By BECKY GILLETTE
SOUTHAVEN — Some people might perceive that a bigger hospital is a better hospital. But in the case of Baptist Memorial Hospital-DeSoto, advantages have been found allowing the hospital that serves a large surrounding rural area to engage in a unique physician collaboration targeted towards improving health outcomes while reducing costs for cardiac care.
“DeSoto is almost like a test site for a lot of these ideas and projects because they are controllable here,” said Dr. Arie Szatkowski, director of the Cardiac Service Line at DeSoto and a cardiologist with Stern Cardiovascular Foundation, which is part of the Baptist Medical Group. “We have one group of cardiovascular specialists, and a heart surgeon who works well with us. We have one group of hospitalists who work with us. When you try to do collaboration projects at bigger hospitals with multiple groups of cardiologists and surgeons, it can be difficult to work together.”
Improving cardiovascular care wasn’t just about better outcomes at lower cost, but putting Baptist DeSoto on the map.
“There was a time ten years ago when some people thought DeSoto was the worst,” Szatkowski said. “We were determined to change that perception.”
At the same time, they were aware that many patients struggle to pay their medical bills. Medical bills are the leading cause of personal bankruptcy in the U.S. You may do a good job of fixing someone. You may save a life. But if that person goes home, can’t pay the bills and becomes homeless, you have created another problem. “And you have to be aware of that,” he said.
Physicians at Baptist Memorial Hospital-DeSoto set out to reduce costs and improve efficiencies including developing a process for same-day discharge for people requiring cardiac catheterization and stenting procedures. Instead of the patient staying overnight as they do at most facilities, physicians developed a process to discharge patients the same day.
“We developed a radial-artery-in-the-wrist approach for all cardiac catheterizations as opposed to through the groin,” Szatkowski said. “We then developed a same-day discharge process. This increased same-day discharge for cardiac cath and stenting from 20 percent to 75-80 percent. We did that within a year. We are now expanding that to Baptist Memphis.”
In addition to allowing people to get home faster, other advantages are saving costs on hospitalizations—which helps the pocketbooks of both the patient and the hospital–and opening up beds for other people.
“The biggest part is people are happy with a stick in the wrist as opposed to the groin,” Szatkowski said. “They can get up and go home the same day. Psychologically, it is a much more calming approach.”
They closely studied the way they manage heart failure and chest pain. There was a huge variation of approaches including utilization of some expensive testing and treatment that did not improve outcomes.
“We spent a long-time developing order sets that specifically address common diagnoses,” Szatkowski said. “We were all focused on providing people who come to our facility with the best care. And we had an administration that was also supportive. We know hospitals are struggling financially, too, so any costs we save can be used to improve the quality of care. From the business standpoint, in addition to making sure the outcomes are good and people come out without complications, we also implemented strategies that reduce the cost of that care. We deliver the right care and we deliver without holding back care that is necessary.”
The hospital first focused on quality because without good outcomes, you can’t deliver on operational efficiency and financial savings. You can’t build a long-term plan without a vision of how to manage heart problems. The hospital got involved with a couple of national registries that collected data to compare Baptist Memorial Hospital-DeSoto to national benchmarks and best practices for cardiac procedures.
DeSoto was the first hospital in the greater Memphis area to get involved with the registries that focus primarily on outcomes and metrics. The registries track patient survival rates and look at whether appropriate evidence-based medicine is being applied to each patient.
“We drilled down on that so well in recent years that we have achieved American College of Cardiology Platinum Status, which is the highest ranking, for the past several years,” Szatkowki said. “We have been able to drive the appropriate utilization of order sets created by physicians for Electronic Medical Record here at Desoto to 80 percent appropriate use for patients admitted with these particular cardiac problems such as heart failure and heart attack.
“The American College of Cardiology came to evaluate us to see if we qualified for excellence in accreditation for chest pain, heart failure and atrial fibrillation management and they couldn’t believe how well we were doing with our order set utilization. They hadn’t seen this kind of physician engagement elsewhere in the nation. Of note, we are the only hospital in our area that has been recognized by the American College of Cardiology for excellence for care of patients who present with heart failure, chest pain and atrial fibrillation.”
Stern has a collaborative partnership with Baptist Health to focus not only on quality outcomes, but the operational and efficiency components of how they deliver cardiac care. An example is a council and finance committee made up of doctors, managers and nurses who focused on reducing costs of care delivery. For instance, they determined which procedural items had the greatest impact on outcomes at the lowest cost.
Similar work is now being done with the with the electrophysiology lab. Anything that is more expensive but clinically no better is removed from the items list.
Often doctors might not even be aware of the relative costs versus effectiveness of procedures. Szatkowski said this collaborative partnership has allowed the physicians to be more cognizant of the cost component when providing patient care.
“The only way that we are going to make an impact on the high cost of healthcare is if physicians get directly involved so they understand the process and make changes to how care is delivered,” he said. “In the end, we are the ones who write the orders.”
Located in what has been one of the fastest growing counties in the U.S., Baptist Memorial Hospital-DeSoto has grown from 30,000 patients a year to 70,000 per year over the past 13 years. The hospital recently completed a project doubling the size of its emergency room.
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