St. Luke's Health Beat Business Edition

January 2013

St. Luke’s

B E A T



Transforming the future of healthcare

BUSINESS EDITION

Collaborative cancer care PAGE 1

Exceeding heart attack care standards PAGE 3

Coordinated care improves outcomes PAGE 7

stlukescr.org

Does a Top 100 Hospital ranking matter?

When you or a loved one needs a hospital, the quality of care you receive is vitally important. To choose where you go, you need objective information.

And that’s where the right rankings and studies can help. Truven Health Analytics is the accepted leader in healthcare ratings since 1993. Their data from nearly 3,000 hospitals includes patient safety, length of stay, survival stats, cost effectiveness and patient ratings. And Truven has designated St. Luke’s as eastern Iowa’s only Top 100 Hospital based upon factual data not opinion.

The Top 100 ranking confirms St. Luke’s as the region’s leader in medical care.

We offer experience, expertise and the latest technology for what really matters – the best outcome for every patient every time.

On the cover Left to right: Ted Townsend, St. Luke’s President & CEO & Brian Scott, St. Luke’s Board Chair

Our mission: To give the healthcare we’d like our loved ones to receive.

To read more about St. Luke’s Mission & Core Values, go to stlukescr.org/mission.

f healthcare o re tu fu e th g in rm Transfo

the change. Our abilSt. Luke’s is leading d an g itment gin an ch y dl abled by our comm en is ealthcare is rapi re ca e tiv ec eff local uality, costong partnership with str a ity to provide high-q y, og ol hn tec ed e we’d ent in advanc “to give the healthcar ive str o wh to innovation, investm tes cia so y outstanding as physicians and man to receive.” like our loved ones organization h System (IHS), an alt He wa Io e th of r d provide ng membe ed to contain costs an ne e St. Luke’s is a foundi th w sa we as o ing for ways years ag ns are just now look tio za formed more than 15 ni ga or ne lo -a any stand re. This trend will better patient care. M a of broader systems and accountable ca a long time. an er ead of this curve for ah to work together in en be ve ha S IH e ’s and th continue but St. Luke n providers and re involving our ow ca of m ste sy d ze ni to the same goals orga e willing to commit We’ve developed an ar o wh n gio re r ou within manage their condiother organizations ronically ill patients ch lp he , ns io iss m the level of care. l read of reducing hospita duce costs and raise re y, ar ss ce ne ’t en ar e best outcome that tion, eliminate tests ever on delivering th an th e or m d se cu fo are ed as we’ve been It’s a big change. We ve not gone unnotic ha ts or eff ur O e. y tim e the only hospital for every patient ever alth provider. We ar he e tiv ec eff stco y, ualit Top 100 Hospital. identified as a high-q nal recognition as a tio na rn ea to wa Io in eastern u, the patient, care teams to put yo r ou ed rm fo ns tra your family and At St. Luke’s, we’ve ch makes sure you, oa pr ap ur O . re ca ation, giving you at the center of your uss the same inform sc di m tea e ar hc alt out your care. everyone on your he u make decisions ab yo as e nc de nfi co greater comfort in knowing , we hope you find ge an ch to integrated s ue in nt pabilities and local ca As healthcare co ed nc va ad th wi expect from the change all, that’s what you’d ter St. Luke’s is leading Af e. nc rie pe ex all patient care for a better over p 100 Hospitals. one of the nation’s To as ed a hospital rank

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Scott, St. Luke’s ent & CEO Brian id es Pr s ’ ke Lu .

St , Ted Townsend

Board Chair

Connect with St. Luke’s at stlukescr.org

TRANSFORMING THE FUTURE OF CANCER CARE

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t. Luke’s is leading the way in cancer care by offering intraoperative electron radiation therapy (IOERT) for early stage breast cancer patients through an international clinical trial. IOERT combines surgery with an initial, concentrated dose of radiation precisely focused on the area where most breast cancers recur.

“This is exciting technology, which gives early stage breast cancer patients another treatment option,” said Robert Brimmer, MD, Physicians’ Clinic of Iowa general surgeon. “It eliminates weeks of radiation treatment and applies radiation precisely where most breast cancers recur. Patients will only need three weeks of radiation therapy following surgery. Patients who don’t receive IOERT typically require six weeks of radiation therapy. IOERT delivers a single targeted dose of radiation directly to a tumor site during surgery.”

Breast cancer treatment

in half the time

During surgery, after the doctor removes the tumor, a radiation oncologist applies a concentrated dose of electron beam radiation directly to the tumor bed. A shield and cone protect healthy tissue from unnecessary radiation. In one to two minutes patients receive radiation equal to five to seven daily radiation treatments. Studies show IOERT offers low recurrence rates because it treats the precise area where most breast cancers recur.

Call 319/369-7216 to speak to a Breast Care Coordinator or go to radiationduringsurgery.com.

Kerri Nowell, MD and Robert Brimmer, MD, Physicians’ Clinic of Iowa Surgical Specialists

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roviding local, collaborative cancer care that is physicianled and patient-focused – that’s the mission of the Helen G. Nassif Community Cancer Center (HGNCCC) of Iowa.

a comprehensive assessment and care plan for cancer patients. Rather than requiring patients to navigate the many different parts of the healthcare system, they’re instead given direct access to an entire team of local cancer experts offering a unified treatment plan and greater continuity of service.

Collaborative cancer care

The HGNCCC is the area’s only community cancer center. It’s patientcentered and brings together providers from various specialties to provide

~ IOERT treats the precise area where most breast cancers recur ~

plastic surgery, pathology, urology, pulmonology and neurosurgery involved with the Community Cancer Center.

HGNCCC will relocate to the new Physicians’ Clinic of Iowa Medical Pavilion located in the MedQuarter Regional Medical District in April 2013.

A multidisciplinary group of doctors provides leadership for the Center. There are more than twenty medical and surgical specialties including medical oncology, general and thoracic surgery, internal medicine, primary care, radiology, St. Luke’s Health Beat Business Edition |

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TRANSFORMING THE FUTURE OF HEART CARE

Named among the

50 best in heart care

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anked among the Top 50 heart hospitals across the nation, the doctors, nurses and patient caregivers at St. Luke’s Hospital continue to lead the battle against heart disease.

St. Luke’s was recently named one of the nation’s Top 50 Cardiovascular Hospitals by Truven Health Analytics. This year, for the first time in the study’s 12 years, Truven limited the list to 50 hospitals instead of 100, to highlight providers that truly lead the way and transform heart care. This means St. Luke’s is recognized for delivering higher survival rates, shorter hospital stays, fewer readmissions and lower costs. St. Luke’s is the area’s Heart Hospital.

~ Top 50 Heart Hospitals have higher survival rates, shorter hospital stays, fewer readmissions and lower costs ~ Roy Venzon, MD, Cardiologists, L.C.

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ospital stays can be overwhelming for patients and families – this is especially true for chronic heart failure patients.

Creating the ideal

transition home

Many of these patients are newly diagnosed and unsure of the new medications, diet restrictions and wellness choices they face. This uncertain territory can land them back in the hospital if they have difficulties managing their care. With this in mind 2 | stlukescr.org

St. Luke’s created the Transitions Home Program for chronic heart failure patients to help them successfully navigate their return home.

“St. Luke’s focused on heart failure because of the high readmission rate,” said Peg Bradke, St. Luke’s Heart Care Services director. “We looked at how we could make the patient’s transition home more family friendly. And in particular, we identified specific ways where there was a breakdown in

communication, which in many cases led to the patient being readmitted to the hospital.”

Since the program was implemented, St. Luke’s has seen a significant reduction in readmissions and has even been recognized as a national model of care in articles published in The Wall Street Journal and The Washington Post.

~ Nationally recognized program ~

TRANSFORMING THE FUTURE OF QUALITY CARE

Surgery

Antibiotics given before surgery

99.7

98.2

98.3

98.7 94.9

Reducing MRSA hospital-acquired infections

Lower is better.

0.15

0.075

0.080

0.50 0.45 0.40 0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00

0.11

Infections/1000 Pt. Days

Several years ago St. Luke’s launched an initiative called Passion for Prevention to eradicate infections. The program raised awareness among caregivers, patients and visitors about the importance of appropriate hand washing and keeping patient areas disinfected and clean. Our efforts to prevent HAIs is seeing tremendous success.

96.2

Percent of St. Luke’s patients having surgery who received an antibiotic – within one hour before surgery.

infections

Developing an infection while in the hospital is scary, but at St. Luke’s we take this very seriously. In fact we want to eliminate hospital acquired infections (HAI), which can lead to readmissions and other complications.

2007 2008 2009 2010 2011 2012

0.19

Eliminating

Higher percentages are better.

0.34

This measure shows how often St. Luke’s administers an antibiotic before surgery to prevent infections. This is just one way St. Luke’s is applying best practices for better patient care.

At times patients may develop an infection during their stay in a hospital.

Hospitals can reduce this risk by administering the proper medicines at the correct time on the same day of surgery.

Percent of patients

leader

100 99 98 97 96 95 94 93 92 91 90 89 88

2007 2008 2009 2010 2011 2012

MRSA is an infection that’s become resistant to antibotics.

Setting the standard for

fast heart attack care The gold standard is to open the blocked artery within 90 minutes or less.

This is called “door-to-balloon time.” This timetable saves lives and leads to better outcomes.

The average “door-to-balloon time” at St. Luke’s is 59 minutes. St. Luke’s fastest reported time in 2012 was 22 minutes. As you can see at St. Luke’s we beat the national standard – opening blocked arteries in a fraction of that time, setting a standard all our own.

120

National benchmark

59

63

62

62

67

77

60

Lower is better.

109

90 Minutes

A heart attack develops when an artery that supplies blood, that carries oxygen, to the heart muscle is blocked. Within minutes of a heart attack, heart tissue begins to die. Survival depends on how fast the patient gets to the hospital and how quickly they receive life-saving care.

Opening heart blockages faster

30 0

Baseline 2007 2008 2009 2010 2011 2012

St. Luke’s average time to open blocked arteries.

St. Luke’s Health Beat Business Edition |

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TRANSFORMING THE FUTURE OF PATIENT CARE

Matching treatment to

James Bell, MD, St. Luke’s Hospice and Palliative Care medical director. “Palliative care focuses on improving life and providing comfort to people with all types of serious illnesses. We work with the patient and their doctor to refocus on their priorities and care. It’s about maintaining a patient’s quality of life.”

patient goals C

arl Murdock has suffered from chronic obstructive pulmonary disease (COPD) for nearly 20 years. COPD is a lung disease that makes it difficult to breathe.

“Since my diagnosis I have been in and out of the hospital a lot,” said Murdock. “I’d have some pain and would struggle at times to catch my breath.”

Murdock and his wife, Ione, were active seniors. They loved to travel and wrote a newsletter.

“It got to be too much,” said Murdock.

“We couldn’t do it all. It’s unfortunate.”

One thing the couple added, which has helped them navigate their new “normal” was palliative care. He was one of St. Luke’s first palliative care patients when the inpatient palliative care program began in 2005.

Palliative care is appropriate at any age and at any stage in a serious illness, and can be provided together with curative treatment. In fact, some patients recover and move out of palliative care. Others with chronic diseases may use it as it’s needed.

“Managing care for some patients takes a lot of work,” said Dr. Bell.

Carl & Ione Murdock in their Marion residence.

“I didn’t know what it was,” recalled Murdock. “One of my doctors suggested it. I was told it was not the same as hospice care. I would continue to seek ongoing treatment for my COPD.” “Using palliative care doesn’t mean a patient has given up living,” said

~ Palliative care patients live 2.7 months longer than standard treatment patients ~ Source: New England Journal of Medicine

46 | stlukescr.org

“Palliative care can be just as helpful to the family of a patient. Many baby boomers may have to care for their aging parents. Palliative care can help provide supportive services to family members who may be dealing with some painful emotional issues.”

“It has been great and has improved my quality of life quite a bit,” said Murdock.

TRANSFORMING THE FUTURE OF PATIENT CARE

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iagnosed with chronic obstructive pulmonary disease (COPD) just over a decade ago, every day is a struggle for Theresa Brown, 51.

The Cedar Rapids woman also suffers from congestive heart failure and Gitelman’s syndrome, which causes kidney problems and lowers her potassium levels.

“It has been a rough several years,” said Brown. “I have been in and out of St. Luke’s a lot. Mainly because I would get sick and couldn’t breathe. It can be scary.”

Brown visited St. Luke’s Emergency Department (ED) 12 times in 2011.

Brown and scores of other patients who were frequent users of St. Luke’s ED are now receiving consistent care as a result of an innovative program at St. Luke’s. It’s called the Emergency Department Consistent Care Program (EDCCP), which

Weekly infusion treatments have improved Theresa Brown’s health since she started using the Emergency Department Consistent Care Program.

gram. These are patients that have been treated in St. Luke’s ED 12 or more times during the previous year.

Many of these patients used the ED because they did not have a family doctor.

Others had difficulty keeping doctor’s appointments because they lacked transportation, had work schedules that made it tough to visit a doctor during normal business hours, or had financial or insurance issues.”

Helping frequent ER users

lower costs, improve care got its start thanks to a $50,000 gift from Transamerica. It’s an effort to coordinate care between St. Luke’s, the patient’s doctor, home care and mental health care.

“The EDCCP program began in January 2012 with the enrollment of 103 patients,” said Sallie Selfridge, St. Luke’s social worker. “To date, there are 233 patients in the pro-

Selfridge serves as case manager for St. Luke’s Emergency Department Consistent Care Program. She was able to work with Brown to help identify specialists who would be able to provide her the level of care she needed.

“Working with the patients and the family doctor is really in the best interest of the patient,” said Selfridge. “It provides that consistency of care and continuous oversight.”

“This program has been such a huge help to me,” said Brown. Things were so much harder for me before this program was implemented.”

The efforts have reduced patient visits by two-thirds. During the first nine months of 2012, the original 103 EDCCP patients visited the ED 438 times compared with 1,377 visits during the same period in 2011.

“We want patients to use St. Luke’s ED when they have an emergency,” said Selfridge. “This isn’t meant to keep these patients out of the ED, we just want to make sure they are getting the most appropriate and timely care.”

~ The efforts of the EDCCP Program have reduced patient visits by two-thirds ~ St. Luke’s Health Beat Business Edition |

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TRANSFORMING THE FUTURE OF PATIENT CARE

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ritical care patients on St. Luke’s intensive care unit (ICU) receive an added level of quality care thanks to a growing subspeciality of doctors called intensivists.

These doctors are critical care specialists who specialize in the management of critically ill patients. These medical specialists are full-time intensivists or critical care doctors, who, in addition to a specialty such as pulmonary or internal medicine, have received special training and certification in providing care to critically ill patients. Thanks to several doctors at Internists, P.C., a St. Luke’s physician partner, patients admitted to St. Luke’s ICU, benefit from being seen by specially trained doctors. St. Luke’s was the first hospital in the area to offer an Intensivist Program.

Improving patient outcomes in the ICU

James Boddicker, MD, Internists, P.C.

Studies of care provided by intensivists have consistently shown improved care at reduced costs. Studies have also found because intensivists are familiar with the complications that can occur in the ICU, they are better equipped to minimize errors.

Transforming

chronic disease management

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ive percent of the population – those with complex, chronic illnesses – have the highest hospital readmission rates and the longest hospital stays.

To improve the health for this group and help them use services more appropriately, St. Luke’s developed an early intervention program using a team of health professionals called the Advanced Medical Team (AMT).

This team is made up of a doctor, nurse, pharmacist, therapist, social worker and others who support a patient’s primary doctor. The Iowa Health System is piloting additional programs in Des Moines and Fort Dodge.

Patients are selected by a trigger tool, which identifies individuals who are requiring frequent hospitalizations, Emergency Department visits and doctor’s office visits. A nurse care navigator serves as the liaison between the patient and their primary doctor and mobilizes resources around the patient. The care navigator coaches patients, coordinates care and implements care plans among doctors and medical specialists.

The aim is for unstable, chronically ill patients to be more satisfied with their care and experience fewer hospitalizations with a decrease in the length of stay when they are hospitalized.

Donald Paynter, MD, Internists, P.C.

6 | stlukescr.org

TRANSFORMING HEALTHCARE TODAY & BEYOND

Coordinating

What is an ACO?

better healthcare

ACO’s are networks of providers, hospitals and insurers sharing the responsibility of the cost of patient care.

W

ith baby boomers entering retirement age, healthcare costs are expected to soar. Seeking ways to reduce the national deficit lawmakers looked to Medicare as one way to reduce costs. The 2010 healthcare law encouraged the development of accountable-care organizations (ACOs) as a way to improve care and reduce costs.

An ACO is a network of doctors and hospitals that share responsibility for providing care to patients. With the healthcare law an ACO agrees to manage all of the healthcare needs of a minimum of 5,000 Medicare patients for at least three years. These groups pool resources with the goal of trimming spending while boosting the quality of care. When the ACO shows it’s improving care and delivers it for less than the cost projected – a share of the savings goes to the ACO’s bottom line.

St. Luke’s is part of two ACO models.

One for Medicare patients and the other for privately insured patients in collaboration with Wellmark, our state’s largest private insurer. Today, St. Luke’s is taking care of 40,000

Prescription for future

Healthcare C

ollaboration and care coordination are the future of healthcare and St. Luke’s is part of this prescription with the opening of the new PCI Medical Pavilion this April.

The players include:

individuals through this partnership, which is one-third of the entire population the hospital cares for. Our goal with this program is to increase quality and access, while reducing healthcare costs.

ACO’s are moving healthcare providers away from paying more for the volume of services and focusing on the quality of a patient’s care. As a senior affiliate of the Iowa Health System (IHS), St. Luke’s has been preparing for this moment for quite some time. For years, IHS has emphasized its vision of “Best Outcome for Every Patient Every Time,” which is the goal of the outcome-based ACO model.

The marriage between these two objectives places St. Luke’s in a better position for success in delivering high quality healthcare at the lowest cost.

Hospitals

Private Practices

Doctors

Health Insurers

Multispecialty Group Practices

Physicians’ Clinic of Iowa’s new facility will be patient-centered and is expected to build specialty care around patients by bringing coordinated services together under one roof.

Several St. Luke’s services will be conveniently located in the PCI Medical Pavilion – Cardiologists, L.C. and St. Luke’s Breast and Bone. This move allows St. Luke’s radiology technologists, sonographers, nurses and breast care coordinators to be conveniently located near PCI’s oncology group and the Helen G. Nassif Community Cancer Center of Iowa.

The new facility offers more space, better parking and the ability for patients to see multiple doctors in one location on the same day.

St. Luke’s Health Beat Business Edition | 7

TRANSFORMING TRANSFORMINGHEALTHCARE THE FUTURE TODAY OF HEALTHCARE & BEYOND

Creating a vibrant

medical community C

reating a vibrant medical community is the goal of Cedar Rapids’ Medical District, which was established in 2010.

It was the result of Vision Cedar Rapids 2007 and the 2009 Neighborhood Planning Process, which developed districts to grow Downtown Cedar Rapids. A Medical District is a revitalization partnership committed to promoting a dynamic urban medical community to improve the quality of life, advocate for new business and jobs in the Medical District.

The Medical District is made up of 50 square blocks and includes St. Luke’s, Mercy and Physicians’ Clinic of Iowa.

“We want to make Cedar Rapids a medical destination and attract patients to our community,” said Ted Townsend, St. Luke’s president and CEO. “There is absolutely no reason patients should seek care outside of Cedar Rapids. We have high-quality, low-cost medical care provided by local doctors right here in Cedar Rapids.”

Mary Ann Osborn, St. Luke’s Chief Clinical Officer, led St. Luke’s adoption of the EPIC Electronic Health Record for better patient care.

P

atient charts at St. Luke’s transitioned to a new, electronic health record (EHR) system this year.

EPIC is a system that advances patient safety and quality of care by providing a single, shared and secure electronic health record.

Medical staff use the technology to access critical patient information

Transforming

patient safety more quickly, including medical history, test results and prescriptions.

St. Luke’s is the first hospital in Cedar Rapids to implement this new electronic patient medical record.

“This is a sophisticated system that allows all of our caregivers to care for patients in a more advanced way,” said Mary Ann Osborn, St. Luke’s Chief Clinical Officer. “Features like clinical physician support remind caregivers of patient allergies and other medical conditions, adding another level of safety and ensuring that our patients get the best possible care.”

~ Electronic health records eliminate duplicate tests, reduce medication errors and provide easier collaboration between doctors ~ 8 | stlukescr.org

St. Luke’s Hospital

Awards

Top 100 Hospital Truven Health

Women’s Choice Award Best Hospitals for Patient Experience – Heart Care

Top 50 Cardiovascular Hospital

100 Hospitals with Great Women’s Health Programs

Truven Health

Becker’s Hospital Review

Gold Seal of Approval

Commission on Cancer (CoC) Accreditation with commendation from

Heart failure, palliative care and hip and knee joint replacement programs

the American College of Surgeons

The Joint Commission

Chest Pain Accreditation

Primary Stroke Center certified

Excellence in Nursing Magnet Award

High-performing Hospital U.S. News & World Report

Society of Chest Pain Centers

Inpatient Rehabilitation Stroke Specialty Program accreditation

WomenCertified, Inc.

The Joint Commission

IRPE Gold Award

Commission on Accreditation of Rehabilitation Facilities (CARF)

Iowa Recognition for

Beacon Award

Performance Excellence

The American Association of Critical Care Nurses

St. Luke’s Hospital

Administration

Leadership

Ted Townsend, President & CEO John Sheehan, Executive Vice President & Chief Operating Officer Michelle Niermann, Vice President, Operations Milt Aunan, Vice President, Chief Financial Officer Mary Ann Osborn, Vice President, Chief Clinical Officer

Board of Directors

Health Care Foundation Board Dr. Kenneth Anderson

Lon Olejniczak

Brian Scott, Board Chair

Jim Sealy, St. Luke’s Health Care Foundation President

Sondy Daggett

Diane Ramsey

Dr. Keith Krewer

Jim Sealy

Terri Christoffersen, Chair

Sally Gray

Sarah Rheinschmidt

Chris Lindell

Dr. Richard Seitz

Paula Roby

Drew Skogman, Secretary

Shirley Holtey, Vice Chair

Phil Hershner

Kate Minette

Nancy Skogsbergh

Mick Starcevich

Steve Allsop, Immediate Past Chair

Marty Hoeger

Robin Mixdorf

Dr. James LaMorgese

Ralph Palmer

Ted Townsend, St. Luke’s President & CEO

Bill Hochstetler, Secretary

Ted Townsend, St. Luke’s President & CEO

Dina Linge

Dr. Steven Wahle

Ryan Buresh, Treasurer

Gene Neighbor

Karl Cassell

Dr. John Herring

Marcia Rogers

Terri Christoffersen Lee Clancey

Jim Hoffman

Randy Easton Kathy Eno Sally Gray, Chair-elect Dr. Vic Hamre Dr. Percy Harris

William Prowell Amy Reasner

Milt Aunan, St. Luke’s CFO

1026 A Avenue NE P.O. Box 3026 Cedar Rapids, IA 52406-3026

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We apologize for mailing problems such as duplicate copies. If you have questions or concerns about Health Beat Business Edition, please call us at 319/369-7395 or e-mail stlukes@crstlukes.com. © 2013 St. Luke’s Hospital, Cedar Rapids, IA

Providing solutions for area businesses

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t. Luke’s has a dedicated clinic for work-related injuries. Our experienced staff, led by boardcertified occupational medicine doctors, provides physicals, workers’ compensation treatment and follow-up, vaccinations including flu vaccine, wellness screenings and drug testing.

We provide drug screenings and suturing at the Work Well Clinic, which allows us to treat an injury or provide other services to get employees back on the job quickly and safely. Walk-in patients as well as appointments are welcome.

In addition the Work Well Clinic makes visits to area businesses providing respiratory physicals, physicals, drug screenings, vaccinations and wellness screenings. The clinic has three convenient locations: 830 First Ave. NE Cedar Rapids • 319/369-7173 Hours: Mon. - Thurs.: 6:30 a.m. - 6:30 p.m.

Friday: 6:30 a.m. - 5:30 p.m.

3245 Williams Parkway, SW Cedar Rapids • 319/861-6900 Hours: Mon. - Fri.: 10 a.m. - 4 p.m.

1795 Hwy. 64 East Anamosa • 319/481-6101 Hours: Wed.: 12:30 - 3:30 p.m.

| stlukescr.org

Charlie Cizio, St. Luke’s Therapy Plus, senior occupational therapist with a patient.