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MU Health strategy envisions 'integrated care' for Jefferson City

MU Health strategy envisions 'integrated care' for Jefferson City

December 9th, 2018 by Joe Gamm in Local News

Photograph courtesy of Julie Smith The cross on top of St. Mary's Hospital shines brightly in this 2017 photograph.

Separately, St. Mary's Hospital and Capital Region Medical Center provide adequate care for Jefferson City-area patients. But, St. Mary's is bleeding money and CRMC — with which MU Health Care already has a relationship — could be doing better financially.

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MU Health Care says it can lessen both hospitals' woes and improve patient care by buying St. Mary's Hospital and consolidating some services from the two Jefferson City health providers by creating integrated care.

The combination, according to Jonathan Curtright, chief executive officer of MU Health Care, will increase the number of patients both will be able to treat.

"You have a small program at St. Mary's. And you have a small program at Cap Region," Curtright said during a meeting with the Jefferson City News Tribune editorial board. "If we put these things together, we believe that one plus one is going to equal three."

Curtright, Philip Gustafson, interim president of St. Mary's Hospital, and other staff members from the health organizations met with the editorial board Thursday to discuss the potential sale of the hospital.

In August, SSM Health, a Catholic nonprofit and the St. Louis-based owner of St. Mary's Hospital, announced it was in exclusive discussions to sell the hospital and other Central Missouri health care facilities to MU Health Care. The sale would also include the transfer of SSM Health St. Mary's Hospital-Audrain, along with outpatient, home care, hospice and medical group locations throughout the region to MU Health Care, as well as transfer of SSM Health St. Francis Hospital-Maryville and its affiliated outpatient home care, hospice and medical group locations to St. Joseph-based Mosaic Life Care.

The process is in the due-diligence phase, in which both parties are looking at the proposal to see how it fits their missions.

A strategic approach

"We think this is an incredibly strategic move — making it so we can continue to create this system of care to take care of 1 million Central Missourians," Curtright said. "Primary care will be a foundation for all of it."

The primary-care foundation will also have to be sustainable. The current system — with two hospitals working in competition — is not sustainable for Jefferson City, he said.

"We can do a better job in health care, of controlling costs," he said. "Nearly 20 percent of the economy — nationally — goes for health care. We must do a better job of controlling costs."

One way to control costs is through integrated care, said John Nguyen, the chief marketing officer for SSM Health who participated in the editorial board meeting via teleconference.

Integrated care coordinates general and behavioral health care. It can integrate mental health, substance abuse and primary care services to produce the best outcomes for people experiencing multiple health care needs.

"Integrated health care is the path upon which the country is headed. The movement toward care that is really more about providing exceptional experience, that lowers the overall cost of care and delivers the highest level, is really the movement that we are moving toward as a country," Nguyen said. "In order to do that, you really need to integrate all parts of care — from primary care, clinics, hospitals, home care and hospice services and the high-level tertiary care that really only a highest-level provider can deliver."

Integrated care or monopoly?

Doctors at Jefferson City Medical Group — including Jeffrey Patrick, the group's president — suggested the phrase "integrated care" simply means the services are controlled by one entity.

"There are plenty of ways to be in networks and be aligned and provide a variety of care in a quality cost-effective way without them having to own," Patrick said Friday. "In fact, it's better for them not to own."

The difference in cost reflects that, he said. If someone were to get a colonoscopy at JCMG, they would pay only a third to half the cost of the process at a hospital outpatient facility, he said.

"You do need the outpatient competition for a hospital to keep them honest and to keep the costs down for the community," he said. "If they get the power to absorb us, you're going to lose that."

Jefferson City has supported two hospitals for years and can continue to do so, he said. More worrisome, Patrick said, is a concern that MU Health Care would create a monopoly in Central Missouri.

Studies show if there's no competition for hospitals, prices go up, he said.

SSM Health and St. Mary's Hospital's management made mistakes, he said. About a year ago, after Gustafson was named interim president of the hospital, he presented a plan — on which JCMG doctors collaborated — to turn around St. Mary's economic fortunes, according to Patrick.

It contained a doable strategy St. Mary's could achieve, he said. But, it was turned down.

Despite that, Gustafson has dramatically turned around the finances of the hospital, Patrick said.

What changed?

Just four years ago, St. Mary's Hospital opened a new facility that cost the health system hundreds of millions of dollars. Within about two years, SSM began discussions around selling the Jefferson City hospital.

The industry has changed in that time, Nguyen said.

"The desire to build a facility was important to us just to maintain the quality of care standards. That hasn't changed over the years. The truth is, payment pressures continue to increase — both from government and national payers," he said. "That evolution is happening more rapidly now than before."

The difference is best seen in determining how the hospital coordinates services, he said. The health care provider has to figure out how primary care physicians and specialty services work together to provide the best health care rather than competing.

"We're not going to have competing programs at St. Mary's versus a competing program at Cap Region Medical Center," Curtright said.

The intent is to combine the capabilities of both, he said.

The best example, he said, would be to look at cadiovascular surgery. Both hospitals have invested heavily in their cadiovascular programs. But, quality and safety in cardiovascular surgeries are strongly correlated with the amount of volume that hospitals do.

CRMC handles about 50 cases a year and St. Mary's about 80.

"One hundred thirty is not large enough of a cardiovascular program. Put these two together, we should be able to do 250-plus," Curtright said, "because we think we'll be able to recruit enough general cardiologists, enough surgeons to do this work."

There will be a large enough population to attract more patients, instead of two smaller programs competing with one another.

Of 9,000 patients in Central Missouri annually, 5,000 are getting their care at MU Health Care, about 1,800 getting their care at Boone Hospital, and 2,200 are getting their care in St. Louis, he said.

"We believe a lot of those patients are going to be able to not have to leave the area to get their care. And we don't necessarily think they have to get their care in Columbia," Curtright said. "They can get their care right here."

Consolidation and recruitment

A consolidation of services between the hospitals will make it easier to recruit more sub-specialists to Cole County because of the larger population of patients who need their services.

MU Health Care already provides primary care in quick care clinics at Hy-Vee locations with urgent care centers and continues to invest in primary care.

The parties involved in the hospital sale discussions believe there is immediate need for more specialty care in Jefferson City. Hospitals can do more obstetrical care here in the city. Seriously ill babies in neonatal intensive care units are being taken to Columbia. That can be rectified with a "more intense neonatal intensive care unit here," Curtright said.

"There are ways that you can aggregate services right here in Jefferson City in a thoughtful way," he said.

Ballpark numbers show the Jefferson City hospitals each receive about 35,000 emergency room visits annually.

"Neither emergency department can absorb 70,000 emergency room visits in the existing chassis. We are going to have to have some level of emergency services, acute services, at both facilities," Curtright said. "Because of that, there will also have to be imaging, procedural rooms and some level of patient care at all of our facilities as well."

Mental health care will also get a boost in the arm, he said.

Even with 20 beds available, St. Mary's is under "great stress" for psychiatric care, Gustafson said.

Patients — over time — have become more violent and more aggressive.

"We have more work injuries related to that than anything else," he said. "If we were to continue with that, we seriously need to look at whether we continue to be even in that business."

Some days, it is almost as if the hospital is trying to operate a mental institution because those patients demand so much attention, he said. The hospital ends up with six to eight potentially suicidal patients in the emergency room at any one time, he said. People experiencing episodes of mental illness can distract health care providers.

"My concern is always — you diverted all your attention here, but you've got these people here for acute sickness," Gustafson said. MU Health Care has staff members with expertise that could help in those situations, he said.

All the specialties gaining patients in Jefferson City would assist the hospitals recruit and develop local physicians.

Having two large multi-specialty health groups in Jefferson City — Capital Region Physicians and JCMG — is an advantage for recruiting, Curtright said.

MU Health Care has been working with organizations such as JCMG to see how they may better partner with them and improve access to care for patients.

"Because of our geographic and other limitations, (recruitment) has been a challenge to us," Curtright said. "It has been a challenge for many communities across the country."

Recruitment and development within a community to provide core services is vital, he said.