Wednesday, October 14, 2009

From MGMA: Cleveland Clinic's approach

How has the Cleveland Clinic developed a reputation for delivering high quality care at comparatively low costs?

Of course, there isn’t a single answer to that or a step-by-step path other organizations can take to emulate them. But speaking at the MGMA annual conference in Denver this morning, CEO Toby Cosgrove offered a few insights on what they have done to achieve that reputation.
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Perhaps one of the most notable differences in their model is that physicians are all salaried. They all receive one-year contracts, and extensive annual reviews determine their salary for the next year. “No incentive forces us to do more or less,” Cosgrove told the crowd.

Cleveland Clinic isn’t alone in physician salaries, and Cosgrove said he gets some skepticism about the approach. But he says it can be done across the country and may reduce unnecessary tests or procedures. The salaries are based on national averages for each specialty.

Another unique feature is that the healthcare organization is organized around organ systems and diseases, so that, for example, heart surgeons and cardiologists are sharing the same water cooler. This is how collaboration and innovation happen, he said. And it’s patient-centric.

Cleveland Clinic also works hard to measure quality, publishing annual outcome books for each institute. Then there’s the EHR connecting the nine community hospitals and 17 health centers. It’s been expensive and time-consuming, he said, adding “I don’t think we’ve saved a penny.” But it will improve quality, which eventually may cut costs.

One really interesting approach they have adopted was the creation of two Chief Experience Officers to improve patient satisfaction. This came after Cosgrove was challenged by an attendee at an event in which he speaking who asked what Cleveland Clinic did about the patient experience and whether they taught empathy. They hadn’t focused on that, so Cosgrove made some changes.

Cosgrove also detailed the organization’s employee wellness programs, such as free yoga classes and healthier food in the cafeteria. (He made headlines for adopting a policy of not hiring smokers.) This area is where the country needs to focus on to really cut the cost of healthcare in the U.S., he said. Forty-percent of premature deaths are caused by behavior, he said.

Referring to the healthcare reform debate in Washington, Cosgrove said, “All this won’t do anything to control costs,” adding the country must reduce the burden of chronic diseases.

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