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Highlights from the March Breakfast with the CEO

17 Apr 2016

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Opening comments
It is helpful to remind ourselves about the Common Ground Compact and the commitments we have CherylNesterBowersmade to one another, good communication being one of those. Don’t forget the Common Ground newsletter that comes out every other Sunday, with information for Salem Health medical staff. We continue to track what articles are most read by you, and tailor content towards those needs.

Could you summarize the changes in leadership?
OHSU Partners is the joint management company charged with clinical operations at OHSU and Salem Health. The CEO of OHSU Partners is Peter Rapp; Chief Clinical Integration Officer is Tom Yackel, MD; Chief Information Officer is Cort Garrison, MD; Chief Strategy Officer is Mike Hill, and Pam Vukovich is the interim Chief Financial Officer. (Pam, former CFO of Legacy Health System, will return to the Salem Health Board when a permanent CFO is found for OHSU Partners.) Norm Gruber is President of OHSU Partners and is retiring in June. I (Cheryl Wolfe) am CEO of Salem Health and Cindy Grueber is the interim Senior Vice President and Executive Director of OHSU Healthcare. The site executives are members of the OHSU Partners management committee.

The management company is funded by both OHSU and Salem Health, each paying 50 percent of operating costs, while the boards at OHSU and Salem Health are still in charge of their respective clinical enterprises. It is also worth noting that the Salem Health Board’s primary responsibility and accountability to the community has not changed. I am a non-voting member and ex officio member of the Salem Health Board of Trustees.

Are we going to get a new CIO?
Yes. It's been a tough search and we have interviewed a number of candidates, but it has been difficult to find the right person. Leah Mitchell is the interim CIO, and we will continue to look for a permanent replacement.

What stake does Tuality Healthcare have in OHSU Partners?
Tuality Healthcare reports to the interim Senior Vice President and Executive Director of OHSU Healthcare. Tuality brought beds into the affiliation but no additional income, unlike Salem Health and OHSU which both brought profitable bottom lines. Tuality is essentially being integrated into Partners to help meet OHSU’s need for additional beds. While only one data point, the first month of financials from Tuality are good: More beds are full and they have a positive margin for first time in three years.

If another entity joins, will control of the management company change?
It depends on the financial situation of the new institution.

How does population management relate to affiliation?
Great question. Propel Health is the name of the population health organization Salem Health and OHSU have helped establish. Through Propel Health, seven different groups, including OHSU, are working to learn how to manage populations. Propel is a separate company from Partners.

It would be very expensive to do population health on our own. With Propel we have access to advanced software and combined expertise. I am on the board and Peter Rapp is the chair.

Providers are deeply involved with Propel Health. A quality committee is setting up best practices for diseases, led by physicians. The committee overseeing the establishment of an accountable care organization (ACO) to take advantage of Medicare shared savings is governed by independent, non-hospital employed physicians and clinics. In fact they have 51 percent voting rights on that committee.

Vanderbilt and Memorial Hermann are two organizations that have modeled what a population health enterprise can look like, and Propel is looking closely at what those organizations have done over the last five years to be successful. Physician engagement is clearly a critical part of these models.

How do non-employed providers interface with the hospital?
The Quality Operations Committee (QOC) is probably the place where non-employed physicians have the biggest impact. The QOC is a board committee, with delegated authority to do improvement work. More than 70 percent of the committee is independent physicians.

What is the role of the Vice President of Medical Affairs?
The VPMA is a new position and an evolving role. VPMA Dr. Andrew Furman is on a team with the CMO, Dr. Ralph Yates. Together they interact and engage with the medical staff. The VPMA and CMO are liaisons with the president of the medical staff and president-elect, and work together on whatever problems or goals need attention. The VPMA rounds proactively with the medical staff and helps to triage issues raised by the QOC or section chiefs.

We have noticed that one common denominator with successful health systems are providers who are heavily involved in the process. The VPMA helps us achieve that goal here.

When looking for a CMO, we saw a lot of young talent who were not ready for the CMO role but had tremendous potential. So we decided to create a second position that is in a succession plan for CMO and adds another physician voice to the leadership team.

We have assigned a member of the executive leadership team to every medical section, and are working to further open up communication between administration and physicians. We want to be sure we are considering all the facets of a situation before a decision is made. Not all decisions will sit well with physicians, but let’s dialogue and communicate to make sure we make the best decision possible.

Providence met with a group of independent physicians. What are your thoughts?
You may have attended a meeting with Providence where they shared their plan to build an ASC and office building in Salem to treat their 45,000 insured lives. Providence verified this with us, including their intent to start taking community patients to Portland for their hip, knee and spine surgeries. Legacy and Silverton Health along with PacificSource are other examples of new models evolving in our community.

Obviously, this is concerning and represents a significant threat to the hospital and independent practicing physicians. Salem Health is actively working to partner with independent providers to keep care local for our community. Together, we provide a model to sustain provider independence which is not the Providence approach. We provide exceptional care, and believe for many patients, receiving care locally is the best option.

The Providence model contrasts with the OHSU affiliation. The affiliation model is built on the belief that care is best when delivered regionally. OHSU partnered with Salem Health in large part because of our strength as a community health system. We believe keeping patients close to home is best for our community and providers, and want to actively partner with our providers to ensure this remains possible, which is why we are working to establish clinically integrated networks (CIN).

The heart of what we are doing is quality and good relationships with physicians. Engagement with physicians is one of the best things we can do. To that end, I just went to a medical staff leadership conference with MEC members from both of our hospitals in San Francisco where we talked about common issues and building relationships. We also opened up the weekly executive leadership committee meeting to medical staff leadership, so they can come and give input at any time.

What is the philosophy about marketing of specialties at Salem Health?
There has been sporadic work, but no long-term strategic look. We want to know if we can measure the effect that marketing has in our community before we spend money on it.

What is the financial agreement with OHSU?
During the affiliation process, we looked at each organization’s finances over the past six years and came up with an average bottom line split: 19 percent to Salem Health, 81 percent to OHSU. Going forward, both organizations work to a common bottom line, and divide the results 19/81. Through this arrangement, it doesn't matter who takes care of patients, because everyone benefits at the end. Currently, Salem Health is doing a little better financially, but over the long term, the affiliation will stabilize finances for both parties. Given the financial differences, it is a big deal that Salem Health received a 50/50 say in Partners company.

Do you foresee unionization in Salem Health’s future?
Unionization is always a possibility. Employees have the right to make that decision. However, they would have to go through a campaign where we will have the opportunity to talk to our employees about the pros and cons.

Is the management company contracting for both Salem Health and OHSU?
Currently contracting remains separate.

How are capital projects handled in the affiliation relationship?
Salem Health still owns our assets. If a project was already planned at the time of the affiliation, the project will not be interrupted. Going forward, the management company will make strategic decisions. The capital budget proposed by the management company must still be approved by both boards.

What are the plans for the emergency department? They frequently seem overwhelmed.
The volume that is coming through the emergency department is pretty remarkable. We will hit 110,000 patients this year, up from 80,000 10 years ago. The long-term fix is to create more room in the emergency room, especially building a separate space for those who come to the emergency department but don't need emergency care. We are reviewing the master site plan with the strategic physician group, and the emergency department needs are front and center. Increased access to urgent care centers can help. More primary care can also help.

We are also doing a lot of work on the back end to increase patient flow, but volume keeps increasing. Heroic things are done in the emergency department every day. Despite the record patient volumes, patient satisfaction scores are over the 90th percentile in the emergency department.

Are we looking at chronic disease management to help with emergency department volumes?
In the context of population health, yes. Population health is the strategy to provide disease management through holistic treatment and preventing problems before they start.