By Larry McClain
One of the things that makes Health:Further unique is the way it unites multiple healthcare conferences under one umbrella. Here are some highlights from day two of Tuesday’s HFMA and HIMSS Southeast Summit presentations:
Payer-Agnostic Quality Scorecards
Austin Purkeypile, COO of Florida Hospital East Orlando (soon to be renamed “Adventist Health”), gave an interesting talk entitled “Mission And Margin: In What Order?”
“Hospitals consistently underestimate the effect of culture on the success of an initiative,” said Purkeypile. “And we consistently overestimate the marginal cost of any single patient encounter.”
Purkeypile added that quality metrics like length of stay (LOS) and readmissions are almost invariably skewed toward Medicare results in those categories. That’s why his hospital will soon move to payer-agnostic quality scorecards.
“We have to remember that HCAHPS scores don’t measure compassion,” he said. “You can’t quantify a single act of kindness. For example, we recently treated a newly diagnosed diabetic who kept saying that he really missed being able to eat apple pie. So one of our staffers brought him a sugar-free apple pie. Those simple, spontaneous things don’t ever show up in quality metrics.”
“New studies reveal that loneliness is just as bad for your health as smoking,” added Purkeypile. “Maybe it’s time we start looking for digital solutions. People find dates on the Internet, so why can’t we help them find friends?”
Purkeypile was particularly proud of three recent innovations at his hospital:
- Partnering with a Federally Qualified Health Center to broaden care for the roughly 10 percent of local residents who don’t have health insurance.
- Starting an internal “disruption group” to continuously challenge the hospital’s business model.
- Intentionally lowering the ED admissions rate by 6 percent based on evidence-based protocols.
Using Telehealth To Integrate EMS and Mobile Crisis Teams
Melissa Camp, director of special operations at Charleston Dorchester Mental Health Center in South Carolina, opened her talk with a grim statistic: there are 12 million behavioral health ED visits each year in the U.S. – and many of them are unwarranted.
Charleston County’s EMS Services and Mobile Crisis Team have a service area that stretches 100 miles end-to-end. Like most of their counterparts nationwide, they have the daunting task of separating real emergencies from faux episodes that are often a thinly veiled way of getting an ambulance ride rather than paying for a cab. “Every community has its share of people who call 911 and say that they’re suicidal just to get a free ride to another part of the city,” she said.
For years, the “solution” was to send EMS ambulances to every caller in order to determine the true severity of the situation. Here’s how it now works in Charleston County:
A dispatcher receives a 911 call for a behavioral issue, and EMS and law enforcement proceed quickly to the scene. Soon thereafter, an EMS supervisor in an SUV arrives, allowing the ambulance to go back into service. The SUV is equipped with a telehealth-enabled laptop or smartphone and a printer. The supervisor then reaches out to the Mobile Crisis Team to set up a telehealth evaluation.
“The old way was to send almost all behavioral health callers either to the ED or jail if substance abuse was involved,” said Camp. “Now we can send them to the appropriate place for care. Patients experiencing mental health crises can be sent to the mental health center, and addicts don’t wind up in the ED.”
By using telehealth to integrate the activities of EMS, law enforcement and the Mobile Crisis Team, Charleston County has been able to divert 56 percent of 911 callers from the ED.
“The savings have been enormous when you consider that a typical ambulance ride costs $350 or more – and an ED visit can easily wind up costing $2,000,” said Camp. “Since implementing our telehealth evaluation program, we’ve saved Charleston County $1.1 million in just one year.”