Academic docs seeing the need to standardize and create more value

Dr. C. Wright Pinson is CEO of the Vanderbilt Health System in Nashville and deputy vice chancellor for health affairs and associate dean for clinical affairs at the Vanderbilt University Medical Center.

Pinson, a hepatobiliary and liver transplant surgeon, oversees 1,500 physicians, four hospitals, 100 outpatient clinics and a budget of $2.6 billion. He cofounded and co-directs the Masters in Management in Health Care program. As a sidelight, Pinson plays drums in a rhythm and blues band with other Vanderbilt colleagues that has shared the stage with stars such as Charlie Daniels and Delbert McClinton. Modern Healthcare editor Merrill Goozner recently spoke with Pinson about federal funding cuts for academic centers, quality-improvement efforts and Vanderbilt’s efforts to build a broader integrated network. This is an edited transcript.

Modern Healthcare: How is the federal freeze on funding for graduate medical education and National Institutes of Health research grants affecting your institution?

Dr. Wright Pinson: So far, we’re weathering the storm satisfactorily. Our grants amazingly are up 5%. But the difficulty comes in creating enough bottom line to support (our mission). Our outpatient growth has been near 10% for years and that continues. The inpatient growth is less, though we still have growth. The bottom line, though, continues to get compressed. Serving the underserved, medical education and biomedical research do not have bottom lines. They require some transfer from clinicalcare revenue. The shrinking bottom line creates tension for those programs.

MH: Why is Vanderbilt doing better than other academic centers?

Pinson: We have a tremendous cadre of exceptional investigators who have continued to be successful and very competitive in the grant world.

MH: What is the relationship between the for-profit healthcare industry centered in Nashville and your institution?

Pinson: We have many forums like the Nashville Area Healthcare Council where we have the opportunity to interact on a regular basis, and that has been very beneficial in both directions. We import expertise from the industry in management of our operations.

MH: Where does Vanderbilt stand on improving quality of care and patient outcomes?

Pinson: We have reorganized our whole quality, safety and risk management effort and have tried to integrate that with the operating teams in a more robust way. We are beginning to make more rapid progress on quality and safety measures. We are looking at our core inpatient operating models, as well as our core outpatient clinic operating models, and we are re-engineering those models, standardizing them and making sure they are reliable. We’re looking at our billing and collection operations, and we’re upgrading the software and procedures and getting personnel who can drive us to a higher level of efficiency. And we are setting our standards higher in terms of meeting patient expectations of quality, safety and service.

MH: Is it harder to get physician buy-in on clinical standardization in an academic medical center?

Pinson: Historically, that would have been the case. But physicians at our institution are seeing the urgency to perform to higher standards and the need to create more value. So there is a willingness to take on standardization and setting performance criteria that I have not seen in the past. We are a learning organization and this idea of taking in new ideas and applying them is actually quite well received.

MH: Can you talk about any improvement initiatives that are underway?

Pinson: We have developed a variety of project teams. We try to take on half a dozen 100-day projects and bring them to an end point, then work off of a list and take down the next most significant projects. Inside a large organization, it’s very hard in some ways because of its size. These project management teams bring appropriate focus with a specific end point that drives us to conclusions in a meaningful time frame.

MH: Is Vanderbilt considering forging alliances and extending its brand the way Duke and the Cleveland Clinic have done?

Pinson: Since 2011, we have developed the Vanderbilt Health Affiliated Network. We have found institutions that have relatively similar value systems, often independent not-for-profits, and we have coalesced into a network of

“We are setting our standards higher in terms of meeting expectations of quality, safety and service.”

about 45 affiliates across Tennessee. We should be clinically integrated formally by the end of this year. Through that network, we will push out evidence-based standards of care, collecting quality data, driving efficiency and lowering cost all across this network. It’s starting to spill over to some of our neighboring states.

MH: Is there a long-term vision of melding this into a network and taking on risk contracts?

Pinson: I think it could evolve to that. Our first task, though, is to meet the requirements for clinical integration and demonstrate that we can provide value and savings in the network as it stands now. We can begin to think about how we create more value over time.

MH: Is Vanderbilt moving toward forming an accountable care organization and taking on population health management?

Pinson: We are definitely learning how to manage populations. We look at this network as covering a large enough geographic footprint that we could reasonably take on a population.

MH: What is Vanderbilt doing to produce more primary-care physicians?

Pinson: Vanderbilt has traditionally been far more focused on specialty care and research in its medical school, and I don’t think we are likely to become a significant force in primary care, although we have a curriculum that allows people to focus on primary care if they want to.

MH: Some of your peers, such as the Cleveland Clinic, put a huge emphasis on their technology transfers. What is Vanderbilt doing in that arena?

Pinson: We have set up a technology transfer office over the past decade, and we are transferring a number of ideas through contracts. It’s now hundreds a year. It is beginning to bring in significant dollars.

Our pharmacology department is fantastic, and their ability to push out potential ideas has been superb. Those ideas have been generated in the areas of diabetes treatment, erectile dysfunction, hypertension and the neurosciences.

MH: As a liver transplant surgeon, what do you think about the debate on when to treat people who test positive for the hepatitis C virus? With limited budgets for Medicaid and prison populations, do you support just monitoring patients’ liver function and waiting to provide treatment?

Pinson: It makes absolute sense. It is not clear that there’s any big benefit in trying to treat people prophylactically. It makes a lot more medical and financial sense to monitor people until they get to a point where it looks like they’re developing some fibrosis or other evidence of disease progression before you treat. Everybody that you identify who has hepatitis C probably does not require treatment.