Yoga instructor Karin Bertozzi had just finished class one day last October when she stepped into a market to buy lunch. “I felt great,” recalls the mother of three from Bethesda, Maryland. She felt no chest pain, no breathlessness, nothing to indicate that the wall of her aorta was about to burst. Moments later, she collapsed. An ambulance took her to nearby Suburban Hospital, now a member of the Johns Hopkins Medicine family, where surgeons repaired a tear in the wall of her heart’s biggest artery. Today, Bertozzi, 47, is eager to lavish praise, though she’s uncertain where it should fall. “Suburban or Hopkins saved my life,” she says. “And I’m here to talk about it.”
In an era of surging competition, declining admissions and shrinking spending, it’s becoming increasingly common for hospitals to have more than one name on the door. Many hospitals and systems are teaming up to attract patients, cut costs and polish their reputation for excellence, as Suburban did when it agreed to merge with Johns Hopkins, some 40 miles away in Baltimore, six years ago. Brand-name medical centers and their community counterparts benefit in different ways, experts say. “The big brands extend their geographic reach and presence. Smaller hospitals bask in reflected glory,” says Stuart Seides, physician executive director of MedStar Heart & Vascular Institute in the District of Columbia, which in 2013 formed a “clinical and research alliance” with Cleveland Clinic. What do these mergers and alliances mean for prospective patients? It’s worth asking a few questions to try and assess whether a relationship is leading toward performance improvements and better care or is more about marketing.
In the case of Suburban Hospital and Sibley Memorial Hospital, another member of the Hopkins family located in the District of Columbia, patients will continue to be cared for by local community-based physicians, most of whom are not Hopkins academics, even if now part of a group bearing the Hopkins name. However, if patients need more sophisticated care, perhaps guidance getting rapidly into cutting-edge clinical trials, they have more streamlined access to top specialists at Johns Hopkins Hospital; physicians can make the arrangements by simply picking up the phone. (Those who prefer to be referred to a local D.C. expert closer to home still have that option.) Bertozzi, whose medical history suggests an inherited connective tissue disorder that may run in the family, is consulting with cardiovascular geneticists at Hopkins. “We think it’s important for my kids and siblings, so we know what we’re dealing with,” she says.
Behind the scenes, a set of quality assurance and performance improvement procedures designed to upgrade patient-safety procedures on every unit within the Hopkins system have been implemented, targeting such potential risks as patient falls, infections and drug administration errors. “Every Monday, everything happening at every hospital is reported centrally,” says Suburban’s president, Gene E. Green.
Mayo Clinic and Cleveland Clinic are also intent on improving outcomes and the patient experience, though they’re branching out in a different way. Rather than accumulate hospitals — Mayo already owns 22, while Cleveland Clinic has 11 — they’re building relationships with the goal of sharing their expertise and opening doors to new research opportunities.
Both systems carefully screen potential affiliates. “It’s a pretty deep dive,” says David Hayes, medical director of the Mayo Clinic Care Network. Once affiliated, the institutions share their medical wisdom in a kind of plug-and-play format. Hayes likens the concept to the “Intel Inside” sticker on his laptop. Patients gain access to “a deeper bench of specialists.”
Mayo affiliates pay a subscription fee to tap the medical center’s expertise across all specialties; Cleveland’s program charges the hospitals for its initial six-month screening and an annual fee for cardiac-care expertise. Mayo’s network includes more than 30 U.S. hospitals, among them Tucson Medical Center, Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and Northshore University HealthSystem in Illinois. Besides MedStar in D.C., Cleveland Clinic’s 21 partners include Dallas-based Baylor Scott & White Health and North Shore University Hospital in Manhasset, New York. “You can have an impact by taking care of patients directly, and you can have an impact by working through and with others,” says Ann Huston, Cleveland Clinic’s chief strategy officer.
Here’s where their approaches diverge. Mayo experts serve as a resource; AskMayoExpert, a Web-based information system, allows doctors to obtain clinical information and treatment guidelines on hundreds of medical conditions. Mayo also offers eConsults and eTumor Boards, so local doctors can consult directly with Mayo specialists. “We’ve got great doctors on our medical staff, and they do great things, but we don’t have anyone on staff who treats only heart tumors,” says Jeffrey DiLisi, chief medical officer of the Virginia Hospital Center in Arlington, a Mayo affiliate. “Now our VHC patients have access to specialists with that kind of expertise.” Once a year, Mayo experts visit and review all performance measures to determine whether care is high quality and readmissions, complications and deaths are kept to a minimum. If they find an issue, DiLisi says, they help address it.
Cleveland Clinic applies the same standards to surgeons at affiliated centers that are used to evaluate surgeons in Cleveland, says Joseph Cacchione, chairman of strategic operations for the clinic’s Heart and Vascular Institute. Although affiliates are managed locally, he says, they are “centrally accountable” for the quality of their heart care. Little escapes the notice of the clinic’s quality experts, who review all deaths, imaging studies and the appropriateness of care and monitor data on such key factors as infection rates and time in the operating room. “Every quarter,” says Seides, “we submit 156 data points that have to do with heart and vascular care.” Any lapse is scrutinized, and safeguards are put in place to keep it from happening again.
Affiliates get to use the institutions’ names in their advertising. And a number of the best-performing Cleveland affiliates are also assured a stream of patients thanks to the clinic’s relationships with a growing list of large self-insured employers, such as Walmart, Lowe’s and Boeing, that want high-value heart care for their employees. Increasingly, clinic physicians are sending patients that once might have traveled to Cleveland to affiliates closer to home. All get the benefit of a second opinion, which in 10 to 15 percent of heart surgery cases brings welcome news that surgery isn’t needed after all, Cacchione says.
The partnering trend is still young, and it may not be possible yet to get a firm indication that a relationship has led to better care. “I haven’t seen any evidence that hospital integrations lead to any improvements in quality or cost reductions,” says Barak Richman, a Duke University professor of law and business administration who studies hospital partnerships. For one thing, he notes, “you’re dealing with medical personnel who crave independence and aren’t particularly good at taking directions.” So ask the same tough questions no matter whose name is on the door. How many of these procedures do you do a year? What are your mortality and complication rates? How long does it take before your patients return to their daily activities? Be wary of doctors or hospitals that refuse to answer. “If you’re going to bring yourself or a loved one to an institution, and you’re looking at a brand,” Seides says, “you need to understand what this means.”
Excerpted from U.S. News’ “Best Hospitals 2016,” the definitive consumer guidebook to U.S. hospitals. Order your copy now.
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What Does a Hospital’s Brand Name Mean? originally appeared on usnews.com
