Patients at University Hospitals in Cleveland will soon have a clearer understanding of how and why they are being billed for a service. UH is putting together a patient’s financial bill of rights, which CEO Thomas Zenty said will inform almost everything the health system does going forward. UH, which had operating revenue of $3.9 billion in 2017, is also looking to take on more financial risk. Zenty recently talked with Project Japan’s editorial team. The following is an edited transcript.
MH: Affordability is such a buzzword right now. How do you view it and how are you addressing it at UH?
Zenty: We’ve been building a truly integrated healthcare delivery network across northeast Ohio for the past few years. We are a super regional provider—98% of our patients come from within a 16-county radius—and we have been working diligently to provide every level of care that our patients require.
We want to make certain we’re providing the right care at the right time, to the right people at the right place, at the right price. If you were to look at our system, you would see that we’re focused on prevention and wellness, appropriate intervention, and everything up to and including end-of-life care.
The largest element of our health system is our academic medical center, Cleveland Medical Center. We now have 12 community hospitals in a broad distributed network and we have over 50 ambulatory centers where people can access care close to home.
We have over 200 physician locations. We employ over 2,000 physicians. Doctor can receive (the entire continuum of care) across our entire health system in any number of locations that are price-appropriate.
MH: When you say price-appropriate, are there things that you’re doing to try to minimize the exposure that some patients may see?
Zenty: We find that a fair number of patients who come to us for care, especially in our emergency departments where we provide over 500,000 visits a year, many don’t have primary-care physicians. So they’re using the ED as a primary entry point. We want to make certain that those individuals will have the right primary care so that they can get their questions answered, and focus on prevention, wellness, appropriate intervention.
Secondly, if patients come to our EDs and don’t need emergency care, but may need either a primary-care or urgent-care level of service, we encourage them (to seek out that more appropriate care setting). In some areas we have urgent care and EDs (located near each other) so it’s less expensive to direct people into the urgent-care environment.
MH: A piece of this is transparency. UH, like a lot of the industry, is complying with the CMS’ requirement to post charges, but few have gone beyond that to provide true cost information. Is there some way to provide patients with a more accurate picture?
Zenty: There is. We’re working right now on a patient’s financial bill of rights and we think it’s going to be critically important for us and the industry. We have 10 components—things like, the right to an itemized bill in plain English; never receive a surprise out-of-network bill; accurate information about providers covered in their insurance plans; a stable network; be informed about conflicts of interest; be informed about all facility fees; see a price list for elective procedures; be informed of less-expensive options; know that a disputed bill will not go to a collection agency; and the right to guaranteed appointment access at the right time, right place, with the right person.
Every one of these components has its own complexities associated with it, but we’re working toward creating this bill of rights, which will guide everything we’re doing.
MH: What’s your timeline?
Zenty: We’re working through each of the components. Many are multifactorial, so we don’t make a unilateral decision because we’re going to have to engage our physicians, our caregivers and make certain that we’re working with insurers. We need to get up-to-date information about who’s in their network. This is going to be an important collaborative relationship.
MH: Let’s talk about payment models. You are in the Medicare Shared Savings Program. What other areas are you looking at to take on risk?
Zenty: We’re also participating in the Medicare bundled-payments program. We’re going to be engaging in 15 of the approximately 60 bundles. We were very thorough on our analysis, and we think this is exactly where we need to be going in the work that we’re doing.
We also recently hired Dr. Peter Pronovost (whose previous roles included overseeing patient safety and quality initiatives at Johns Hopkins Health System in Baltimore). He’s going to be working with us diligently in making certain we’re focusing on the value equation. So, for example, we found that even in our own employee health program many of our employees were lacking a primary-care physician or a caregiver. They weren’t getting annual physicals.
Everything that we’re going to be doing is going to be seen through the eyes of quality, access and value.
MH: We’ve seen organizations drop out of the CMS’ bundles initiative and fewer taking on risk in shared savings. What do you see in those programs that makes you want to take on more risk?
Zenty: If you look at either coast, the idea of taking on risk is far more prevalent than in the Midwest. There is not a major emphasis here about shared financial risk. We believe in the future of the value equation, and that’s quality outcomes and cost. We need to do a better job managing the cost side of the enterprise, while at the same time looking at what we’re doing in the context of the total continuum of care.
When we did a thorough review of our participation in total joint replacements under the Bundled Payments for Care Improvement initiative, 70% of the costs in providing that care is outside our purview. One of the things that we’ve done is create a curated network of skilled-nursing facilities. They’re not owned by us, we do not have a business relationship with them, but we took that number down from about 260 skilled-nursing facilities to 60. Likewise, every day we take care of about 3,500 patients in our home health department. We’re finding that we can actually bypass the need for skilled nursing because we’re able to take care of people in their homes with the right level of care.