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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



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 70

 Overhead for 60

surgical suites, 50

patient rooms, etc. 40

30 59.5


10 20.4
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
 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
 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
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
 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
Your role in the journey … be informed
 Ask questions when you go to the doctor or the
 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