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Healthcare Governance and the Increasing Focus on Patient

Safety and Quality: How This Trend Will Affect PAs

Nancy McKeague SPHRApril 5, 2014

Value of our $3 Trillion System

Top Occupations Employed by Hospitals

• Healthcare practitioners /technical occupations: 53.7%• Office and administrative support: 13.37% • Healthcare support: 12.76%• Management occupations: 3.71%• Building and grounds maintenance: 3.40% • Food prep and service: 2.48%• Community and social services: 2.40%• Business and financial operations: 2.01%• Computer and mathematics: 1.23%• CEOs/ other top executives 0.5%

Bureau of Labor Statistics April 2014

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The Role of PAs in Hospitals

• Almost 40 percent of clinically practicing PAs work in hospitals.

• How can we quantify the value that PAs bring to the hospitals?

• What will the role be of PAs in revenue generation and other aspects of hospital healthcare?

• Discussion must include PA counterparts in private practice and other settings.

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PAs Helping to Transform Healthcare

Growing recognition that:• PAs not only treat disease, but also promote

health, and decrease healthcare demand through preventive care.

• PAs are leaders in team-based, coordinated care.

• Healthy People 2020, an initiative headed by HHS, has four health principles that align with the type of care that PAs provide.

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Healthy People 2020 Principles

These principles are: 1.helping people to live longer through

preventing disease,2.eliminating health disparities, 3.creating environments that promote good

health and,4.promoting healthy behaviors through all life

stages.

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Prevention-focused and Holistic

• PAs can decrease demand for care by improving prevention, education and coordination of care.

• PAs assume some of the routine work for physicians to help maximize office hours and treat more patients.

• Preventive care will reduce overall healthcare spending by warding off diseases that strain the economy and work productivity.

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PA Quality Ratings

Studies have consistently shown that:• PAs provide high-quality care with outcomes

similar to physician-provided care. • Incorporating PAs can improve outcomes. • Patients are just as satisfied with medical care

provided by PAs as with that provided by doctors, and sometimes more satisfied.

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Patient-Centered Medical Homes

• One example of an emerging care model that is strongly supported by healthcare reform is the PCMH.

• This model makes use of all healthcare providers’ skills in ways that are most efficient and effective for patients and encourages open and continued communication between providers and patients.

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Patient-Centered Medical Homes

• In a PCMH, all clinicians work together to provide care that is comprehensive, ongoing and coordinated. The clinical team provides primary, acute and preventive medical care.

• The team also integrates specialty referrals and other services from the health system and community.

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Engaging Patients in Care Management

• PAs play a vital role in chronic care management.

• Chronic care management programs may reduce hospital admissions, readmissions, specialty care, and prescription drug use.

• This model relies heavily on patient education and empowering patients to play an integral role in their healthcare.

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Blue Cross' Enrollment Breakdown

For the 2014 open enrollment period:• 56% of BCBSM and BCN members bought

products on the Marketplace;• 88% of on-Marketplace enrollments were

subsidy eligible;• 22% are experiencing reductions of $500 to

$1,000 in their monthly premiums; and• 55% of total enrollees were new to BCBSM

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Strategies to Improve Performance

Competency-Based Hospital Boards

• Health care boards are bombarded by constant change and complexity.

• Traditional decision-making methods often take too long, don’t always provide the answers

• Leaders struggle to manage the sheer volume of strategic initiatives

• Calls for different types of decision contexts, simple, complicated, complex, and chaotic.

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Key Board Responsibilities

• Oversight of legal and regulatory compliance, • Upholding efforts to improve health care

quality and patient safety, • Physician relationships and competition, • Safeguarding the organization’s charitable

assets, and • Protecting the hospital’s credit rating.

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Roles Expands for Compensation Committees

• Now responsible for aligning the health care organization's strategic goals and executive compensation.

• It is being called upon to oversee succession planning and senior executive bench strength development.

• It now performs virtually all important human resource functions related to the organization's top executives.

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Competencies + Diversity + Culture

Key Strengths and Experience:• Executive leadership• Business Management• Finance, Investment and Audit• Clinical Care and Quality Improvement• Law• Community Health• Advocacy

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Trustee Decision-Making

• How would you define the relationship between the board and hospital management?

• Is the board’s decision-making process inclusive, or do a few board members dominate key decisions?

• Is the board getting the educational guidance it needs to understand the hospital, its market area and the health care industry?

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Trustee Decision-Making

• Are you comfortable speaking up when you disagree with management proposals or the direction the board is going with a particular decision?

• What is the board chair’s role? How does the chair relate to the CEO and other board members?

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Issues Facing Hospital Trustees

• Costs will continue to grow at a rate faster than payment increases.

• Insurance exchanges will put downward pressure on premiums, which will result in lower payments in 2014.

• Use of less costly delivery sites — such as post-acute versus acute — will reduce hospital revenue.

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Issues Facing Hospital Trustees

• Physician alignment will continue to be one of the top concerns for CEOs.

• Hospitals will be focused on strengthening relationships with physicians through employment, economic risk sharing or shared savings with payers.

• Primary care is still the key focus and episodes of care require a close, economically aligned specialty connection by major service line.

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Models and Demographics Changing

• New models of care, such as accountable care organizations, clinical integration, bundled payments or patient-centered medical homes require a close working relationship, including economic incentives, between the hospital and healthcare providers.

• Many physicians are approaching their retirement age, which will require new and innovative uses of this workforce.

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Quality and Transparency

• Transparency will grow and data will become more available to the public, employers and purchasers. There will be increasing visibility of quality scores and pricing, making value much more important.

• Expect employers, organized labor, the public, health plans, and, competitors to access publicly available data to see performance scores.

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Connecting the Boardroom to the Bedside

• Many boards demonstrate their focus on patient safety and harm-reduction by regularly hearing from the front-line clinicians at meetings.

• Board members occasionally attend clinical team meetings after receiving permission from the front-line staff.

• A chance to and drive home the message of board involvement in quality.

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Culture Must Change

• Without meaningful culture change, no hospital can sustain best practices that rely on open, transparent communication between clinicians with varying roles.

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