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Higher tech, lower costs.

Indiana's hospitals are using gee-whiz technology to deliver health care better, faster and cheaper.

Two days after her hysterectomy in December 1991, Carol Sue Wright of Frankfort was out buying Christmas cards.

She had the family over for Christmas Eve and Christmas day, took the tree down the day after Christmas and left for a vacation to Florida the 28th.

Wright had a laser-assisted hysterectomy at The Laser Center at St. Francis Hospital Center, Beech Grove. She went in on a Wednesday and was home on a Friday. "I never took a pain pill--didn't even have to take an aspirin," she says.

Michael Simpson, director of The Laser Center, says with a laser-assisted hysterectomy, the patient can be up and around in a matter of two weeks, as opposed to six to eight weeks without the laser. The cost of the procedure can be a little more, he adds, but that is usually counterbalanced by the cost of the length of the hospital stay for the hysterectomy without the use of lasers. And the significantly shortened recovery time means the patient can return to work weeks earlier, which can save the employer a significant amount of money.

Laser-assisted surgery is just one of the technologies and programs that hospitals around the state and the nation are putting in place to help lower costs for patients while maintaining or increasing quality.

Methodist Hospital in Indianapolis is on the cutting edge of a particularly remarkable new technology. It is the only hospital in the state and was the first in the Midwest to offer outpatient brain surgery.

Called stereotactic radiosurgery, it is a "very sophisticated, computerized target system" for brain tumors, says John Fox, senior vice president. A computer takes an MRI or CAT scan of the brain, and targets an inoperable brain tumor. A radiation beam is focused on the tumor for about 45 minutes, to either eradicate it or reduce it to make it operable.

The entire procedure, beginning with the MRI scan, takes a day, but the patient is able to walk around with a head frame on. The head frame keeps the tumor targeted.

The cost savings for this procedure is "unbelievable," Fox says. A normal operation for a brain tumor can cost $20,000 to $30,000, he says. "This procedure, with all of its after-care, is probably one-fifth of that."

The hospital performed the first stereotactic radiosurgery about five months ago. "We're getting calls from all over the country," Fox says. "If you ever want to see medicine and technology merge, this is it."

Another such merger can be found in video thoracoscopy, says Cybele Bjorklund of St. Joseph Medical Center in South Bend. The procedure, which employs video technology to see inside a patient's chest, is used to remove a portion of the patient's lung, which formerly required cutting open the chest and spreading the ribs. "That involved a painful and extensive recovery period and often a lengthy hospital stay," she says. "Video thoracoscopy will let you do this without opening the chest."

Laparoscopic surgery is a similar example of cost-cutting through technology. Dr. Maurice Arregui, a surgeon at St. Vincent Hospital and Healthcare Center in Indianapolis, says the laparoscope can make numerous medical procedures simpler and less expensive--gall bladder removal, appendectomies, hysterectomies and hernia repairs are among the applications.

The laparoscopic technique involves making a tiny incision through which the surgeon inserts the laparoscope, allowing him to use a video monitor to look at the organ being operated on and maneuver surgical instruments. In many cases, the incisions are made in the navel, and the result can be less visible scarring plus less overall trauma to the patient because incisions are significantly smaller. Like many of today's revolutionary procedures, the big savings from laparoscopic surgery comes from shorter hospital stays and recovery periods.

Lance Dodson of St. Anthony Medical Center in Crown Point says laparoscopic surgery can be a cost-saver for all hospitals. "A person can be up within a day or two" in a gall-bladder surgery, Dodson says.

He also points to increased outpatient surgery as another area where all hospitals are reducing costs. Outpatient surgery has increased at St. Anthony by 40 percent the last two years. High-technology procedures are making the increases possible. "The whole outpatient surgery field has increased dramatically," he says. "We're finding ways to treat people without hospitalizing them."

An example where high-tech equipment has made more outpatient procedures possible comes from Valerie Hardig of St. Margaret Mercy Healthcare Centers in Hammond and Dyer. She says the hospital's oncology center is using a device known as a computerized high-dose remote after-loader to assist in radiation treatment of malignancies in the lungs and esophagus as well as gynecological cancers.

"A predetermined dose of radiation is delivered directly to the tumor through a catheter," she explains. "It actually spares most of the surrounding healthy tissue, which is better for the patient." It also happens to be an outpatient procedure that takes three to five hours. The typical alternative, a radiation implant, can require a hospital stay of up to five days, she explains.

Ball Memorial Hospital in Muncie, meanwhile, has plans to increase its use of outpatient services. In June, it opened its Outpatient Medical Pavilion for outpatient surgery. The hospital performs an average of 300 to 400 outpatient services a day, including X-rays, surgery, blood tests, EKG readings and cardiac and physical rehabilitation.

Some technological devices that seem relatively insignificant can have a big and positive impact on the way hospitals operate, notes Marjorie Soyugenc, president of Welborn Memorial Hospital in Evansville. An example she cites is the hospital's medicine-dispensing system. It allows patients to dispense medicines themselves from their hospital beds, as the medicines are needed.

"It's a major time saver for our nursing staff," Soyugenc says. And increases in efficiency ultimately can yield savings in labor costs, which are among the biggest expenses hospitals face. "We're always looking for unique things" to keep costs down, she adds.

But beyond offering the latest technology, hospitals are scrutinizing their operations--everything from the hospital air-conditioning systems to recycling programs--in an effort to reduce costs and stay competitive in the healthcare field.

Fred Kerr, president of Lutheran Hospital in Fort Wayne, says his hospital has been examining its entire facility for cost-saving opportunities.

An example is the hospital's ice-chill air conditioner. The air conditioner uses most of its power at night--when electricity is not as much in demand throughout the hospital--by making huge blocks of ice. In the day, it conserves its power by blowing air over the blocks of ice. The hospital opened its new acute-care facility in April, and the building "is designed in many ways to save costs," Kerr says.

The hospital also is working with its medical staff to analyze the costs of its major procedures--a move many of the hospitals in the state are making.

The hospital compares its costs for a procedure, like a coronary bypass, to other hospitals, and finds the place that is the most efficient and proficient in the area. The hospital then adjusts its own procedure to bring the cost in line. This is done for each medical procedure at the hospital. At Lutheran, the goal was to bring the cost down by $4,000 for each coronary bypass operation.

It's an ongoing process, and as new procedures are developed, the plan is implemented. "We'll never finish it," Kerr says. "It's something we started last year, but now we see it as an ongoing thing."

At St. Joseph Medical Center in South Bend, David Baytos, chief operating officer, says the hospital began conducting a similar study in 1987. Areas of study include women's and children's health, oncology and neurology, Baytos says.

St. Joseph is a member of the Holy Cross Health System, a network of other hospitals in the area, which allows them to share experiences and compare costs, and gives them purchasing power. "The purchasing power is just phenomenal," Baytos says.

St. Joseph also has begun a recycling program that has "significantly reduced the amount of trash that we generate," Baytos says. The hospital accepts polystyrene, paper, cans and cardboard for recycling. It has reduced the monthly waste bill by several thousand dollars.

Gina Smith of Kosciusko Community Hospital in Warsaw says Kosciusko has targeted $300,000 in savings just by making minor adjustments over the course of a year. Kosciusko is examining all of its procedures, and finding the best use of its staff in order to reduce costs. It also has begun recycling glass and paper products and using group-buying programs. "We really just examined everything we buy," she says.

Kosciusko also did a labor study, and according to outside experts, the hospital staff of about 500 was about 6 percent larger than necessary. Through attrition and by moving people around, Smith says hospital officials hope to reduce the staff by that amount.

Kosciusko also is working with its staff and with other hospitals to find the best ways to reduce costs for all procedures. "About 10 years ago, hospitals were in such competition, they didn't want to cooperate," she says. "Now they realize they need each other."

At St. Vincent Hospital in Indianapolis, an outside consulting firm was hired to help reduce costs for patients in a program called "Care 2001." For example, a chest X-ray used to involve more than 46 different steps--including paper work--from start to receipt of the bill, according to hospital president and CEO Bain J. Farris.

It took 89 minutes to complete the 46 steps, which Farris calls "outrageous." Now, the same process takes 12 steps and 19 minutes. "We literally had to reorganize that entire process," Farris says.

Another result of the study is that the average length of stay in the hospital is 16 to 18 percent shorter, Farris says. "We're changing for and toward the patient. We exist to care for patients."

Fox of Methodist Hospital in Indianapolis says the hospital is about halfway through a three-year, general cost-reduction plan that looks at everything and involves ideas from the hospital staff. Fox says 430 ideas are being implemented that will eventually save about $30 million.

"The hospital was doing well, and is financially healthy, but we believe that as hospitals are becoming more competitive, we find it's paying off" to reduce costs, Fox says.

To remain solvent and competitive, serving the needs of the patients will have to be the priority of hospitals nationwide--providing the best care at the lowest cost. "The new understanding about quality is that quality has to be considered from the point of view of the customer, and cost plays into that," says Lutheran's Kerr.

"Cost is integral to quality, not in opposition to quality," he says. "Hospitals have traditionally looked at quality as the very best care for everyone, regardless of cost. We missed the cost factor that everyone is looking for."

Keeping costs down also means keeping patients healthy. Increasingly, hospitals are bringing outreach educational plans about wellness to the public. This is often motivated by the business world, where companies seeking healthier employees often contract with a hospital for health services for its workers.

"Everyone knows health-care costs are skyrocketing; people are looking at where the best cost for their money is," says Tom McMullen, manager of corporate health services at St. Francis. "Seven out of 10 causes of death are related to lifestyle. We need to address that."
COPYRIGHT 1992 Curtis Magazine Group, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992 Gale, Cengage Learning. All rights reserved.

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Title Annotation:Indiana hospitals' new services
Author:Martel, Judy
Publication:Indiana Business Magazine
Date:Nov 1, 1992
Previous Article:Milestones in Elkhart.
Next Article:On the mend.

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