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Urban health - big cities, big challenges

by Lisa Chamoff, Contributing Reporter | December 16, 2014
From the December 2014 issue of HealthCare Business News magazine

Improving population health
Holmes, of the North Carolina Rural Health Research Center, says that as the industry moves toward accountable care organizations — networks that coordinate patient care and are rewarded for delivering it better and for less money — it’s not clear what the long-term role of rural hospitals will be.

Paul Bengtson, chief executive officer of Northeastern Vermont Regional Hospital in St. Johnsbury, Vt., who leads the American Hospital Association’s Section for Small or Rural Hospitals, says his hospital is a member of one accountable care organization, OneCare Vermont, and works closely with two.

“I have never had anxiety about accountable care organizations,” Bengtson says. “I actually like the concept. I like that they’re pushing us to do things that we should otherwise do. What I don’t like is the fact that there’s another layer of bureaucracy layered on all the other layers of bureaucracy.”

Like in Anson County, N.C., there is reason to shift to improving the health of the overall population. Bengtson notes that in Vermont, hospitals like his work closely with physicians, housing agencies, social service agencies, and agencies on aging.

“Vermont is a very interesting and progressive state,” Bengtson says. However, despite some progressive moves that can help address some of the special challenges that rural hospitals face, there are always going to be issues related to funding.

“The payment reform piece is not keeping up with the delivery reform piece, and that’s what’s causing most of the anxiety,” Bengtson says. “We’re living in a time of great ambiguity, so you have to have high tolerance.”

The Henry Ford Health System, which serves Southeast Michigan, including Detroit and some suburban areas, can see the challenges of urban hospitals pretty clearly. Readmission rates in Detroit are much higher than the system’s facility in West Bloomfield, says David Nerenz, director of the Center for Health Policy and Health Services Research at the Henry Ford Health System.

“As far as we know, not only are the staffing levels and the EMR system essentially the same, but we have additional resources in Detroit to deal with the challenges,” says Nerenz, who describes partnerships with community health organizations. “We see higher readmission rates in spite of all of that.”

The challenges of urban hospitals can vary greatly — Detroit, which has an aging, unreliable bus system, is a little different than the Upper East Side of Manhattan, where buses and relatively inexpensive cabs are easy to find. Nerenz, who also serves as vice chair of research in the department of neurosurgery at the Henry Ford Health System, says the outcome of a minor spine procedure can differ based on the patient’s circumstances — recovery can be more difficult if there’s no access to a park, or if they live in a fourth-floor walkup and it’s the middle of the summer.

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