The system is the star

Original post:  Aug 20, 2015

At the Healthcare Transformation Group (HTG) meeting over the past few days, we heard from the CEO of Geisinger Health System (GHS), Dr. David Feinberg. As is his right, he proudly extolled the many virtues of his health system. I found some very interesting pieces that I thought you should hear about, too.

Dr. Feinberg started off humbly. He explained about his first visits to his far-flung clinics in central Pennsylvania. During one visit in the heart of Amish country, the director pointed out a hitch rack. He thought it was some procedural item, and asked what it did. The director calmly explained that this was where the Amish would tie up their horses when they would come in for a visit!

He talked about one of the key measures Geisinger watches carefully. It is the "O to E" ratio. The O stands for "observed" while the E stands for "expected". For any given group of patients, there is an expected mortality rate. That represents the E in the ratio. The O represents how many of the patients Geisinger served actually died. If the observations match the expectations exactly, your ratio is 1.0. If you go above 1.0, that means you are doing worse than average. If you go below, you are doing better than average. 0.7 is considered a good score. In May 2015, the entire Geisinger system had an O to E ratio of 0.5!!

GHS also offers some very interesting twists. They have a program called "Proven Heart". They have refined their work to such a degree that they offer what the NY Times has called a "warranty" on their heart procedures. Here is a link to an article that discusses this program:  http://www.nytimes.com/2007/05/17/business/17quality.html?_r=0 Here is an excerpt from that article:

The group, Geisinger Health System, has overhauled its approach to surgery. And taking a cue from the makers of television sets, washing machines and consumer products, Geisinger essentially guarantees its workmanship, charging a flat fee that includes 90 days of follow-up treatment.

Even if a patient suffers complications or has to come back to the hospital, Geisinger promises not to send the insurer another bill.

....

In reassessing how they perform bypass surgery, Geisinger doctors identified 40 essential steps. Then they devised procedures to ensure the steps would always be followed, regardless of which surgeon or which one of its three hospitals was involved.

From screening a patient for the risk of a stroke before surgery, to making sure the patient has started on a daily aspirin regimen upon discharge, Geisinger’s 40-step system makes sure every patient gets the recommended treatment.

....

When the system began, Geisinger was performing all 40 steps for bypass surgery only 59 percent of the time. Now, an operation is canceled if any of the pre-operative measures have been forgotten. For the last seven months, Geisinger says, its teams have managed to have a perfect record in following all recommended steps for surgery and follow-up care.

The program has been so successful, Wal-Mart actually will allow employees who require heart surgery to have it done at GHS instead of a local hospital without any co-pay. They will actually pay for the patient and a companion to travel to GHS and have the procedure. Once there, GHS typically finds that about 40% of the patients do not require surgery! This results in enormous savings for everyone.

Dr. Feinberg attributed the ability of GHS to get this type of result to a special culture. In this culture, he notes that the system is the star (not the individual clinician).

GHS is actually considering a full guarantee on all of their services. They are experimenting with a model they call "Proven Experience". I'll try to keep an eye out to see how it goes!