The way David Posch, CEO of Vanderbilt University Hospital and Clinics, described the health care industry’s current landscape to members of the Patient and Family Advisory Council at the group’s August meeting Tuesday night was by quoting the opening line of Charles Dickens’ “Tale of Two Cities” — “it was the best of times, it was the worst of times.”
Posch and Marilyn Dubree, MSN, R.N., Executive Chief Nursing Officer, met with the 18-member council to explain Evolve to Excel (E2E), a comprehensive initiative begun in June and designed to strengthen operational practices throughout VUMC’s clinical enterprise and the School of Medicine to ensure long-term success of the organization.
“There are academic medical centers across the country doing at least as much in cost reduction as us, if not more. Revenue reductions from government sources and other payers are happening on all fronts, such that if you’re an academic medical center all of your missions, teaching, research and patient care are affected,” Posch said. “There’s opportunity for us to improve as there are a lot of legacy activities that in the current day need to be changed at our Medical Center. Managing change toward opportunity is the objective.”
E2E is in response to current and future financial pressures created by declining reimbursements for the treatment of Medicare and Medicaid patients along with reductions to federal research funding, actions associated with the federal sequester and other legislative actions aimed to address the national debt.
“Some of the changes that are coming are well known to us and some aren’t. Yet we are planning to be prepared,” Dubree told the council, made up of both patients and the family members of patients, many of whom suffer from chronic conditions that require repeated visits to the Medical Center. E2E is a “great opportunity led by great hearts and great minds.”
E2E’s focus is on increasing the efficiency and effectiveness of the Medical Center across all areas. The E2E process is led by Medical Center and University employees who are content experts in areas necessary to move the change process forward.
“What we’re doing is all about quality,” Posch told the council. “We’ve had to figure out a way to move the quality needle up and the cost needle down,” Posch said. Every year we’ve made some improvements to our quality and cost structure, but now we’re trying to figure out how to accelerate these improvements in quality while lowering costs in the accomplishment of our missions of patient care, research and education.” Posch said Sequestration has “measurably and dramatically changed the revenue we’ve received as an organization.”
Through E2E, the Medical Center’s goal is to achieve $100 million in operational cost savings during the current fiscal year and a total operational cost savings of $250 million by the end of fiscal year 2015. The E2E process will enable the Medical Center to achieve these goals while preserving VUMC’s mission-critical programs.
Posch began the two-hour meeting by asking what questions the council, who sees the Medical Center with “fresh eyes,” wanted answered, and he and Dubree answered them all.
“We see what things work best and the things that work not quite so well,” said Council chair Don McSurley. “That’s the power of the patient and family advisory council. We don’t see things every day, but we see them every third and fourth day,” he said.
Health care is fundamentally changing, Posch said. “The changes are going to stay. And Vanderbilt has to lead in reshaping the fundamental model of how we do what we do to be successful.”
