Health care is the Times forum topic Tuesday
By Nelson Sigelman
Published: August 20, 2009
The new $42 million Martha's Vineyard Hospital, scheduled to open for business early next year, is evidence, by itself, of a new era in health care on Martha's Vineyard.
Tuesday at 6:30 pm, at the Old Whaling Church on Main Street in Edgartown, three leaders in the medical and hospital fields will discuss the relationship between Martha's Vineyard Hospital (MVH) and Massachusetts General Hospital (MGH) in the context of the national health care discussion, as part of The Martha's Vineyard Times series, "Newsmakers - People and Issues in the News."
An illustration of the new Martha's Vineyard Hospital.In the new Island hospital, an advanced medical information system will electronically link the small, rural nonprofit hospital and its patients, physicians, and technicians to Massachusetts General Hospital, one of the nation's renowned nonprofit medical institutions and a member of Partners HealthCare group.
The changes taking place on Martha's Vineyard occur during a sharp national debate on health care delivery, access, insurance, and costs. In addition, the Island hospital faces the additional challenge of providing health care to a significantly older and aging year-round population and a fluctuating mix of seasonal residents and visitors.
The panelists on August 25 will be Dr. Pieter Pil, chief of the Martha's Vineyard Hospital medical staff and a member of the hospital board of trustees; Dr. Peter Slavin, president of Massachusetts General Hospital; and Lynn Nicholas, president and CEO of the Massachusetts Hospital Association.
Change the incentives
"I think it is a great example of how two organizations, caring for different populations with different strengths and abilities, can partner together and make care better and rationalize it more effectively," Dr. Slavin said in a telephone conversation Tuesday.
As an example, he said Mass General has been assisting Martha's Vineyard Hospital with the design and installation of the building's information systems, and the Boston hospital has been working with the clinical staff to strengthen the clinical programs and the integration of care here with the care provided at Mass General.
Dr. Slavin, a professor of health care policy at Harvard Medical School, said providing care for a seasonal Island population is a unique aspect of Island medical care. "How do you staff up the hospital to meet the very high demand in the summer and then ramp down the staffing and care during the winter months," he said. "I think that has been, and continues to be one of the biggest challenges Martha's Vineyard faces."
According to Dr. Slavin, sharing information between MGH and MVH as part of the electronic medical records system will provide better and more efficient care. "The fact that when patients are seen at Martha's Vineyard Hospital or Mass General that the clinicians caring for them can see the same information and have it at their fingertips is enormously helpful, and that facilitates care being delivered at the right place, at the right time."
About health care costs for patients, Dr. Slavin said much depends on what happens in Washington and whether a plan is put in place to cover the uninsured much more completely. He added it is quite likely that there will be a gradual move away from the fee for service reimbursement system.
"Right now the incentive in health care is, whenever in doubt do more," Dr. Slavin said. "I think we would probably be better off with a health care system where there is not that incentive and more of an incentive to conserve resources."
Dr. Slavin said he is delighted that the national debate is taking place. "I give the president and the leaders of Congress a lot of credit for trying to organize a very thoughtful, structured, comprehensive debate about health care," Dr. Slavin said. "I am disappointed that some groups have used it as an opportunity to promote an agenda that is somewhat separate from what this debate should be all about."
As an example, Dr. Slavin cited said efforts on the part of some politicians to try to shift large amounts of Medicare money from higher wage areas like Massachusetts to lower cost parts of the country. "That is really not what health reform is all about," he said.
The debate needs to focus on how we extend insurance coverage to the 15 percent of the population that does not have it, and who is going to pay for that, and how to slow the rate of growth in health care costs, Dr. Slavin said. "Unfortunately, there is too much energy being focused on other distractions, and some of those distractions threaten to take the whole effort down."
Community at heart
Dr. Pil, a graduate of Yale University School of Medicine was chief resident at Brigham and Women's Hospital, when he and his wife, Dr. Karen Casper, who works in the hospital emergency room, moved to the Vineyard in 2002.
In an Op-Ed published on October 26, 2006, Dr. Pil said the decision to move to the small community hospital that is at the center of health care on the Island, was a decision he made with his heart.
"After all, people would ask, why would you work at a small, rural institution after spending years training at tertiary care facilities?" Dr. Pil wrote. "My response was that my training would help to provide the same level of care I had learned to dispense in the big city to my new community on the Island. One of the most important lessons I learned in my training was to do right by the patient: provide quality care, and the business of medicine will take care of itself."
In a telephone conversation Tuesday, Dr. Pil described the changes he anticipates from the relationship between Martha's Vineyard Hospital and Mass General.
Dr. Pil said two issues loom large in the health care discussion: the cost effectiveness of care and the quality of care.
Mass General will provide MVH with information technology that comes with huge fixed costs. The access to patient information that technology will provide will enable the hospital to better measure patient outcomes, he said.
For example, he said the medical staff would be able to track the blood pressure of patients.
"We will be able to pick a physician on the staff, pull up their patients, see the blood pressure, pick out the hypertensive patients and see in fact if three months later those patients' blood pressures are better controlled," Dr. Pil said. "Right now we would have to dig through a mound of papers in each office to do that. With information technology we can just pull it up with a click."
Dr. Pil said that people do not argue over the cost of appropriate care. "One issue that has come up in the national debate is that nobody wants the quality of his or her care to be compromised by any sort of government intervention," he said. "But the problem is that without information systems there is almost no way to measure what the quality of that care is."
Information technology is only one aspect of the Mass General relationship, according to Dr. Pil. The other is that it allows for the virtual "integration of care."
Dr. Pil says the future emphasis in the health care system will be on the outcome, not the treatment. "The take home lesson is going to be that we are not going to get paid just for patient visits," he said. "We are going to get paid for producing outcomes. That is, if we have a diabetic patient we are going to have to prove that we are taking care of that patient."
Dr. Pil said it would not matter if a patient were noncompliant. "If Mrs. Jones's blood sugar is out of control, the physician will be held responsible to ensure that in fact Mrs. Jones's blood sugar is controlled," he said. "And that is going to require phone calls, and it is going to require support staff and the Mass General has taken the lead in that."
