Favorite

Taking the Payment Improvement Initiative to heart 

Cardiologist David Rutlen and UAMS team make changes in the best way to care for their patients.

click to enlarge UAMS Cardiologist David Rutlen image
  • Brian Chilson
  • UAMS Cardiologist David Rutlen

Dr. David Rutlen, 67, has been a cardiovascular researcher at Yale University, chief of cardiology at the Medical College of Georgia, and director of cardiovascular medicine at Froedtert and The Medical College of Wisconsin Cardiovascular Center in Milwaukee.

The director of cardiovascular medicine at the University of Arkansas for Medical Sciences for the past eight years and a clinician, Rutlen and "a cast of thousands" (as he likes to say) took on another challenge in 2012: revamping the way UAMS originates care for congestive heart failure patients as part of the state's Payment Improvement Initiative to control Medicaid spending.

For six months, attending physicians, fellows, residents, nursing students, pharmacists — the number was actually 40 — met to examine what UAMS was doing to treat its patients with chronic heart disease who come to UAMS for acute care. It looked at the heart failure order sheet of various procedures and asked, what should be here and what need not be here?

Who among us has not had a doctor ask us to get a test another doctor performed in recent months? Shouldn't that be determined before one is ordered? The medical center's order sheet — which drives doctors' decisions in testing — included cardiac ultrasounds, chest X-rays, full blood work. And Rutlen said the team said, "Let's just rethink this." What if the patient had had an ultrasound recently? Was the chest X-ray really needed? Why order full bloodwork when what you want to know is whether the patient's kidneys are functioning the way they ought or has their poor heart function loaded their lungs or legs with fluid? Isn't it critical to get a pharmacist and the nursing staff involved to see what medicines the patient has been taking (heart patients are sometimes on as many as 30 meds, Rutlen said)? Are we providing the best care? What if the patient was put on an intravenous diuretic instead of a bolus, and what if the patient was to be seen a week after his hospital visit to make any needed adjustments in medications? Should that be included in UAMS'protocol?

The approach was to see "what exactly do we need to know to take care of the patient?" Rutlen said. The result was a "sea change," impacting not just its Medicaid patients but all heart patients seen at the medical center.

UAMS expected that its average charge for 30-day episodes of congestive heart failure would be in the $4,700 to $6,500 range, Rutlen said. But the data came back better: UAMS' average charges to Medicaid for 20 episodes of congestive heart failure were $3,500. That's in the "commendable" range established by initiative, which means UAMS will get money back from the state Medicaid system.

Will the Payment Improvement Initiative make a real difference in containing Medicaid costs? Rutlen believes it will.

The Payment Improvement Initiative is only tangentially related to the Affordable Care Act, which expanded Medicaid eligibility and thus access to health care for hundreds of thousands of Arkansans. But the PII's creation of the medical home — the coordinated care of patients by cooperating providers — could help with outreach to persons who didn't have insurance or who simply didn't feel comfortable going to the doctor. Rutlen's wondering about his patient with congenital heart failure whom he's never been able to convince to have the surgery he needs. Maybe he will now.

"It's exciting," Rutlen said. "Medicine is moving so quickly. ... With the Affordable Care Act, you can look at it as a burden or as an opportunity."

Rutlen added, "My personal perspective would be for universal health care, but only Obama's plan would have passed" Congress.

Favorite

From the ArkTimes store

Speaking of...

Comments

Subscribe to this thread:

Add a comment

More by Leslie Newell Peacock

  • Up and running

    It was 12 years in coming, the Little Rock Technology Park.
    • Jul 13, 2017
  • Stopping the bleeding: police, EMS coordination at Power Ultra

    Twenty-eight were injured in the mass shooting; none killed.
    • Jul 5, 2017
  • Two suits challenge new abortion laws

    Arkansas legislators "matched cruelty with creativity" this year with the passage of new laws to block women from getting legal abortions, the deputy director of the ACLU's Reproductive Freedom Project said Tuesday in announcing the filing of two suits in federal court challenging new laws.
    • Jun 22, 2017
  • More »

Readers also liked…

  • The ballad of Fred and Yoko

    How one of the world's foremost Beatles collectors died homeless on the streets of Little Rock.
    • Mar 31, 2016
  • Big ideas for Arkansas 2015

    Readers and experts suggest ways to change Arkansas for the better.
    • Dec 17, 2015
  • 2016 Best of Arkansas editors' picks

    A few of our favorite things.
    • Jul 28, 2016

Most Shared

  • So much for a school settlement in Pulaski County

    The Arkansas Democrat-Gazette's Cynthia Howell got the scoop on what appears to be coming upheaval in the Pulaski County School District along with the likely end of any chance of a speedy resolution of school desegregation issues in Pulaski County.
  • Riverfest calls it quits

    The board of directors of Riverfest, Arkansas's largest and longest running music festival, announced today that the festival will no longer be held. Riverfest celebrated its 40th anniversary in June. A press release blamed competition from other festivals and the rising cost of performers fees for the decision.
  • Football for UA Little Rock

    Andrew Rogerson, the new chancellor at UA Little Rock, has decided to study the cost of starting a major college football team on campus (plus a marching band). Technically, it would be a revival of football, dropped more than 60 years ago when the school was a junior college.
  • Turn to baseball

    When the world threatens to get you down, there is always baseball — an absorbing refuge, an alternate reality entirely unto itself.

Latest in Cover Stories

Event Calendar

« »

July

S M T W T F S
  1
2 3 4 5 6 7 8
9 10 11 12 13 14 15
16 17 18 19 20 21 22
23 24 25 26 27 28 29
30 31  

Most Viewed

  • A week at Midtown

    Can a dive bar be reborn?
  • Plan for the homeless echoes Gillam Park history

    It's a dumping ground, again.
  • Repulsed

    Regardless of the spectrum of your religious beliefs or lack of, does alluding to any religious icon or symbol of any religion [when writing of] the joys of double-finger penetration inspire any of your readers to any form of greatness?

Most Recent Comments

 

© 2017 Arkansas Times | 201 East Markham, Suite 200, Little Rock, AR 72201
Powered by Foundation