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Minutes of Y's Men Meeting of March 9, 2017

Michael Daglio

Along with his position of Norwalk Hospital President, Mr. Daglio is the Chief Strategic Officer of the Western Connecticut Health District.

This group is moving toward value based medicine.  This means that payment will no longer be based on services provided by the hospital, but on the achievement of wellness for the patient through reduced costs, standardized care and increased service. The emphasis will be on preventing people from having to go to a hospital, but providing excellent care if they do have to go.

To accomplish this there must be an expansion in the field of primary care.  This requires more physicians who do more than the old model for primary care and who do it with standardized care to achieve the best outcomes. This can prevent hospital visits.

There is no doubt that services provided in hospitals cost more than similar services provided outside a hospital setting.  Yet, some outside service providers can provide better services than a hospital at the lower cost because they can bring economies of scale to the process along with a staff that just specializes in particular services.  Hospital need to outsource these services to these outside providers.  Western Connecticut Health District is doing this now with lab services and wants to expand this approach to radiology in the near future.  The District is also encouraging the development of community health programs that promote better behavioral health practices for their served populations.  The District is also partnering with specialists who can provide their services in the District using District staff trained to the specialty standards. One such partnership in the future will be with the Sloan Kettering hospital for cancer care.  The District is also beginning a sharing program among its hospitals so expensive services and equipment are not duplicated among these hospitals.

Q & A

Q.  Are you getting specialists tied in with urgent care centers?

A.  Urgent care centers are low cost providers and we are attempting to get them surrounded by specialists.

Q.  How do proposed changes in the health care law affect you?

A.  Don’t know the answer yet about payments, but the state is hurting us more than the Federal government.  We pay a lot into the state and get very little back.

Q.  What is a concierge practice and what are its benefits and costs?

A.  The costs vary depending on the practice, but it provides highly personalized service.  It is a newer model and one growing in popularity.

Q.  What is happening with the new focus on single rooms in hospitals?

A.  We are trying to keep people out of hospitals, but we still have to modernize and the new hospital codes require single rooms.

Q.  How are you dealing with fixed costs?

A.  Fixed costs are overwhelming many hospitals particularly small ones.  You need volume and this leads to necessary consolidation.

Q.  Why isn’t customized care better than standardized care?

A.  By standardized care we mean providing those things that have proven to be most effective, but every patient is still treated individually.

Q.  Can hospital food be improved?

A.  Bad food is often the result of doctor placed restrictions on a diet. The food is getting better and we now use an outside service that can provide higher quality food at a lower cost.

Q.  What is good and bad about the ACA?

A.  It incentivizes the right things, but is unpredictable as to its compensation levels.

Q.  Why different compensation levels for admissions for observation rather than in-patients?

A.  Observation patients are treated as out-patients so those rules apply.

Q.  Why are physicians compensated in accordance with their number of relative value units (“RVUs”)?

A.  That is the old method of compensation that resulted in doctors seeing as many patients as possible during a day.  We are attempting to get away from that model and go to a model that compensates based on outcomes.

Q.  Why can’t my own physician visit me in the hospital?

A.  He can, but your in hospital care will be directed by the hospital physicians to expedite the process and get you released sooner.

Q.  Do CT hospital building codes require that they be built to allow for additional expansion?

A.  No, but at Norwalk we build in extra space.

Q.  If hospital costs are being reduced, why aren’t consumer costs going down?

A.  Not all hospitals are doing what we are doing and it takes a little time for the savings to be realized.

Q.  Why doesn’t Norwalk use some of the St Vincent’s physicians if that would help St Vincent stay afloat?

A.  The economics are such that we have to use in-network physicians.