​Irvine-Calif.-based Hoag Orthopedic Institute recently earned a five-star rating from the Centers for Medicare and Medicaid Services for patient experience and quality; making it one of only eight hospitals in California to receive the ranking. Dereesa Reid, CEO at Hoag feels the CMS rating is exciting and believes that CMS, with the value-based program, is creating a "gold standard" for clinical quality and transparency.

Hoag Orthopedic Institute is 51 percent owned by Hoag Memorial Hospital in Newport, Calif., and 49 percent owned by physicians. Hoag Orthopedic Institute also includes a 70-bed hospital in Irvine and two surgery centers — one in Orange and one in Newport Beach.

With the latest CMS program, besides simply providing a rating, consumers and professionals can compare clinical quality and patient satisfaction "apples to apples," as Ms. Reid puts it.

Why five stars is important

The comparison and the star rating is a huge boost for consumers as well, who are able to quickly understand what a star ranking could mean, and how it could impact their decisions about healthcare.
"The five stars is just a really progressive way that our fellow government is trying to be a catalyst for healthcare reform. I think it's good," says Ms. Reid.

Hoag Orthopedics has been publishing their annual outcomes report for the last four years, but with their recent five star ranking, the hospital has seen a larger amount of mainstream press and attention that they may not have otherwise. This attention will help and encourage hospitals with excellent ratings continue to provide excellent care.

"Once you start consumerizing this message, it gets out to local papers, and I had people walking up to me at the gym and asking if that was my hospital. And I had people walk up to me in the hospital and say they read about this," explains Ms. Reid.

The physician ownership advantage

One of the unique features about HOI is the physician ownership. The Patient Protection and Affordable Care Act no longer allows physicians to establish new physician-owned hospitals, but HOI was established before the law changed and has been able to maintain its status. HOI is a hybrid between a community based, non-profit hospital and physician owned hospital.

"I do believe anytime you are allowed to align physicians and employees, and get people on the same page, you get a different outcome. You are able to align organizational needs and hit the goals in a straight line of sight ," says Ms. Reid. "The big win here is it goes back to what Dr. Michael Porter and Dr. Elizabeth Teisberg wrote about in Redefining Healthcare. I think you start seeing better quality and higher patient satisfaction in large centers of specialty care withhigh volume and specialized expertise."

Ms. Reid puts emphasis on not only providing care, but the passion that can come from these sorts of specialty centers, noting her employees come to work passionate about orthopedic care. The physicians and staff are empowered to focus the patient first and provide better practice orthopedic care . Nurses and staff are also empowered to develop new and improved methods of care coordination and champion emerging new best practices.

"I think when physicians are empowered to lead, and administrators focus on removing barriers so they can practice their profession at the top of their game, you get a different result. It just so happens that because of physician ownership our physician leaders are actively involved with the hospital and our entire team. Similarly, I see evidence in academic medicine of really great physician empowered organizations; Cleveland Clinic is a good example," says Ms. Reid.
Ms. Reid was initially drawn to the physician empowerment of HOI when she saw a group of physicians who were committed to being a solution to healthcare reform, and who were fortunate to establish the hospital before the law changed, but admits there are good and bad examples everywhere.

"For orthopedics, especially for joint replacement, we have an aging population that are wearing their joints out more quickly because of obesity, so I don't think that we are doing more [procedures than we need to]. We even look at ways not to do surgery," says Ms. Reid.

HOI also takes emergency cases and has trauma doctors that cover EDs in Irvine and Newport Beach, as well as take admissions from other hospitals. "It is not all just elective surgeries," says Ms. Reid.

Pushing quality higher

As for healthcare reform and a push for higher quality healthcare, Ms. Reid would urge physicians and healthcare administrators to find ways to step-up and have a vision to understand how to do something differently with excellent outcomes and value.

"As a nation, we've got to quit thinking about partisan politics and come to the table as Americans, and in healthcare, as Americans who have the opportunity to make an impact on our entire country," says Ms. Reid.

Some of the ways Hoag has been able to reach high levels of patient satisfaction and quality lie in a number of factors, including using Press Ganey, reacting to patient satisfaction reports immediately and collecting their own data analytics.

"There is also a technology out on the market that allows our patients and nurses to interact via our television. We might ask them, 'is your room clean?' or 'how is your noise level?' So we intervene, in other words, if your patient needs something right now and we have a mechanism that lets us know that, we can go solve that right now. Then they see their needs are being taken care of in a timely fashion and they are happy," says Ms. Reid "You can not sustain this type of patient satisfaction and this type of clinical quality without a team of people who get up in the morning and come to work totally committed. This organization is about them."

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