‘Obamacare,’ ailing economy, rising costs lead to health care revolution

At one Phoenix medical center, health care reform means creating an electronic records system to reduce the distressingly high number of patients who die from hospital-acquired infections.

At another, it means finding a better way to treat a man who showed up at the emergency room more than 365 times in one year.

Health care experts say the Patient Protection and Affordable Care Act

(ACA) passed by Congress in 2010 has contributed to significant changes in Arizona’s approach to health care.

But the experts also say the law — known commonly as Obamacare — is only one factor in what some describe as a health care revolution in Arizona. A bad economy, fewer people with health insurance, steadily rising costs and huge increases in uncompensated care also have contributed.

Faced with a broken system, preventable deaths and wasted resources, hospitals are being forced to find better ways to treat patients.

“We all pretty much accept that health care as currently structured in this country is simply unsustainable,” says Bill Byron, senior director of public relations and online services for the Banner Health System in Phoenix. “We can’t continue on the same path. That is a path of rising costs and more rising costs.”

Because authorities believe little can be done to lower fees charged for health care, the reforms try another approach: using financial incentives, penalties, public and private grants and technology to cut down on unnecessary care. Although the primary purpose of the ACA is to increase the number of Americans with health insurance, the drive to make health care more efficient has begun to affect patients’ lives.

St. Joseph’s Hospital and Medical Center in Phoenix is pursuing strategies to prevent patients from returning repeatedly and unnecessarily to the emergency room. Some patients have been showing up hundreds of times each year for the treatment of relatively minor maladies, including one who showed up more than 365 times one year, says Suzanne Pfister, vice president of external affairs for the medical center.

One goal of the program is to refer such patients to doctors who can provide more appropriate care outside of the emergency room.

Also in Phoenix, the Banner Health Network was chosen to take part in a pioneer accountable care organization designed to reduce costs for Medicare patients by coordinating and keeping better track of the services they receive. The goal is to cut down on such inefficiencies as duplicated medical procedures, misplaced medical charts and a lack of coordination among doctors.

Under the ACA, St. Joseph’s, Banner and other medical systems are forming partnerships with community health organizations to provide care to patients in poor or rural parts of Arizona. The law also is providing grants to improve care in such areas. For example, the El Rio Community Health Center in Tucson recently received $5.5 million from U.S. Health and Human Services to build a new main clinic.

“There is so much going on right now,” says Tara Plese, director of government and media relations for the Arizona Association of Community Health Centers. “It’s so voluminous. Every time we turn around, there is a new project coming out. It is kind of like a health care revolution.”

Chuck Lehn, chief executive officer of the Banner Health Network, considers the ACA a catalyst for improvements. Thanks to the ACA, hospitals are creating new business models that reward successes such as dealing more efficiently with chronic illnesses.

“It’s started a dialogue,” he says. “It’s started people getting focused around health care.”

But he says the economic downturn was even more significant, putting pressure on hospitals to find better ways to treat patients during a time of state funding cutbacks, fewer patients with insurance and rising demands for uncompensated care.

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The reforms are occurring at a time when some conditions in hospitals are worse than many people realize. For example, significant numbers of patients die because outmoded record-keeping fails to identify sepsis — a frequently fatal bacterial infection acquired in hospitals — in time to treat it.

The ACA provides financial incentives to hospitals that develop sophisticated electronic record systems to help identify and prevent such problems. But bringing such systems online can take many years, and many hospitals have yet to create them.

The Banner Health System — which benefits from the incentives — began developing its electronic records system in 2003, long before Congress passed the ACA. Banner’s system monitors patients 24 hours a day.

Among other things, it quickly alerts doctors to symptoms that signal the onset of sepsis.

Banner reported recently that the electronic records system reduced hospital deaths significantly: during 2011 and the first two quarters of 2012, the mortality rate for sepsis among intensive care unit patients was 8 percent, compared to the national average of 25 percent to 50 percent previously.

Nationally, there were 34,843 deaths in hospitals from sepsis in 2010, the latest year for which statistics are available. Medical authorities believe electronic communications systems eventually could save thousands of lives each year throughout the country.

Banner’s electronic system also is being used to prevent overdoses of radiation in hospitals. It alerts doctors whenever a patient has received three previous CT scans within 90 days prior to a doctor’s order for a new one. The overuse of such scans — which provide detailed images of the human body — can lead to dangerously high levels of radiation.

The system provides warnings when complications occur during childbirth and alerts doctors when patients undergoing sedation show signs of delirium, notes Dr. John Hensing, Banner’s executive vice president and chief medical officer. In sedation cases, doctors are able to react more quickly to reduce the risk of death.

The Affordable Care Act has been a welcome addition as hospitals pursue such strategies, offering financial incentives that boost efforts to provide more efficient care, Hensing says.

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At St. Joseph’s, patients were showing up at the emergency room repeatedly with relatively minor conditions that could be treated less expensively in a doctor’s office.

In one year, charity care for patients who could not provide compensation rose to $17 million a month from $8 million, largely due to the effects of the recession and patients’ inability to obtain their own private care, Pfister says.

So with a $140,000 grant from the Mercy Care Plan, St. Joseph’s Family Medicine Center began its medical home pilot program in January 2011.

It enrolled 2,800 patients who were registered in the Arizona Health Care Cost Containment System — people who were finding it difficult to obtain any kind of medical care.

“These were the toughest of the tough,” Pfister says.

Participants were quickly set up with doctors who treated them not only for their immediate affliction, but evaluated them for other conditions such as high cholesterol or a lack of immunizations. The goal was to provide preventive care whenever possible. Patients who were hospitalized left with a plan for follow-up treatment.

The pilot project cut costs and increased quality so significantly that it was expanded to other parts of the medical center, Pfister says. The hospital reported an 8-percent average reduction in costs per patient involved in the pilot program, a 12-percent reduction in emergency room visits and a 14-percent reduction in inpatient hospital stays among members of the group.

Like Lehn, Pfister says the Affordable Care Act has provided a focus to help bring about changes that were influenced by a variety of other factors. She predicted that five years from now, such strategies will affect a much wider range of people.

“I can look at my 80-year-old mother and I can see where that coordination of care makes a difference,” she says.

To Plese, of the Arizona Association of Community Health Centers, an essential part of the new approach is its emphasis on wellness and preventive care — treating potential illnesses before they become costly.

Such efforts are not new to health care in the United States. But she and others believe that a higher level of sophistication — including the use of electronic records, better coordination among providers and better care for women and children — will lead to a higher level of success.

“I don’t think people understand this is going from a sick care model to well care,” Plese says.

The federal law provides aggressive new incentives and penalties to encourage hospitals and other health care providers to change their approach to delivering health care, says Kim Van Pelt, director of Arizona Health Futures at St. Luke’s Health Initiatives. It encourages hospitals to form partnerships with community care organizations to provide health care in communities that often have been neglected, she notes.

The formation of accountable care organizations to coordinate services among various providers has been an essential part of the reform. The organizations are playing key roles in developing new solutions — to get people working together on “the latest and greatest care model,” Lehn says.

“All of this really starts with the clinicians looking at how to do things better and getting people on board to do that,” he says.

In the end, the reforms will matter less on what state or federal government does than on private industry and consumers, Lehn says. The key is to come up with good ideas and get people to buy into them — which essentially means doing whatever is necessary to take care of themselves.

“People need to recognize that they have health care risks to manage, and that they need to be partners in dealing with them,” he says.

Impact of Affordable Care Act on Arizona: Here are some of the effects of federal health reform on Arizona:

Since 2010, Arizona has received $9.4 million in grants from the Prevention and Public Health Fund created by the ACA.

Health centers in Arizona have received

$49.8 million to create new health center sites in medically underserved areas, enable health centers to increase the number of patients served, expand preventive and primary health care services, and/or support major construction and renovation projects.

Arizona has received $30.8 million in grants for research, planning, information technology development and implementation of affordable insurance exchanges.

The state has received $1 million in planning grants to conduct research and planning to help determine how its exchange will be operated.

As of December 2011, 69,000 young adults in Arizona gained insurance coverage because of the requirement that health plans are required to allow parents to keep their children under age 26 on their family coverage if the children lack job-based coverage.

In 2011, 637,233 people with Medicare in Arizona received free preventive services such as mammograms and colonoscopies or a free annual wellness visit with their doctor. In the first six months of this year, 258,660 people with Medicare received free preventive coverage.

— Source: HealthCare.gov