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St. Luke’s Remote Care to Cut Boise Visits
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Friday, September 14, 2018
 

STORY AND PHOTO BY KAREN BOSSICK

Wood River Valley residents who suffer a stroke may no longer need to fly to Boise to determine if they can benefit from a clot-busting shot.

St. Luke’s Medical Center has launched the region’s first virtual hospital in the building that used to house Morrison-Knudsen in Boise.

One of the first virtual care centers in the nation, it will offer a neurologist in Boise the opportunity to use telemedicine equipment such as military-grade two-way cameras and remote monitoring equipment to diagnose and treat a stroke victim lying in the emergency department at St. Luke’s Wood River.

St. Luke’s opened its new Virtual Care Center two weeks ago. The $3.4 million high-tech hub features a centralized medical team that can provide critical care and neurology service remotely to Idaho towns that don’t have such specialists.

Right now the Virtual Care Center has specialists in urology, nephrology, pediatric programs and sleep medicine. Other specialties will be added in the future.

“What this means is that a patient in the Wood River Valley who has kidney trouble will be able to go to a local clinic and consult with a specialist in Boise via two-way, audio/video equipment, rather than having to go to Boise” said Dr. David Pate, president and CEO of St. Luke’s.

“And, if someone has a stroke, we can wheel the equipment into the emergency room on a cart and the neurologist in Boise can sit at a console and make recommendations to the ER doctor. That can save stroke patients a flight to Boise, which could cost $10,000 to $20,000 depending on where you live.”

And that’s not all.

Patients in Boise can be given devices to take home with them that will allow nurses to monitor heart rate, oxygen levels and other vital signs in real time. If nurses see something out of line, such as the patient’s  weight jumping, they can surmise that the patient is starting to retain fluid and doctors can  adjust medications to correct the problem before the patient even feels sick.

“We can reduce ER visits by 38 percent and hospitalizations by 56 percent,” Pate said.

Pate addressed community health providers and other stakeholders Wednesday in St. Luke’s Health System’s annual Fall Forum held at St. Luke’s Wood River Medical Center.

He said the hospital’s emphasis on virtual care is one of the ways the hospital system hopes to provide better outcomes while cutting health care costs. And, he said, it’s among the things that will keep St. Luke’s a top 15 health care system for quality and safety among hospitals that include the Mayo Clinic, Johns Hopkins and UCLA.

“When I got here nine years ago, St. Luke’s was not a quality leader. It was not even a leader in our market,” he said.

Today it’s the best in the nation based on pages of measurable factors, such as complication rates, readmissions, wait times in the ER and mortality rates.

HOW’S ITS VALUE-BASED CARE GOING?

St. Luke’s mission of providing value-based care, rather than the traditional fee-for-service care, is nearing profitability, Pate said.

The value-based system rewards not for volume but good patient outcomes. Thirty-six percent of the patients in St. Luke’s network are in the value-based system. The others are in fee-for-service.

Pate said going to the new insurance plan where St. Luke’s absorbs any losses if the cost of caring for those in the plan exceeds the budget at the end of the year, is painful as the hospital lost money the first couple years. But, he said, it had to be done.

He pointed to Kodak whose leaders knew digital cameras were coming but refused to make the shift because they had been doing so well under the old model. Ditto for Blockbuster Video, which was doing so well with its model of renting out videos and collecting fines for those that were returned late that it refused to change and went bankrupt.

“I got here as affordable health care was being debated,” he said. “We knew we had to transform health care.

Pate told of one hospital system that backed out of value care as it saw profits drop. But St. Luke’s has lost less than it expected, he said. And it is expected to return to profitability in 2020.

“I know how proud I am of what St. Luke’s is doing,” he said. “St. Luke’s is spending money to keep patients out of hospital, even though that’s antithetical to hospital nature. We’re doing because it’s the right thing to do.”

“Our object is to get premiums down and health care costs down,” he added. “We’re not there yet, but we’re on our way.”

TREATING THE FIVE PERCENT

St. Luke’s has determined that 5 percent of the 152,000 patients in its system account for 50 percent of the costs. Those 5 percent, identified through data analytics, typically have multiple chronic illnesses, such as diabetes, hypertension and kidney problems.

Half of those five percent have accompanying mental health issues, such as depression, and their costs are two to three times that of others in the half of the five percent, Pate said.

Typically doctors make a few adjustments during office visits and say, “See you in two months,” Pate recounted. Now, they’re sending the patients home with iPads and the ability to upload data so they can monitor them in real time.

CUTTING REHAB

Pate said there’s perceived to be an overuse of rehabilitation and other post-acute facilities in the United States.

Part of this is attributable to insurers who say they will pay more if the patient stays in such facilities at least 25 days. It’s also been suggested that, in some cases, keeping a patient in the hospital just one more day will alleviate the need to go to a rehabilitation facility.

St. Luke’s has been able to cut such stays five days from 20-plus days.

“It detrimental to your health if you stay longer,” he said.

KUDOS TO ST. LUKE’S COMMUNITY HEALTH

Pate praised St. Luke’s Wood River’s Community Health program for helping patients to secure transportation, dental care, lodging and money for prescriptions.

Of 27 patients helped in this way, 18 needed fewer or no visits to ER.

A PLUG FOR MEDICAID EXPANSION

Pate noted that 55,000 Idahoans do not have insurance, in part because Idaho’s legislators have rejected expanded Medicaid offered by the federal government.

He’s optimistic that Idaho voters will approve an initiative in November that would expand Medicaid under the Affordable Care Act.

“That will make a big difference,” he said, adding that Jerome and Canyon counties are among those with higher uninsured rates. “The polls suggest that 70 percent of the people support it, so if there’s a good turnout…”

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