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Steven J. Corwin, M.D.

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What's Next

Posted: 06/28/2012 5:41 pm

The constitutional question is over. Now, hospitals and medical leaders must continue to resolve the issues of access, affordability and quality. A lot has been done but we have more to accomplish and the problems transcend politics.

In the past few years, hospitals and other medical organizations have faced federal pressure to reduce Medicare spending, state pressure to cut Medicaid, as well as funding limits imposed by the Affordable Care Act.

Ten thousand people every day now turn age 65, according to census data, and the medical community is seeing shortages of doctors, nurses and other skilled staff. That means more demand for medical care.

New York hospitals and medical leaders will embrace these changes, as they always have been, to make medicine better, more accessible, and more affordable. To meet these challenges, the medical community must experiment and implement solutions. So far, the results are encouraging.

At my own hospital, our goal is to reduce recurring costs by $1 billion over 10 years while improving quality, maintaining safety and stimulating innovation.

For example, every Friday morning, hundreds of senior leaders from all departments inspect the entire hospital. At the same time, they make sure everyone knows safety protocols and follows them. It sends a powerful message about getting the basics right.

With technology, we have identified patients at risk of potentially fatal blood clots -- the number one complication for hospital patients -- so they can be given preventive care. Expanding these automated systems across the country will save many lives and money.

We also reduced product lines and achieved bigger volume discounts from fewer vendors. Costs for supplies, medicines, and equipment were reduced by more than $20 million annually with no impact on patient care.

We standardized basic practices and introduced technologies to reduce infections from central lines by 50 percent.

To keep patients out of hospitals, we have worked with area physicians to change primary care. Done right, primary care can keep people out of expensive emergency rooms, save hospital beds for people who need them and manage care in the community. The method, we and others have found, is to approach primary care with a team rather than one doctor.

Our own experience with an inner-city population showed a 9.2 percent drop in emergency room visits in the first six months.

Our work is not alone. Many other leading organizations have been just as effective at addressing the cost-quality curve and have been sharing best practices across the country. The Institute for Healthcare Improvement and the Joint Commission, as well as other organizations, have publicized and expanded these projects across the country.

Of course, different hospitals will need different solutions. For example, community hospitals have different needs than teaching hospitals. The solutions must be flexible, but the concept should be the same.

What we know is the medical community is prepared to embrace change using best practices and rigorous scientific research. We can find our own way through the rules set by courts and legislatures, and the challenges of budgets and staffing.

As we move beyond the constitutional question, our responsibility continues to be delivering excellent medical care, battling disease and improving the quality of life. Our experience should shape policy.

Dr. Steven J. Corwin is Chief Executive Officer of NewYork-Presbyterian Hospital.

 
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