A little bit about the journey …
 Our mission is to provide good, safe patient care.
 Medicine is not an exact science, and the people
treating you are human.
 Greatly increased focus on
quality and patient safety,
and it is paying off.
But it’s a journey.
We need your help
 Patients, family members and the community have a
vital role to play in their care.
 We invite you to join us on this journey to better
health, and we’ll give you some tools to do this.
 During this presentation, I’ll share some of our
challenges, our progress, as well as the things you
can do.
Why is this work so critical?
More than 9.8 million patients a year
9191353
665,788
Inpatients
Outpatients
Today’s hospital patient is really sick …
 With the expansion of outpatient and less invasive
procedures, hospital lengths of stay have decreased,
but the patients are sicker.
 Nearly half of Medicare patients have an average of
three or more chronic conditions.
 The current 65-and-older population is expected to
double by 2050.
Hospital care is not cheap
 Skilled staff available 24/7, millions of dollars
in equipment
 Overhead for
surgical suites,
patient rooms, etc.
70
60
50
40
30
59.5
20
20.4
10
14.2
5.9
0
Wages and Benefits
Other Services
Prescription Drugs
Other Supplies
Cost of hospital care decreasing …
 Hospital care as a percent of total spending has
actually declined from 43 percent in 1980 to 33
percent in 2009.
 Alabama’s hospitals are extremely efficient when
compared to other states.

16th lowest cost per discharge in the country

9th lowest net patient revenue per discharge
The cost to you, the consumer
 Per capita health spending (all services) for 2009
was $8086
 Average annual premium for employer-sponsored
coverage - $15,745 in 2012.
 Key drivers of increased cost:

Increase in technology and new medications

Rise in chronic disease – 75 percent of increase

Administrative costs – average about 7 percent for
government and private insurance plans
The hospital journey to improve care and
reduce costs …
 Began coordinated statewide effort to improve care:

Monthly meetings of Quality Task Force

Twice-a-year forums for networking/education
 Formed valuable partnerships:

Work with Alabama’s Quality Improvement Organization

Reinforce focus on key quality initiatives

Huge participation in automated infection surveillance system
More on partnerships
 Worked with deans of nursing schools to help
integrate latest science of patient safety into
curriculums
 Joined with key state organizations to form a
clearinghouse for information from IHI, a national
quality improvement organization
 Alabama hospitals benefitted from a grant to help
reduce specific infections.
More on partnerships
 Many Alabama hospitals have joined a national effort
to reduce readmissions by 20 percent and hospital
acquired conditions by 40 percent by the end of
2013.

Examples of the 10 focus areas include: the prevention of
infections, falls, pressure ulcers and adverse drug events

Work includes regional workshops, best-practice sharing, data
collection and use of evidence-based initiatives to improve
care
Efforts paying off … reducing infections
 Alabama’s hospitals helped pilot automated
surveillance system and are leading the country in
our progress
 Alabama had the 2nd highest rate of participation in a
national project focused
on prevention of
blood stream infections.
 Decreased infections by
53% in two years!
Reducing infections …
 Of the hospitals participating, 40 percent went
without a single blood stream infection for two years!
 Another project prevents catheter-associated urinary
tract infections
 Alabama’s hospitals worked with Public Health to
create a statewide system for reporting infections.
 The public can view hospital-specific infection
information online.
Efforts are paying off … literally
 CMS, the agency that pays hospitals for caring for
Medicare patients, has begun pay for performance.
 One percent of all hospital reimbursement withheld
and used to reward hospitals on their performance.
 Alabama hospitals ranked number one in quality
performance and quality improvement.
 As a result, Alabama’s hospitals will receive the
second largest bonus payment of any state.
Efforts paying off … for patients!
 Not every quality improvement project is easy to
quantify, but …
 Estimates are that through the two-year program
targeted at reducing blood stream infections:

11 lives were saved

$4.8 million was saved by reducing infections and shortening
days in the hospital
The journey never ends
 Research on techniques, medications, etc.,
continues to provide evidence of ways to improve
care.
 Quality and patient safety are being built into the
culture of hospitals, but it takes reinforcement
 Being in the 95th percentile for infection reduction is
fine until it’s your mother who gets an infection …
striving for 100 percent!
We need you to join us on the journey
 Through next spring all hospitals will be working with
patients and families to improve care.
 Information about how you can help is available at
www.jointhehealthjourney.com.
Your role in the journey … be informed
 Ask questions when you go to the doctor or the
hospital
 Many tools available including these websites:

Hospital Compare

Blue Cross Blue Shield

Alabama Department of Public Health
 Listen carefully to instructions, particularly when
leaving the hospital
Your role in the journey … fight infection
 While in the hospital, wash your hands frequently
 Don’t touch surfaces that need to be germ-free
 Ask visitors to stay home if they are sick
 Cover your hands and mouth when coughing
 Ask your caregivers if they’ve washed their hands
Your role in the journey … more info.
 On the new quality website, you’ll find:

Lists of suggested questions to ask your doctor/hospital

Links to the quality reporting websites mentioned

Information on advance directives

A list of medical terminology

A resource list for businesses to use with employees
So, join us on the journey
 It’s a never-ending road, but one that’s well worth
traveling!