Category Archives: UNC Health Care

Patient Experience at UNC Health Care

UNC Health Care recently received its Hospital Consumer Assessment of Healthcare Provider Systems (HCAHPS) scores for June 2009-June 2010. HCAHPS measure patients’ ratings of their hospital experience and the results are compiled into 10 core measures as outlined by the department of Health and Human Services.

We ranked highest in the Triangle area in all core measures, which include things like overall hospital experience, bedside manner, communication, cleanliness and guidance through treatment options, among others.

We also were given a high overall ranking by 81 percent of surveyed patients, exceeding the state and national averages of 69 and 67 percent, respectively. The full list of our rankings can be found here.

We strive to provide our patients with the best care we can deliver. Through coordination of care and collaboration with other health systems, we are able to offer better measurement of outcomes, ultimately improving care. This will become increasingly important as we continue to grow.

Our HCAHPS scores help us identify our strengths and weaknesses as a System through the lens of our most valued graders: our patients. And these measurements will help us drive improvements in care quality as we move forward.

Expanding Care in our Area

Last week, UNC Health Care broke ground on its new Hillsborough campus, set to open for patient care in 2013. This expansion is part of our mission at UNC Health Care to provide access to high-quality care across our state. Once complete, the Hillsborough campus will ensure better access for patients who require care outside of the Chapel Hill community and help to alleviate some of the capacity issues at our main campus.

This expansion would not be possible without the dedication and hard work of our physicians. Their role is the focus of phase one of the project, a three-story physician office building, which will be completed in 2013. This facility will include an urgent care and outpatient clinic, imaging and oncology services. UNC Health Care Physicians are central to our ability to provide these services to the surrounding community.

The urgent care unit, in particular, will allow people with non-emergency issues to receive treatment, rather than traveling to our main campus’ emergency room. This will ease our emergency room crowding issues and help us keep medical costs low.

The second phase of the project is the UNC Hospitals – Hillsborough Campus, which will be home to 68 beds. Fifty of those will be used for acute care and 18 for intensive care units. We plan to be fully operational by 2015.

UNC Hospitals has 803 licensed beds in Chapel Hill currently, and those beds are typically at 90 percent. However, in the past few months, we have operated at nearly 100 percent capacity. The Hillsborough campus will allow us to move patients with non-emergency issues off our main campus to receive the care they need. This also will give us an opportunity to turn some of our semi-private patient rooms into private rooms – providing a better patient experience.

Our new Hillsborough campus will translate into jobs and overall growth for our area. This project is the result of decades of hard work and we are pleased to meet the growing health needs of our surrounding community.

Health care services: growing demand, diminishing resources

There is no shortage of troubling trends in health care: increasingly high rates of obesity and chronic disease, rising costs – all amid a backdrop of falling resources in both the public and private sectors.

But before you succumb to pessimism, take note of some real progress being made to design a health care system that can do more with less.

UNC Health Care is making a sustained effort to improve communication between doctors and patients. As I discussed briefly in a prior post, doctors and patients can be on different pages, leading to inefficient, fragmented care.

For example, a patient heavily influenced by direct-to-consumer advertising may demand drugs that are not appropriate for his situation. And busy work and family schedules can cause patients to delay seeking care, all too often moving treatment from primary care physicians to crowded (and expensive) emergency departments.

A recent Health Affairs report found that acute care – newly arising health problems that are not typically life-threatening – is treated by a primary physicians only 42 percent of the time. Nearly a third of acute care visits – 28 percent – are emergency room visits. The other 30 percent of acute care visits are made to specialists and outpatient departments.

At UNC Health Care, we are working to build team models that coordinate the actions of multiple physicians and help patients become more informed advocates for their own care. This will help close the information gap between health care professionals making treatment decisions and patients receiving care.

One promising concept is the “patient-centered medical home.” This approach teams primary care doctors with specialists, gives patients better cost and quality information and leverages health information technology to avoid duplication and medical errors. It gives patients a convenient and trusted place to go for care, encouraging earlier and less-costly treatment options.

We are piloting the medical home concept with Blue Cross and Blue Shield of North Carolina, our first such partnership with a third-party-payer. Working together to drive quality up and prices down makes sense to both parties and we have high expectations for the project.

We also are working to provide patients with greater access to coordinated care facilities through the establishment of the Triangle Physician Network. Physicians in our network share a collaborative spirit and have access to robust electronic patient records that facilitate coordination of treatment.

These initiatives are early but important steps toward a new era of collaboration between providers and their patients. We believe these efforts will yield more fruitful doctor-patient communications, better coordination among health care professionals and greater consumer understanding of how the delivery system works. None of these improvements will happen overnight, but there are promising signs that we are moving in the right direction.

Annual North Carolina Leadership Dinner

Raleigh, NC

Yesterday evening, I spoke at the North Carolina Leadership Dinner as part of the 2011 Emerging Issues Forum, presented by the Institute for Emerging Issues at North Carolina State University. Each year, the Forum brings together leading thinkers and decision makers to foster bigger and better ideas for innovation and improvement of our state and nation. I have included my remarks below.

I have been working on improving the public’s health for almost 35 years. And as I look out in the audience, I know that many of you have been in the trenches for as long, or longer than I have.

We are fortunate in this state – and especially fortunate in this region – to have access to some of the best medical care this country has to offer. I arrived in this state a little over a decade ago. The decisions that our state’s leaders made long before I arrived, and the teamwork with which they approached the challenge of building modern health care in North Carolina paved the way for all that we enjoy today.

But through the years, there have been several activities that I am especially proud of:

From fluoridating the public water supply in my home town, Birmingham, Alabama, to starting Medicare’s efforts to publish information allowing quality comparisons across the Nation’s hospitals.

From adding “Prevention” to the name of the CDC, and making prevention a practical reality in the Nation’s health system, to creating the NC Institute for Public Health, the outreach and service arm of UNC’s school of public health.

And from building the NC Cancer Hospital to implementing the new University Cancer Research Fund, I am deeply proud to have been involved in each of these efforts – but I am by no means claiming exclusive credit for any of them – they were very much team efforts. These achievements required lots of people, many organizations and institutions, working together to do challenging and important things to improve the public’s health.

For most of these years, I also have been working on reforming the American health care financing and delivery system – beginning with my work as a lower-level White House staffer for President Reagan.

I did the staff work for his health reform package from his State of the Union speech 28 years ago. I am sure you all remember it, right?

No, you don’t, because it did not get enacted.

Many health reform efforts – by many administrations – over many decades – went nowhere.

Of course, last year President Obama and the Democrats in Congress passed the Accountable Care Act. And promptly, the Republicans began the repeal effort.

It is too early to say how all this will turn out – and it is not my purpose this evening to speak in favor of or against the ACA.

Many of you know this, but let me be plainspoken. I have been appointed to political positions by three Republican presidents – Reagan, Bush 41 and Bush 43. At the same time, Nancy-Ann Deparle and Don Berwick – the key people on health reform for President Obama – are close friends of mine.

So I believe I have a reasonably balanced perspective on health reform.

You do not need me to handicap what’s going on in Washington – there are plenty of others who are doing that – take your pick.

But I will make one point – the various activities I mentioned at the beginning of my talk this evening – things I’m proud of being a part of over the years – they were team efforts – made possible by broad-based, bipartisan collaborative work.

We very much need a team effort to fix health care in America – and here in North Carolina.

Of course, there are limitations to what a single state can do, acting alone. But that should not be an excuse for total inaction.

That’s my message this evening – to all of us here convened by Governor Hunt and the Emerging Issues Forum – all of us, consumers and providers, business leaders and elected officials, rural and urban, Republicans and Democrats.

I believe the single biggest thing holding us back from thoroughgoing reform of our health care system is that we each believe that somebody else needs to change, needs to reform. If only they would do it, then all would be well.

I think we are the collective victims of our concerted efforts to blame someone else. Or to believe some things that just aren’t true.

What I am going to do with the remainder of my time this evening is empower us to rethink our long-held assumptions, and to move us from our comfortable, but mistaken, positions. This will guide us toward a team effort to build a much better American health care system, starting here in North Carolina.

So, here is my list of the top things we know for sure about health care – things that are not true.

1. The American health care system is the best in the world.

For all the good it does, it really needs a major overhaul. I believe the oft-reiterated slogan that our country’s system is the “best in the world” is evidence of a desire to keep everything as is. I am an “American exceptionalist” too, and I know that some of you hate international comparisons – but it is simply undeniable that on average, outcomes of care in the US are not as good as average outcomes in many other industrialized countries. This is mostly because of our inability to close the disparity in the health outcomes for certain ethnic or racial minorities.

The international comparisons are not looking at the best each country has. They are comparisons of where things are on average – from top to bottom. And our bottom is what pulls us down. These people spend large parts of their lives outside the health care system. They haven’t seen the inside of a doctor’s office for years. They know only the ER at a hospital as their usual source of care. When it comes to a national average, they get equal billing with those who take advantage of the best we can offer.

2. Everybody eventually gets the care they need.

Repeated studies have shown conclusively that there is a huge cost to American society of “uninsurance” – people seek care later, have worse illnesses and worse outcomes. And we have the crazy quilt of cross subsidies – paying customers pay much more to cover the cost of uncompensated care – for UNC Health Care, which includes Rex Healthcare here in Wake County, that’s $300 million this year.

3. Almost always, the quality of care people get is very good.

Many researchers, especially Dr. Beth McGlynn at RAND, have shown that far too commonly, people do not get the care they need – and others like the Institute of Medicine have shown the harm done in the processes of care because of the lack of attention to patient safety. I chair the board of the National Quality Forum, and we are working with all parties at interest to measure and report results and then to drive vast improvements in care quality.

4. The cost of care in America is not really a problem. It is a clean, non-polluting industry that employs millions of people. And at a time when the economic problem is “jobs, jobs, jobs,” health care is one sector where employment continues to grow.

Health care now represents 17 percent of our economy, which is far more than any other country. At a time when we are worried about our competitive position in the world economy, this has to be a concern. And the Medicare actuary has just said that health reform is going to add to aggregate health spending.

Let me be even more emphatic – proposals for health care reform that do not take cost control seriously should not themselves be taken seriously. Indeed, that is a major shortcoming in last year’s legislation.

5. If you like your care, nothing about it will change

This is a line often used by President Obama. Unfortunately it is one of the most hurtful of these mistaken ideas. Because almost everything about American health care must change if we are to be successful in overhauling it as I am suggesting.

We need to redesign care in fundamental ways, to create coordinated care across primary and specialty doctors and others, so that each of us has a “patient-centered medical home.” As I hope you have heard, that is what we are doing in a very innovative pilot medical office with Blue Cross Blue Shield of North Carolina.

This initiative, if successful, could help avoid putting consumers in the middle of health insurance conflicts.

Let me say a bit more about health reform. The news media focuses on conflict in the health care debate. That focus keeps attention from an emerging Washington consensus on health care. In watching the back and forth between Republicans and Democrats, we pay no attention to what they agree on.

They agree that on the fact that future government will take less of the financial risk attributed to growing health care costs. Yes, they disagree about who should bear the risk instead, and how that risk should be borne. Democrats in Washington prefer solutions that put more risk in the hands of health care providers, and Republicans want individuals to deal with more of the risk themselves. But we should not let this back and forth cloud the reality that both parties are telling us that the government will take less of the risk. Both parties are saying that some parts of the health care system will have to change in the future.

Let me say again – we very much need a team effort to fix health care in America – and we need to do that right here in North Carolina.

I have tried to tell you the truth, about a series of long-held and unfortunately mistaken ideas about health care. You might be sitting there frustrated, and even disappointed with what I have told you.

I am hoping that as I went through some of the myths about our health care system, many of you thought, “Well, Bill, you’re right.”

The problem is that the myths don’t go away. Ours is a free country, and everyone is entitled to believe what he wants. And unfortunately, I think the average North Carolinian is not yet on board to face the challenges ahead.

There is a vast gap between the experts and the public on health care. For example, there is a consensus among those who do research on our health care system that much care that is delivered is unnecessary. But that is not the view of the average American. When surveyed, 67 percent said they do not get the tests and treatment they need. Only 16 percent said they received care that was unnecessary.

This divergence of views has had a powerful impact on what happens when health care experts suggest ideas to politicians about how best to go about dealing with lowering costs. By going along with the experts’ assumption that we have unnecessary care, those politicians created an opportunity for their opponents to reach the 67 percent who think they do not get the tests and treatments they need. And that, I would suggest, is how the term “death panel” gained such potency.

The reason we continue to over-treat is three-fold:

  • Patients demand more
  • Most health care is paid for on a fee-for-service basis, so the more you do the more you make
  • Our medical liability system makes providers reluctant to say no to patients.

Those who expect individual consumers to make more cost aware choices also have reason to be disappointed. Only 22 percent of Americans say they have ever asked about cost when making health care choices.

As someone who has worked very hard to create information that would allow comparisons of health care providers, I find it disheartening to learn that 70 percent of Americans believe there are no big differences across health care providers. If you don’t believe there is a difference, you will never want to look for anything better.

In a free market, the consumer rules. At this point, the consumer is not open to much of what the experts recommend.

As we try to rally the citizens of North Carolina and the nation to take on the challenge of health care overhaul – a major problem is this disconnect between the “experts” and the “average person.” I confess to being a health policy wonk – and we “experts” have long been concerned with the issues on my list above.

But the typical hard working North Carolinian – who today may hold down two jobs and surely wants to be responsible – all too often cannot afford the co-pays and deductibles if he has a sick child, especially one with a chronic illnesses.

That is what real people are worried about. And we owe it to them to come together to work on these real issues with vigor and determination, not just hunkering down with our long-held positions and slogans.

Our state has long had a proud record of innovation and leadership in health and health care. With the ideas and energy that you and the Emerging Issues Forum speakers have brought to this conference, I am very hopeful.

Yes, I mean those words. I am hopeful, but they can surely sound like high-minded platitudes. It is not enough for us simply to say “let’s work together.” We actually have to do it.

There is an old Greek proverb: “A society grows great when old men plant trees whose shade they know they shall never sit in.”

Friends, young or old, let’s go out – together – and plant some trees. With teamwork, we can do great things for North Carolina.

Pre-State of the Union Reflections

President Obama’s upcoming State of the Union speech will be met with high expectations. Not only is this his first chance to address Congress since the November election, but it comes on the heels of eloquent remarks about the importance of civil public discourse following the Arizona shootings that drew praise from both sides of the aisle.

The President’s speech will give us some clues about how the rest of his term could go, particularly as it relates to Congressional relations. This is most important in the arena of health care reform. The House just this week passed a bill repealing the Affordable Care Act, but this measure will likely fail in the Senate. There is no doubt that the public is divided about whether the new health care reform law is the right approach for improving care, increasing coverage and reducing costs.

The next few months are expected to usher in a period of continued debate about changing federal health reform legislation. The State of the Union speech should tell us what President Obama hopes to achieve.

I hope the President will mention progress on the much-anticipated rules for accountable care organizations (ACOs) being written by the Centers for Medicare and Medicaid Services. The broad outlines for how ACOs will operate are becoming clearer, but many of the details are yet to be ironed out. ACOs could have a profound impact on how Americans access quality care in the future: This system would provide a financial incentive for reliable performance measurement and improved outcomes.

I hope the President also will recognize that profound change is sweeping through health care independent of the ongoing Washington debate: industry consolidation, greater partnerships between hospitals, physicians and other health professionals, and an increased emphasis on shared responsibility for improving health outcomes and reducing costs. I recently spoke with UNC-TV’s NC Now about these changes.

Regardless of what happens at the federal level, it seems clear that health care delivery models based on patient volume alone is not sustainable. UNC Health Care is moving swiftly to put in place new arrangements that make possible more cooperation and between primary care, in-patient care and specialty providers.

One way UNC Health Care is working to keep pace with these changes is our innovative, first-of-its-kind partnership with Blue Cross and Blue Shield of North Carolina to form a new medical practice based on the medical home approach. We also are partnering more closely with physician groups, bringing them greater IT resources for decision making and integrating their expertise into our hospital system.

The oft-stated goals of health care reform promoted by the president and the opponents of his approach to reform are similar to the mission of UNC Health Care – improving quality and efficiency so that we can ensure patients have access to excellent and affordable care. I look forward to hearing what President Obama sees as the next steps to reaching this goal.

UNC and Wake County Physician Partnerships

Last week, I had the opportunity to speak about the future of academic medicine to the Wake County Medical Society alongside Dr. William J. Fulkerson, executive vice president of Duke University Health System. I have included my remarks below.

A lot is happening in medicine and health care, in the nation, in North Carolina and in Wake County. I am pleased to join with my Duke colleague, Bill Fulkerson (Executive Vice President, Duke University Health System), on this program tonight, to discuss issues of common interest. All that we do has to be done in a way that meets the health needs of our fellow North Carolinians, and improves the care that they receive.

We at UNC Medicine and UNC Health Care are leaders in research, teaching and clinical care. We have much to celebrate. The recent 2011 USN&WR rankings of the nation’s medical schools put us #2 for primary care and #20 for research. More than half of all UNC research dollars were awarded to School of Medicine investigators.

And we are working to provide even more research opportunities. We, like Duke, are one of 55 institutions nationwide who have received an important, large NIH grant that enables us to speed the implementation of new ideas and technology into clinical practice, and to collaborate with new partners.

We are currently collaborating with more than 600 community members across the state in all areas of medicine, and we invite you to partner with us in these new research opportunities. They are specifically designed to move us out of our traditional university research environments, to be much more engaged with the community. You can find more information about this on our website: http://www.tracs.unc.edu.

At UNC we take our educational mission very seriously. We have long partnered with others across the state to train our medical students and our residents and fellows. A full 40 percent of the clinical experiences of UNC med students occur outside of Chapel Hill – WakeMed is an important educational site for us here in Raleigh. And our residency programs are much intertwined with WakeMed’s clinical activities here, too.

We have recently announced the formation of two branch clinical campuses of the UNC School of Medicine, in Charlotte and Asheville, which will allow us an even more focused way to educate medical students there, and to expand the size of our med school class.

UNC Health Care Now and in the Future
UNC Health Care, including Rex Healthcare, employs more than 12,800 people, and last year we saw more than 270,000 patients. We provided almost $300 million in uncompensated care – an important part of our mission to serve the state, a substantial portion of which was to residents of Wake County.

Rex Healthcare expands our reach to the people of Wake County. The NC Cancer Hospital at Rex, set to open in 2014, will be a dedicated cancer center here in Wake County. It will provide patients access to the resources of UNC’s NC Cancer Hospital, which opened last year.

New Opportunities for Partnership
We believe academic institutions, local health care providers and physician groups will work even more closely together in the future, as we together face pressure to serve patients better and more cost effectively.

It is about more than just payment rates. Success in the future will require physicians and hospitals to become true partners in the delivery of coordinated, quality, lower-cost care.

We think academic health centers like ours are a good starting point. For the most part we are already integrated within our organizations – and now we are reaching out to partner with others across our communities. We have no cookie cutter approach to physician relationships – we have created partnerships that include employment, joint ventures and academic affiliations.

Rex and UNC have a decade-long track record of successful collaboration with physicians. We are always happy to have you speak directly with those physicians to learn more about how they view UNC/Rex and how they view our approach as a partner. Our guiding philosophy has been to partner with the best physicians in a community, and to help ensure that we get patients to the right care at the right time. In particular, this means that if the needed care can be provided locally, it should be provided locally, by our partner physicians. Certainly we want to be available at UNC for your patients, as we are to all of the people of North Carolina, for tertiary or quaternary medical care. But we have no intention of siphoning patients from your market. Again, our partners at Rex and in the community can validate our success with this model.

Leading organizations will be the ones that understand how to work collaboratively and effectively with physicians. We recently launched Triangle Physician Network (TPN), a joint effort of UNC and Rex to operate a regional network of leading physician practices. There are currently more than 130 physicians in TPN. It is led by physicians, for physicians.

Our strategy for affiliation is simple – we listen to and work with quality doctors to develop mutually beneficial relationships. We want and need physician help with making this strategy work well over the long haul – to improve what we are doing today and to develop innovations for the future. Improving communication and care coordination is an important aspect of this effort – I am on the board of the new NC Health Information Exchange, and we are fully committed to providing our primary care and specialty physician practices the ability to coordinate with the latest in electronic medical records and other technology.

The Road Ahead
There are many challenges ahead. There is an urgent need for more primary care providers, especially in rural and other under-served areas. Health reform is a big unknown, especially with the political turmoil around us – though I remain a firm advocate for thoroughgoing health reform. I am very much aware, as a former school of public health dean, that we need to make major progress in improving the health of the population – issues like smoking cessation, physical activity and the obesity epidemic.

I appreciate the work that all of our colleagues do to meet the challenges before us. As I said earlier, all we do has to be done in a way that meets the health needs of our fellow North Carolinians, and improves the care that they receive.