Growing pains: Providers in central Texas meet demand by building hospitals and coordinating care
The rapid growth in recent years in central Texas has created many challenges for healthcare providers in the region, but it's also provided opportunities for some major advances in care.
The Austin metropolitan statistical area, which includes the counties of Bastrop, Caldwell, Hays, Travis and Williamson, surged 37%—to about 1.7 million people—from 2000 to 2010, according to U.S. census figures. That growth has placed additional demands for healthcare services on the region's providers, according to health leaders in the area. They have responded, in part, by building four hospitals to bring the region's total of major health facilities to 29, according to the Texas Department of State Health Services.
“It's one of the fastest-growing areas of Texas,” says Amanda Engler, a spokeswoman for the Texas Hospital Association. “Consequently, we're seeing a lot of growth in healthcare in that area.”
Mark Hazelwood, president and CEO of Seton Healthcare Family-North, says physical structures were less critical to his organization's ability to serve an expanded population than the new organizational approaches Seton has added. Greater care coordination between hospitals, clinics and private physicians has helped Seton improve patient care, even as growth placed greater demands on the overall organization. Still, Seton has opened three of the region's new healthcare facilities.
The critical role of greater care coordination also was credited by Dr. Robert Pryor, president and CEO of Scott & White Healthcare, with helping his organization to accommodate the region's growth. Scott & White, which opened another of the region's new hospitals, says greater care coordination gives it the ability to track and compare patient costs across entire “episodes of care,” such as the total cost of caring for a heart attack victim from hospitalization through recovery weeks later.
That data allows the hospital system to target increased efficiencies and savings in treatment of many of the sickest and costliest patients who come to its facilities, Pryor says. “It allows us to build on the economies of scale that fit within the hospital-to-clinic continuum and lower the per-unit cost,” he says.
Those integration efforts may help Austin providers avoid penalties under a growing number of payer initiatives that will hold hospitals accountable for the costs of such episodes of care and deteriorating patient conditions after discharge. One such proposed CMS regulation, known as the Hospital Readmissions Reduction Program, will cut a percentage of payments to hospitals with “excess readmissions” among patients suffering acute myocardial infarction, heart failure and pneumonia.
Some hospital leaders have complained that such initiatives hold them liable for patient choices and circumstances after they leave “the four walls of the hospital,” but Hazelwood argues that hospitals are uniquely positioned to lead the integrated-care approach among the various types of providers in a particular area.
Hazelwood credited the integration efforts with Seton Medical Center Austin's rankings among the top 5% of hospitals nationally and first in Texas for coronary interventional procedures, according to a healthcare ratings company's examination of data from the CMS.
The two leading hospital systems in the Austin region also have been out in front of the recent federal push for widespread provider adoption of electronic health-record systems. For example, Scott & White has used systemwide EHRs for more than a decade.
“With that comes powerful integrated care,” Pryor says of the ability to share patient information among providers treating the same patients. “It even allows us to track the care patients receive weeks or even months after discharge.”
Despite those early efforts, the hospital system will need to undertake additional efforts, including replacing its EHR system with one that complies with the specific requirements of the federal program, Pryor says. The federal program will offset a part of the significant financial cost that replacing a systemwide EHR will carry through incentive payments and subsequent add-ons to the hospital's Medicare and Medicaid payments in future years.