sharing for the good of the patient. And even for the physicians, to make their life easier and able to care for the patient appropriately, means giving them an insight into the patients — what had happened to them if in fact they showed up at somebody else’s ER instead of mine. We want to give them insight.
So we’re working HIE to HIE as far as queries go to query and retrieve information back and forth. We’re not sending data to another HIE and they’re not sending data to me, but what we are doing is querying each other’s HIE. So if there’s a common patient that we have, you have the ability to do a search across multiple HIEs and be able to pull back any information related to that patient that might be of value.
Gamble: Switching gears a little bit here, you talked about the merger that was almost 3 years ago, the latest merger with South Jersey Healthcare and Underwood Memorial. I wanted to talk about what needed to be done at that point just as far as the network and connectivity challenges and how you dealt with that.
Pacek: South Jersey had a fairly robust wide area network for which we actually use Comcast services for fiber in the area here; it’s a completely redundant, wide area network, and so we wanted to add Woodbury campus into that network. On the good side, we had a hospital to deal with — they were not Comcast costumers, so we got them up as quickly as possible. Comcast worked with us to extend the wide area network through the Woodbury facility, again dual pads, dual rings, so that we have complete redundancy.
On the Woodbury campus, they did not have a lot of ambulatory services. That is actually one of the reasons for the acquisition, to give us a better footprint and to help expand in the ambulatory space in their community. We’ve been doing a lot of that, and the benefit I’ve seen out of our relationship with Comcast — because they are our big provider of our wide area network — is the ability to get implementations done quickly. We’re bringing our practices left and right. We’re acquiring practices or we’re just doing leasing arrangements for services with physician practice, but that requires us to share data back and forth. So we need to have connectivity to every single office that we connect to. We’re at over 70 locations now. The Woodbury campus, like I said, a lot of that was not connected to the Underwood Hospital at the time at all, so we worked really hard to provide services quickly to them. The nice thing about Comcast is the way we have our services set up, I can call them and change my bandwidth on demand in minutes or hours, rather than days and weeks and months like it used to be. I used to have to pull out a circuit and get a new circuit installed. Now it’s bandwidth on demand. The way we’ve established this network with them, I can get services up very, very quickly.
Gamble: That’s something that needs to be strong when you’re talking about, to see the unbelievable movement with the practices and adding to the network. It’s pretty amazing.
Pacek: It is. Because we’re becoming more and more electronic, you got to have the redundancy as well. These practices can’t be down; they can’t do without their electronic medical record. As far as our approach, and we host a lot of that. A lot of services we host here are still run out of Malvern, because being a Soarian customer, it’s hosted in Malvern, and we even have dual connectivity back to Malvern. We have connections from Woodbury, we have connections from Vineland. If the Woodbury is down, it comes back through and everybody reroutes through Vineland and goes out to Malvern, so we have high level of redundancy in order to keep things moving and keep things up.
Gamble: Alright, so there’s certainly been a lot of growth to the organization since you started. How long have you actually been with the organization?
Pacek: I started in early January of 2008, so I’ve been here over seven years now. One of the things I was brought in here to do is to help evolve the information systems and the capabilities we had here. They spent a lot of money building a brand new hospital in Vineland. I worked with many of the executives here at another facility, and a lot of them migrated down in the early 2000s. I didn’t get down here until 2008, and so one of the questions is, ‘Everybody went down there in 2000 and you left me behind, why is that?’ and they said, ‘We didn’t spend any money on IT, quite honestly. You would have been bored. It wouldn’t have been the place for you. You grew, you learned, you continued to expand upon your experience, and now we want to take advantage of it here.’
And that’s been very successful. That’s what’s kept me happy for seven-and-a-half years. Honestly, this organization’s been committed to information systems since the day I walked into the door. Financially, the board has been great at supporting all the financial initiatives that it took to get these things done, from implementing Soarian across the board to converting Woodbury onto the Soarian platform, to standardizing on all our phone telephony or IP telephony across the enterprise, all the wide area redundancy — you name it. The board and executive team here have been extremely supportive of what needed to get done.
Gamble: That’s obviously something we hear so much; that it’s really critical to have that kind of buy-in and know that’s one less battle you to have to fight.
Pacek: Absolutely. They’re very collaborative and this organization has trust. You’re the CIO. And obviously, I get input. They’re not my projects; they’re what I’m hearing from the organization as a need. And when you present it and you go forward, 99.9 percent of the time they’re right behind me saying, ‘this makes sense, let’s go for it.’ That gives you a lot of personal job satisfaction as well, and keeps the staff happy. They know if we need to get something done, we’re going to be able to do it without a lot of difficulty.