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Exempla Saint Joseph Hospital's Alignment with Physicians Advances Quality

July 14, 2010
Catholic Health World June 15, 2010 Volume 26, Number 11 Exempla Saint Joseph's alignment with physicians advances quality At Exempla Saint Joseph Hospital in Denver, almost half of the doctors work for one medical group. Among their exclusive domains are the emergency department and neonatal intensive care. Saint Joseph Hospital gets about 50,000 visits annually to its ER and delivers about 10 percent of all babies born in Colorado. Considering all that activity, hospital President and Chief Executive Bain Farris is grateful for the size, efficiency and medical results of the large primary care and multi-specialty practice. "The medical group is very outcome-driven and has a structure that can tackle programs and problems," Farris said. "At most hospitals, I'd have to deal with six or seven groups for cardiology alone. With this system, I believe the potential for doing something good for patients is greatly enhanced." The doctors work for Colorado Permanente Medical Group, part of the Kaiser Permanente health insurance organization. California-based Kaiser Permanente owns clinics, hospitals and medical information systems and is the nation's largest nonprofit health insurance company. Kaiser Permanente pays salaries to its 15,000 physicians. Among them are the 850 physicians employed by the Colorado Permanente Medical Group, 585 of whom work at Saint Joseph Hospital. Farris said the Kaiser system's reputation for concerning itself with medical outcomes, not fees for services, bodes well for Saint Joseph Hospital as the nation's health organizations learn how to adjust to the new federal health insurance law. He called it a good model for the future. "I believe the law is going to mandate a much closer integration between doctors and hospitals," said Farris. "I don't know that Kaiser's method is the only way, but it's a very effective one. I believe the Kaiser model will do very well as we go forward to 2014," the year many of the federal reforms are to be imple-mented. "Together we get a better outcome in a more efficient way," he said. Farris said that members of the Colorado Permanente Medical Group are actively engaged with Saint Joseph Hospital administrators in shaping hospital treatment protocols and procedures for improving infection control, safety and performance. "They follow the best-documented medicine," Farris said of the Kaiser physicians. Built to last The Kaiser insurance system dates to the 1930s, when Dr. Sidney Garfield ran a small hospital in the California desert that charged a flat prepaid rate that covered hospital care for workers. Garfield's system got its name during World War II, when it became the health program for the 90,000 shipyard workers at San Francisco Bay employed by industrialist Henry J. Kaiser. The Kaiser system began providing health insurance to the general public shortly after the war ended. Kaiser Permanente now owns 34 hospitals in California and one each in Oregon and Hawaii. Its 8.6 million members see Kaiser Permanente primary care doctors and nurses in Kaiser Permanente clinics, get referrals to system specialists and go to system or system-affiliated hospitals for treatment. Kaiser Permanente also operates in Colorado, four other states and the District of Columbia through group contracts with independent hospitals. Its doctors have worked at Saint Joseph Hospital in Denver since 1969, and the Kaiser Permanente network in Colorado has grown to include similar arrangements at 14 other hospitals. The company owns 20 clinics in the Denver-Boulder area and in Pueblo. Kaiser Permanente Colorado insures 519,000 people, including employees on the Denver city government payroll. The 565-bed Saint Joseph Hospital is near downtown and was founded in 1873. It now is part of the three-hospital Exempla Healthcare system in Colorado and is owned and operated by the Sisters of Charity of Leavenworth Health System in Lenexa, Kan. Saint Joseph Hospital contracts with the Colorado Permanente Medical Group and gets about 70 percent of its patients through the Kaiser Permanente insurance system. The Colorado Permanente Medical Group doctors treat all patients in the Saint Joseph Hospital departments they staff. Rewarding quality Salary provides about 95 percent of a Kaiser doctor's compensation. Amy Smith, a spokeswoman for Kaiser Permanente Colorado, said the system pays bonuses according to ratings of quality outcomes and patient satisfaction. She said Kaiser Permanente Colorado's insurance rates are about 10 percent below the state's market average. Dr. Shawn Dufford is a Colorado Permanente Medical Group anesthesiologist who is medical director of perioperative services at Saint Joseph Hospital. Dufford was in private practice before he joined the group practice five years ago. Dufford said Kaiser's electronic medical records provide doctors with comprehensive patient histories, allowing them to obtain information quickly and avoid the expense of ordering repetitious tests. "Because of our style of integrated care, patients aren't going from one provider to another depending upon the ailment," Dufford said. The care is coordinated. "In private practice, you may not get all the information from the primary care doctors. In fee-for-service, the incentive is to charge for services. Our incentive is to manage the overall well-being of the patients. I think that allows for better collaboration between the doctors and the hospital, and it leads to better outcomes." Dufford said Saint Joseph Hospital recently was ranked number one on the American College of Surgeons' National Surgical Quality Improvement Program, a voluntary survey of 227 participating hospitals. It consistently scores in the best quartile each year in mortality and morbidity. Seamless care Farris said Saint Joseph Hospital has a higher-than-average case mix index of serious illnesses, but its average length of stay is less than four days, a rate below the national average. Its readmission rates also are below the U.S. average. Farris said a big reason for that is Kaiser Permanente's system of seamless medical management of its patients, from first visit to surgery to outpatient services. Farris became the hospital's president and chief executive in January after having served as chief executive of St. Vincent Hospital, now St. Vincent Indianapolis Hospital, part of Ascension Health. He also has worked on the senior leadership team of the Sisters of Charity of Leavenworth Health System. Farris said Saint Joseph Hospital has the usual tensions among individual doctors, doctors' groups and departments. He said the hospital strives to encourage cooperation between the Colorado Permanente Medical Group and practi-tioners in other medical groups, and he said Kaiser Permanente's culture encourages that cooperation. "There are Kaiser doctors who think we spend too much time on the community doctors, and some community doctors think we just pay attention to Kaiser. In that sense, nothing is new here," Farris said. "What's important is whether we can focus on giving the highest quality of care at the most appropriate cost, and we have a real advantage here." Farris said doctors of the Colorado Permanente Medical Group understand and respect the hospital's Catholic mission. He said Kaiser Permanente supports the hospital's medical education program and the Sisters of Charity mission to the poor and underserved. "You don't have a relationship for 40 years if there isn't a shared belief in the goodness of the mission," he said. Copyright © 2010 by the Catholic Health Association of the United States For reprint permission, contact Donna Troy or call (314) 253-3450.