In a similar situation
ERIE – It’s a small thing, said Anne Pedersen, clinical director of UPMC Hamot hospital’s Emergency Department, when a Mirror reporter visited here recently.
New chairs in a conference room – no big deal.
But to Pedersen, they’re a telling indicator of the benefits Hamot realized after its acquisition by UPMC in 2011.
“We have the resources here now to do the things we needed,” she said.
UPMC has acquired many hospitals over the years to create its world-famous western Pennsylvania system, but the Hamot acquisition is the one most similar to the takeover of Altoona Regional Health System, which UPMC is hoping to complete by July 1, officials say.
In taking over Hamot, UPMC has committed $300 million, incorporated the Erie hospital into its computer system, added services by sending specialists routinely from Pittsburgh, provided easy access for Hamot doctors to consult with experts in Pittsburgh and generated credibility that helps recruiting and enhances Hamot’s service to smaller hospitals in its region, according to Hamot officials – including President Jim Fiorenzo, who spoke at a meeting of the hospital’s community “corporators” on the day of the reporter’s visit.
“It’s all positive,” said corporator Laurie Root of her hometown hospital’s affiliation with the Pittsburgh giant.
She lived for 30 years in Washington D.C., where it’s easy to take first-rate health care for granted.
It’s not so easy to take it for granted in Erie, but it’s available nonetheless, she indicated, because of the UPMC affiliation.
The care is personal for her, because it has enabled her husband to avoid the stress of traveling to Pittsburgh – as he would have had to do otherwise – for treatment of a back problem, she said.
UPMC is investing the $300 million over 10 years to upgrade facilities and secure the hospital as a regional hub and referral center, according to officials.
That investment includes the expansion of Hamot’s “horribly undersized” emergency department, according to medical director Dr. Fred Mirarchi.
Independent hospitals in similar need find themselves in a “devastating situation,” he said.
With 83,000 visits a year, Hamot’s emergency department is the busiest in the UPMC system, but it only has 34 beds.
Ideally, it should have 70, he said.
UPMC has already upgraded two trauma bays at $40,000 each, with another on the list.
The trauma upgrade will include the addition of intravenous fluid warmers, which can be critical in treating hypothermic patients.
The emergency department work has also included installation of a secure electronic medication dispenser, which tracks who removes what pills and when and how many pills of each type are left.
The dispenser system replaces a more time-consuming and inefficient procedure that involved the emergency department contacting the pharmacy and it sending the pills through tubes.
UPMC incorporated Hamot into its electronic records setup one night last September after 500 workers from Pittsburgh spent two weeks in Erie, according to Hamot Chief Medical Officer Dr. Richard Long.
Hamot’s old system had 64 subsystems, according to Long.
It now operates on two, according to Fiorenzo.
Hamot had spent $30 million over 10 years on the old setup, which had deficiencies including limited programs for doctors, finance and human resources and some components’ inability to “talk” to others, Long and Hamot spokeswoman Carly Manino said.
An unaffiliated Hamot would have struggled to keep up with future technology development, Fiorenzo said.
The kind of change UPMC bestowed would have cost $40 million if Hamot had remained independent, according to Long.
UPMC has spent billions on its technology systems, which are “the Cadillac versions of everything,” Long said.
UPMC’s visiting specialists include five from Magee-Women’s Hospital of Pittsburgh, whose need-based appearances “enhance the local gynecologic care women are already receiving from their own physicians in the Erie region,” according to Debbie Burbules, president of UPMC Women’s Hospital and the Hamot website.
Those doctors’ services include maternal-fetal medicine, gynecologic oncology, urogynecology, reproductive endocrinology and multiple births, according to the website.
Hamot couldn’t have afforded those services on its own, because it lacks the population base to support them, Burbules and Long said.
Specialists come to Erie also to cover patient needs when there’s a shortage of a particular kind of doctor, Long said.
Of all Hamot’s departments, the Women’s Hospital probably benefitted most from the merger, Burbules said.
“There hasn’t been a downside,” she said.
UPMC pediatrician specialists in gastroenterology, pulmonary care, endocrinology and cardiac care also come routinely for clinics at the Shriners Hospital in Erie, helping to keep it open, Long said.
Patients appreciate having services in town, Long said.
“No one wants to drive to Pittsburgh,” said neonatal specialist Dr. Michael Balsan.
Local care is less expensive, more efficient and more satisfying to patients, Balsan said.
Hamot doctors can now consult comfortably with top UPMC experts and make referrals more knowledgeably.
They have unfettered access to first-rate “intellectual resources” like renowned “thought leader” Dr. Andrew Peitzman, chief of the Trauma and General Surgery Division, Pedersen said.
Ditto for Dr. Joseph Darby, medical director for critical care outreach at Presbyterian-University Hospital.
Doctors can email Peitzman and get a reply immediately, Pedersen said.
The merger has also “cut through some of the stuff” that sometimes make referrals difficult, Balsan said.
It has helped create a network of relationships that can make it “seamless” for patients who need to go to Pittsburgh for services not available in Erie, like heart transplants and complex valve replacements, said Theresa Kisiel, executive director of cardiovascular nursing and quality at Hamot. “You know the protocols,” Kisiel said.
Those kinds of patients come back to Hamot for follow-up care more often than before the merger, and their doctors in Pittsburgh are easily available for follow-up consultations, Kisiel said.
Those network connections allow an Erie-area patient who has lost 90 percent of his heart function to live at home after getting a ventricular pump implant in Pittsburgh, according to Kisiel.
“Doctors my doctor trusts,” she said. “Not just somebody we hear is good.”
The merger has given Hamot access to various best practices through regular committee meetings with representatives from all the hospital affiliates, according to Long.
A “huge initiative” is the Clinical Decision Unit that congregates observation patients – those too sick to go home, but not sick enough to admit.
Their numbers were up to 7,000 last year, 1,500 more than the year before, Long said.
Grouping them allows nurses to focus on getting them in and out – or admitted – quickly, without compromising safety.
The hospital gets only about 25 percent as much reimbursement for observation patients as the $7,000 a day it has been getting recently for inpatients, and payers expect those observation patients to be out of the unit within 24 to 36 hours, according to Long.
“It behooves you to move them through,” he said.
There’s also patient satisfaction.
“If you come in with a minor problem, [you] don’t want to sit in here,” Long said.
A common observation diagnosis is chest pain, and the unit nurses are focused on EKGs, blood tests and stress tests that can differentiate between those who need help and those who don’t.
It was much harder to focus on patients who ended up with indigestion under the old system, when they were next door to one recovering from open heart surgery patients, Long said.
Every day the clinical decision staff reviews the status of all its patients, with the expectation of moving a percentage along.
“Every hospital in the country is dealing with this,” Long said. “It’s the new normal.”
Another best practice initiative seeks to quicken emergency department “throughput” with the help of UPMC Mercy.
The goal is to get patients out the door within 150 minutes or admitted to the hospital within 210 minutes.
Since Hamot began working on the problem, its numbers have improved, and are now within the guidelines, Long said.
“You hear stories of eight-hour waits in emergency rooms,” he said. “You can’t have it.”
The best-practice committees cover issues such as quality metrics, information technology, purchasing and pharmacy, and the best ideas get adopted by vote, Long said.
It’s a two-way street, for UPMC adopts ideas from local affiliates.
It has adopted Hamot’s clinical information system and its practice of posting banners with a slogan to encourage frequent hand-washing systemwide, according to Long and Manino.
It’s easy to share best practices when you’re in a hospital “family,” Burbules said.
It’s not so easy when you’re independent, because of pride and competitiveness among hospitals, Burbules said.
Attracting doctors easier
The credibility injection from merging with UPMC has made it easier to attract doctors who might previously have hesitated for fear they “were coming to Podunk, Pa., never to resurface,” Burbules said.
“You are tapping into a world-renowned system,” she said. “They’ll give us a try.”
They know if it doesn’t work out in Erie, there’s a “lifeline to a bigger entity,” with other options, she said.
Those can include a professorship, Fiorenzo said.
The additional credibility has enabled Hamot to exert its influence more effectively within the Erie area, according to Kisiel.
On one ambulance call, emergency workers transporting a Jamestown, N.Y., patient to a helicopter landing site felt enough confidence to open an artery under guidance by Hamot personnel, who were working with protocols partly devised by UPMC, Kisiel said.
Only one official encountered by the reporter expressed reservations about the merger: corporator Steven Simon, a Russian Orthodox priest, community activist and former practicing lawyer.
Overall, the affiliation is probably good, Simon said.
But many people in Erie remain skeptical, having seen companies leaving town after they passed out of local control – including Hammermill Paper, he said.
He doesn’t like cynicism and is willing to trust “people in really high positions who continue to tell us how wonderful [the UPMC merger] is,” he said.
“But there’s a certain element of ‘let’s see,'” he said.
The UPMC affiliation agreement includes promises to maintain specialty services at Hamot for at least 20 years – including level two trauma, cardiac, neurosurgery, neurology, orthopedics, oncology, plastic surgery and women’s and children’s health.
But after that agreement expires, Simon wondered, is UPMC going to be sensitive to local needs or simply “look at the bottom line?”
Health care is highly complex, and UPMC is “world-class,” he said.
“[But] in the long run, Pittsburgh calls the shots,” he said. “There’s a certain sorrow that we’re not running the show anymore.”
Many Hamot doctors were worried when they first learned about the possibility of merger with the “giant to the south,” Long conceded.
There’s always some “angst” when a hospital contemplates being acquired, said Balsan, who worked as a UPMC contract employee at Hamot for years before the merger.
They worry about loss of local control and a mass exodus of patients to the takeover hospital’s main campus, he said.
But the fear of loss of local control is always “illusory” because there isn’t any real local control in health care anyway, Balsan said.
And rather than a mass exodus of patients, the UPMC merger has actually resulted in more local care, he said.
Statistics bear that out: since UPMC acquired Hamot on Feb. 1, 2011, 7 percent fewer Erie County residents have left the county for care – even as 8 percent more out-of-county residents have come in, according to a hospital-generated chart.
That happens because of the strengthening of care at the local hospital, according to Balsan.
The fears have not come true, Long said.
Mirror Staff Writer William Kibler is at 949-7038.