Sunday, February 21, 2010
HCA Southwest Virginia bolsters system, services
Inpatient admissions are up at HCA's four regional hospitals as the health system has grown its staff and revamped operations.
JARED SOARES The Roanoke Times
Dr. Ben Barton (right) performs surgery at Lewis-Gale Medical Center with Chuck Gery, a physician assistant (left), and Ruth McMullan, a registered nurse.
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As Carilion Clinic has undergone a very public transformation of the way its hospitals and outpatient centers provide health care in Southwest Virginia, Carilion's chief competitor HCA Southwest Virginia has also made a series of changes to bolster its network of hospitals and doctors.
With attention diverted to Carilion's acquisitions and ramped-up hiring practices, HCA has been aggressively recruiting doctors and adding services to bring more patients under its umbrella.
Since January 2008, HCA has added about 110 new physicians to the medical staffs at its four hospitals, Lewis-Gale Medical Center, Alleghany Regional Hospital, Montgomery Regional Hospital and Pulaski Community Hospital.
Of those new doctors, 65 were brought in from outside the market to fill needs in various specialties. The other 45, however, were doctors who were already practicing in the region, and presumably decided to switch from Carilion to HCA.
In all, HCA Southwest Virginia employs nearly 3,600 people in the region. There are approximately 650 physicians who are on the active staffs or affiliated with the system's four hospitals. Citing proprietary and competitive reasons, HCA does not release its total budget for the system. The four hospitals reported a combined $433.5 million in total assets for 2008, according to Virginia Health Information. Similar financial information, however, is not available for nonhospital services run by the health system.
While the approach to changing HCA's operations in the region has not been as dramatic as Carilion's, early indications are the strategy has worked as the combined four-hospital network has seen inpatient hospital admissions grow over the past two years.
"Our volume growth has been substantial," said Victor Giovanetti, president of HCA Southwest Virginia. "It's covering virtually every service line and it's the result of a number of changes we've made."
While HCA has seen growth in several health care services, the hospital system has made a concentrated effort in cardiovascular care, oncology and orthopedics. All three are areas that attract high volumes of patients and are typically profitable.
Specifically the hospital system says it has seen a 4.7 percent jump in total inpatient hospital admissions, when comparing the year ended June 30, 2008, with the year ended June 30, 2009. At its Salem flagship hospital, Lewis-Gale, the increase was even greater at 5.1 percent.
The data come from publicly reported information but was provided to The Roanoke Times by HCA. Still, public data available from the health data group Virginia Health Information reveals a similar finding.
Total discharges from Lewis-Gale increased 5.5 percent when comparing the year ended June 30, 2008, with the same period in 2009, according to VHI. For the same time periods, VHI data revealed that total discharges at Carilion's flagship hospital in Roanoke remained nearly flat, decreasing by 0.76 percent.
Giovanetti attributed the results to three things: a focus on the quality of care provided, building physician relationships and coordinating the HCA hospitals and services under one umbrella.
"We have literally created a system, one system, that has multiple entry points," he said. "Our new structure of delivery has provided a significant change in how we serve the region."
While mostly providing data on patients admitted to the hospital, Giovanetti said the system has also seen an increase in outpatient services. As an example, from 2008 to 2009, radiation oncology grew 16.6 percent.
New leadership
Those who work closely with the hospital executive say Giovanetti's leadership is also a key driver in the changes at HCA.
"He's energized things," said Dr. Bob Williams, a surgeon with Salem Surgical Associates who admits patients to Lewis-Gale. "He has emphasized quality ... and he's willing to work together for patients and physicians to achieve that. And it's the warm and fuzzy. It's being nice to people to do whatever they can to help physicians and patients."
Giovanetti, 46, was named the CEO of Lewis-Gale in October 2007. In July 2008, corporate executives of HCA Inc. in Nashville, Tenn., placed him in charge of the newly designated HCA Southwest Virginia.
The jump in inpatient admissions that occurred in just a year under the new system was intentional, Giovanetti said. Creating HCA Southwest Virginia, which operates under one budget, has also allowed the system to better manage its financial resources so money is spent on supporting the system's growth.
Giovanetti admitted it is only the beginning of reaching his goals for the region.
"It's a significant change," he said. "My goals are always lofty. We always passionately reach for the stars. There is so much more we can do as a team."
It's that team approach and Giovanetti's drive that has physicians who work with the hospital system talking.
"I think it used to be a rather insular, self-contained bunch," said Dr. Larry Monahan about the historical reputation of the Lewis-Gale medical staff. "With Mr. Giovanetti's personality and personal everything, he has really transformed that."
A longtime practicing physician with Jefferson Internal Medicine Associates in Roanoke, Monahan joined the medical staff at Lewis-Gale after leaving Carilion's medical staff in 2008. He recently was appointed to the board of trustees of Lewis-Gale for a three-year term.
Monahan has been a vocal critic of the direction Carilion has taken. He said that while changes at Carilion drove many physicians such as himself to Lewis-Gale and HCA, the changes at HCA will continue to draw more health care professionals and, ultimately, patients.
"I think the Lewis-Gale hospital will attract more and more really fine doctors who want to focus on really fine patient care in a really fine institution," Monahan said.
Monahan, Williams and other physicians who work with HCA attributed much of the surge in doctors joining the medical staff to Giovanetti's openness to working with the staff.
Giovanetti said he is focused on "creating the right relationships the right way" with doctors who want to either be independently employed or employed by HCA.
"It is being shouted from the mountaintops that you can do whatever you want and they will support you," Williams said. "You can be employed. You can be independent. It doesn't matter."
Publicizing the quality
While the HCA medical community may be hearing Giovanetti's messages loud and clear, the system has also been aggressively publicizing itself.
With the creation of HCA Southwest Virginia, the company sought to build its public image as a cohesive health care network where patients aren't left to fend for themselves. Throughout the past two years, the company has rolled out a new logo and started to refer to itself more frequently as HCA Southwest Virginia, instead of by individual hospital names.
More than a new logo, the company has focused its message around a single word: quality.
The rare news release issued by the hospital system typically cites success stories in achieving certain quality marks for various medical procedures. The most frequently cited quality achievement by HCA Southwest Virginia is its national ranking in the top 10 percent of hospitals for those measures tracked by the Centers for Medicare & Medicaid Services.
As an example, the CMS measures indicate that 100 percent of heart attack patients were given aspirin when they arrived at the hospital. Giving an aspirin is an evidence-based protocol known to save lives. Nationally, 94 percent of heart attack patients are given aspirin on arrival. "If we adhere to evidence-based medicine, we will get quality outcomes and it will cost less," Giovanetti said.
Small changes add up
In part, the commitment to high-quality outcomes brought Dr. Ben Barton to Salem.
Barton arrived at Lewis-Gale in June 2006, just a few months before Giovanetti. But he said the message of high-quality care has only become stronger since Giovanetti took the helm.
"I can make clinical decisions that are completely devoid of any administration mandate," Barton said.
Barton came from Nashville with the challenge to build the cardiothoracic surgery department for HCA in the region. It was a professional opportunity Barton said he didn't want to pass up.
Prior to Barton's arrival, open-heart surgery at Lewis-Gale had stopped for several months. The surgeons who had done the procedure left to work exclusively for Carilion.
Cardiovascular surgery increased 13.3 percent at Lewis-Gale for the year ended June 30, 2008, according to the data provided by HCA. That makes it one of the areas where the system saw the highest growth in the past year.
But Barton's goal for the department wasn't to attract huge numbers of patients. Instead, he said, his focus is on being the best for achieving high-quality outcomes. He is especially proud of the department's mortality rate for 2008. It was 0.6 percent, better than the national average of 1.6 percent.
Barton can think of changes that will help the department continue to grow. He would like a separate cardiovascular intensive care unit. But he said he is pleased with incremental changes that have already been made to support his work. A dedicated cardiovascular step-down unit was recently put in place, and a second heart surgeon was recently hired.
The attention to heart care hasn't just been on surgery. HCA has also devoted energy to its cardiology services. There, too, they have seen a significant gain in the number of patients, up 11 percent in one year.
In the emergency rooms of each of the four hospitals owned by HCA, there is a dedicated space to treat chest pain. These areas, called chest pain centers, have been accredited with the nonprofit Society of Chest Pain Centers. Carilion Roanoke Memorial Hospital and Bedford Memorial Hospital are also accredited. To be accredited, hospitals pay a $200 application fee, $15,000 accreditation fee and travel costs for the two people who review the site.
Incremental changes are also improving care in other services. Williams, who specializes in breast cancer surgical procedures, said it's the ongoing changes that are ultimately improving the care of cancer patients.
He pointed to several examples. The hospital system helped hire a new surgeon who joined Salem Surgical, an independent practice, over the summer. In breast cancer treatment Williams said he is pleased with new technology purchased by the hospital system. Just within the past two months HCA hired a nurse navigator to help breast cancer patients understand all the aspects of the treatment plans.
"It's been a steady change. It's been a consistent change," Williams said. "It's really made a difference."
