About this story series
This is the second in a series of consecutive Sunday stories on major hospitals serving Butler County. The Journal interviewed hospital executives about plans for their organizations in the year ahead, and how pivotal 2013 is for the major employers as they adjust for health care reform.
Feb. 10: West Chester Hospital
TODAY: Mercy Health — Fairfield Hospital
Feb. 24: Fort Hamilton Hospital
March 3: McCullough-Hyde Memorial Hospital
March 10: Atrium Medical Center
March 17: Bethesda Butler County TriHealth Hospital
Health care delivery is undergoing a transformation process, and long-time Butler County hospital administrator Tom Urban has his feet planted firmly in two worlds: the world as it is now, where hospitals and other health providers are paid based on volume, and the future where the health system is value-based.
Urban has this unique perspective because his hospital group Mercy Health has taken the leadership role in the Cincinnati region for moving to this new system of care.
Mercy Health is the first hospital group in greater Cincinnati to receive the designation of an Accountable Care Organization from the U.S. Centers for Medicare and Medicaid Services. An Accountable Care Organization is the term given to a group of health care providers who coordinate care, manage chronic diseases and try to improve the overall health of their patient population.
It’s where health care is going, and ties payments to quality goals instead of patient volume. The intent is to restrain growing health care costs by making populations healthier, cutting back on redundant services and keeping patients out of more expensive hospital settings.
It’s with that focus in mind that Urban’s title has technically changed from president and chief executive officer of Mercy Health — Fairfield Hospital to market leader and president of Mercy Health — North Market to reflect his responsibilities to help coordinate care in the market between the hospital, doctors practices and outpatient centers. The north market for Mercy consists of Butler and Warren counties and northern Hamilton County.
The challenge that arises is how to move to this new system while still maintaining the Fairfield hospital’s bottom line in a world that still pays for numbers, Urban said.
Hospitals will still be important but the changes mean “we have to think beyond the four walls of the hospital,” Urban said. “It’s stressful but exciting. Exciting because that’s the direction we should be heading and I’m working for an organization that’s really taking it seriously and leading that. On the other hand I still have a hospital to run and I get paid on how many X, Y, Z’s I do.”
Mercy Health, which currently operates six hospitals including Fairfield, formed a new internal organization Mercy Health Select to take the three-year contract with Centers for Medicare and Medicaid to test the accountable care model. Mercy Health has been assigned 22,000 of its existing high-risk Medicare patients to monitor results.
The program runs from July 2012 to July 2015.
There are no penalties and any savings that result will be shared between Mercy Health and CMS.
“We’re learning a lot about how to even prioritize the patients,” Urban said. “Think of a pyramid of patients that are healthy and never use the hospital on kind of the bottom of the pyramid and then as you get up near the top, someone who’s been hospitalized 10 times last year because they can’t control their diabetes. So you stratify those patients and you focus on the ones at the top of that pyramid.”
The Fairfield hospital and Middletown’s Atrium Medical Center are the biggest hospitals serving Butler County. Mercy Fairfield ended 2012 with almost 1,500 full- and part-time employees. Last year’s revenues are not yet available, but hospital officials said they expect a 10 percent increase over 2011 revenues of $217 million. As Butler County’s busiest emergency department, Mercy Fairfield said it had about 61,400 ED visits in 2012.
The new patient unit Fifth Floor Patient Tower is open for business, Urban said. Last year Mercy Fairfield finished the multi-million project to add a new patient floor on the fifth floor of its patient tower, previously shelled space, adding 29 oncology private patient beds. The additional beds raise the hospital’s total registered bed count to 293.
New developments this year include an outpatient wound care center opening in March, Urban revealed. The hospital is adding two hyperbaric oxygen chambers, which help accelerate the healing process of major hard-to-heal wounds such as amputations.
Robotic surgery is advancing, Urban said. Mercy Fairfield has had robotic surgery going on three years. It started with prostatectomies and gynecological type surgeries and is now being applied to more general surgeries including gallbladder and bariatric surgeries, he said.
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