"From an operational standpoint," Attebery says, "we'll be doing this for the next five years." He says the hospital system will be directing physicians to be both clinical and financial managers.
"We'll be properly allocating fixed resources on a per-episode or per-population basis that the physician mind-set, either individually or collectively, expands to encompass the new value-based system properly," Attebery adds. "We have to change the culture of physicians so that they no longer believe his or her sole role is to manage clinical episodes. Physicians have to be comfortable with everything we do that is an objective quality measurement."
Constant evaluations are necessary to reduce variability in the system and improve outcomes through process of care, he says. While Wellmont has had steadily good outcomes in providing cardiovascular care, that doesn't mean Attebery is totally pleased.
"We are doing better on the structural quality than the internal processes, in which we are not as tight as we want to be," he adds.
Attebery noted that the hospital system ranked in the top 10% in the nation for overall quality of care under the CareChex program by the Delta Group, a privately held healthcare information company.
In 2011, Wellmont's 505-licensed-bed Holston Valley Medical Center in Kingsport, was rated the top hospital in the nation for interventional carotid care, and among the top for its market for heart attack treatment and other cardiac care. According to CMS data, the hospital reported a 30-day mortality rate of 16.2% for 549 patients between 2007 and 2010, consistent with the national average.