Carilion Clinic: Carilion COO Nancy Agee Elected Chair of Virginia Hospital & Healthcare Association

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Thursday, November 6, 2008

Carilion COO Nancy Agee Elected Chair of Virginia Hospital & Healthcare Association

Calls for providers to improve care, safety and efficiency

RICHMOND, VA (November 6, 2008) Members of the Virginia Hospital & Healthcare Association
(VHHA) today elected Nancy Howell Agee, executive vice president and chief operating officer of Carilion Clinic in Roanoke, chair of the association. Ms. Agee was honored earlier this morning during the association's 82nd Annual Meeting of the Membership at The Homestead in Hot Springs, Virginia. She succeeds Michael J. Schwartz, president and chief executive officer, Prince William Health System in Manassas, who remains on the VHHA Board of Directors as immediate past chairman.
In remarks to the membership, Ms. Agee stated, "Our mission and vision are clear: to improve the health status of the communities we serve and to make Virginia the healthiest state in the nation. We will face obstacles in the coming year that will make our goals more challenging.
But together, we can and will make improvements to the care we provide, making it more efficient and safe...and we can weather any storm so long
as we are unified."

(Here is the entire text of her address to the VHHA membership this morning)

2008 Annual Meeting of the Membership
Virginia Hospital & Healthcare Association

Remarks by Nancy Howell Agee, Chairman

It is an honor to stand here today as your new chair of the Virginia Hospital & Healthcare Association. Our membership is characterized by a healthy diversity, and we each have our own set of unique issues with which we grapple. But, as an association we come together unified by a common purpose to care for patients.

I want to thank my Family. And, I also want to recognize my fellow Carilion Clinic attendees who are here today. Thank you for the work you do every day to make Carilion Clinic what it is today. As Mike mentioned earlier, as an Association, we have done much to further health care in Virginia and collectively we take pride in our accomplishments.

And, yet, we have much more work to do.

As a field, we must make changes to become a stronger, more efficient system of care and be ever more vigilant in protecting our patients and our communities.
There are winds of change all about us, not the least of which is a new political climate. Regardless, our principles and values must remain steadfast.

Our work together is important. In my opinion, there are four compelling issues which should shape our work over the next few years.

First, we need long-term, viable solutions for growing our healthcare workforce. We all know the statistics – and we all know it’s not just nurses. Though, we are making some progress. Just two weeks ago, the Virginia Community College System reported a 67% increase in the number of nurse graduates in their 23 programs across the State. The increase is attributed to implementing several recommendations from our 2005 Task Force. Many of you or your staff provided comments and participated in the Task Force’s hearings on Nursing education.

In addition, several innovative programs have been initiated such as the one announced last Friday between Shenandoah University and Inova Health System to expand the accelerated second degree Bachelor of Science in Nursing Program.

Workforce shortages from Nurses to Pharmacists and Therapists to Physicians are a national topic of discussion. Yet, we need to do more than talk. While we can’t solve these perplexing problems on our own, we must redouble our efforts to ensure that more solutions are forthcoming.

We need to continue educating the public and our Federal and State policymakers on how workforce shortages affect patient care. We need to find ways to fund education and innovative approaches to staffing. From health career camps to raise enthusiasm for health care careers among young people to the recently announced efforts to create the VTC School of Medicine, we must find new ways to assure a viable workforce.

Creating a stronger, more diversified workforce is important, but even the best qualified, mostly highly trained staff won’t enjoy meaningful work if we don’t improve the care we provide.

Our second important issue is assuring patient safety and high quality of care. These efforts lie directly in our hands. As Mike stated previously, work has already begun on three separate initiatives to improve patient safety in Virginia, and they will continue in 2009 and beyond. The VHHA has asked nursing homes, physicians and nurses to join us in these efforts. To truly be successful, all of VHHA members must participate as well. The buck should stop here. Ultimately, we are the ones responsible. Our patients come to us at times of great need and when they are most vulnerable. They trust us to give the appropriate and necessary care they need. They should expect and receive high quality care free of errors.

Ensuring the highest quality of care and keeping our patients safe should not be obtained at the cost of over treatment. My third issue. Our society has the ability to cook dinner by pushing a button. Little wonder, that our society both questions most of what we do and expects us to provide comprehensive services at low costs and nearly instantaneously. That said, it’s our responsibility to assure that safe, high quality care is provided efficiently.

A litigious environment and fear of not covering every base if someone comes in complaining of a headache, however, should not compel us to provide more services than a patient really needs. Additionally, efficiency should not prevent us from listening intently to what our patients are trying to say. When a patient navigates our fragmented system of care obtaining a CT Scan, multiple lab work and MRI, seeing specialist after specialist all at a high cost and possibly low value, are we truly providing a safe and caring environment? Are we truly advocating for our patients. We must work at improving efficiencies and taking the time to listen to our patients because sometimes a headache is just a headache and aspirin might be the best medicine.

In the October 30 issue of the New England Journal of Medicine, Henry Aaron authors an article entitled, “Waste, We Know You Are Out There.” Aaron quotes Peter Orszag, Director of the Congressional Budget Office, in his August 2008 notice that “a variety of credible evidence suggests that health care contains the largest inefficiencies in our economy. As much as $700 billion a year in health care services are delivered in the U.S. that does not improve health outcomes.

The challenges to reduce waste are monumental. As Aaron himself points out, unfortunately the U.S. health care system could not be better structured to frustrate the elimination of waste than if it was designed to do so; commercial payors lack leverage; Medicare, by law, cannot exercise supervision or control over the practice of Medicine; patients have little knowledge or financial incentive to avoid waste. And, doctors – whose ethics and training enjoin them to do what is best for patients and whose financial interest may cause them to interpret what is best, perhaps over broadly, have few incentives to root out waste.

And sadly as we may know but much of the public doesn’t realize, scientific evidence to support medical practice is frankly scarce.

Senator, now President-Elect Obama has suggested as part of his health care reform that we earmark 1% of Medicare revenues and a similar amount from private insurers and others to evaluate treatments and to establish a national electronic database on medical outcomes.

This leads to my last point. As an association, we have the opportunity and the challenge to aid the Commonwealth and, indeed the nation, in making material advancements towards reducing health care costs. The U.S. spends two times as much per capita on health care as the average of the ten other richest countries in the world. The U.S. healthcare system is as large as the entire economy of France. Yet, more than one person in six younger than 65 is uninsured. And, while other countries spend less per person than we do, they notably achieve equal or superior results.

To continue following our same processes, ever begging the Government to not cut one more time, is the classic definition of insanity: doing the same thing and expecting different results. I am reminded of Charlie Brown’s innocent faith that this time Lucy will not yank the football away.

Let’s face it; both business and labor leaders alike are convinced that employer financed health care is undermining U.S. competitiveness. Many business executives, long opposed to healthcare reform by the Government are now clamoring for Government involvement. Ted Kennedy is working feverishly to draft one big bill to achieve universal health insurance coverage and reform the U.S. health care system. Most authorities suggest that a complete overhaul is unlikely. I would agree with them but for the confluence of Ted Kennedy’s own illness and the respect that he holds by fellow Senators along with a clear message that the American public is fed up with business as usual. Increasing outlays for Medicare and Medicaid threaten a fiscal meltdown. Add to that, the potential for expanded S-Chip and other expenses lead to only one conclusion. There will be less money and more requests for services. Approaching the burgeoning issues in health care like we have always done is just like Charlie Brown’s approach to the football that Lucy held – heedless of experience, hopeful without a strategy and flat on his back.

In summary, we are challenged on to be united in our dedication to health care reform. We must act with thoughtfulness yet dispatch, confidence coupled with wisdom, pledged to face down naysayer’s and meet the challenges ahead.

Together, we can and will make improvements to care delivery, find ways for efficiency and safety and develop sustainable workforce. We can drive out waste and develop health care reform we can all believe in and that Americans can afford.

I look forward to working with all of you as we move forward.

Thank you.