DOC-Line

Since 2007 DOC-Line has informed the Medical Staff – both hospital and community based - about important news that affects them.Here is the basic structure:

• Chief Medical Officer Notes
• Chief Operating Officer Notes
• Executive Notes
• Medical Staff Presidents and others
• Keeping up – What’s New
• Clinical Integration
• Vox Medicus
• Individual physician’s editorials

DOC-Line employs a format designed for quick, easy access by readers. Important information is often summarized with links provided to more detail if the reader desires it.

With our new affiliation, this is a significant edition of DOC-Line for WCHN and the Medical Staff. We sincerely ask for your feedback on ways we can improve its value to you.

Matt Miller, MD
CMO WCHN
Matthew.miller@wchn.org

CMO Notes

Matthew Miller, MD
Chief Medical Officer, WCHN

The New Network Affiliation:

What does it mean for the Medical Staff?

Later in this edition of DOC-Line Dr. Murphy will share with you the “why” of the network affiliation. Others will cover “how” and “who.” I want to describe the “what” – what it means to you and the Medical Staff.

We all understand that the buffeting forces of healthcare reform and accountable care will change the way we function professionally. We all went to medical school because we wanted to take care of people. We may have taken different paths but we all share that fundamental value. It’s clear that the future will require us to work more effectively together if we are collectively going to be responsible for taking care of people in our region; keeping them healthy and making them better. It follows that we, the Medical Staff, and our three hospitals must work collaboratively.

But there is another imperative beyond collaboration in order to manage the health of a population —we need to be big enough to handle a large bunch of people. Size matters. We have to provide almost everything patients need and we can do that better if we’re bigger. We need to have consensus on how a condition should be managed, so it happens the same way wherever the patient goes. We need to share information electronically so that nothing falls through the cracks. We have to do it well with great outcomes that matter to patients, without wasting resources or doing the unnecessary. It’s been said “No margin – no mission.”

Yes, we must manage the cost of care because we’ll be responsible for those costs and that’s how we’re going to be paid. Healthcare will always be local and local also means every personal interaction between a single patient and a single provider; we just want to be a bigger “local”. Why should anyone go elsewhere?

What does that mean for you? Our network of three hospitals (so far!) respects that physicians can partner with each other and with the hospitals in different ways. Employment is one model but not the only one and employment doesn’t automatically equal alignment. We can collaborate through a Physician Hospital Organization, through joint ventures, through co-management agreements, and even through collective support of totally independent practices. We will support and nurture a collection of primary care providers across our communities, fostering a model of the patient centered medical home. We will develop network wide service lines for major conditions that cry for better collaboration like Cancer Care and Cardiovascular Care. And we will agree, through team based, consensus driven review of the best available evidence, how major conditions should be cared for be it pneumonia, a hip replacement or obstetrical care.

We will need a network approach to care management in order to manage our patients in all those complex transitions of care across time and location.

In other articles in this edition of DOC-Line please find further discussion on how our PHO, spread across the full network, can be a core vehicle for our potential and essential risk-based contracts to manage populations. Another article will describe what it really means, from a regulatory perspective, for us to be sufficiently clinically integrated to take that risk. Future articles will devote more attention to the electronic requirements of that clinical integration from coordinated and connected EMRs to a robust Health Information Exchange (HIE)

Medical Staff leadership (chairs, chiefs, MECs) at all three hospitals will remain local, although we are anticipating approval soon for a single license between Danbury and New Milford Hospitals. Norwalk will retain licensure independence and thus its own Medical Staff, although there will be some centralization of leadership through my role as Network Chief Medical Officer. There will be a Vice President of Medical Affairs at both Norwalk (Lew Berman) and Danbury Hospital (TBD), with a Chief of Staff (Tom Koobatian) at New Milford. Our respective chairs will be working with all of you to begin the work of clinical standardization noted above but it will be a team effort with no preconceived notions of “the right way”. We’ll take what’s best at any of the hospitals, and include what we can glean from outside expertise. But we all start with a terrific base---three hospitals and three medical staffs with terrific records for quality, safety and service. How can we go wrong?

I’m sure many of you have questions and comments. We’ll get more and more information to you as details and specifics are formulated. In the meantime, feel free to contact me at any time at matthew.miller@wchn.org.