The content of this blog reflects the personal views of Dr. King and does not represent the UT Medical School at Houston or its affiliates.
I recently asked Dr. Jessie Tucker, Senior Vice President in the Harris County Hosptial District and Administrator at LBJ General Hospital, how he thought healthcare reform would affect Houston in general and LBJ specifically. I thought his comments were worth sharing.
“Healthcare reform provides enormous promise for us to better develop a more integrated healthcare tapestry that improves care quality and cost efficiency. By encouraging activities that focus on care processes and outcomes from the patient’s perspective, reform suggests that it will no longer be business as usual. Sound leadership will serve as the conductor for this very complex symphony of change and collaborative, team-oriented compliance programs will provide the string arrangement for the composition. Such leadership must foster a fertile environment for competence and commitment with a foundation in trust.
The Harris County Hospital District’s (HCHD) Lyndon B. Johnson General Hospital (LBJ) and other member TMC affiliates are clearly committed to high quality care. However, it is the integration of that care where reform will leave it’s mark on Houston. We have to move beyond the current episodic levels of responsibility, liability and concern of our sometimes fragmented system of care. We will have to focus more on the quality and cost efficiency of the patient’s complete experience and for some, this is a new way of thinking. This almost Six Sigma or Lean – beginning to end – approach to revamping the processes of how our patients receive care in our hospitals, clinics, facilities and even in their homes, requires that we concentrate our efforts on the continuum of care and not just the most recent and immediate episode. Within the context of the patient’s experience and clinical appropriateness, the process focus of Six Sigma’s DMAIC framework and other process improvement tools will surely help to illuminate the path to post-reform success.
Requirements for ensuring the value-added integration of health information technology, providing service and care integration/non-fragmented care, assuring cost efficiency, and significantly decreasing fraud are several of the key components of reform that will change the operational landscape for healthcare delivery in Houston. An additional significant opportunity can be found in the insistence on a more comprehensive and integrated approach to physician partnership. Many current contractual arrangements will be significantly one-sided and clearly inappropriate within the domain of reform. Some of these arrangements will undoubtedly need to be revisited to ensure Accountable Care Organization success.
Evolving IRS needy patient billing, FTC “Red Flag”, RAC, and SEC not-for-profit disclosure rules along with DOJ increased scrutiny of insurer mergers and acquisitions is more than an alphabet soup of Federal agency concerns. These and other changes and proposed changes speak to a cultural shift in healthcare organizational responsibility, accountability and patient protection. Penalties for poor performance on CORE measures, infection rates, readmission rates, patient satisfaction, medication error rates and many other performance metrics will all work to improve outcomes and alter our often inadvertently fragmented system of care. This increased scrutiny provides numerous opportunities for consistently maintaining high quality care with a focus on the patient.
LBJ, along with our UTHealth physician partners, is poised and prepared for reform and welcomes the opportunities that reform will bring. Within the context of Donabedian’s structure, process and outcome model for quality, LBJ is undergoing a total transformation.
Structurally, LBJ will add a three-story 83,000 sqft clinic building and ASC, renovate and expand by 70% the Level III Trauma and Emergency Center to comfortably accommodate nearly 100,000 visits a year, and renovate it’s current ORs and GI suites. With the space made available by the new clinic building, LBJ expects to be a semi-private hospital within the next 24 months. We will also expand the infrastructure with a redesigned campus and entrance, build a parking garage and complete a renovation of the cafeteria. With an eye on a facility master plan that will operationally balance the hospital, these major physical changes coupled with minor renovations and a cultural dedication to efficiency and patient satisfaction prepare LBJ for the new day. The HCHD is also in preliminary discussions with several other partners to ensure an appropriately comprehensive and balanced LBJ campus.
In the way of processes, LBJ will implement a fully electronic patient record system in the fall that links with every other HCHD facility. This will increase the timeliness and subsequent value of data for quality and financial decision-making, accountability and compliance. Secondly, the current interdisciplinary Optimization Initiative in the hospital is aggressively challenging every norm. The goal is to ensure that our operational practices and policies are the best for our patients and deliver care in the most cost efficient manner possible. UTHealth is an integral part and essential contributor to this effort with members of the medical staff co-leading several work groups.
The return on this new record system and this comprehensive analysis of our operations will be seen in our subsequent decisions. We will continuously improve our clinical and compliance outcomes, efficiency and cost effectiveness using derived evidence and industry best practices. By maintaining this new era focus, we will be prepared for reform, far exceed the expected returns for the stakeholders of Harris County, and most importantly provide comprehensive world-class care for our patients and their families.”
Jessie L. Tucker III, MBA, Ph.D., FACHE – SVP/Administrator, Lyndon B. Johnson General Hospital | Dr. Tucker has over 20 years of healthcare leadership experience, is a Commission on Accreditation of Healthcare Management Education (CAHME) Commissioner, a former American College of Healthcare Executives (ACHE) Regent and serves on several ACHE Committees. Before retiring from the Army in 2009, he led dental and primary care facilities and teaching hospitals, and taught in health and business graduate programs. Dr. Tucker was the 2007 recipient of the ACHE’s Robert S. Hudgens Memorial Award for Young Healthcare Executive of the Year and was awarded the Legion of Merit among other military awards. His research interests and publications include patient satisfaction, financial management and quantitative methods works.
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