Hospital loyalty low among patients in central Indiana

Hoosiers in central Indiana express little loyalty toward hospitals when seeking care, a study from Regenstrief Institute Inc. suggests.

The analysis by the Indianapolis-based institute asserts that of all patients visiting a hospital twice in one year, roughly half went to two different hospital systems.

The results might seem eye-popping at first glance, but aren’t that surprising to Dr. Blaine Takesue, an institute researcher who led the study.

“You have people who have insurance who can go wherever they want to [for care],” he said. “With a [health maintenance organization], you have to go where they tell you, but there’s a lot of people who don’t [have to].”

Health care officials in the Indianapolis area say patient choice historically has been a higher priority for both employers and employees in Indiana than it has in many other states.

Yet more important, the high rate of patient crossover could help bolster the argument for health information exchanges, whose electronic capabilities allow physicians to share patient records more easily.

Takesue launched his study, just completed in September, about six months ago after he became curious about how many patients at his Indiana University Health-affiliated practice on the south side visited other facilities.

Using data from the Indiana Network for Patient Care (INPC), a database of patient records operated by Regenstrief, he and fellow researchers identified 860,000 patients who had lab tests performed during the first six months of 2010 at facilities within the city’s five major health systems.

The patients subsequently generated more than 1 million hospital visits during the 12 months following their initial visits, which Takesue and his team categorized as “in system” and “out of system.” The study found that at least 50 percent of patients visited two different hospital systems.

Regenstrief’s interest in the widespread patient mobility is to argue for the use of health information exchanges that allow hospitals to easily swap medical records, thereby avoiding redundant tests that drive up costs and sometimes put patients in more danger.

Area hospitals share patient records electronically through Regenstrief’s network. And doctors can receive lab reports and quality reports from services provided by the not-for-profit Indiana Health Information Exchange (IHIE).

Nationally, provisions of the 2009 federal stimulus promote the expansion of electronic health records by authorizing $38 billion in spending to help doctors and hospitals establish electronic medical record systems.

Hospitals adopting electronic records more than doubled from 2009 to 2011, to 35 percent, according to a survey by the American Hospital Association that the U.S. government reported in February.

At Franciscan St. Francis Health on the south side, Dr. David Mandelbaum has led its transition to electronic medical records since the system went live in February 2011.

The learning curve has been pretty steep for much of the hospital’s staff, but most realize the benefits, said Mandelbaum, who spent 23 years as a general surgeon.

“I can’t tell you how many times I saw a patient sent to me by a referring physician who said, ‘Gosh, I’m here to see you about abdominal pain and, oh, I had a CAT scan at one hospital and an ultrasound at another hospital,’” Mandelbaum said. “If we didn’t have those records prior to their arrival, good luck in getting them in the allotted time.”

But the Regenstrief data from Takesue’s study also show that hospitals have their work cut out for them under the new concept of accountable care organizations.

So-called ACOs derived from the Patient Protection & Affordable Care Act require hospitals to manage the health—in and out of the hospital—of a specific group of patients. And it’s much more difficult to do that if those patients are frequently going somewhere else for care.

Each ACO must take responsibility for managing the health of at least 5,000 Medicare patients. In one estimate, the federal government expects the program to save it $940 million over four years—although others say the savings could be a lot less.

Managing patient care would be much easier if every hospital used the same electronic medical record system, but that is unlikely, said Dr. John Fitzgerald, CEO of IU Health Physicians, a joint venture of the IU Health hospital system and the IU School of Medicine.

IU Health uses eClinicalWorks while St. Francis prefers Epic Systems, for instance. Still, with the help of IHIE and Regenstrief’s INPC, Indiana is still considered a “top model” for the implementation of electronic medical records, Fitzgerald said.

“It is really to the patient’s benefit and for their quality of care to reduce duplicate testing and the cost of care,” he said.

Meanwhile, Takesue said local hospitals are beginning to take steps to retain more patients.

“Every hospital is trying to capture as much of the market as they can,” he said. “That’s why you see IU Health building west and north, to build facilities where patients are.”

The Regenstrief study is just the fourth in the United States to examine the extent of patient crossover between health care organizations, Takesue said. However, the previous three are not as broad. One conducted in Atlanta, for example, restricted its research to neurosurgical patients.

Takesue, also an assistant professor of clinical medicine at the IU School of Medicine, hopes to have the results of his study published in a medical journal.•