Medical Technology Leadership Forum

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Medical TechnologyLeadership Forum

• October 15, 2007
• Bruce G. Pitts, MD, MBA
• MeritCare Health System

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MeritCare

• Multispecialty group practice with 420 employed
  physicians and 183 midlevel providers
• 35 practice locations in ND and MN
• 583-bed tertiary care teaching hospital on 2
  campuses in Fargo
• 7500 employees 23,000 hospital admissions
• 1.4M clinic visits per year
• 750M annual net revenue
• Home Health, DME, Pharmacies, air and ground
  ambulance
• Connected by EPR, PACS, telehealth, ground and
  air transport, web of administrative and medical
  outreach

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ND Healthcare

• 80 of care provided by 4 health systems
• Old, physician-driven, not-for-profit,
  rural-urban, integrated health systems
• Fate of MD and for-profit ownership

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Total Medicare reimbursement per enrollee (Part A
B) State Level Rates (2003)
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Inpatient Part A reimbursements per
decedent during the last two years of life
(2000-2003) State Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Sum of inpatient reimbursements and Part B
payments per decedent during last two years of
life (2000-2003) State Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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PCP visits (Part B) per decedent during last two
years of life (2000-2003) State Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Medical specialist visits (Part B) per decedent
during last two years of life (2000-2003) State
Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Total MD visits (Part B) per decedent during
last two years of life (2000-2003) State Level
Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Medical specialist FTE inputs per 1000 decedents
during last two years of life (2000-2003) State
Level Rates
ND
Primary care physician FTE inputs per 1000
decedents during the last two years of life
(2000-2003) State Level Rates
ND
Dartmouth Atlas
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Total physician FTE inputs per 1000
decedents during the last two years of life
(2000-2003) State Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Hospital days per decedent during the last two
years of life (2000-2003) State Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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All hospital discharges per 1000
Medicare enrollees (2003) State Level Rates
ND
Ratio to ND Benchmark
States
Dartmouth Atlas
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Procedure rates per 1000 Medicare enrollees State
Level Rates (2003)
ND
ND
CABG
Carotid Endarterectomy
ND
Coronary Angioplasty /- Stenting
Dartmouth Atlas
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Net Flow Ratios of Personal Health Care
Spending By State of Residence (1998)
Net Flow Ratios
ND
States
Martin, A. et. al. Health Care Spending
During 1991-1998 A Fifty State Review, Health
Affairs, 21 (4) 112-126.
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PMPM Cost on Risk Adjusted Basis
BHCAG data
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ND Population Health
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AHRQ Meter Score for Overall Health
Care ND 59.74 (12th of 50 states) Best
Performing States WI 65.76 MN 62.77 NH 62.36
ME 62.35 RI 61.67
AHRQ, 2006
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Maybe you can have it all

• Not-for-profit ownership model and integration of
  health services - permits alignment of
  incentives, removal of waste, lower cost, higher
  quality
• The ecosystem of health care - managing something
  that is very complex to create value where
  clinicians and patients meet
• Value creation, glue, and the buffering of
  perverse incentives