Jefferson Healthcare providers are taking a look at an affiliation agreement between the rural public health care system and nonprofit Swedish Health Services in the aftermath of a Seattle Times investigation into the Swedish Neuroscience Institute.

The CEO of Swedish Health Services, Tony Armada, resigned Feb. 21 amid controversy about the rise of surgeries at the Swedish Cherry Hill facility, raising concerns about patient care and contracts with doctors that emphasized volume and billing, according to stories in the Times.

Armada resigned a matter of days after Jefferson Healthcare Chief Executive Officer Mike Glenn reported to hospital commissioners Feb. 15 that the hospital’s provider leadership council, a group of doctors and others who are involved in the clinical operations as well as administrative operations, was to look into the affiliation and see if “there are any appropriate next steps to it,” including whether any action should be taken regarding patient referrals to Swedish.

Glenn told the board Feb. 15, and repeated in a Feb. 27 interview, that referrals to Swedish are provider to provider and that they are not part of the affiliation agreement.

“Jefferson Healthcare providers are under no obligation to refer patients to Swedish,” Glenn told commissioners. “The affiliation is largely administrative.”

Glenn said Monday that he does not think the hospital tracks the number of patients referred from Jefferson Healthcare clinics to Swedish programs, although that figure could show up in market share reports. So, he said, without that data, which he doesn’t have, he doesn’t know whether the number of referrals have gone up, down or stayed the same since the affiliation. He said referrals are made by physicians based on the needs of the patients and on how well the Jefferson Healthcare physician knows the Swedish physician – or other institute’s physician – to whom the patient is being referred for care.

Hospital officials assigned the council the task of coming up with recommendations, Glenn said, and since that time, “They asked the administration to bring back more information since it [the Times story about the neuroscience institute] is unfolding.”

“If they think it’s appropriate, they’ll make a recommendation, and I’ll forward it to the board,” Glenn said. “What providers would appreciate is if there is a response, that it be a measured response. There are procedures that Swedish does that no one else does.”

Glenn elaborated on the agreement, saying, “The affiliation was mostly administrative and focused on how our organization can work together to increase local services.”

“Frankly, we have not been particularly successful with it,” Glenn said.

AFFILIATION BACKGROUND

The idea of Jefferson Healthcare affiliating with Swedish was raised in 2010 by former CEO Vic Dirksen. After Dirksen retired, Glenn was charged with moving forward with the idea, which he said made sense at the time in part because Jefferson Healthcare wanted entry into an electronic medical records system called Epic, which didn’t market to small hospitals.

“You needed to piggyback onto a large hospital” to get Epic, Glenn told the board. “That was our big goal.”

Other goals of affiliation included improving access to care, co-developing best practice treatment protocols, providing consulting services and training, and presenting quality improvement activities.

Back in 2010, Glenn said there were concerns about the survivability of small rural hospitals, and so the relationship with a larger system was a “hedge” in the event the small hospital model became unworkable.

Glenn admitted there were big goals over the years, with Jefferson Healthcare hoping to attract a neurologist to the community as well as a sleep provider and possibly an orthopedic surgery. That didn’t happen.

What did happen was that Jefferson became one of the first small hospitals to go live with the Epic records system it wanted. And Glenn says the hospital did receive preferential treatment with training programs and tours of facilities.

The amount of money Jefferson Healthcare has paid Swedish has dropped over the years – from a high of $75,000 when the 20-year agreement was signed in 2011 to a low of $11,000 last year.

Glenn noted that the contract terms are renewed every year and can be terminated with a six-month notice. He also noted that a telestroke agreement with Swedish predated the general affiliation agreement.

CONCERNS

One commenter at the Feb. 15 meeting, according to an audio recording of that meeting, said that what he had gathered from The Seattle Times articles was that Swedish prized production over patient care.

“Those are the easy dots to connect by reading the article,” Glenn concurred. “That was not far below the surface, I would agree.”

Another commenter questioned what Swedish got out of the affiliation if not referrals.

“We gave them money,” Glenn said, in exchange for administrative services and support.

NOT USED MUCH

Dr. Kent Smith, who is chief of staff at Jefferson Healthcare and chief of the Emergency Department, told commissioners Feb. 15 that he had not read the articles in the Times and that “if this is specific to neurosurgery, we don’t have much dealing with them anymore.”

For example, he said, most cases of patients with brain bleeding go to Harborview Medical Center.

“In our world, if a patient has a preference, we always try to make that happen,” Smith said.

Smith also said that the stroke team at Swedish is “very efficient” and that in a matter of 10 minutes’ notice, a doctor from Swedish can be connected to a doctor at Jefferson Healthcare and care for the patient by telemedicine.

And Glenn noted that the one thing that patients and doctors probably would not want to see is for administrators to interfere in a patient’s or doctor’s choice of care provider.