John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
Health care in our country costs too much, and in many regions, quality and access are not what they should be. Nationally, year-over-year growth in health care expenditures is one of the main drivers of the growing deficit and the national debt. In Vermont, quality is excellent compared to national norms, and most of our citizens have access to needed services. We can always improve on both of these dimensions, but the real issue is that health care costs have been increasing at an unsustainable rate over the past decade.
In our many conversations with the Green Mountain Care Board (GMCB)—the five-member panel charged with overseeing Vermont’s health care reform effort—they have articulated three goals, all centered on the cost issue:
- Move more care out of a fee-for-service payment methodology and into a system of reimbursement in which providers take responsibility for a defined patient population and are paid based on outcomes and improved quality.
- Improve coordination and collaboration among health care providers in our region.
- Reduce the rate of growth in health care spending—i.e. “bend the cost curve.”
These goals are laudable and attainable, in my opinion, but it will not be easy.
“Bending the cost curve” will require difficult choices and lots of hard work. We have already witnessed the rubber meeting the road in this regard. The administrative leaders and board at Rutland Regional Medical Center needed to review all of their existing programs and make tough choices to create a budget for FY 2013 that works. The decision? Discontinue inpatient rehabilitation services. The service provided was of very high quality and a real patient/family satisfier, but was relatively small and very labor-intensive. In addition, inpatient rehabilitation services are available at Mount Ascutney Hospital and Fletcher Allen, relatively short distances from Rutland.
This is a real-world example of what it will take to “bend the cost curve” in Vermont. The debate about this decision was controversial and intense, and many still do not agree with the outcome. Similar discussions and decisions, all difficult, will follow as providing services close to home will be only one factor to be considered along with quality and the cost to provide services. Determining where to provide services, increasing collaboration and coordination among providers, and improvements in quality all hold promise for cost savings.
Improving quality and becoming highly reliable is an excellent cost-reduction strategy. Consider, for instance, our efforts to eliminate central-line associated blood stream infections. Four years ago, we experienced about nine infections per month in all of our critical care units combined. Between May 2011 and May 2012, we had none due to the efforts of many in our organization. Assuming about $50,000 in excess cost for each infection, this is over a $5 million reduction in annual expense.
I am confident we can truly reform health care in our region and bend the cost curve, but it will take the efforts of all of us and much hard work.
John R. Brumsted, M.D. is the President and Chief Executive Officer of Fletcher Allen Health Care and Fletcher Allen Partners.
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Great article Dr. Brumsted. As in the case with Rutland, hospitals and providers will continue to evaluate service line compression or in some cases expansion, however one of the key components to drive down costs within a community will be managing the utilization of resources and the population’s health. Historically, consumers have used their hospitals emergency department as a fissure for healthcare services, bypassing the physician offices and ultimately adding an incredible amount of fiscal and operational strain. Moving forward, the continued collaboration of enterprise health systems such as FAHC, and federally qualified health centers, like the Community Health Center of Burlington will promote a healthier community, improve access and transparency among providers, and mitigate costs that have primarily been funneled through the emergency department. I think an interesting article in the future would be to focus on the community and peripheral health centers that FAHC is working with to improve health outcomes within the region. Thank you for your time and effort you place into educating all of us on the boiler plate items affecting us within healthcare reform
Brumsted’s approach to “bending the cost curve” – discontinuing a high-quality, patient-friendly, successful LOCAL inpatient service – typifies the corporate, not patient-centered, view of medicine – and the push to centralize care along the factory model – or “McMedicine”, which is what FAHC is turning all our local services into (like Hinesburg Family Health).
“Bending the cost curve” should include lowering corporate costs: CEO and officers’ salaries, and capital expenditures for unnecessary and overused equipment (imaging, and diagnostic & therapeutic installations whose use has little basis in outcome evidence).
It is deplorable that Brumstead and the rest of the good old boys (including those on the Board of Directors) have forsaken patient-centered care for the sake of corporate finance. Yes, they inherited a $400 million mess, and they are spreading this debt load onto VT hospitals and clinics like an aggressive, invasive tumor. The hallmark of this approach is the gross overuse of services and procedures with little supporting evidence (like a 25-30% overall surgical-birth rate, for example).
The best plan for FACH would be for the state to take it over; go into receivership; cut the & overuse fat seriously (maybe turn most of the hospital into long-term elder care); and really work on providing the care that patients need, instead of the income streams that doctors want. We should be rejecting the ‘health care industry’ model and rediscovering our roots in serving ourpatients.