STORY AND PHOTOS BY KAREN BOSSICK

When Dr. David Pate took over as president and CEO of St. Luke’s Health System 10 years ago this coming Saturday, one of the first things he addressed was the quality of care.

Under his leadership, the hospital system tackled sepsis, infection from poor health care that Pate noted was what killed President William McKinley, rather than the two bullets his assassin fired into his abdomen.

But he still wasn’t satisfied, even though St. Luke’s infection rate was 1.1 percent—under the 2 percent many hospitals experience.

And, so, St. Luke’s staff began looking at how to cut the rate of infections among those getting knee and hip replacements.

“There’s two ways you can get infected. One is when the skin is not prepared well enough for surgery. The other is when particulate matter falls into the open wound,” Pate said.

Knowing that particulate matter ruins a computer chip, the hospital called on the expertise of engineers at Micron and Boise State University to help figure out how to keep particulate matter from falling in an open wound.

Two years later, the hospital estimates that 51 recipients of hip and knee replacements are alive who would have died if the new measures had not been put in place. Patients were able to avoid the $100,000 in subsequent care that would have been needed to treat infection. And they were able to avoid disability.

That is just one of the many success stories Pate recounted Wednesday at St. Luke’s Health System’s annual Fall Forum held at St. Luke’s Wood River Medical Center.

Ten years ago, Pate noted, St. Luke’s had just 8,500 employees and St. Luke’s Magic Valley was under construction.

Today it’s the state’s largest private employer with 14,500 employees. It has $2.5 billion in operating expenses. Its clinics have grown from 70 to more than 200 and its number of beds from 700 to 1,088. And it treats 103,000 children—double the number it was treating 10 years ago.

The hospital just opened a $40 million children’s center in Boise that will offer all the treatments a child might need under one roof rather than having to drive to various locations around Boise.

And it’s marking six years as a top 15 health care system for quality and safety, according to Truven Health Analytics.

But there’s more to do as the hospital system addresses the challenges ahead in the next five years, Pate said.

That includes getting patients seen quicker and by the right provider, which will mean extending hours since people don’t get sick only between 9 a.m. and 5 p.m. on weekdays.

And it includes addressing the affordability of health care—something St. Luke’s is already trying to do by steering away from pay for service.

“When I came here, everyone agreed one of our biggest problems was the reimbursement system paying for what we do regardless of whether it’s needed or not. Well over 30 percent of health costs are payments are for low value or no value services,” he said.

To illustrate, Pate told how his own mother in Texas was continuing to take antibiotics, even though they were no longer needed, according to most doctors’ prescriptions today. The antibiotics made her sick, aggravating a heart condition. And that prompted her to go to the emergency room where she was  admitted for an overnight stay.

Excess cost. No benefit. Something that even hurts the patient, he noted.

Similarly, Pate said, between 30 percent and 50 percent of Walmart employees who had originally been told they needed back surgery did not need it, given a second opinion.

“When I came here, we ranked fourth in frequency for back surgery. Under the value approach—trying alternatives like physical therapy first—we may find some patients don’t need that surgery so we save health costs in the long run,” he said.

Here are some other observations;

• MENTAL HEALTH: Pate said St. Luke’s will never be able to address the shortage of mental health professionals by hiring enough psychiatrists. But it can provide mental health care for Idahoans through telepsychiatry, embedding licensed social workers in clinics and even using technology such as Chatbox, software that simulates how a human would behave as a conversational partner.

  Research shows that many patients using Chatbox did better than those with live therapists, he said.

• SUICIDE PREVENTION: St. Luke’s just received a $3.3 million grant to study suicide interventions, given Idaho’s high rate of suicide. Half of those who attempted suicide called primary physicians within 30 days leading up to the attempt so there may be more that can be done there, Pate said.
• ARTIFICIAL INTELLIGENCE: Artificial intelligence will never replace doctors but it can augment them, Pate said. Computers, for instance, have a better track record of looking at a picture of a skin lesion and diagnosing whether it’s cancerous than physicians. The same goes for lung cancer.
• EXPENSIVE DRUGS: One of the challenges in the near future is addressing the issue of affordability for certain conditions. A new drug has just come out that could cure a rare pediatric condition that kills kids before they enter their teenage years, but it costs $2.1 million.

  Similarly, new gene editing appears able to remove the abnormal gene and substitute a normal blood cell to cure sickle cell anemia. But at what cost?

  “We’ve got to figure that out,” Pate said.

• ANTIBIOTIC CRISIS: Pate said that hospitals in the East are losing patients to death because they cannot treat what ails them with antibiotics. We’re running out of antibiotics, he said, but drug companies don’t seem particularly interested in addressing the need.

“I think we will need a federal solution,” he said.

• MEDICAID EXPANSION: Pate said St. Luke’s is addressing Medicaid Expansion by working on options other than accessing emergency room. Many of patients who would be covered under Medicaid expansion are currently charity cases, and there are lots of things a primary care physician can get under control without those patients having to access emergency room care, thereby reducing health costs.
• ADDRESSING PHYSICIAN SHORTAGE. St. Luke’s just opened a new resident program for six in Nampa where the hospital projects a physician shortage.
• KEEPING HEART PATIENTS OUT OF THE ER: St. Luke’s has created heart failure clinics, giving patients a way to be treated without going to the ER and being admitted.
• INTENSIVE CARE: St. Luke’s spent a $11.7 million grant to create intensive care program after seeing that outcomes are better if an ICU is managed by physicians specializing in intensive care. Obviously, St. Luke’s can’t have intensive care specialists in all of its hospitals. But technology allows the physician in Boise to monitor patients in Ketchum. And the physician there can work with the nurse to do things during the night they couldn’t do before, such as taking a patient off a ventilator.
• A FIRST: St. Luke’s has performed its first bone marrow transplant.
• HELPING THE HOMELESS: The hospital is partnering with the City of Boise to provide housing and social service for homeless people, who tend to access the ER frequently.
• BUG FORENSICS: St. Luke’s recently created a central laboratory where it can identify a bug in less than 24 hours versus the three to four days it previously took. That allows doctors to finetune antibiotics quickly, cutting costs and improving success.
• KIDS TRAUMA: St. Luke’s recently opened a children’s trauma center after research showed that children generally experience worse outcomes when treated in a general trauma center. More kids get craniotomies, too, in general trauma centers, Pate said.
• SKI INJURIES: St. Luke’s worked with Bogus Basin, Tamarack and Brundage ski resorts to create an app tracking real time injuries on ski slopes.
• HEART VALVES: St. Luke’s has become one of the few hospitals in the Northwest using transcatheter aortic valve replacements, alleviating the need for open heart surgery. Physicians thought it would be for the least healthy patients. But now they realize it should be standard.
• CUSTOMER SATISFACTION: Cash collections have gone up since the hospital introduced patient-centered billing to go with patient-centered care. And customer satisfaction has climbed from the 30s to the 80s.
• FAMILY PROGRAM: St. Luke’s has started a unique program for refugees, inmates and survivors of domestic and sex violence.

Pate said he thinks St. Luke’s is going to weather whatever changes in health care might come about as a result of the next two presidential elections because of the changes it’s made. But it’s projected that five to 16 rural hospitals in Idaho would close, depending on the changes that are made.

That would be devastating to small towns, Pate added, because hospitals are typically the largest employer and the best paying employer.

Pate noted that the Treasure Valley is one of the fastest growing areas in the country.

“We’ve got to find ways to better manage the patient population so we don’t have to build a $600 to $800 million hospital,” he said.

He also stressed the need for hospital employees to embrace best practices for best patient outcome. He recounted the story of a hospital in Houston—once a star in heart surgery--that lost federal funding after being rated among the worst performing hospitals in the nation for coronary artery bypass surgery.

 “You can be world famous. But, if you take your eye off the ball, you lose,” he added.