Mike Purvis is the chief administrative officer for Sutter Medical Center of Santa Rosa, an affiliate of Sutter Health. Mr. Purvis has been with Sutter in Santa Rosa for the past three years, helping to lead health systems’ efforts in rebuilding and relocating its current Chanate Road hospital to a $284 million facility on Mark West Springs Road just north of Santa Rosa.
Q: Now that health reform is here to stay, what is the feeling among hospitals and large providers? Will the Affordable Care Act adequately contain costs for providers?
Mr. Purvis: Uncertainty. The politics in Washington D.C. are unstable and complex, which makes it difficult to understand how all the pieces will come together. We need to focus on providing exceptional quality and affordable care in an integrated delivery system, which Sutter Health has been focused on for many years.
Health care reform is not designed to reduce the operational cost of care but it will reduce payments to providers. The ACA is likely to slow future cost increases when considering the total cost for care. This cost moderation will be achieved through more effective and appropriate utilization.
Q: Lately, the North Bay has seen significant movement toward coordinate care among providers, particularly in the form of accountable care organizations (ACOs) or ACO-type structures in the private sector. Will this movement continue and, if so, what will it look like for providers?
While there is a lot of activity and discussion about ACOs, for the most part there is little evidence of meaningful progress in care integration and coordination. Sutter Health has pursued a strategy for several years focused on creating integrated systems of care linked with a full electronic patient information that facilitates exceptional quality, service and care coordination.
In Sonoma County, the Sutter physician organization of 107 providers is fully operational with an electronic health record. Patients are able to directly schedule appointments online, email health questions to their doctor, view test results, order prescriptions etc. The new Sutter hospital will open with an electronic health record that will additionally connect patient’s hospital records.
Q: From your perspective, what is the biggest challenge facing hospitals “post” health care reform? Reduced payments from the Centers for Medicare and Medicaid? Maintaining a healthy patient census?
Mr. Purvis: We will not be post health care reform for many years. The transition is a lengthy and complex process with significant unknowns.
The biggest challenge will be that providers receive less payment while simultaneously needing to invest in infrastructure that will enable managing population health rather than episodic illness care. Transitioning to new payment systems will be a formidable challenge.
Q: There is a palpable shift toward prevention and keeping patients out of the hospital as much as possible. How will hospitals balance that while maintaining a healthy patient census? Will the old notion of “heads in beds” eventually become antiquated? Will that mean smaller hospitals?
As we move to the health care reform model, the focus will begin to shift away from the hospital toward preventative and home based programs and services. This is a key reason why Sutter’s new hospital is designed to care for patients in a much more effective way. For example, the new hospital will have all private rooms — a key factor in caring for the patient and providing a healing environment to increase recovery time.
Q: To what extent will technology play a role in the aim of reducing health care costs and producing better patient outcomes? Can you give an example of something that your company has done? Obviously we are familiar with electronic health records, but what are some other areas in health IT and technology overall that are worth noting?
Mr. Purvis: Sutter Health has launched an approach to coordinate end of life care though a home health program called Advanced Illness Management (AIM). The electronic health record is important part of AIM as it facilitates constant and timely communication across providers and care settings. The program coordinates care around the patient at home which improves the patient’s quality of life, provides comprehensive and safe care, and lowers the cost of services for those with advancing illness. Hospital utilization at the last 12 months of life is the most costly. Statistics show that the AIM program reduces hospitalization by 50 percent, Intensive Care Unit days by 75 percent and length of hospital stays by one day. Patient and family experience is greatly improved with a high provider satisfaction as well. Sutter’s AIM program will launch in Sonoma County this month.
Q: And, what are the associated challenges of developing and implementing such technology?
Mr. Purvis: We need to make investments in technology that we do not get paid for today with the hope that there will be a financial return in the new payment system of population management. Examples include preventative care and most home based services. On another front, Sutter Medical Center is investing in the leading edge minimally invasive technologies. The new Sutter Medical Center will open with a state-of -the–art Hybrid Operating Room. The Hybrid Operating room is a blend of an operating room and a diagnostic and interventional procedural suite, which allows for flexibility of the high technology procedures that are emerging in health care.
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