A presente entrevista foi feita pelo nosso novo colunista, Christopher Matthews, americano, ex-administrador hospitalar da Força Aérea Americana, recém-chegado ao Brasil. O entrevistado foi Dr Porter Jones, do Hospital Israelita Albert Einstein, onde atua como Diretor de Parcerias Estratégicas e na Divisão de Prática Médica. Porter Jones é formado em Química e Medicina, com CPA em Analise Financeira de Negócios e MBA pela Universidade de Harvard. A entrevista falou sobre avaliação do corpo clínico, o cenário de saúde do Brasil, criação de valor para o paciente, reembolso de convênios, economia de saúde e segurança do paciente.
Matéria produzida originalmente em inglês. Para português, clique aqui.
Interview with Dr. Porter Jones, Medical Practice and Strategic Partnerships at The Hospital Israelita Albert Einstein, Sao Paulo, Brazil (dated July 7, 2014)
Chris Mathews: What is your current role at Albert Einstein?
Dr. Porter Jones: Right now I oversee three separate areas. The area that I currently focus 50-60% of my time is the Division of Medical Practice. This division oversees the medical practice of our open clinical staff via clinical and operational information. Einstein does not employ its physicians, thus we have numerous tools to oversee the clinical care that our open clinical staff provides to our patients, ensuring that Albert Einstein standards of patient care are up kept. This department includes an outcomes division, a quality division, health economics, epidemiology and medical records. My other role is to oversee international partnerships. We have numerous international partnerships with institutions such as MD Anderson Cancer Center in Houston and Cleveland Clinic in Cleveland, OH. Additionally, I oversee the business development of our Oncology Department.
CM: What are you passionate about as both a physician and healthcare executive?
Dr. Porter Jones: One thing that I just love in regards to being here in Brazil is the desire for continually bettering the patient experience here within the hospital. There is bureaucracy here in Brazil, just as any place, but I also feel that things are not set in stone as you may see in the United States. We have a great opportunity here within Brazil to take the best practices of numerous places throughout the world, the United States, Europe, Asia, and implement those practices into what we do here. We have a lot of room to be malleable in the way we oversee care. Creating these new ways of looking at the patient experience, creating these new ways of how we treat and how we go about patient care is exciting to me, and exciting to see the growth, the change, and how we can do things differently than they were done prior.
CM: What are your thoughts on the current state of Brazilian healthcare? What direction do you think it’s headed? What are some of the issues that need attention and focused action?
Dr. Porter Jones: As in the United States, we are really focusing on evidence based medicine. One thing that Einstein is specifically focusing on is outcomes vs. cost, the value we give to the patients we treat. What is the patient getting out of their care? Value driven care is where we’re heading. That is where Brazil’s heading. We as healthcare providers must show the cost benefit of doing certain procedures and using certain technologies to continue to ensure that care can be given at the highest level, at the lowest cost to ensure we’re not frivolously throwing away financial resources to treat a patient.
CM: So quality needs constant focused attention and is imperative with respect to monitoring patient outcomes right?
Dr. Porter Jones: Yes!! Payers are not yet looking at this. Payers are not looking at who is currently delivering better medical care. Payment in Brazil is still not performance based. I believe this is going to change quickly and things will start to be looked at and start to be reimbursed on quality of care and clinical outcomes. If you’re not in front of this wave, you will be far behindwhen suddenly everybody starts saying, “Alright we want to see your outcomes, we want to see the outcomes for a certain subset of patients and that’s how we’re going to reimburse.” Unfortunately there just isn’t a national Brazilian database or archive looking at national outcomes. At Albert Einstein we currently measure patient outcomes internally. We track patient outcomes along with the cost associated with patient care so as to be able to quantify the value of care that we are giving to our patients.
CM: In today’s healthcare discussion we hear a lot about cost control and efficiencies; however the creation of value for the patient is often left out of the conversation. Can value and efficiency be obtained simultaneously?
Dr. Porter Jones: Value is the medical outcome the patient receives compared to the cost to reach said outcome. We can use the latest and greatest technology that costs a fortune but if that particular technology doesn’t generate a better outcome for the patient, there’s absolutely no need to be using it. On the flipside, if an incredibly expensive technology significantly betters the clinical outcomes, there is an argument to be using that technology regardless of the added cost. The process of care needs to be looked at from a value perspective. Buying new equipment, using the latest technology, using the latest drugs does not necessarily equate to better outcomes and that’s something that needs to be measured. At Einstein we try to constantly look at that cost benefit analysis. With a new technology, investment or implementation of new protocols the question is always asked, are we achieving better clinical outcomes? And if not, we need to return to the drawing board and look at why we’re not getting better outcomes. Do we need to be using the new technology? Is the added cost adding value to the care delivered?
CM: What process do you have in place at Einstein that ensures this analysis is completed?
Dr. Porter Jones: Here at Einstein, we use our Health Economics division to perform these analyses. It’s actually quite rare to have a Health Economics division within a Hospital because often times the results of the analyses lead to implementation of new processes or protocols that may be inhibitory to the bottom line. As an institution, you have to commit to adding value to patient care regardless of the financial impact. Short term financial losses when focusing on providing the best care for the patient pale in comparison to the long term gains the hospital will have when putting patient care first.
CM: You have considerable experience working in strategic partnerships, how can strategic partnerships narrow the gap between some of the disparities we see in healthcare resources and services?
Dr. Porter Jones: Working with international hospitals in the form of strategic partnerships has been an incredible learning for me. I’ve realized that implementing the best practices from an institution that has been developing these best practices over years and years of success and failure is an incredible way to advance quickly, and on the right trajectory. We have a strategic partnership with MD Anderson Cancer Center. We use their clinical protocols that they’ve been developing and refining for years and years, and then slightly adjust to our reality here at Einstein. This allows us to provide the best possible care to our patients using protocols that have been vetted by the best cancer hospital in the United States. We’re working with the Cleveland Clinic on implementing a new type of neurosurgery procedure. Again, you’re taking their learnings, years of outcome data, years of quality data, and using just the absolute gold standard practices that they’ve created. This is a way to jump ahead much quicker than if we were to develop everything internally. Ultimately we still have to adapt these practices to our reality because the cultures are extremely different, but that’s the key to all of this. You take the best of something from another leading institution, you adapt it to your reality and to your culture, and then you can really create something that gives the best possible care to the patients.
CM: Can a similar partnership and or modeling approach be transferred and duplicated within local communities with constrained healthcare resources?
Dr. Porter Jones: I think sometimes you’re going to run into instances where a certain technology or equipment may not be available in a more rural community, but look, a lot of the things we implement and a lot of the things that we believe actually give our patients great quality care do not involve technology or a huge investment, it is processes, it is efficiencies, it’s a look at quality, a look at safety, and making sure that our patients feel comfortable and that they understand what’s going on with their care. Most of the time it ends up being protocols that actually create quality for the patient, it’s not necessarily a huge investment in technology or physical infrastructure. Those protocols make all the difference. You create a more standardized way of treating the patients, and 99% of the patient population falls under that standardized treatment path. Those are things that can be rolled out and implemented in community hospital settings and really don’t take much investment or much capital expenditure, yet still give those communities the added benefit and increased quality of care to their patients that they’re striving to give.
CM: Have you seen a lot of engagement from those local communities, or is it a constant marketing effort to get this message out?
Dr. Porter Jones: One of our pillars here at Einstein is the social aspect of medicine. How do we give treatment in the best way possible to other communities? We go out to other communities to educate healthcare professionals, treat patients, and implement our best practices in community hospitals. We have hospitals and clinics in Paraisopolis and M´ Boi which are medically underserved communities. Einstein is extremely active in medically underserved communities as this is one of our four main focuses here as an institution.
CM: What are some of the latest medical innovations and best practices that you can speak about that are occurring at Albert Einstein and elsewhere in Brazil?
Dr. Porter Jones: Two major pushes that we're working on are medical education and electronic medical records (EMR). We’re planning on opening a medical school in 2015. We feel that medical education is of utmost importance to keep a large facility like Einstein moving forward, and with that medical education comes a lot of research, which is the backbone of an evidenced based hospital. Our other push is implementing one of the most sophisticated electronic medical records from the United States. We will be the first hospital in Brazil to implement such an EMR. These projects aren’t necessarily innovations, so much as they represent a change in thinking where Einstein really wants to be focusing on outcome driven care. We want to look at information. We want to really start to synthesize all the data across patient fields and make sure that we are giving care the way that the literature or the data is representing. I truly believe other hospitals are going to follow suit.
CM: What message do you have for other healthcare leaders in Brazil?
Dr. Porter Jones: Value in the sense of patient outcomes and cost is the absolute most important driver right now when looking at your patient care. Everything has to be driven by the outcomes of the patient. Bettering medical outcomes often comes with added investment; however, it can also include decreasing costs through efficiencies and the use of protocols. Delivering value driven care is much harder than it looks, but that should be the focus for most institutions in regards to moving forward and being at the cutting edge of patient care.
CM: Would you say leadership is key here in driving that organizational mindset of value?
Dr. Porter Jones: Yes, without a doubt. It’s a mentality change, and that’s where leadership needs to step in and give that direction and show what can and should be done with respect to creating value for the patient.
CM: What are some of your biggest challenges, and biggest opportunities that you see in the years ahead in Brazil?
Dr. Porter Jones: I think some of the biggest challenges, at least for Brazil, that I see, would be managing and evaluating information. Using data to adequately provide evidence based clinical care to the patients. I still feel like data and information in regards to running the hospitals needs to be used more prevalently. Data do drive operations and clinical care is not used enough in Brazil. There’s a lack of investment in IT (Information Technology) infrastructure. A lack of investment in individuals like statisticians, bio-statisticians that can actually analyze the information in a useful manner. There is still a large gap from where the United States is in regards to running a hospital based on solid and adequate data.
There also needs to be a larger focus on recruiting and getting top talent into the healthcare system. I´m not talking about people like myself who have been in the healthcare system for ten plus years, I’m talking about individuals who have different experiences. People that have been in the oil sector, people who have been working as engineers outside of healthcare, because they bring a different mindset of how to look at problems in healthcare. The recruitment of top talent especially outside of healthcare is going to be key to the growth and innovation of the healthcare sector here in Brazil.
