With 37,000 individual members and nearly 5,000 hospitals and other provider groups on its roster, the American Hospital Association (AHA) is a major player in national healthcare debates and in shaping policies aimed at improving quality.
John Combes, MD, AHA senior vice president and president and chief operating officer of the association-affiliated Center for Healthcare Governance, serves on several national advisory groups on medical ethics, palliative care, and reducing medication errors.
Among his many duties, he is a principal investigator for a national project aimed at reducing hospital-acquired infections called “On the CUSP: Stop Bloodstream Infections,” sponsored by the Agency for Healthcare Research and Quality (AHRQ). (CUSP is the Comprehensive Unit-based Safety Program, developed by Johns Hopkins University and the Michigan Hospital Association.)
Dr. Combes recently talked with The Hospitalist about the AHA’s vision for healthcare reform, integrated care, and the role of hospitalists in redesigning hospital-based care.
Question: What are the AHA’s biggest priorities over the next year?
Answer: Healthcare reform and making sure that we can increase coverage for patients without insurance. There are 48 million uninsured in this country, and we are very supportive of increasing that coverage to make sure that people have good access to healthcare.
Q: The AHA has stated that “clinical integration holds the promise of greater quality and improved efficiency in delivering patient-centered care.” What’s your vision for clinical integration?
A: What we recognize is that in a reformed delivery system, we have to have a lot of partnerships between hospitals and clinicians—physicians in particular—and between hospitals and other facilities, such as long-term care facilities and post-acute facilities. We need to be able to bring better-coordinated care that meets the patient’s needs, and we need to work with each other to constantly improve that care. So that’s why we’re looking at an integrated delivery system. In our minds, it really means one registration, one bill, one experience for the patient.
Practically speaking, if you look at the healthcare reform legislation … there are pilots in there for accountable-care organizations (ACOs) and other payment reforms. And we’re very interested in making sure that hospitals can participate and take a leadership role in the development of those kinds of new structures.
Q: What role do you expect hospitalists to play in the continued drive for higher quality and more efficient care?
A: I think hospitalists can become a critical partner with the hospital in helping us redesign inpatient care to make it more efficient and effective. Additionally, hospitalists have a key role in engaging and keeping involved the community-based PCP, and making sure that they are considered part of the care team, even though they may not be present in the hospital, since they have the continuing responsibility for the patient.
I think as we look at other models of care delivery, such as the patient-centered medical home, it’s critical that hospitalists really develop some strong relationships and communication networks with those groups as well, so that the care for the patient can become seamless and transitions are not as dangerous as they’ve been in the past, in terms of missed opportunities and missed handoffs.
It’s critical that hospitalists really develop some strong relationships and communication networks with those groups as well, so that the care for the patient can become seamless and transitions are not as dangerous as they’ve been in the past, in terms of missed opportunities and missed handoffs.