By JACK WEATHERLY
Do no harm. That has been the guiding light of the Hippocratic Oath for the physician-patient relationship for 2,500 years.
It takes on a broader meaning in modern medicine.
And that’s certainly the case for Dr. Michael Henderson, new chief medical officer for the University of Mississippi Medical Center.
His emphasis for the past decade in his long, prestigious career has been to limit what are called “hospital acquired conditions.”
Those include things such as infections, blood clots and bed sores, Henderson said. Some can even be fatal.
“Many of the things that we used to think were inevitable we can prevent,” he said. While the goal is the ideal zero occurrence, that hasn’t been achieved “yet,” Henderson observed.
The other side of the coin is improving performance.
“The national movement is getting away from . . . getting paid for volume of stuff we do to getting paid for the value. Are we getting good outcomes?” Henderson said.
The hospital achieved a world-class outcome in 1963, when Dr. James Hardy carried out the first successful lung transplant ever.
UMMC celebrates that achievement with the annual Hardy Lecture, which this year happened to be the day before Henderson sat down for an interview.
Henderson attended the University of St. Andrews at St. Andrews, Scotland, where his father was dean of the medical school.
From there, he completed his surgical training at the Royal College of Surgeons in Edinburg, Scotland before taking a position in 1978 at Emory University in Atlanta, where he started a liver transplant program.
After 14 years at Emory, he moved to the renowned Cleveland Clinic, where he was chairman of surgery — and put together a transplant center. “It stimulated me to get involved in the transplant field nationally,” Henderson said in a UMMC in-house publication.
The clinic, as a member of the Ohio Transplant Consortium, “was in the forefront of the nation’s first efforts to create a database for organ donation and guidelines for allocation to patients,” according to the UMMC article.
During the second half of his 22-year tenure at the clinic, Henderson — now chairman of the advisory committee on surgical quality improvement for the American College of Surgeons — shifted to overseeing quality and safety outcomes, an emphasis he brings to UMMC.
Dr. Charles O’Mara, associate vice chancellor for clinical affairs, was quoted in a UMMC publication on Aug. 18, 2014 as saying that patient care and safety were the most important things facing the institution.
Dr. William H. Cleland, then UMMC chief medical officer, was quoted as saying: “We want good outcomes for our patients, regardless of financial outcomes. We certainly aren’t trying to tackle this because of the financial implications.” Cleland retired on Aug. 31.
The implications at that time, according to the article, were penalties imposed by the Centers for Medicare and Medicaid Services, which began withholding 1 percent of all Medicare payments during the fiscal year that started Oct. 1.
The penalty is required by the Patient Protection and Affordable Care Act, sometimes referred to as Obamacare.
On a scale of 1 to 10, with 10 being the worst rating, UMMC has a score of 8.05, which means a loss of $1.5 million in this federal fiscal year that ends Sept. 30. Additionally, private insurers have refused to pay $1.5 million in as all or part of bills of patients who suffered an HAC, the article said.
Ratings by the agency for some other institutions in the Southeast are as follows: University of Tennessee Regional Medical Center, 10; University of Alabama Hospital, 8; Emory University Hospital, 8; University of Arkansas Medical Center, 10, and Vanderbilt University Hospital, 3.
Henderson, who took his new position on March 1, declined to comment on whether the recent controversy over the state College Board and its contract dispute with Dr. Dan Jones, chancellor of the University of Mississippi system, including UMMC, is having any effect on recruitment.
He said that whereas the first half of his tenure at the Cleveland Clinic involved recruitment of surgeons, that is not the case at UMMC.
Jones has accepted a position at the medical center as director of clinical and population sciences at the Mississippi Center for Obesity Research. He is a tenured professor at UMMC and a physician.
Henderson said he decided to stay in the United States and not return to Scotland simply because of the wealth of opportunities in America. “Support for research for an academic was better in the U.S.,” he said.
The National Health System in Great Britain is state-run and is truly socialized medicine, a fearsome specter to those who see Obamacare as a step in that direction.
Scotland was about a decade ahead of the United States in terms of quality, safety and outcomes, Henderson said. He said later in an email in response to a question that the NHS does have drawbacks, including longer wait times for surgery and more-restricted access to some specialty care.
Emphasis on the three-part approach is crucial to bringing U.S. health-care costs under control. “The cost of health care in the United States is out of control,” amounting to 18 percent of the gross national product, and growing, he said. But reports say that the increase has slowed in recent years.
“It used to be every doctor had their way of doing it,” he said.
Now, because of strides in medicine and resulting complexity, the team approach — starting with the physician and including other professionals as well as the patient — is the new and evolving paradigm.
That means that a playbook is needed, a standardization of the best approach to treating an illness, he said.
Standardization means better individualized care, he said. “Who should go down this path or that path?” Say that if an oncologist sees 50 cancer patients a year, perhaps the care should take one direction for five of them and 45 another.
“How do we agree to get the five from 10 different doctors going down that smaller path?” Henderson said. “What’s happened to date is that all 50 patients would probably all get the same treatment. They all didn’t need the same treatment, as we learn more about the cancers.”
On the macro level, the big picture is to focus on quality, safety and outcomes, he says.
Henderson, 70, was asked if this is last medical assignment. He chuckled and said, “I’ve said that before,” paused and said, “Probably.”
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