Region’s hospitals increase cooperation through leadership groups
One of the toughest issues hospitals have faced during the COVID-19 pandemic is where to place patients — whether they’re COVID-19-positive or not — when they’re ready to leave the hospital but not ready to head home.
Most of the skilled nursing facilities where patients — most, but not all of them seniors — normally could be admitted would not take patients who were either COVID-19-positive or recovering from COVID-19 for fear of infecting their existing, vulnerable patients. They wouldn’t even take a non-COVID-19 patient unless the person had tested negative for the coronavirus twice in two days.
To try to address that and other issues related to post-acute care, case management leaders from the seven southwestern Pennsylvania health systems and hospitals organized a task force in late March to talk weekly and share best practices and common problems — a model based on one that the region’s hospitals’ chief medical officers had already formed early in March.
“We’ve all been trying to manage discharges during the pandemic,” said Dr. Monique Reese, senior vice president, home and community care, at Highmark Health, the parent company of Allegheny Health Network, who organized the group. “We didn’t know who would accept [COVID-19-positive patients], or who wouldn’t, and who had capacity. So we agreed as a group to leverage web technology so we could identify which nursing facilities and which home health organizations had capacity.”
The group, formally known as the Western PA Home & Community Task Force, involves the same seven health systems that are also part of the chief medical officers consortium: AHN, Butler Health, Excela Health, Heritage Valley, St. Clair Hospital, UPMC and Washington Health System.
Dr. Don Whiting, AHN’s chief medical officer who came up with the idea of the CMO consortium, said creating the task force and other groups of leaders in different specialties to talk about how to address the pandemic regionally, came out of discussions in his own consortium.
“There have been a fair number of connections made in the clinical communities during the pandemic,” Dr. Whiting said. “In all, we’ve created nine different work teams to talk over issues like the CMOs have done.”
In addition to the CMO consortium and the case management task force, all seven health systems and hospitals are participating in leader groups for interventionists, hospitalists, call centers, supply chains, command centers, disaster planning and infection control.
There has even been communication between the health systems’ presidents, Dr. Whiting said.
The CMO consortium itself was an outgrowth of a meeting Dr. Debra Bogen, director of the Allegheny County Health Department, put together between most of the health systems in mid-March, which spurred Dr. Whiting to create a formal group.
Dr. Bogen, who has taken part in some of those calls, said Wednesday during her online press conference, that the “level of collaboration is amazing and should really be an example for others around the country.”
“This regional collaboration has only brought good things to our citizens and our response,” she said. “That collaboration, I can’t say enough good things about it. And I hope that that exchange of information will continue long after the pandemic because it brings best practices to our community when we work together.”
All of this might come as a surprise to residents of the region used to the bare-knuckles competition that has been the hallmark of the Pittsburgh health care industry for most of the last decade — and not just between UPMC and Highmark/AHN.
“Well, it is a disaster time,” said Dr. Whiting. “This is not a normal time. When it comes to life and death, everyone rallies around; there’s no turf battles over this,” he said.
He points to the CMO’s first joint success: Agreeing to share 65,000 of the sought-after N95 masks that Highmark and AHN worked to get MSA Safety of Cranberry to donate. The masks were made available to every hospital in the consortium.
Similarly, the case managers’ task force got all seven health systems and hospitals to use the same technology platform to search for available skilled nursing facilities and home health care organizations that could take COVID-19-related patients.
The technology, called CarePort Guide, operates kind of like a search engine for hotels, for example, and lets hospitals search using patient-specific criteria for a skilled nursing facility or home health care organization that either has space or can provide in-home care to a discharged patient.
It comes with a public version where the families can look for a facility that is near them, or one with a higher federal rating, or even to take a tour of the facility virtually — much as a user would when looking for a vacation hotel.
Highmark and AHN were already using the technology but made it available to all the other systems that weren’t already on it, though UPMC already used a version of Guide.
It was a welcome offer for most of the health systems.
“It really cuts down on the calling back and forth with facilities,” Erica Shaffer, executive director of home, health and facilities at Excela Health, said of using the Guide. “It helps make sure there’s a safe discharge plan.”
Lissy Hu, founder and chief executive officer of CarePort, which is based in Boston, said it has been encouraging to see the health systems in Pittsburgh agreed to use the Guide.
Since “many health systems work with the same nursing homes in the community” and home health organizations, she said, “coming together and using one platform is beneficial not only to the hospital and provider, but the skilled nursing facilities and home health organizations.”
Despite the use of the technology, what the health systems all found was there were very few beds available for them to place anyone other than someone who had not had COVID-19 and had had two negative tests in 24 hours — something the hospitals understand.
“They have a huge vulnerable population,” said Lynn Watson, director of continuum of care at Washington Health System, “and they would not want to take a risk on a patient without knowing they were safe.”
“Facilities are being overly cautious. They want to understand what’s coming into their building,” she said.
The result of that has been some necessary workarounds, said Deborah Brodine, president of UPMC Senior Services.
“Frankly, what’s been happening at UPMC hospitals has been that we just keep those patients at the hospital longer” until they can be sent home to get in-home care, she said, something other hospitals said they have done, too.
One of the biggest benefits from the task force has been being able to share frustrations with peers on a weekly basis, said Joann Hatton, system director of utilization management at Heritage Valley Health.
“It’s nice to collaborate, I think,” Ms. Hatton said. “It’s been reassuring to know we’re not alone” in trying to figure out some of the challenges during the pandemic.
The question, as it is for all of the now nine groups that the health systems have participated in, is whether it truly marks a change for health care in the region of cooperation over competition.
“I’m not sure,” said Kaitlin Shotsberger, executive director of quality and care management at St. Clair Hospital. “We certainly see the utility in it. It helps provide additional information to families and patients. But I’m not sure if [the task force] is going to just be a COVID-19 thing or not.”
“I hope so,” she said. “I think anything that can unify options for patients across the region is beneficial.”
By Sean D. Hamill – Reporter, Pittsburgh Post-Gazette