Welcome to NMC

Jill Bowen

Hospitals must get “better, faster, and cheaper” to survive, said Ian Morrison, a healthcare futurist who spoke at a recent Vermont Association of Hospitals & Health Systems meeting.  That directive is not new to NMC and we rank strongly in measures of quality, efficiency, and cost as a result.  Still, Ian is right: we have to change how we do what we do so it costs less in order to continue to be able to care for our community.

 Vermont and the nation are shifting away from a “volume-based” reimbursement for healthcare (that pays hospitals and providers based on how many patients they treat) to a “value-based” approach (that rewards quality and efficiency).  Ian shared four “must-do” strategies for hospitals to make that transition. 

1.  Clinician-Hospital Alignment.  Hospitals and physicians and providers need to be aligned and working towards the same clinical and financial goals.  NMC, most other Vermont hospitals, and many physicians have opted to participate in the Accountable Care Organization (ACO) proposed to Medicare by Fletcher Allen and Dartmouth.  That pilot would align incentives tied to quality and finances among participants relating to the care of the Medicare patients covered by the ACO.  Alignment is also increasing as more physicians seek the stability of employment by hospitals, which NMC has provided in several instances to preserve or expand access to care.  As hospital employment is not a “one size fits all” solution, NMC is working to engage our entire medical staff – private practice docs, NOTCH, employed physicans, etc – in efforts towards greater alignment. 

2.  Quality and Patient Safety.  We must ensure the right care is provided at the right time in the right setting.  A recent unannounced Medicare (CMS) survey of NMC’s quality program resulted in no findings or recommendations.  That’s a wonderful testament to the work of the NMC team on quality and patient safety.  Our staff continues to be vigilant in our work relating to preventing hospital-acquired infections, success in which has allowed us to maintain a post-surgical infection rate that is a fraction of the national average.  We are working to reduce avoidable visits to the Emergency Department and prevent readmissions to the hospital.  We are collaborating with primary care practices and other partners to implement Vermont’s Blueprint for Health in our community. By expanding efforts like these and using evidence-based best practices, we can leverage quality to reduce costs.

3.  Efficiency through productivity and financial management.  As reimbursements are reduced and as more people are covered, we will have to become even more efficient to remain viable.  Currently, every position that comes open at NMC is carefully reviewed by our Leadership Team to see if there is an appropriate alternative exists.  NMC uses a formal “cost accounting system” to identify opportunities to eliminate the expense of unnecessary variation, duplication, or delays.  Moving forward, we believe that we can use LEAN techniques to do an even better job of streamlining to remove costs.

4. Integrated Information Systems.  NMC uses Meditech as our hospital electronic health record and are in the selection process for a new physician practices system.   Making sure our systems “talk” with one another and can share information with other providers is key.  For example, our ability to digitally send MRI and CT images to Fletcher Allen greatly reduces the chances that these costly diagnostics will be repeated when we have to transfer a patient.  Through direct interfaces and the emerging VITL (Vermont Information Technology Leaders) health information exchange, hospitals and providers will be able to take advantage of the power of sharing the patient record as we share in the care of the patient.

Ian cautioned hospitals that real change is needed.  We cannot to simply “rearrange the deck chairs on the Titanic.”  We need to help create a sustainable system that allows Vermont to continue to rank as the healthiest State in the nation.  NMC is committed to being an active, influential participant in healthcare reform. We can make a meaningful difference by implementing our pilot to reduce avoidable Emergency Department visits; by participating in the ACO and helping develop its clinical protocols; and by engaging our physicians, staff, fellow hospitals, and community partners in additional efforts to reduce costs without sacrificing quality and access.

 - Jill Berry Bowen, NMC CEO