How To Leave With Class

Tabitha Dabkowski, PA-C, Julie Price, PA-C, and Allin Vesa, MD.

“Certainly, we had some challenges along the way,” said Dr. Allin Vesa, “But Iredell was our baby, and we nurtured it.”

Until recently, Dr. Vesa was the Medical Director for the Emergency Department at Iredell Health System in Statesville, North Carolina. Iredell had an average size community emergency department – about 34,000 visits per year – but Dr. Vesa had been there for 11 years, most of his career, and he felt a sense of ownership over the place.

So, when the health system asked for core metrics to be included in the contract, Dr. Vesa didn’t shy from the challenge. Starting in July of last year, Dr. Vesa and his team of three core physicians and five APPS were responsible for achieving four goals:

  • Door to provider time of less than 35 minutes
  • Door to discharge of less than 158 minutes
  • Left without being seen rate below 2 percent
  • Patient satisfaction ranking above the 50th percentile

Dr. Vesa said he knew they could get there. He had a dashboard with the four metrics that he reviewed daily: red dots for failing to meet the metric, green dots for meeting it. The first few months it was mostly red dots. But, as various process improvements began to take effect, he and his team started to see improvement. “We started to see positive changes, and so that motivated us to push even harder.”

By March of 2017, the department was green on two of the four metrics. In April and May, it was three out of four. By June it was four out of four. Then, in April 2017, Dr. Vesa found out they had lost the contract to a smaller, local group. Dr. Vesa said there could be a few other reasons why they ultimately lost the contract. The hospital said specifically that they did not like that they were flexing physician hours during times of low volume, for example. But whatever the reasons, failing to meet core performance metrics was not one of them.

“We all had to process the whole loss of the contract,” Dr. Vesa said. “But after that, we thought, we’re leaving in six months, and we’re going to knock this thing out of the park. We will demonstrate what USACS is all about and what a valuable group of providers they are losing.”

Dr. Vesa’s dashboard stayed green for the last 6 months of the contract through the eventual handoff to the new group. Left without being seen was at our below 1%, and door to provider time hovered around 30 minutes. The department was a model of efficient, quality patient care in a low volume setting.

US Acute Care Solutions itself has had to pick up the pieces of groups that have left hospitals in bad standing, as if, in spite, they had wanted to demolish things on their way out the door. Dr. Vesa was determined to exemplify the opposite. “The handoff was very professional, very collegial,” he said. “Wake Forest actually thanked us for giving them a nice product. They thanked us for the nice transition.”

As for Dr. Vesa and the other core physicians at Iredell, all of them stayed with US Acute Care Solutions and left to plug holes at nearby campuses in North Carolina. Dr. Vesa now works at Carolinas HealthCare System Huntersville in Lincoln, which is roughly the same commute he had to Iredell.

He remains proud of the work he did as Medical Director: “We just build a culture of appreciation, a culture of integrity… I will always be grateful for my team and for the opportunity to serve them, our patients and the community.”