June 6, 2003

Partners and MGH leaders update hospital community

As he completes his first five months as president and CEO of Partners HealthCare, James J. Mongan, MD, has been visiting Partners hospitals to offer leaders and staff his views about the value of the system, health care costs and quality and safety initiatives.

In an update to MGH leadership June 4, Mongan said that with 33,000 employees, Partners is the largest private employer in Massachusetts, providing care for 21 percent of Eastern Massachusetts residents. With a budget of $4.5 billion, 40 percent of the patient care revenue comes from government sources such as Medicare and Medicaid, and 60 percent comes from private payors. Because of the size, scope and structure of Partners, the system has been able to provide quality care across a wide range of settings while offering access to this care for the area's low-income residents.

According to Mongan, Partners has enhanced patient safety throughout the organization through implementation of computerized order-entry systems. In addition, patient care in some Partners institutions has shifted from higher-cost to lower-cost settings, and cost per case has been reduced by shortening the length of stay and consolidating purchasing power. In addition, Partners has helped stabilize several financially vulnerable community hospitals, such as Newton-Wellesley and Faulkner Hospitals.

Mongan noted that rising health care costs continue to be the biggest challenge Partners institutions face. He emphasized, however, that while health care costs are rising, the MGH and BWH have lower than average costs compared with other urban teaching hospitals of similar size. Partners can help control costs by
continuing to focus on activities such as reducing length of stay and better managing FTEs, supply costs and space utilization costs.

He stated that the public is looking for a value proposition in health care and that Partners must enhance its focus on providing effective and efficient care of optimal quality. "It has been our history to provide high-quality care, and it must be our future — it differentiates us," he said. "Practicing within an integrated health care system gives us the opportunity to focus on care of a population of patients over time, to improve the quality and cost effectiveness of care through investing in resources so that we can become national leaders in this area."

Mongan closed by describing some systemwide quality initiatives that soon will be underway such as expanding disease management programs, improving patient safety by reducing medication errors and enhancing quality by investing in utilization infrastructure. More information about these initiatives will be published in a future issue of Hotline.

Allison Rimm, vice president for MGH External Affairs, gave a report on the
comprehensive strategic planning efforts of the MGH and the Massachusetts General Physicians Organization (MGPO) to help position the organizations for success in the face of the challenges they face. These challenges include growth in the context of capacity constraints, significant financial pressures, the downturn in the economy, federal and state budgets causing serious downward revenue pressure, and aggressive efforts by competitors to focus on high-margin service mix.

The focus of the planning efforts will be developing strategies to achieve margin targets while meeting patient demands, maintaining and enhancing clinical excellence and improving quality and patient safety.

Phase one of the planning has been completed, which included a thorough assessment of the current and projected fiscal, market, growth and capacity conditions of which the hospital and the MGPO operate. A recent retreat was convened with senior clinical and administrative leaders to lay the groundwork for the next phase, which will address some of the larger strategic challenges. Task forces are being formed to focus on certain areas and develop specific recommendations.

Brit Nicholson, MD, chief medical officer for the MGH and one of the co-chairs of the Quality and Patient Safety work group, gave a brief update on the progress in this particular area, which included development of a mission statement, a proposed vision of quality and safety for the hospital, and the development of five-year goals.

Some of the issues that are expected to be addressed in phase-two planning include margin improvement, expense management, new business opportunities, capacity management, operational improvements, clinical innovation, community-based growth and workforce issues. More information about the progress of the strategic planning efforts will be reported in upcoming issues of Hotline.

Peter L. Slavin, MD, president of the MGH, concluded the meeting with an update on the hospital's current financial status and reported on the outstanding work that has been done to make the length of stay 5.6 days for May, the second lowest in the history of the MGH. April's length of stay broke the record for the lowest in MGH history at 5.44 days. Slavin also congratulated Warren M. Zapol, MD, chief of MGH Anesthesia and Critical Care, for receiving the prestigious Inventor of the Year award presented by the Intellectual Property Owners Association (See next week's Hotline for more details).

"We as an organization have many challenges ahead of us, but I am confident that with the dedication and hard work of our employees and staff, we will be able to navigate these challenges and become an even stronger institution in the next 10 years," said Slavin.