West Jefferson Medical Center: Dr. Alfred Abaunza, Chief Medical Officer

by HCE Exchange on August 19, 2010

On August 29, 2005, Hurricane Katrina immeasurably changed not only the landscape of New Orleans, La., but the lives of the city’s residents. To assist in recovery efforts, communities from around the country came to the aid of Louisiana’s largest city, offering housing to evacuated residents and eventually sending carpenters and other helping hands to help rebuild the city.

Filling the void left with the closing of several medical facilities is neighboring West Jefferson Medical Center, located in Marrero, La., just across the Mississippi River from New Orleans in Jefferson Parish. West Jefferson, a 451-bed non-profit, full-service medical facility, was not affected by the flooding after Katrina.

“There have been some difficult times in New Orleans since Katrina and as such, we have become a bigger factor in the community’s health care,” said Alfred Abaunza, M.D., chief medical officer of West Jefferson. “The community hospital that was serving many of the indigent no longer exists and the VA hospital is no longer functioning. So, we had to ramp up our services during difficult financial times.”

West Jefferson, founded in 1956, offers a full spectrum of services, including emergency services, an aeromedical helicopter flight program, heart and vascular care, neuroscience, orthopedics, radiation therapy and a cancer program. In addition to his role as chief medical officer, Abaunza also serves as the medical center’s compliance officer.

Medical Community Needs

In addition to filling a void among medical providers, West Jefferson saw that area medical schools were in need of places for their residents to practice. In the days following Katrina, Abaunza reached out to Louisiana State University (LSU) and Tulane, and now residents from those two institutions train at West Jefferson. In addition, those residents are helping to re-populate the center’s medical staff.

“We reached this point through cooperation among all the hospitals,” Abaunza said. “We recognize that the major facilities where the residents were being trained were destroyed by Katrina. That left no hospitals in New Orleans where they could train. Now we have residents from both medical schools training here.”

New Leadership

West Jefferson has undergone internal changes, the biggest of which was the welcoming of a new CEO, Nancy R. Cassagne. According to Abaunza, the new CEO has changed the culture of the entire executive group, establishing a vision using persuasive skills to get everyone to follow her in that direction.

“We have much more teamwork and cooperation,” he said. “We all have a clear understanding of what we’re trying to do.”

Abaunza said that her intention was to improve the quality of care at West Jefferson and to make sure all services are provided cost-effectively. Decreasing costs and improving the quality of care “has been a dramatic change for all of us,” he said.

“The interaction between the staff management and physicians is much more open now, with more transparent transactions,” he said. “With open communication, there’s a lot more cooperation.”

Evolving Roles

In the 10 years since Abaunza came to West Jefferson, the chief medical officer’s role has evolved from one where he focused on the medical staff and direct medical staff activities to accepting line responsibilities such as the hospital’s pharmacy. He believes this is a natural assumption of responsibility.

“It helps to have a physician in that management role, just to control both the supply of drugs coming into the hospital and the utilization of the drugs ordered by the physicians,” he said.

Also, chief medical officers are branching out more from just medical staff activities to medical staff contracting, handling joint ventures with the medical staff and managing a number of physician agreements that traditionally have not been part of the chief medical officer’s role.

One of Abaunza’s more traditional responsibilities involves overseeing quality control efforts. West Jefferson recently added one program from the American College of Surgeons (ACS) to review general surgery, as well as a program called Crimson, from The Advisory Board Company, to conduct quality studies on the medical staff as a whole. Crimson is a physician management data analysis platform that generates detailed physician profiles that encompass quality performances, adherence to pre-defined order sets and resource utilization.

“We intend to collect more data, analyze it, and then give feedback to the physicians and improve the quality of care with delivery,” he said.

When it comes to measuring performance, West Jefferson has used consultants in the past. However, Abaunza said it’s easier for them to cooperate with organizations like the ACS than to create their own performance product.

“If we conduct our performance review with the American College of Surgeons and submit our data, our data gives us the ability to benchmark against other hospitals doing the exact same thing,” he said.

Capital Expenditures

Looking at IT equipment, West Jefferson recently added a new Varian Medical Systems RapidArc linear accelerator for its radiation therapy department. The medical center also has the only CyberKnife in the area. In addition, they’re working toward a conversion of emergency room charting from paper to electronic, as well as a CPOE, so that physicians can electronically enter patients’ orders. McKesson Corp. handles the majority of the medical center’s IT needs, Abaunza said.

Health Care Challenges

On a national level, Abaunza expressed concerns about what’s going to happen with heath care funding. Locally, decreases in Medicaid reimbursement are hitting the community hard.

“Many physicians do not want to accept the Medicaid-level of payment and reducing it further is going to reduce the number of physicians who are willing to treat those patients,” he said. “It’s becoming very difficult to find physicians who are willing to take more Medicaid patients and we recognize that the charity system in this town is not going to be functional for a long period. Finding physicians who can treat these patients is a constant challenge.”

Managing day-to-day challenges is nothing new to a medical center that serves a community still recovering from one of the nation’s largest natural disasters. With new leadership and constant monitoring of physician and nursing performance, Abaunza sees West Jefferson continuing to move in a direction that is beneficial for both the medical center and the community.

-by Kathy Knaub-Hardy

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