“There was also the excitement of building and moving into the new hospital,” he admits, “and, personally, the opportunity for me to work more directly with [CEO] Ron Werft, for whom I have great respect.
Yes, he misses the interactions he had with patients, but he has entered a whole new world that continues to open his eyes. “I am amazed at the level of competency and all the details and expertise it takes by so many different people. The infrastructure that surrounds the hospital system and all the behind-the-scenes work is just incredible.”
As a member of the executive management team, the VP for Medical Affairs and Chief Medical Officer provides liaison between hospital administration and the medical staff, sharing the challenges and perspectives of each in caring for patients and running a busy hospital. Working to see that each understands the other’s needs is key, acknowledging the common goal of providing outstanding service and high quality care for our community.
Wroblewski points out that this is a difficult time for physicians everywhere, and perhaps more so in Santa Barbara because of high housing costs and the lower government reimbursements to doctors here compared to those in larger metropolitan areas. “It’s not easy to attract new physicians to our community, especially when overhead for independent practices could easily account for 50 percent of income in this town,” he says.
Yet the range of services offered in our community is regional in scope and really very impressive, he believes: level II trauma center, teaching hospital, pediatric subspecialties, interventional cardiology and cardiovascular surgery, neuroscience/stroke program, wound management, and more—all involving an unusual breadth of medical expertise.
“We’ve been a great medical staff over the years, and we need to sustain that,” Wroblewski believes. Expanding clinical/research options with UCSB, for example, and improving visibility of Cottage Health System outside our region can help attract the kind of physician to our community who would relish working on such studies with world-class scientists.
What lies ahead with healthcare reform? What will it look like in 5–10 years? Wroblewski believes firmly in the need to integrate care in better ways, and not just in the hospital, but beyond that— through the course of a patient’s disease and illness—with the development of evidence-based protocols and effective coordination of care outside the inpatient hospital setting.
Health information exchange is a perfect example of such coordination. “If we had a uniform IT [information technology] platform,” he stresses, “we’d know when a patient had had a CT scan at another facility, for example, and it wouldn’t be duplicated unnecessarily. We could communicate so much more effectively with other hospitals, with pharmacies, with all healthcare entities.”
But health records need to be available electronically, not only in the hospitals but in doctors’ offices, so that information can indeed be exchanged appropriately. With that goal in mind, Cottage Health System is investing significant capital to help members of its medical staff with the technology expenses associated with establishing electronic health record systems or EHRs in their offices.
“Quality and efficiency remain key drivers,” Wroblewski says, pointing out that shorter lengths of hospital stays will reduce costs for all. “In the future, we won’t be paid for volume, but instead for value and effectiveness. And that’s why clinical integration is so critical.”
“We’re actually very efficient in the use of resources,” he points out, referencing the Dartmouth Atlas, an online database published by The Dartmouth Institute for Health Policy and Clinical Practice. Recent Atlas data indicates that the Santa Barbara health service area appears to be well served by physicians who balance a patient’s needs with appropriate resource utilization. And data shared on Medicare Hospital Compare shows readmission rates in our health service area to be well below the national average. Given that government reimbursement in the era of increasingly accountable care will be scrutinizing these kinds of measures, Wroblewski feels such data will serve us well.
In looking back at the first year of his new career, Wroblewski reflects on how much he has learned about the operations of a multi-hospital system like Cottage. “As a practicing cardiologist, I would come to perform my procedures and see my patients in their hospital rooms, never realizing what an incredible amount of effort and expertise is needed to provide those hospital services that I just took for granted,” he says. “In the past year, I have been continually amazed at the extraordinary breadth of talent within our hospital system; truly, it made practicing medicine at CHS a pleasure and privilege.”
BY JANET O'NEILL | PHOTO BY GLENN DUBOCK