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Transcripts of Dr. Turkal's videos

Introduction

The point of this conversation is very clearly to create a dialog, a 2-way street so that individuals have an opportunity to give us feedback about how we are doing or feedback about a topic or to raise questions. So, we very much encourage people to send e-mails, tell me what you are thinking, give us a chance to respond.

Physician as a CEO

Well, my friends and my family ask me a lot about what is like to go from being a family doctor to running an organization. You see, it's really the same principles. What I do as CEO of Aurora and what I did as a family doctor are really very, very similar. It's a lot about listening, it's a lot about sitting down and looking into a topic, looking at a group of people and listening to what's going on, then diagnosing it and making some suggestions on how to make it better.

The great thing about being a family doctor is every day in the office is different, different problems, different challenges, different approaches and what I found as a family doctor is, that all the text books, all the things that the books say about how you treat patients gives you about 10% of what you need. What really matters is listening to what people say, developing relationships and then figuring out together what the solutions are.

And that is what these talks are about. It is about listening to what our patients in our communities have to say about health care and figuring out better ways together to deliver a product that's very important. Health care is just so very important to everybody. We all have illnesses, we all get sick and we all have family members who need health care. Our responsibility as an organization is to deliver the very best way we can, and the very best way to do that is to listen intently to our customers and say: “What is it that is going to make this really good, really special and really comfortable for you?” So, the roles of CEO and the role of a family doctor, very, very similar.

Understanding integrated health care

Integrated health care is a term that is utilized by many and practiced by few. We set out about a decade ago at Aurora to deliver what we call integrated health care and when we talk about integration we talk about smoothing out the bumps between the parts of health care.

One of the reasons that we have hospitals, clinics, pharmacies and Visiting Nurse Associations is that we want to deliver the entire package of health care to individuals and families, but we don't want to do it in pieces. We want to look at the whole individual and we want their experience to be smooth across the pieces of Aurora.

We've been striving to do that for 10 years. Now we are making some very good progress. We are doing that using some tools to help us.

One of those is making sure that we are connected electronically at all of our sites. We have a computerized patient record that is now essentially fully implemented at Aurora. So if you go to an Aurora facility in Green Bay and then one in Milwaukee, the doctor is able to access your record in both places. That cuts down on redundant care. We don't repeat tests that don't need to be repeated and we don't have to ask questions that have been asked already.

And in my own practice last year I had an opportunity to care for an elderly patient of mine who was visiting family in Kenosha over the weekend. She fell down and hit her head. She went to our emergency room in Kenosha and had a whole series of tests done. She came to see me on Monday without her family members and she couldn't remember everything that was done. Without ever leaving the examining room I could pull up on the screen her cat scan, her blood work, and I could reassure her that her injury though it made her feel really awful, was not serious, was not life threatening. We were able not only to make her feel better about her condition, but we saved thousands of dollars by not having to repeat tests.

That goes on every single day at Aurora, hundreds and hundreds of times where we access our computerized patient record and we are able to see what has been done, what that patient's history is and we avoid recreating the wheel over and over and over again.

Integrated health care improving intensive care

About two years ago we invested in a product the centralizes the monitoring of all our intensive care unit patients. We have 254 ICU beds across Aurora. The ability to monitor those patients centrally has really done some wonderful things to enhance patient care.

First of all we didn't change anything at the bedside, so all of the nurses and doctors that were at the bedside, are still there. This is sort of a backup extra system; it's like a guardian angel to make sure we are doing all the right things for patients in the intensive care unit. So, it has a smart software that detects minor changes with intensive care unit patients before they get to be major changes, and we staff this centralized monitoring location with a critical care physician, critical care nurse and a pharmacist.

Those people are available 24 hours a day for calls from doctors, calls from nurses to say: “We have a patient that has this problem, can you help us?” We can turn on a camera in the room to look at what's going on with patients.

What that has meant is that patients in hospitals like Burlington or Sheboygan that don't have intensive care physicians, now have intensive care physicians. We'll never in my lifetime have enough intensive care doctors but we have been able to use technology to leverage that expertise suppressive system.

And the result of that has been that we have essentially eliminated pneumonia from patients that are on ventilators at Aurora Hospitals. We've reduced mortality; we shorten length of stay in the ICU because we are catching problems before they get to be major problems.

Integrated health care -- Aurora Quick Care

The last couple of years we've offered a service called Aurora Quick Care. It's a kiosk that is present in pharmacies and in some department stores. It's staffed by a nurse practitioner.

It is designed to take care of about 14 different conditions like strep throat and ear infections that always happened at night, always happened on the weekend when the doctor's office isn't opened and offers an opportunity for patients who are very wise and know what's wrong, to go and get a confirmation about: “is this an ear ache in my child that needs treatment or not, is it strep throat or is it just a little cold?”

By doing that in that setting, we dramatically reduced the cost of care. Because before that existed, a lot of those patients had to go to the emergency room, you can easily run up a bill of a couple of thousand dollars in the ER, because it is the most expensive place to deliver urgent or routine care like this.

Aurora Quick Care allows us to do it in a setting that is convenient for patients, easy access, very quick. Most patients are in and out in 20 minutes, gives them a diagnosis that they have now confirmed and they know what to do, puts them at ease and it's done in a very cost effective manner.

That's exactly what we wanted to achieve with integration, now we are to the point that we are really seeing those savings.

Growth in health care: Controlling costs, increasing access

There is so much debate right now, particularly in Milwaukee and in eastern Wisconsin, about the effect of growth on health care, how does that affects cost, how does it affect the community. Our business leaders are very concerned about health care cost. What they may not recognize is that I'm very concerned about health care cost, too. We have 25,000 employees at Aurora and we are self-insured for our health care. The cost of health care is important to us too, it is important as an employer, it is important as a community member.

So, when we think about growth, we think about cost. Our commitment is the only way we are going to grow is if it helps us to reduce cost overall to the people we provide care for.

I would say we have been very clear about our desire to serve eastern Wisconsin, that particular geography, the eastern third of the state and we found ways to provide access to patients in those communities across eastern Wisconsin. We have been very clear about what we wanted to do and been clear about why we wanted to be a particular size and we've gone about doing that. Have we got some criticism for that? Absolutely! Could we have done that better in some communities? Absolutely.

And I think as we look to grow in the future, much of our growth will be in the geography that we are already in by expanding our hours at an individual clinic by making it easier for people to access us, by using more things like Aurora QuickCare.

So, our growth is very important because it's how we help to control cost but most importantly we've grown to provide good access to people all over eastern Wisconsin. We are pretty much within 10 or 15 minutes of everybody in eastern Wisconsin of some facilities at Aurora and that's by design, and that growth has allowed us to really make it easy for people to get the health care that we need.

Growth in health care fueling our economy

The interesting thing about health care that a lot of people probably don't know or realize, is that it's been one the biggest stimulants to growth in the economy in United States in the last half of a decade. The last 5 years in particular the growth in health care has created jobs, has created lots of different things in various industries. So, we have been looked at from a cost perspective but not so much of it as a product perspective of what we provide to communities in terms of jobs for people, security, growth of communities, growth of the economy.

We want to make sure that as community partners and as community leaders, that people begin to see us as part of that new health care economy, part of the new knowledge so that as we move to an economy that is not based only on manufacturing and production but knowledge, that health care is viewed as part of that knowledge based industry.

Growth in health care serving Waukesha County

The controversy in Waukesha County about our growth there has been a fascinating one. Wilkinson Clinic is over 100 years old; Wilkinson Clinic is part of Aurora Health Care. We have wonderful physicians at Wilkinson Clinic. We have Visiting Nurse Association delivering care in Waukesha County we have pharmacies there. We don't have a hospital right now but we care for 40,000 people.

As I have talked about Integrated Care in the fact that we want to deliver care across all aspects of health care continuum. A hospital in Waukesha County is a critical part of that. Our ability to connect our doctors via our computerized patient record with the hospital where they deliver care, that's how we reduce the cost of care.

We have an opportunity I think, in Waukesha County and in other places to do a little healing with the community. We have had a rough go of it there, I don't think that's a secret to anyone and I don't like controversy. I wished we could turn the clock back and talk about different ways to make sure the community understand us better but we can't. Going forward, I think my overall approach -- just as it has been as a physician -- is it's time to heal some of these wounds and move forward and make this really good for the community.

Health care costs overview

Health care cost is something that is on everybody's mind today; it's on the mind of patients, employers, it's on my mind as well and we very much want to be part of the solution. As a percent of Gross Domestic Product cost of health care, the percent of what we spend nationally on it, has gone up and up and up, at least doubling in the last generation. That is not sustainable. We know that in health care, business leaders know that. We want to create an environment that's good for business and be a part of the growth of the economy without being a drain on other business in the economy. So health care cost has to be addressed.

Health care costs savings through integration

Integrated health care helps on the cost front dramatically. Because we only do a 1/3 of what we do in the inpatient setting now, and we do most of it in other settings like doctor's offices, pharmacies and so on, we dramatically reduced the cost of care, particularly for somewhat simple problems, particularly for chronic care that should happen mostly in the outpatient settings. So the integration allow us to say we can deliver care in any one of 10 locations, let's pick the one that's most convenient, most cost effective for our patients. So, we hear back from insurance companies and from insurance brokers that our overall cost of care is really a better value than many of our competitors because we do most of it in settings that's outside the hospitals. We feel really good about that.

Health care costs -- what we can do together

We only account for something like 40% of the change in health care cost every year and we are very comfortable taking responsibility for that 40%. The rest falls in the hands of other people and let me talk about a couple of groups that are very important.

I'm out talking with employees a lot about health care cost and what they can do in the work environment to reduce health care cost, and it's really about having a healthier employee population. So every time an employer implements a program that decreases smoking, every time an employer helps with things that encourage flu shots or encourage exercise, those things modify health care cost rather dramatically.

In the end though, the issue of health care cost has to be between the physician and the patient. And we believe, and certainly studies show this to be very true, that the way patients make decisions about health care, drives so much of the cost. What I'd like to hear from patients is how we can do a better job educating them about what the cost of health care is, about what their role may be. In the end the role of patient is what we all know it needs to be. It means, you take good care of your body, if you have a health problem you get it taken care of early, and you take the advice of health care providers so that you are doing the very best thing you can to maintain health over the long run.

An open letter to the community on health care costs