Vital signs improve at Valley

It's not easy running a hospital these days.

Even as insurance payments drop, costs for new services and technologies rise. Amid that fiscal balancing act, hospitals grapple with the ultimate responsibility: saving lives.

But one Las Vegas hospital dodged some of those challenges and won national plaudits for boosting profits, reducing expenses and improving quality of care.

Valley Hospital Medical Center just landed on a nationwide list called 100 Top Hospitals: Performance Improvement Leaders. The roster, compiled by Connecticut business consultant Thomson Reuters, breaks hospitals down by category rather than rank, and in the teaching-hospitals division, Valley was one of just 25 medical centers nationwide to make the list. In areas including patient mortality, length of stay and profitability, Valley improved faster than 98 percent of other teaching hospitals its size.

"The management team at Valley Hospital has been able to focus the organization on improvement," said Jean Chenoweth, senior vice president for performance improvement and 100 Top Hospitals programs at Thomson Reuters. "Permanent improvement must be based on adjusting the systems of an organization and (giving staff incentives) to move from a blame environment to an improvement environment. When I look across their metrics, (Valley) is very well-aligned in improving its efficiency, its clinical performance and even its financial performance."

Credit the enhancements to the genesis of Valley's teaching program three years ago, said Gregory Boyer, the hospital's chief executive officer and managing director.

Valley officials wanted to transform the facility into a teaching hospital to help relieve a local physician shortage in internal and family medicine. Once Valley's teaching program launched, hospital executives adopted a prominent national medical protocol called Milliman Care Guidelines. The guidelines come with interactive software that provides standard models of care for acute illnesses. That means consistency: Cardiologists will order the same tests for all patients experiencing heart attacks, for example. And where there's consistency, there are shorter hospital stays and better cost management, Boyer said.

Valley officials also embraced National Patient Safety Goals under the Joint Commission, a national organization that accredits and certifies hospitals. The safety standards include using two patient identifiers when administering medications, avoiding confusing or too-common medication abbreviations and spotlighting awareness of drugs that look alike or sound alike. The measures bolstered efficiencies and outcomes, Boyer said.

The realities of modern-day health care economics make Valley's upgrades especially impressive, Chenoweth said.

Reimbursements from Medicare and private insurers are shrinking. Hospitals bear the administrative costs of negotiating payment with hundreds of insurers. And the law requires hospitals to treat uninsured patients who can't afford to pay.

"The improvements are quite a feat, because resources are getting tighter and tighter," Chenoweth said.

Charles Moseley, chairman of the department of health care administration and policy at the University of Nevada, Las Vegas, agreed that hospitals face obstacles to upgrading performance.

"Hospitals didn't used to have to be concerned about being internally efficient," Moseley said. "Now, they have to deal with cuts in reimbursement and increases in the uninsured. But they have to be willing to undertake these efforts, and there are some initial costs in trying to improve their systems."

To find hospitals that made the most improvements, Thomson Reuters weighed data from the Centers for Medicare and Medicaid Services from 2002 to 2006. The study rated nearly 3,000 hospitals in eight areas: patient mortality, medical complications, patient safety, length of stay, expenses, profitability, cash-to-debt ratio and use of evidence-based medicine, which focuses on treatments proven through objective tests rather than interventions based on anecdotal support.

Chenoweth declined to disclose hospital-specific results. But Thomson Reuters' analysis found that the 100 most-improved hospitals went from posting more patient deaths and adverse safety events than expected to experiencing fewer such occurrences than expected in the study period. Their expenses grew an average of 2.5 percent, compared with a 17.4 percent average gain among their peers. Profit margins jumped from less than 1 percent to 6.9 percent, and average stays among patients fell nearly a day despite treating more patients with graver illnesses.

"The vast majority" of hospitals outside the top 100 improved noticeably in just three of the eight areas, the report said.

Most hospitals made strides in patient mortality, length of stay and patient safety.

But few hospitals outside the top 100 improved their financial results. Two-thirds of hospitals studied failed to decrease expenses per patient discharge, and the other third saw expenses grow. Also, 84 percent showed little or no change in profitability, and 77 percent didn't boost their cash position.

Valley officials said they plan to increase the hospital's number of residents from 71 to 90. They want to add a neurology residency to the hospital's 4-month-old Stroke Center, and they're considering establishing a pulmonary critical-care fellowship program that would bring in "intensivists" to monitor cardiac intensive-care patients around the clock. The neurology and cardiology additions would "have a dramatic effect on quality of care and outcomes," Boyer said.

Chenoweth said Valley's position as the sole local hospital on the top 100 list doesn't mean the rest of the city's hospitals lag substantially in quality, or that they're not improving. Still, it seems area hospitals could learn a lot from Valley, Chenoweth said, and that's why Thomson Reuters compiles the list.

"The patterns are so clear that (Valley) is improving that I think they're onto something," Chenoweth said. "We name these winners because they're setting a new standard, and by publishing their names, other hospitals can say, 'What the heck are they doing over there?' We hope it creates a good learning process."

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512.