Ellis Medicine
Classes/Events | School of Nursing | Contact Us | Site Directory
Share |

The President's View

Two Important Numbers in Healthcare

by Jim Connolly 7. April 2014

The two most important numbers in the American healthcare system are 5 and 50, writes Ezra Klein in a recent article in The Washington Post. What Mr. Klein is referring to is the fact that five percent of the population accounts for about 50 percent of the American healthcare system’s spending.  Mr. Klein details it further, stating that the health problems of 15 million Americans consume one-tenth of the United States’ overall gross domestic product (GDP). 

The 5% is comprised of those who are chronically ill.  They are often the underserved that are “frequent flyers” in our emergency departments and admitted in our hospitals. They require an enormous amount of resources from hospitals, physicians, nurses and staff – both financial and labor. Often, the problems that require frequent trips to the emergency department are not new diagnoses, rather the poor management of existing conditions such as diabetes, congestive heart failure and asthma.

Nearly two years ago, Ellis Medicine partnered with the Visiting Nurse Service of Northeastern New York and many community agencies to create Care Central. Care Central aims to help those who have limited access to healthcare services and to be a centralized location for community support services. One aspect of Care Central is it Chronic Care Team, which works with many of the aforementioned “frequent flyers” to help them gain access to the medications they need to prevent complications and to connect them with community services to help manage their conditions.

Mr. Klein also states that the problem with the 5% isn’t that they aren’t necessarily extremely sick; instead, it’s that they have obstacles to accessing care and are often difficult to find in the system. That’s where Care Central steps in – to connect these patients with the services they need.

When patients arrive in the emergency department, they are identified as those who could benefit from having the help of Care Central to help manage their care outside of the hospital. Our Care Central team of registered nurses, social workers and support staff visit patients while they are in the hospital to introduce themselves and their services. The team continues to assist the patient when they leave the hospital and return home, helping them coordinate their follow-up appointments or connect with the services they need to keep them well in their own homes and/or keep their chronic conditions from getting worse.

Ellis Medicine’s investment in Care Central is similar to that of a research and development expense. Ellis does not receive an economic incentive for its efforts in Care Central; instead, Ellis loses revenue on the inpatient side if Care Central is successful in its mission – to keep the chronically ill out of the hospital. So why has Ellis invested so heavily in a program that ultimately reduces its revenue? The answer is simple – it is the right thing to do for our community.

Care Central is still evolving to meet the needs of the community and provide the right services to the right people in the right places. The success of Care Central will ultimately be realized if the “frequent flyers” access the emergency department less than they have before and become healthier in their own homes.  We need to help bridge the gap between 5% and 50% not only for the overall financial health of our country, but most importantly, to help those in greatest need of our assistance in accessing high quality healthcare.

If you are interested in reading more, please check the links below:

Getting to the root of the problem
By Steven Ross Johnson

If this was a pill, you'd do anything to get it
By Ezra Klein

Changes in healthcare like the Affordable Care Act will make it necessary to practice population-based care
Executive Inights

Looking Back at 2013

by Jim Connolly 10. January 2014

A Lot to Celebrate
As we look back at 2013, I am very proud to reflect on all of the accomplishments and advancements made at Ellis Medicine throughout the last 12 months.  In spite of the many challenges we face, 2013 was another successful year at Ellis Medicine as it continues to be a model of innovation, growth and excellence.

 

Innovation

Ellis’ legacy of being at the forefront of change continued in 2013, as Ellis charted its own innovative course in minimally- invasive surgery and new models of care to keep people healthy and out of the hospital.

 

In February, Dr. Kyril Choumarov of Ellis Cardiothoracic Surgery became the first in the region to perform robotic-assisted thoracic surgery for a lung lobectomy.  Just last month, Dr. Nicholas Montalto of Ellis Gynecologic Surgery joined a small group of surgeons in the nation performing the robotic-assisted single incision hysterectomy procedure which leaves women with virtually no scar.  Ellis has also invested in state-of-the-art equipment such as: the LenSx Laser for cataract removal; Transnasal Esophagoscopy (TNE), an office-based, non-sedated procedure for weight loss surgery patients; and Bronchial Thermoplasty, an advanced new asthma treatment.  Ellis also continues providing new hope for chronic heart conditions with the hybrid ablation procedure – another first for the region.

 

Ellis also focused on keeping people well and out of the hospital.  Thanks to a grant from CDPHP, Ellis employed a pharmacist to work in the emergency department on the weekends to improve medication safety of patients.  Ellis also worked with the Schenectady Coalition for a Health Community to develop the UMatter Schenectady Survey – a unique door-to-door assessment of our community’s health needs.  Plus Care Central, a coordinated model of care to help people better manage their health at home, continues to develop, reaching more people in more counties throughout New York State.

 

Growth

In 2013, the Ellis School of Nursing was relocated to 650 McClellan Street, Schenectady and was renamed The Belanger School of Nursing. The construction of the new emergency department and parking garage at Ellis Hospital are moving forward and the modernization of Bellevue Woman’s Center is complete – honoring both its rich history and introducing new, state-of-the-art facilities. Additionally, the great community support of Ellis’ work became visible this fall with the launch of the public phase of Our Health Our Future – The Campaign for Ellis Medicine.

 

Excellence

The most important success of 2013 is the continued great care we deliver to our patients every day.  In 2013, Ellis’ Medicare Value-based Purchasing scores ranked the 7th best of any hospital in New York. These scores include process measures, outcome measures, patient satisfaction and the overall cost of care. Additionally, Ellis was recently recognized with a Gold Baldrige Award for performance excellence for the second year in a row and was honored for excellence in stoke care, knee and hip replacement and cardiac care. The Schenectady Chamber of Commerce awarded Ellis “Corporation of the Year” in 2013 as well!

 

We have also focused on improving patients’ experiences at Ellis Medicine through service excellence and we have been very successful to date.  Our patient experience survey scores have improved in 13 of the 17 questions that patients are asked after leaving the hospital.  These results illustrate the excellent and compassionate care we deliver.

 

In spite of all that is confronting us in healthcare, there are still many things we can reflect on, be proud of and that energize us going forward. 2013 was yet another example of how Ellis adapts to change in the healthcare environment and moves ahead stronger and better positioned to care for our community.  I am so thankful to work together with our entire team of physicians, nurses, staff and community partners to truly make the Capital Region a healthier and better place.

No Man's Land

by Jim Connolly 7. November 2013

Think healthcare is complicated and the changes are hard to keep up with? Believe me, you’re not alone. I have come to refer to the current state of healthcare for hospitals as “No Man’s Land” because of the state of flux we find ourselves in.

 

No Man’s Land is that middle ground between the place we have come from and the destination we are headed to.

 

The place from where we have come from is the fee-for-service environment. Fee-for-service is a reimbursement model where healthcare providers are paid a fee for each service such as an office visit, diagnostic test or procedure. Traditionally, this model has proved costly. High costs of healthcare result from a number of factors, but one focus of healthcare reform is for organizations to ensure care is being delivered in the most cost-effective manner possible. 

 

While much of how healthcare providers continue to get paid is from this fee-for-service model, we are awash in a ton of change.  A new method of reimbursement that is being rolled out is pay-for-performance. This is the land to which we are destined.  Under this method of payment, healthcare providers are rewarded for their ability to meet quality goals and demonstrate cost effectiveness.  In order for an organization to be truly successful in a pay-for-performance world, healthcare services and programs need to be closely aligned and all members of the healthcare spectrum – physicians, nurses, case managers, home health aides and the patient – must be working smoothly together.

 

It’s not an easy task to get all of the players in healthcare to work in a coordinated effort, but at Ellis, we have found success in this endeavor.  We are now connecting our hospital patients with Care Central, a collaborative innovative program that empowers people to self-manage their care with the help of coaches and navigators.

 

Care Central has been very successful and we have seen remarkable improvements in hospital readmissions and management of chronic illnesses.  However, despite these great improvements made by coordinating care, we aren’t currently being paid for this coordination because the pay-for-performance environment is not fully here. 

 

So, we are in a situation where we are investing in programs to move toward a pay-for-performance arena and losing potential revenue in a fee-for-service reimbursement model.  A financially stable not-for-profit healthcare organization is needed to continually re-invest in state-of-the-art technology and new facilities.  The situation leaves organizations financially strapped and in the place I mentioned before – “No Man’s Land.”

 

So, how do we prepare for the future and remain stable in the present?  It’s a question we are answering each day in our efforts to provide the highest quality, patient-centered care.  Despite the challenge of “No Man’s Land” we are moving forward with the development of programs such as Care Central not only because that is where healthcare is heading, but also it is what is right for our patients.

 

No one knows how long we will be in “No Man’s Land.  However, Ellis is well positioned to navigate these challenging and unpredictable waters. I am confident that we will eventually arrive in the new pay-for-performance world as a better, stronger organization.

Health Insurance Exchanges: What You Need to Know

by Jim Connolly 1. October 2013

Health insurance for many Americans is going to change starting October 1.  That is the date when the New York Health Benefit Exchange, an online marketplace for health insurance, becomes active. 

 

What is a health insurance exchange?

Health insurance exchanges were one of the key parts of the Affordable Care Act (ACA), or “Obamacare” as it is commonly called. 

 

Three years ago, President Barack Obama signed the Affordable Care Act into law, thereby changing how we all operate our health systems and how all Americans use healthcare.  For health systems such as Ellis Medicine, the ACA has meant changing how we care for the community.  We have dedicated a tremendous amount of resources and effort into not just caring for people in the hospital, but keeping them healthy in their homes.  For many individuals, the ACA will mean change as well, specifically, when it comes to health insurance.

 

Who is affected?

On January 1, 2014, all Americans will be required to have health insurance or pay a penalty.  Most Americans won’t see any change. Those who already receive health insurance through their employer (or their spouse’s/parents’ employer), or are already enrolled in Medicaid and Medicare are not affected and don’t have to do anything.

 

The exchange will serve people who currently do not have any health insurance, people who buy their own health insurance in the “individual market” (including self-employed people now in “Healthy New York”), and some people whose employers decide to drop group coverage now that their workers can buy insurance through the exchange.  Small businesses will also be able to get group coverage for their employees through a special part of the exchange.

 

Do Your Homework & Shop Around

With health insurance exchanges opening October 1, individuals have three months to shop for health coverage to find the best option for them and their family. Just as you would compare all the features and benefits when buying a car, a new computer or camera, you will need to evaluate and compare health insurance exchanges.  Each of the options is different and there isn’t one option that fits all.  

 

When shopping for health insurance in the New York Health Benefit Exchange, you should come prepared with questions.  While you aren’t comparing gas mileage of cars, you need to compare what doctors are included in the various insurers’ coverage and if you would rather pay a higher monthly payment, or a high deductible when you need healthcare.

 

You won’t be completely on your own when it comes to selecting the insurance that is best for you.  New York State is contracting with not-for-profit agencies called “In-person Assistors” who will help people understand the various options.  In Albany, Schenectady, and Rensselaer Counties, this function will handled by the Healthy Capital District Initiative (HCDI). You can reach HCDI at 518.462.7040.

 

How much will it cost?

One of the important aspects of the exchange is that most people who obtain health insurance through this new program will receive a taxpayer-funded government subsidy to reduce the cost.  Subsidies – in the form of reduced premiums or of an income tax credit – will be available to individuals earning up to about $46,000 a year, with a family of three earning up to about $78,000.  Plus, the exchange will also help people who qualify to sign up for Medicaid, which is entirely paid for by taxpayers and costs the beneficiary nothing.

 

If you qualify for a subsidy, you’ll also have to decide if you want to take it in advance in the form of a premium reduction or at the end of the year in the form of an income tax credit.  While it seems better to get your money “up front” in the premium reduction, if your circumstances change (such as getting a pay raise), then the amount of your subsidy will change and you could end up owing money to the government at the end of the year.  Whichever way you take it, the amount of your subsidy (based on income and family size) will be the same.

 

What health insurance plan should you choose?

In the Capital Region, eight insurers are participating in the New York Health Benefit Exchange.  These insurers each offer different options for individuals and small groups to choose from – a choice of up to 40 different plans. 

 

The least expensive monthly payment plan is the Catastrophic Plan, which is available to single adults under the age of 30.  The remaining plans in ascending order of price are Bronze, Silver, Gold and Platinum. The Platinum Plan has the highest monthly premium, but most comprehensive healthcare services and lowest deductible. All of the insurance plans offered in the exchange have been reviewed and approved by the government, which requires certain benefits (varying by type of policy) and regulates the price.

 

Where should you start in your health insurance shopping?

One of the first questions you should ask yourself is whether you want to pay a higher monthly payment with low deductible or lower monthly payment with high deductible.  The higher level plans provide additional coverage and protection in case you get sick, need surgery or are in the hospital.  The lower monthly plans require paying more money out of your pocket if you need treatment. 

 

You should also look at each option to look at what the plan offers and if your doctor is included in the insurer’s plan.  If you have  an exisiting relationship with a doctor, you should look at plans that include your doctor in it.  If you don’t have a doctor, it’s time to start looking for one.  If you live in Schenectady or Saratoga Counties, you can call Ellis Medicine’s Health Services Navigators at 1.888.633.4661  for help finding a primary care doctor. Regular check-ups with your primary care doctor keep you healthy so you are less likely to need to go to the emergency room or be in the hospital.

 

What happens if you don’t buy health insurance?

For those who don’t enroll in a health insurance plan, they will be penalized in 2014 with a $95 fee and $47.50 per child (up to $285 per family), or one percent of family income, whichever is greater.  Those who don’t enroll will also not have access to the preventive care they need to stay healthy and be at risk for expensive medical bills if they need treatment.  So, if you are contemplating not enrolling in a health insurance plan, at least be prepared by using a medical spending account to save money if you ever need it.

 

Getting through the changes, together

There’s a lot of work for us all.  For organizations like Ellis, we are working to make sure our services are what you need, where you need them.  We are also preparing to care for more patients who may use hospital and healthcare services more now that they have insurance. 

 

For people looking to buy health insurance on the exchanges, you have shopping to do.  Starting comparing the different plans to see which one is right for you.  Ask your doctor and the different insurance companies about any questions you have about the plans.  At Ellis, we are always here to help, so don’t hesitate to reach out to us.

 

There is a new era of healthcare upon us.  Let’s all work together to be healthy!

 

Important Links:

HeathCare.gov

NY State of Health

What is NY State of Health

Healthy Capital District Initiative

Tax Credit & Premium Estimator

Map of Health Plans Offered in NY State of Health

 

 

Welcome!

by Jim Connolly 16. September 2013

I never thought that writing a blog would be part of my job – certainly not thirty-nine years ago when I started working in healthcare or even a few months ago. But here I am, president and CEO of a not-for-profit hospital in New York’s Capital Region, starting a blog in the hopes of establishing an ongoing dialogue about what I care so much about – improving healthcare.

I am often asked: “Jim, what is your typical day?”  The truth is – there isn’t one.  Whether it’s meeting with physicians and staff at Ellis Medicine, developing innovative programs, forging partnerships, or breaking ground on a new project – every day is different. It is an exciting time to lead an organization such as Ellis, but extremely challenging with the effects of healthcare reform and the changing methods of delivering care.

What we are seeing here at the local level in Schenectady is representative of the changes we are now beginning to see across the nation due to healthcare reform.  In the past six years, we have created Ellis Medicine by combining the legacies of three hospitals that served generations in Schenectady County – Ellis Hospital, St. Clare’s Hospital and Bellevue Woman’s Hospital.  We have embarked on capital projects, such as the Medical Center of Clifton Park and the modernization of Ellis Hospital’s Emergency Department, in order to ensure we are delivering the right level of care at the right location in the most efficient, cost-effective manner – all without sacrificing quality. The recent development of Care Central, one of New York State’s first health homes, is extending healthcare services from our facilities to the homes of our residents.  All of these steps stem from the need to make changes in healthcare in order to reduce costs, improve health and wellness, and, whenever possible, keep people out of the hospital.

That may sound strange for a hospital CEO to say. In fact, another question people often ask me lately is: “Jim, why are you pursuing initiatives that negatively affect your bottom line?”  The truth is, yes, these changes do impact a hospital’s bottom line.  The healthier people are, the less likely they are to need a hospital. That means less revenue for the organization.

But it’s our ultimate responsibility to keep our community healthy. We are working to change and reinvent the model of healthcare in our service area.  We’re trying to break down barriers to care, improve how healthcare is delivered and put a renewed focus on preventive care. Many of these steps may mean a reduction in admissions to the hospital, but it’s the right thing to do and we aren’t looking back. It’s been full steam ahead since the state’s healthcare reform mandates set into motion the wheels of change here in Schenectady.   

I look forward to sharing my thoughts about leading Ellis Medicine through this transformational time in healthcare.  I will offer my perspective on a variety of topics and I hope you will join me in this important conversation about healthcare today and where it’s headed tomorrow. I welcome you to ask me questions and share your thoughts.