Since 2005, Joe Landsman has served as president and CEO of the University of Tennessee Medical Center, a 600-bed academic center serving 21 counties. The medical center, which reported total revenue of $707 million and net income of $22 million in 2014, partners with physicians in a 450-physician independent practice association. The center, which is independent from the University of Tennessee, graduates 70 to 80 medical residents a year in partnership with the university's medical school. Landsman was previously UT's chief financial officer and former chairman of the Tennessee Hospital Association. Modern Healthcare Managing Editor Harris Meyer spoke with Landsman about his system's work on developing clinical pathways, how academic centers can compete with other hospitals and the prospects for Medicaid expansion in Tennessee. This is an edited transcript.
Modern Healthcare: What has your organization been doing with clinical pathways and standardization?
Joe Landsman: Over the past three years, we have made an effort to standardize and coordinate the care delivered to our patients across all the different disciplines. We have done that in the form of clinical-care pathways. These pathways are developed by multispecialty teams of our medical staff. We start with evidence-based medicine and a work redesign before we actually build the pathway, which ultimately ends up in our electronic physician order-entry system. We also have pharmacists, physical therapists and nurses involved in the development of the pathways.
We know at what point in the stay we are expecting certain milestones from the patient's perspective, so the patient is educated on what to expect. The first thing we measure is whether we are complying with the pathways. Next is mortality and complications. When you think about the fact that 30% of inefficiencies in our system today are driven by a lack of standardization and a lack of care coordination, these pathways are critically important.
MH: What results have you seen from adoption of the pathways?
Landsman: We've seen a dramatic improvement in mortality for a number of different DRGs, and our complication rate has dropped dramatically as well. Those pathways that are more mature are showing better results than those that are less mature. But they are all moving in the right direction.
MH: How have you engaged your non-employed physicians in this process?
Landsman: We only employ about a third of our active medical staff. It is very much a partnership arrangement with our medical staff. There is rarely a decision made on this campus that the physicians haven't had the opportunity to weigh in on. They have taken up the challenge and are developing the pathways themselves.
MH: Has there been a competitive advantage in the development of pathways?
Landsman: With the movement toward cost and quality transparency, I believe that there will be competitive advantages to this. We are only talking about inpatient now, but we are also breaching into physician offices and the post-acute-care environment. Ultimately, if you want to be a successful healthcare provider at a large academic medical center, the formula is offering the highest quality of care and the safest care in a patient-centered way.
We work in an industry that traditionally has resisted standardization. We have embraced that concept on this campus because we know it will drive quality and safety, service, and efficiency and effectiveness. If we are doing all of those things, we are going to be a good partner for insurers and employers because we will be a low-cost, high-quality provider.