Ninety minutes into his shift, Dr. Gerard B. Hayes has visited six intensive care unit patients, conferred with nurses about 12, and reviewed the records of dozens more.
“Dottie, how are you?” he asks a woman in a purple robe who is suffering from obstructive lung disease. “I’m taking a look at your X-ray right now, and it looks pretty good.” She sits up in her bed, breathing through a tracheostomy tube. “I’ll check in with you later,” he promises.
Comments
Lets be cautious here with describing Steward's network as a model of an ACO. The business model Steward is employing may have some benefits in terms of efficiencies and economies of scale, but its core mission - to provide value to its stockholders (which, by law, is the core mission of any for-profit enterprise) - is not consistent with an ACO model.
ACO's are all about managing the health (and illness) of a given populace, for a fixed amount of reimbursement. Although the Steward business model may help position them to become an ACO, the goal of ACOs is to keep patients healthy and OUT of hospitals. Buying up hospitals (rather than PCP practices) is not the path towards an ACO . . . unless you plan on closing them in the future as fee-for-service disappears.
I wonder if the Boston Globe will ever do any real reporting on healthcare or will it continue to echo press releases.
Why does the Globe feel one critical care specialist remotely monitoring multiple hospitals is such a wonderful idea? The approach has its value for small remote critical access hospitals. These facilities may have as few as 3 beds and are in the middle of nowhere. Steward’s hospital are much larger and in a major metropolitan area. One can only tell so much from looking at a monitor. To correctly assess the situation you actually need to see the patient. Critical access hospitals use remote monitoring because they aren’t big enough to support the service. Steward is using to maximize profit.
Let’s look at some of the other examples of "innovation":
Robotic surgery - EVERY hospital uses surgical robots. Steward has just chosen to center a PR campaign around them.
Fixed rate insurance contracts-This is much easier to do when you can dump, as mentioned in the article, your sick patients on Partners.
Managers working with patients to prevent hospital readmissions- Case management has been standard practice for years. Nothing new here.
The article brings up Blue Cross’ so called Alternative "Quality" Contract. Once again the Globe fails to mention that the indicators in this contract are extremely limited, easy to game and may actually decrease the quality of care as providers neglect on other areas to focus on them
The article does mention but doesn’t go into details about how Steward has been cutting staff. It completely neglects to mention that has done so by purging more experienced professionals and replacing them with cheaper less experienced ones.
The last sentence in the article sums it up "The goal of Steward executives “in the end . . . is to make money for their investors.” Cerberus is in this business for one reason only to make a profit. This is the primary goal and patient care comes in a distant second.
The Boston Globe never hired a replacement health columnist for Betsy A. Lehman, their award winning health columnist, who died in 1994 after suffering from the massive overdoses of Chemotherapy drug administered in error by her medical research team at the Dana-Farber Cancer Institute.
Everyone who posted a comment on this thread should go to www.helenbousquet.com to see what Steward Health Care System put this poor woman through. Actor Tom Hanks introduces her website. They left this woman in a recovery room knowing she had sleep apnea while dosed out on morphine and the woman choked to death. This hospital is owned by the same company, Cerberus Capital, who owns the gun manufacturing company that made the gun used in Newtown. All they care about is money, not patient care. The own the guns, the hospitals, and now the food (they just bought Shaws supermarkets). This is what our world has come to.
And you won't find the mayor at Stewart He will be at MGH. Speaks volumes.
I was brought to Steward Norwood, not by choice, but by ambulance and a result of sports injury...started off preety innocent with a surgeion performing surgery on my wrist, then the fun began....surgeon left on maternity leave, no primary coverage for three months, a procedure that went wrong and sent me back where no doctor was in the emergency room to cover, damage done to my wrist because implants had moved around....I finally saw my doctor in october after her leave, she didn't know what to do and considered fusion.....having had enough of this circus...I went to Beth Israel....they broke the wrist again, fixed the problem, no fusion...and I am back to 100% What poor care at Steward......I wlll never go back and share this story often to friends and colleagues. Profits over Care...!
"Reshaping" it is right - when a patient is in distress, they don't need someone on a medical screen. They need a person in their room. Norwood Hospital under Steward - 10-12 hour waits in ER are the norm again. Fewer aides resulting in overworked or indifferent nurses (I suspect a high turnover rate with a loss of many good nurses). Hospitalists who don't properly communicate with patients, patient families or patient doctors. Patients with fall precautions who have to try to make their own way to a commode because there is nobody available to assist them. No list of patients supplied to local parishes any more so that they can get parish visits. Start asking questions about Steward outside of the hospital and you'll hear another story. I'm sure there are many good people still working at the hospital. Unfortunately, they are being overrun by the incompetence of a corporation that doesn't get what health care should be about. This for-profit hospital chain only cares about its bottom line, not about the sick people that have to suffer through inferior service.