Balancing act
Rising high above serpentine Stoneleigh Avenue and the sprawling Croton Reservoir is the only acute care hospital ”“ as well as the largest employer ”“ in Putnam County.
Putnam Hospital Center in Carmel has been ranked in the top quarter of all 184 hospitals in the metropolitan area by U.S. News & World Report, with special recognition for being “high-performing” in gastroenterology. It”™s also received a prestigious Health Grades Outstanding Patient Experience Award 2010/11, which put the hospital in the top 10 percent in the country and made it one of only eight in New York state to achieve the honor.
But like many such facilities, the 164-bed hospital also finds itself on the frontlines of health care reform as it strives to balance quality, efficiency, economy and government expectations.
Among the changes that went into effect in July is that Medicare now puts 1 percent of reimbursement to hospitals at risk if the institutions do not meet certain criteria.
Donna M. McGregor, hospital president and CEO, sees this as a call to further excellence.
“Everyone is improving, which is great. You want to improve,” she said. “You have to think about it as a patient. If it were me or a relative, I”™d want to be in an institution that embraces change.”
Not everyone at the hospital thinks such change can be for the better.
“I think it”™s an awful thing,” said Janusz Rudnicki, an OB/GYN and president of the hospital”™s medical staff. “It”™s disingenuous”¦ What they want is to take one percent of reimbursement away from hospitals without political risk. ”¦ Some initiatives are good. But this hits every resource,” he said, adding that it potentially affects everything from the nursing and cleaning staffs to buying technical equipment.
What the federal government should do is provide the top hospitals with a 1 percent increase in reimbursement as a reward, Rudnicki said. He also thinks insurance companies should be required to compete on a level playing field, rather than carve out niches of medical groups to which they sell.
The problem, McGregor says, is that when Medicare was instituted in 1966, the lifetime cost per person was $110,000. Today, due in part to an increased life expectancy, it is triple that. And the system can”™t support it.
Nevertheless, she says, Putnam Hospital is doing whatever it can to give all its patients first-rate care while keeping the price tag down. But how do you balance high quality with low costs?
“It”™s a matter of ensuring that the patients are in the hospital the correct amount of time,” she says. “It starts with triage the moment the patient enters the hospital and then moving through the process. “
That process doesn”™t end with discharge either. There are follow-ups not only to survey patient satisfaction but also to make sure that he or she understands any post-hospital requirements (medication, therapy, post-op visits, etc.).
“It”™s a tremendous team effort,” McGregor said. “We really listen to our patients. We”™re doing more formal training, making sure that someone (on staff) is in there communicating with the patient and reducing patient anxiety.”
That teamwork has paid off: The hospital has brought down its length of stay by half a day.
Adding to that efficiency are improvements to the IT infrastructure, she said. On Sept. 11, 2011, the hospital completed phase II of the government”™s “meaningful use” mandate, which requires hospitals to have an electronic record of each patient and doctors to record on computer all medications ordered. Phase III involves more computerized physician documentation.
It also helps, McGregor said, that the hospital is part of the $850-million Health Quest system, which includes Vassar Brothers Medical Center in Poughkeepsie; Northern Dutchess Hospital in Rhinebeck; The Thompson House, a nursing home, also in Rhinebeck; the Hudson Valley Home Care Program and the 150-physician Health Quest Medical Practice.
“That”™s how we keep costs down,” she said. “We run a lot of things on a system level instead of duplicating them on a local level.”
Such efficiency measures are designed first and foremost to serve the patients. Outreach is another aspect of that service. The hospital has a blood management program that enables those who do not want transfusions, including the members of the large Jehovah”™s Witnesses community in Patterson, to undergo surgical procedures using a cell-saver system that collects and returns the patient”™s own blood to his body.
Putnam Hospital has also doubled the size of its plant in the last three years, adding an oncology center, an auditorium, two floors of private patients”™ rooms, with 35 rooms per floor, and enough office space to accommodate roughly 90 percent of the affiliated physicians.
“We”™re able to look at it more like a medical community,” McGregor said. “We”™re really the hub of the (Putnam) community.”