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PARKINSON’S: Integrated practice unit (IPU) offers one-stop-shop model of care

The concept of an integrated practice unit (IPU) would offer patients with the same disease – Parkinson’s is explored in this article but the model has broader applicability – a team of specialists with appropriate resources at hand for the care of a complex chronic condition.  Several case examples of providers who are developing this type of care include:

  • ParkinsonNet in The Netherlands
  • Kaiser Permanente
  • Van Andel Research Institute (Grand Rapids, MI) – based on the ParkinsonNet model
  • Cleveland Clinic

The author identifies two components as critical for an IPU: patient-reported outcome measures and focus on value.

Sources: McKee, K. (2019, August 1). Creating “one-stop shop” care for Parkinson’s. NEJM Catalyst. Click here: https://catalyst.nejm.org/one-stop-shop-care-parkinsons/

Kaiser Permanente. Our care model.  Click here:  https://parkinsonscare.kaiserpermanente.org/our-care-model/

Van Andel Institute and ParkinsonNet explore partnership. (2015, June 2). News Release.  Click here: http://www.parkinsonnet.info/news/van-andel-institute-and-parkinsonnet-explore-partnership

Porter, M.E., Teisberg, E.O. (2019, June). Cleveland Clinic: Transformation and growth 2015. HBS Case Collection. Click here:  https://www.hbs.edu/faculty/Pages/item.aspx?num=36929  Posted by AHA Resource Center (312) 422-2050, rc@aha.org


CARDIOLOGY: How to organize a successful heart and vascular service line in an academic medical center

Reorganization of cardiology-related services into a cohesive heart and vascular service line in 2005 at UMass Memorial Health Care is described in this lengthy article.  The service line was built by consolidating the previously separate divisions of cardiovascular medicine, cardiothoracic surgery, and endovascular surgery.  This article covers key success factors as well as major barriers and challenges.  The reorganized service line was found to have favorable outcomes financially and in other aspects over the study period from 2006 to 2011.

Special Note: There is an ORG CHART showing the relationship of the service line leadership on up to the hospital president.

Source:  Phillips, R.A., Cyr, J., Keaney, J.F., Jr., and others. (2015, Oct.). Creating and maintaining a successful service line in an academic medical center at the dawn of value-based care: Lessons learned from the heart and vascular service line at UMass Memorial Health Care. Academic Medicine, 90(10), 1340-1346.  Available for purchase here: http://journals.lww.com/academicmedicine/pages/articleviewer.aspx?year=2015&issue=10000&article=00020&type=abstract (Posted by AHA Resource Center (312) 422-2003), rc@aha.org


OBSTETRICS: 1 million deliveries in U.S. hospitals studied

Statistics on over one million deliveries at 355 U.S. hospitals in 2008 and 2009 were studied based on Premier, Inc.’s Perspective database.  This provides a fascinating large-scale look at the obstetrics population in the U.S.  Let’s take a look (I’ve rounded the following numbers off and combined some categories from those given in the original article.)

How old are maternity patients?

  • About half are in their 20s
  • About 10 percent are teenage mothers

What kind of insurance do they have?

  • 42 percent managed care
  • 42 percent Medicaid
  •   8 percent commercial – indemnity
  •   3 percent self pay
  •   6 percent other

How many patients…

  • Delivered by C-section this time? 39 percent
  • Have had a previous C-section?  18 percent
  • Are of advanced maternal age?  16 percent
  • Are delivering prematurely?  8 percent
  • Are obese?  4 percent

What was the median length of stay?

  • 2 days for vaginal delivery
  • 3 days for C-section

What was the hospital risk-adjusted infection rate?

  • 4.1 percent of all deliveries were complicated by infection

The authors found that “risk-adjusted infection rates following childbirth vary considerably across hospitals, and that key structural and organizational hospital features explain only a modest amount of this variation.”

Source: Goff, S.L., Pekow, P.S., and others. (2013, June). Patterns of obstetric infection rates in a large sample of U.S. hospitals. American Journal of Obstetrics & Gynecology, 208(6). Author manuscript free here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3670964/pdf/nihms-443021.pdf  Posted by AHA Resource Center (312) 422.2050, rc@aha.org

BENCHMARKS: Vascular procedure utilization

There is opportunity in 2015 for developing or coordinating vascular services, according to the author, an exec with the consulting firm Corazon.  These services are often fragmented and can be characterized as part of turf wars between interventional radiologists, vascular surgeons, and interventional cardiologists.  Reasons why planners should take a look at the vascular service line are reviewed.  I especially like this one planning benchmark given:

  • “…current utilization of vascular procedures is at a ratio of 1.2 : 1 when compared to cardiac procedures.”

Source: Fuller, D. (2015, July). Does vascular remain an untapped market? Cath Lab Digest, 23(7). Retrieved from http://www.cathlabdigest.com/print/25436 Posted by AHA Resource Center (312) 422-2050, rc@aha.org 

MODELS: Regionalization of hospitals and ambulatory care facilities [illustration]

This is an illustration of three different models which might be used to coordinate the bricks-and-mortar facilities within a health care system.  The three types of regionalization illustrated include:

  • Hub-and-spoke model — in which there is a big central hospital that serves as a referral center for smaller hospitals with limited services.  The outpatient centers as well as the smaller hospitals feed in to the big central hospital.
  • Distributed model — in which each of the hospitals is a center of excellence in a different service line, such as cardiology
  • Coordinated model — in which service lines are coordinated among the hospitals and performance is measured at the system level

These models, particularly the hub-and-spokes model of regionalization, are not necessarily new concepts, but I like the way that they are compared in this drawing.

Source: Fink, J. (2014, Nov.) Aligning with physicians to regionalize services. HFM. Healthcare Financial Management, 68(11), 80-86. Retrieved from https://www.hfma.org/Content.aspx?id=25739  Posted by AHA Resource Center (312) 422-2050, rc@aha.org

ORTHOPEDICS: How to make service line successful

Orthopedic implant devices are expensive and one of the main drivers of orthopedic service line costs.  This article, by consultants with Corazon, addresses ways for hospital execs to work with surgeons to ensure a successful orthopedic service line.  I was fascinated to learn of the key role played by vendor case representatives in pre-surgical planning and in being present in the OR during surgery.  The authors discuss the advantages and disadvantages of having case reps present — and how this is a need for many hospitals due to trimmed-down OR staffing, among other reasons.  Another interesting section of this article provides tips for building bundled payments.  Comments on orthopedic patients — how they are usually in for elective procedures, are often self-referred, and are generally healthy — are intended to help build a comprehensive care model that will build volume.

Source: Lang, S., and Powers, K.  Strategies for achieving orthopedic service line success.  HFM. Healthcare Financial Management;67(12):96-100, 102, Dec. 2013.  Click here for access to the publisher’s website: http://www.hfma.org/Content.aspx?id=20567 Posted by AHA Resource Center (312) 422-2050, rc@aha.org