Quality Improvement Measures Get Results at Providence

Photo by Annie Feidt, APRN Anchorage: Maike Henning is Providence Hospital's Clinical Heart Failure Coordinator
In a bright room on the Cardiovascular Unit at Providence, Genaro Reyes is perched on the edge of his bed in hospital issued pajamas.  The 58 year old cannery worker from Cordova was recently medevaced to Anchorage after he woke up in the middle of the night, barely able to breathe.

Today, he’s talking to a brand new type of health worker at Providence. Nurse Maike Henning became the hospital’s first Clinical Heart Failure Coordinator in 2008.  One of her main jobs is to help keep heart failure patients like Reyes from coming back to the hospital within 30 days.

“If you have a large percentage of heart failure patients readmitting in the first month, it’s generally thought you didn’t necessarily do something you needed to do. That it may be partially our fault,” Henning said.

Starting this fall under the Affordable Care Act, hospitals with too many readmissions will lose Medicare dollars. So Henning sits down with every heart failure patient and makes sure they understand their condition. She gives them calendars so they can easily track their weight to monitor for fluid retention, a telltale sign of heart trouble. And she even hands out free scales if patients can’t afford them. Basically, Henning makes sure patients get the most out of their treatment.

“Teaching them how to do the right thing for their diagnosis helps them feel better, live better and have a better quality of life. And that’s really the purpose,” she said.

The program has helped Providence dramatically reduce the number of readmissions.  When Henning started four years ago, about 17 percent of heart failure patients came back to the hospital within 30 days. Last year, that figure dropped to just under 11 percent. The national average is almost 20 percent. That puts Providence in a competitive position as more and more Medicare dollars are tied to quality measures. Dr. Dick Mandsager is Chief Executive of Providence. He says every hospital in the country is feeling the pressure to improve care.

“As the variation in performance narrows and narrows and narrows, good isn’t good enough, you have to be great,” Mandsager said.

Working towards greatness has yielded some impressive results. Six years ago, Providence started focusing on reducing central line infections in its pediatric unit.  Those are the catheters used to give medicine, fluids and nutrients to very sick patients. They are also prime conduits for hospital acquired infection, which can be deadly.  Dr. Mandsager says he used to think some infections were inevitable.

“The word none, as an aspiration, I didn’t think was possible in a complex hospital environment,” he said.

Dr. Mandsager says Providence hasn’t had a central line infection in its pediatric unit in three years. And the rates for central line infections in adults have dropped in half. Improving the quality of care at the hospital has involved streamlining systems and convincing doctors to follow very specific checklists for each medical condition. He says some doctors have criticized it as cookie cutter medicine.

“A few years ago there was a lot of argument about, who told me I had to use that antibiotic? And the rules are very specific for certain conditions. Only certain antibiotics are okay. So it’s been one doctor at a time, one process at a time, one surgery at a time,” Mandsager said.

Working on these problems is hard, and costs money. But more and more, it’s what will be required of hospitals. By Dr. Mandsager’s estimate, in another five years, up to 7 percent of Medicare dollars will be at risk over performance measures. At Providence alone, that amounts to about $5 million each year. Dr. Mandsager says overall, it’s a positive change.

“Yes, it’s a more complicated future from a hospital point of view and yes there’s more risk and yes there isn’t enough money to afford American medicine. We’ve got to change. But with all of that being true, the incentives and challenges to say we’ve got to do better, we’ve got to be safer; I don’t disagree with any of that,” Mandsager said.

As a hospital administrator, Dr. Mandsager says he would prefer more payment certainty. But he says the new payment incentives are helping hospitals imagine a future that’s safer and safer and safer. And it’s hard to argue with that.

This story is part of a reporting partnership that includes APRN, NPR and Kaiser Health News.

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Annie Feidt is the Managing Editor for Alaska's Energy Desk, a collaboration between Alaska Public Media in Anchorage, KTOO Public Media in Juneau and KUCB in Unalaska. Her reporting has taken her searching for polar bears on the Chukchi Sea ice, out to remote checkpoints on the Iditarod Trail, and up on the Eklutna Glacier with scientists studying its retreat. Her stories have been heard nationally on NPR and Marketplace. Annie’s career in radio journalism began in 1998 at Minnesota Public Radio, where she produced the regional edition of All Things Considered. She moved to Anchorage in 2004 with her husband, intending to stay in the 49th state just a few years. She has no plans to leave anytime soon. afeidt (at) alaskapublic (dot) org  |  907.550.8443 | About Annie

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