Health care reform is all about extending health care to millions of Americans who, without health insurance, are left with little or no access to care – no designated primary care provider and acute care that’s generally delivered in an Emergency Department. The Affordable Care Act expands Medicaid eligibility and introduces state-based health insurance exchanges that together welcome millions of new patients into the health care system.
To accommodate this influx, URMC is rethinking our approach to primary care, strategically expanding facilities, and taking steps to avoid unnecessary and costly admissions that can block access to others. In 2011, we began to see encouraging results from these efforts.
URMC’s Center for Primary Care announced that all 22 of its practices have achieved the highest status – Level 3 – by the National Committee for Quality Assurance (NCQA) as Patient-Centered Medical Homes (PCMH). URMC is the first health system locally to adopt the patient-centered medical model and have all primary care practices certified as Level 3 by the NCQA. In the PCMH model, physician practices restructure themselves to provide chronic disease management in a more patient-centered way, a critical short-term strategy for controlling ED visits and readmissions, and setting the stage to accept financial risk in a managed-care environment. In a PCMH, patients must be able to make appointments the same day or the day after they are requested, have sound preventive care including electronic monitoring, and have access to a care manager. In 2011, URMC made a major commitment to the effort, hiring additional care managers and outcome analysts to more quickly transform our traditional practices to medical homes. PCMHs have been credited nationally with improving access, patient and physician satisfaction, and cost efficiency.
One way to create capacity in an overstretched acute-care system is to ensure that all patients leave the hospital with the support necessary to turn the corner and complete their recovery. Experts estimate that one in every five Medicare patients slips off course and must return to the hospital, setbacks that add weeks to their recovery and a collective $17 billion per year in added expense. A pilot project developed in 2010 to reduce the number of avoidable readmissions showed dramatic results when it was applied across all of Strong’s adult medical-surgical units this year. The Safe Transitions program targets patients at high-risk of readmission for intensive follow up. But it also makes timely post-discharge primary care appointments, a follow-up phone call within 24 hours of discharge, and more extensive communication between hospital staff and the primary care physicians the standard of care for all patients. This formula has reduced by seven percent the number of patients who must be readmitted within 30 days for reasons related to their original admission. The team’s goal in 2012 is to reduce overall readmissions – including those for reasons that aren’t related to the original admission – by 15 percent. Success is paramount since, starting in 2012, Medicare will refuse to reimburse hospitals for patients readmitted within 30 days.
URMC’s approach to reducing unnecessary readmissions doesn’t stop at the hospital door. Visiting Nurse Service (VNS) was the first to develop a transition coaching intervention in September 2010 to smooth the way for patients after their discharge. A coach – generally a home care nurse or social worker – visits patients while they are still in the hospital, sees them again at home within 24 to 72 hours of discharge, and places three follow-up calls within the 30-days after they’ve gone home. Coaches reconcile the list of discharge medications with those already in the home, make sure that patients both understand and take medications as prescribed, and assure that they can recognize changes in their condition that could signal a crisis. The coaching program is part of the Finger Lakes Health System’s Agency’s (FLHSA) effort to improve health system performance. In late 2011, the FLHSA released preliminary data from the first six months of the initiative, which suggested that patients who received coaching were 20 percent less likely to return to the hospital after 30, 60 or even 90 days. This year, VNS also developed a fully electronic coaching record and is now able to provide regular progress reports to insurers and the FLHSA.
A four-story vertical expansion project, scheduled to be completed in June 2012, will add 101,000 square feet to the Wilmot Cancer Center - nearly doubling its size. The project will allow for the relocation of two inpatient care units - the Samuel E. Durand Blood and Marrow Transplant Unit, and a Hematology/Oncology unit - from Strong Memorial Hospital to the cancer center, creating a comprehensive cancer care hospital that offers a full continuum of care. The project will also provide additional space for the Wilmot Cancer Center’s growing research programs that are focused on bringing new therapies and treatments from the lab to the bedside in a quicker, more efficient manner.
URMC announced plans to construct an eight-story, 244,000-square-foot pediatric hospital on the Crittenden Avenue side of its campus. Plans for the new Golisano Children’s Hospital include a 60-bed Neonatal Intensive Care Unit (NICU), pediatric imaging, and 56 private pediatric rooms that will be one-third larger than current private rooms. A dedicated entrance and lobby will create a child- and family-centered space to welcome patients and their families. The building will be connected to Strong Memorial Hospital’s third floor, maintaining connection between Strong Beginnings obstetrical services and the expanded NICU. In July, hospital namesake B. Thomas Golisano announced a $20 million gift that kick-started a $100 million campaign to construct the new hospital and invest in programs and expertise.
Eastman Dental completed a $5.9 million renovation that vastly improves access to care in both downtown Rochester and at its main clinic site on the URMC campus. A huge increase in patients over the last decade placed a significant strain on Eastman Dental’s facilities and its ability to provide comprehensive care to all patients. Thanks primarily to its successful Clinical Re-engineering Initiative, for the first time in years, Eastman Dental’s clinic operations produced a positive increase in net assets. Patient satisfaction across many areas continues to steadily improve.
With its focus on resident services, The Highlands at Pittsford launched the development of Project New Life, a multi-faceted strategic plan designed to assure that residents continue receiving the highest quality and most appropriate services possible. The effort is coupled with a $4.8 million construction and renovation project designed around a holistic approach to aging known as the Seven Dimensions of Wellness. Improvements will include development of a Health and Wellness Center, extensive renovations to the assisted living component of the continuum, and major modifications to the kitchen and dining areas.
Women who receive outpatient obstetric and gynecological care at Strong Memorial Hospital will soon enjoy the convenience of a close-by-yet-off-campus location when the hospital moves ob/gyn services into a newly purchased building on Lattimore Road. With 21,000 square feet on the first floor alone, the department plans to locate ultrasound, fetal monitoring, genetic counseling, and laboratory services together with general and special ob/gyn care. The new site – complete with ample parking and easy bus access – will have the capacity to handle as many as 30,000 visits per year.