Collaboration is Key

Welcome to the debut of my new monthly blog where I’ll share my insights on what is happening at UH, as well as my views on local, regional and state matters that concern healthcare, and thoughts about leadership.

I begin today with some very good news that UH recently received related to the new federal legislation that contains positive healthcare provisions for healthcare systems around the U.S., as well as $3.5 million in earmarks specifically for UH, including:

• $1,145,520 for UH Rainbow Babies & Children’s Hospital and UH MacDonald Women’s Hospital for a Birth Safety Simulation Center, with support from U.S. Rep. Shontel Brown and U.S. Senator Sherrod Brown;
• $1.5 million for the UH Jefferson Health Center/UH Geneva Medical Center to create a rural health clinic for Ashtabula County, with support from U.S. Rep. Dave Joyce; and,
• $855,000 for UH Parma Medical Center’s Comprehensive Breast Center, with support from former U.S. Rep. Anthony Gonzalez.

The approved legislation also brought other positive outcomes for UH and other health systems across the country and comprised the following:

• A $25 million grant for UH Rainbow Babies & Children’s Hospital and Children’s National Hospital for a Pediatric Pandemic Network;
• A reduction in one Medicare payment cut that had been planned and the delay of another cut for another two years;
• Extension of the Medicare telehealth waivers and a two-year extension of the Hospital@Home program, for which UH strongly advocated;
• Doubling the funding of the Mission Zero grant to $4 million. (UH is a recipient of this grant, which is used to cover administrative costs of embedding military trauma professionals in civilian trauma centers);
• A $10 million increase in funding of Children’s Hospitals Graduate Medical Education Payment to $385 million. (This will particularly benefit UH Rainbow, as it is used to train resident physicians and dentists); and,
• A requirement for states to provide children younger than 19 with continuous coverage under Medicaid and to extend Medicaid coverage for postpartum women up to one year.

For all these wins, we applaud our Government Relations team that works tirelessly to advocate on behalf of our patients and the community for government funding and support of various healthcare programs. Numerous UH leaders also collaborated with this team to ensure our voice was heard in Washington D.C. and Columbus. We all presented compelling data – and I am truly grateful for the work that led to this outcome.

While a positive win for sure, I approach the future with cautious optimism. In his recent State of the Union speech, President Biden acknowledged our nation’s success in managing the pandemic, while at the same time he emphasized the rising cost of healthcare and his administration’s renewed vigor to address it, because the rapidity of the upward trend line is untenable.

Don’t get me wrong. I concur our industry must address the escalating costs of healthcare, but we also can’t cripple the industry our nation so dearly depended on during the pandemic to keep us all safe. We need a measured response. A leading healthcare industry consultant, Kaufman Hall, stated in its January 2023 report that “2022 was the worst financial year since the start of the pandemic [and that] approximately half of U.S. hospitals finished the year with a negative margin.” That too is unsustainable.

That is precisely why we have taken aggressive actions to optimize our cost structure at UH. We have reduced expenses by more than $250 million in 2022 and are addressing increased costs in our supply chain by working with manufacturers on sourcing supplies domestically, or nearshore, when possible. We are also working with our Group Purchasing Organization to source other supply categories domestically. Not only does this reduce expenses, it provides more stability in our ability to obtain goods that are in short supply.

At the same time, we have also adopted a philosophy that aims to provide our patients the highest quality care at the lowest cost. For example, we are increasing the emphasis on value-based payment models of care, which means receiving shared savings each year from CMS. In 2021 that amount was $7.7 million for UH.

Additionally, through our UH Centers of Excellence, we ensured that nearly one-third of patients who were referred for joint replacement surgery and one-half who were referred for spine surgery were able to avoid unnecessary surgery.

Those patients who did have joint replacement, by the way, had a length of stay of 1.08 days, compared to 3.15 days in an Ohio peer group. Similarly, their readmission rate was 0.65 percent in our Center of Excellence, vs. 3.67 percent in an Ohio peer group.

Another way we are working to keep our costs low while still delivering high-quality care is to optimally manage our workforce. For example, we are creating new models of care delivery that will increase our efficiency. By re-defining caregiver roles, we are confirming the contribution everyone makes in the delivery of quality patient care while also ensuring everyone is operating at the top of their ability or license.

We are also aiding workforce management through innovation and technology, such as the implementation of our new electronic health record (Epic) that will assist with administration, predictive analytics, billing, and myriad other patient and provider needs; launching digital wellness solutions; building and engaging diverse teams and supporting their career growth; digitizing HR functions like credentialing; and using agile scheduling solutions that predict patient demand and schedule accordingly through our Systems Operation Center.

More broadly, we are re-designing our systemwide footprint to gain economies of scale and efficiency in complex care delivery. These efforts will combine synergistically to position University Hospitals for the years to come, both in physical stewardship and operational excellence.

It will take all of us working together – health system employees along with government and community stakeholders – to ensure we protect the vital role our U.S. healthcare system provides in caring for our population while at the same time doing all we can to mitigate our nation’s rising healthcare expenditures that are forecasted to grow 5 percent per year and reach $7 trillion by 2030.

Through collaboration and innovative thinking, we will emerge better, faster, more resilient and ready for a post-COVID world and all its challenges.

Follow Dr. Megerian's blog.