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Real Issues : Real Solutions

JAN/FEB 2012

The George Washington University Hospital Enhancing the environment of care HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com

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Real Issues : Real Solutions

CONTENTS

06 The George Washington University Hospital

IN-FOCUS STORIES 10 Adventist Health System 16 Crittenton Hospital Medical Center 19 The Jewish Home for the Elderly 22 Overlake Hospital Medical Center 26 Saint John’s Health Center 30 The Robert Wood Johnson Foundation 34 CHRISTUS Santa Rosa Health System 36 Empirical Technologies Corporation 38 HealthBridge Children’s Hospital 40 J&B Medical Supply

Kimberly Russo, Chief Operating Officer

44 Kissito Healthcare 46 Mid-South Regional Blood Center 48 Northeast Regional Medical Center 50 Bellflower Medical Center 54 The Pediatric Connection 56 Southampton Memorial Hospital 58 Upstate University Hospital, SUNY 60 Clifton-Fine Hospital

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63 Andrew Technologies LLC 66 Asheville Specialty Hospital 68 Community Care Physicians, PC 70 Community Health Access Network 73 Our Lady of Lourdes Regional Medical Center 76 Southeastern Regional Medical Center 79 Winchester Hospital

JAN/FEB

2012

The George Washington University Hospital

With a national reputation for quality and service and a range of patients that includes heads of state, The George Washington University Hospital in Washington, D.C., holds itself to extremely high standards for patient care. “Healthcare is about providing high quality and service to patients so they can get on with their lives,” said Chief Operating Officer Kimberly Russo. “Everything we do must be about the patient. We value the patient’s perspective and evaluate every decision on how it impacts their care or access to care.” The hospital has embarked on a major quality initiative that touches almost all aspects of patient care. Russo said the hospital plans to be a national leader in quality, service, and patient safety measures in the next three to five years. Hospitals must improve quality, while also reducing costs, and GW Hospital is using Lean Six Sigma principles throughout the hospital to achieve these goals. “Lean initiatives are helping us improve throughput in the facility as a whole, including the emergency department,” Russo said. “We are looking at how efficiently we get labs and other results turned around, and how quickly we get patients back to their lives.” GW Hospital also has a range of employee and physician initiatives, which studies have shown leads to improved quality.

Enhancing the environment of care

oncology care, a cardiology program, and a host of other services.

The hospital’s new facility, which opened in 2002,

In 2009, the hospital felt the need to expand its

already has cutting-edge medical equipment and

surgical suite to address increasing volumes. The

is completely wireless. GW Hospital is nationally

first phase, completed in 2011, added two operating

recognized for its robotic surgery program and was

rooms and added 15 pre- and post-op beds, as well

the first hospital in Washington, D.C, to have the da

as redesigned the endoscopy suite. Phase two is to

Vinci ® Surgical System.

build a hybrid OR, two additional operating rooms,

Technology remains a focus at the hospital with investments related to monitoring equipment,

and more intensive critical-care beds. “The surgical-suite expansion will enhance the

telemetry, the electronic medical record, upgrades

surgical programs we’re known for, specifically

to cath-lab suites, and monitoring for intensive-

neurology, minimally invasive surgery, robotic sur-

care units.

gery, cardiology and vascular surgery,” Russo said.

With nearly 10 years in the new facility, GW

“This project will meet the needs of our community

Hospital is experiencing growing pains and is plan-

in the triad of The George Washington University

ning to expand care to meet its patient’s needs. The

Medical School, the physician practice, and the

371-bed hospital sees about 71,000 patients each

hospital.”

year from tourists to local residents to visiting dig-

In addition to surgical-suite expansions, the

nitaries. It has a Level 1 Trauma Center, a Level III

hospital is working on expanding and improving the

Neonatal Intensive Care Unit, a breast-care center,

emergency department. With 60 percent of patients

HCE EXCHANGE MAGAZINE

of science in speech-language pathology from Rush University in Chicago, Ill., a bachelor of science from

Ricoh Healthcare

Illinois State University, and later earned an MBA from Gallup University, along with working her way up in hospital administration.

For more than a century, Mead Johnson Nutrition has led the way in developing safe, high-quality, innovative products to help meet the nutritional needs of infants and children. With more than 70 products in over 50 countries, our products are trusted by millions of parents and healthcare professionals around the world.

Along with quality and patient initiatives, Russo focuses on employee engagement as a top priority. “Human capital is a huge investment and is most valuable to you as an organization,” she said. “Although quality measures, scores, and profit are important to viability, having an engaged, happy staff greatly impacts your outcomes and the service you provide.” In the coming years, Russo will have her hands full with implementing reform and managing the challeng-

Intelligent diagnosis. Integrated plan. For enterprise optimization.

es coming in healthcare. She said GW Hospital is being efficient with the right staff, making the right strategic decisions, and working on value-based purchasing to address whatever comes its way in the future.

Visit us at meadjohnson.com to learn more.

www.ricoh-usa.com/healthcare

Russo envisions the hospital being a market leader in the coming years and an employer of choice. By Patricia Chaney

coming through the ER, Russo said the hospital is implementing Lean initiatives focused on throughput when making construction decisions.

significant contributions in healthcare administration, management, or policy.

Nationally recognized leadership In addition to the reputation already established by the hospital, Russo is making a name for herself among hospital executives. She was recognized by Modern Healthcare in 2010 as one of its Up & Comers, a program that spotlights rising stars who have made “significant contributions in healthcare administration, management, or policy.” In 2011, she was recognized by Becker’s Hospital Review in “Rising Stars: 25 Healthcare Leaders Under Age 40.” Russo has been COO of GW Hospital since 2009 and served as an associate administrator before that. With a clinical background, Russo always has the patient’s perspective in mind. She received a master

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

02 | Adventist Health System

The not-for-profit organization supports 43 campuses in 10 states and consists of approximately 55,000 employees. In all, the system has more than 7,700 licensed beds. Florida Hospital, the system’s flagship hospital, is one of the largest providers in America. The system also has a long-term care business and home-health agencies attached to some hospitals. Originally established to support the healing mission of the Seventh-day Adventist healthcare organization in the southern and southeastern United States, Adventist Health System maintains Sodexo Health Care

its mission to “extend the healing ministry of Christ to every patient.”

Sodexo Health Care provides industry-leading onsite services and innovative solutions that improve the patient experience and outcomes for more than 1000 hospitals across the country. Through the service spirit, passion and expertise of more than 65,000 employees, we help make every day a better day for millions of patients, their families and friends, plus medical and other hospital staff.

In the mid-1800s, Seventh-day Adventist Christians recognized the need to treat the whole patient. Adventist Health System continues this approach with the CREATION health model -- choice, rest, environment, activity, trust, interpersonal relationships, outlook, and nutrition. In addition, the system has the “His Touch” initiative, which encourages spiritual healing in the hospital and through community partnerships.

Adventist Health System Being one of the largest healthcare systems in the United States is a hefty responsibility. If you add to that a faith-based mission, then you’ve got an organization with extremely high expectations. But Adventist Health System doesn’t let that intimidate them. “We believe that having a faith-based mission calls us to a higher standard,” said Donald Jernigan, chief executive officer. “When you view the people you serve as children of God, that calls you to a different obligation than maintaining your market share or growing your business.”

Donald Jernigan, Chief Executive Officer

Real Issues : Real Solutions

very day e g n i k a M day a better A better day places patients at the heart of everything we do. A healthy patient experience takes thinking, innovation, and ingenuity. From the surgical wing to the food they eat; from the air they breathe to the people who help them have a better day. That’s why so many health care clients partner with Sodexo, the world leader in Quality of Daily Life Solutions.

Guided by Vision 2015 Triad Isotopes Inc.

To promote its mission and provide the highest quality care to patients, Adventist is preparing for a

Triad Isotopes Inc., the second largest radiopharmaceutical company in the nation, is dedicated to nuclear medicine and the communities in which we live and work. With over 1,000 employees and more than 25 years of experience, we deliver the most reliable service, safest products and competitive pricing. Through our open formulary, Triad provides access to all radiopharmaceuticals in the field of nuclear medicine. Our 70 facilities nationwide provide wide-ranging geographic coverage; we are located in 28 of the top 30 metropolitan areas. This extensive network positions us to service national GPOâ&#x20AC;&#x2122;s and regional systems, as well as stand-alone clinics and hospitals.

strong future. As with all health systems, Adventist is working toward electronic medical records, quality and safety measures, and physician alignment. To maintain consistency and high standards across all of Adventistâ&#x20AC;&#x2122;s entities, the organizationâ&#x20AC;&#x2122;s Vision 2015 guides decision-making. The Vision 2015 includes goals for safety, quality, and financial performance. Part of the vision involves making the clinical process completely paperless; ensuring all 43 facilities rank in the top quartile for quality, safety, and patient satisfaction; establishing highly aligned physicians; and building up cash to long-term debt at 125 percent with a minimum of 180 days cash on hand. The vision is ambitious, but Adventist is well on its way to achieving many of these goals. The organization has seen strong financial performance for a decade, and quality measures are improving across the board. The entire system is imple-

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US Foods is a sole source foodservice provider for Premier and is proud to have partnered with the Adventist Health System and their affiliates for more than 15 years. US Foods appreciates the opportunity to be your prime vendor and looks forward to continuing to support your success. US Foods is a creative and innovative business partner who provides value, new products, services and technology that enable its business partners to build and grow their business. US Foods’ legacy programs have delivered documented customer savings in excess of $350 million over the past 15 years. Discover more at www.usfoods.com

Keeping Kitchens Cooking .

physician shortage, the old model won’t be coming back, but Jernigan said Adventist has been making strides in hospitalist care. “I think the new model at first compromised patient care,” he said. “We make sure hospitalist care is optimal and hone in on how they practice.” Physician alignment is also a big push among hospitals. Adventist has initiatives in place that combine interpersonal relationships, software applications, financial services, clinical processes, and business services to help hospitals and physicians approach reform together. The organization physicians’ goals. In addition to working with physicians, man-

and your menus more profitable. Ask your US Foods representative, ™

turn patients over to hospitalists. With a looming

is also working on ways to align its mission with

the kind of food innovation that will make your operations easier in the coming months, about all the new ways in which we’re

care physicians rarely come into the hospital and

aging patient populations, especially those with chronic conditions, is a growing trend. Adventist menting computerized physician-order entry with

has formed collaboratives among hospitals to

completion expected in early 2012.

manage blood sugars as well as eliminating infec-

These efforts not only improve patient care, but

tions. The system also focuses on employee health

also prepare the organization for reform measures

though the Wellness Our Way program, which of-

that require hospitals to do more with less money.

fers incentives to employees to manage or prevent

“The implementation of a clinical-information

chronic conditions and improve their health.

system, coupled with the work done in physician alignment is part of our strategy for getting quality results and lower operating costs,” Jernigan said. “Eliminating unnecessary variation in physician-

Expanding its ministry of care Adventist has been expanding capacity and bring-

practice patterns, getting standardization in supply

ing new facilities under the Vision 2015. The system

costs, reducing overhead, and gaining productivity

has a state-wide network of 22 hospitals in Florida.

through automation are ways we are lowering our

It recently merged with University Community

costs.”

Health and created the Florida Hospital Tampa Bay

Making hospitalist care quality care As many healthcare systems have seen, the rela-

Division along with two other hospitals, making it a 1003-bed system with seven facilities. Adventist is also building a new hospital in Castle Rock, Colo. Adventist is on track to maintain a strong pres-

tionship with physicians has changed over the past

ence in the healthcare market, no matter what

few decades and is changing again with reform on

reform brings, and the system is committed to

the horizon. Jernigan said one trend he has seen

extending its CREATION health model.

during his career has been a “breakdown of the physician model.” Private practice was much more

by Patricia Chaney

common than group practice, and primary-care

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physicians admitted patients into the hospital and

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03 | Crittenton Hospital Medical Center

Crittenton Hospital Medical Center These relationships include RehabCare, which

Healthcare around the country is moving toward a more integrated approach with entities operating less in silos and forming more strategic partnerships with other facilities, organizations, or businesses. As many hospitals merge with larger healthcare systems, independent, not-for-profit community hospitals are examining their viability and their need to add partners in a range of areas.

manages outpatient therapies and the hospital’s CARF-accredited rehabilitation unit; Horizon Health Corporation, providing services for the hospital’s 20-bed mental-health unit; and the University of Michigan, which provides two full-time cardiac surgeons for the heart-surgery program. “We have a great reputation in our community for services, including our cardiology program,”

Crittenton Hospital Medical Center is a 290-bed, not-for-profit, acute-care community hospital serving Oakland, Macomb, and Lapeer counties in Michigan. Crittenton has broken out of the siloed-hospital mentality to form a range of strategic partnerships that expand the level of care it can provide to the community. The hospital provides a continuum of clinical programs with primary, secondary and tertiary-level care. Through partnerships, the hospital is able to offer programs that are not always found in a community-hospital setting.

Partamian said. “We wouldn’t have a service like that or the confidence of our community without the relationship with the University of Michigan.” In addition to partnerships for clinical services, Crittenton is staying on the cutting edge of information technology and medical equipment. The hospital is working with CareTech Solutions for IT solutions, including the implementation of an electronic medical record. “Our hospital is forward thinking in terms of IT development,” Partamian said. “We have invested

Mission-driven partnerships with the patient at the center

“Crittenton Hospital Medical Center is dedicated to enhancing the health status of the individuals and communities.”

Even Crittenton’s mission statement reflects this commitment to developing partners, focusing on the goal of doing what is best and what is needed for patients—“Crittenton Hospital Medical Center is dedicated to enhancing the health status of the individuals and communities we serve in partnership with our physicians, employees, and community members.” Chief operating officer Gregory Partamian said the hospital has been on the Baldrige Journey, a process to attain the Malcolm Baldrige National Quality Award. This journey involves meeting requirements in seven categories that are essential to a management system. “On the Baldrige Journey, we have had to identify core competencies, and strategic partnerships was one of ours,” he said. “We have many strong relationships with organizations that allow us to provide a range of services.”

a lot of money into IT, and we are prepared to meet meaningful-use requirements.” Another part of the hospital’s vision is to become an educator of choice, which has led to relationships with multiple schools in the area. The hospital is a fully-accredited teaching facility with residents from Wayne State University specializing in family medicine, internal medicine, and ear, nose, and throat. It is also a teaching campus for nurses from Oakland University’s School of Nursing and Rochester College’s nursing program.

Keeping the patient at the center of care Throughout all its service lines, Crittenton keeps the patient first. Partamian said the hospital has embraced the Relationship-Based Care Model, which is a vision for care with the patient and

“Our hospital is forward thinking in terms of IT development.”

family at the center. It includes six areas of focus-leadership, teamwork, professional nursing practice, patient-care delivery system, resource-driven practice, and outcomes measurement.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

04 | The Jewish Home for the Elderly

large really look at the hospital as their own. When you have that kind of pride of ownership, you have a much better chance of succeeding.”

Preparing for the future of healthcare Crittenton is in a strong position for the future, and as with all facilities, it is preparing for the future of healthcare. The hospital has already seen a drop in reimbursement for Medicare, and Blue Cross Blue Shield of Michigan announced it would not raise rates for two years. Partamian said the two payers account for about 80 percent of patients, and the hospital will need to figure out how to elevate quality and reduce costs. “We will have to become more knowledgeable about reform, and we are making an educational effort to bring our physicians along with us,” he said. “We need to understand what’s being asked of us and how we respond together with our physicians.” Therefore, Crittenton continues to build relationships and grow strategic partnerships with other businesses, organizations, and its physicians to navigate the coming changes. No matter what, the hospital recognizes that it is part of a larger healthcare system that operates together, from “Nurses are the initial participants in implement-

education to the bedside, to provide the highest

ing the Relationship-Based Care Model, but our

quality care for patients.

The Jewish Home for the Elderly Senior care is a growing area of healthcare with focus moving out of nursing homes and toward home care. The move toward home care comes from a new generation of seniors who are living independently for longer and from a cost perspective in the healthcare system. Providing care at home is more desirable for patients and more cost-effective for providers.

entire organization will adopt the model,” he said. “Together we will create the environment our com-

by by Patricia Chaney

munity deserves. Our staff already embodies the Rotary motto of ‘service above self’ in the way they act and care for each other and patients.” To better provide patient-centered care, Crit-

The Jewish Home for the Elderly, based in Fairfield, Conn., is a large organization made up of a 360bed skilled-nursing facility and home- and community-based services for seniors. The non-profit facility is overseen by a Board of Directors comprised of members from surrounding counties.

tenton is in the midst of an expansion project to add a six-story tower that will have three floors of private rooms, allowing the hospital to be predominately all-private rooms. “We are excited about the expansion project,” Partamian said. “It brings together the whole organization and the community. Our employees have already donated $350,000 to the fundraising campaign. This is a special place. Our physicians, staff, board members, auxiliary, and the community-at-

Andrew Banoff, President & Chief Executive Officer

Although the Jewish Home welcomes all members of the community, its mission is to provide “primarily Jewish seniors the healthcare, housing, and community-based services required to achieve the highest quality of life attainable.” The Jewish Home follows traditional Jewish observances, including Kosher food, on-site rabbinical training programs, and Shabbat and holiday services held in the Jewish Home’s synagogue. The director of pastoral services serves as an integral member of the Jewish Home’s leadership team, and care programs are designed to promote spiritual health as well as physical.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

Growth beyond nursinghome care

A Prescription for Long T L Term C Care S Success.

The Jewish Home for the Elderly has about 750

PharMerica provides quality pharmacy services:

employees and a $45-million annual budget. It

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offers five rehabilitation programsâ&#x20AC;&#x201D;short-term

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rehab for people coming out of the hospital; long-

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term rehab for residents; home-care therapy; ÂŽ

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contract therapy to other skilled-nursing facilities; and outpatient therapy for the community.

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Itâ&#x20AC;&#x2122;s the services beyond the skilled-nursing facility, however, that have seen tremendous growth for the Jewish Home, namely a range of community and home-based care programs. â&#x20AC;&#x153;The Home is a vehicle for senior services, regardless of the level of care,â&#x20AC;? said President and Chief Executive Officer Andrew Banoff. â&#x20AC;&#x153;We have an overriding commitment to serve people in their

The current Jewish Home is located on a 15-acre

demographic. We donâ&#x20AC;&#x2122;t have the acute-care dol-

homes, and we are privileged to work in individual

campus in suburban Fairfield, Conn. Banoff said

lars, a pharmacy, or physicians to support being an

homes.â&#x20AC;?

the new land would provide opportunity to greatly

ACO.â&#x20AC;?

Banoff said the home-care and community programs are receiving great feedback from the community. The Jewish Home recently embarked

Morrison Senior Living, a member of the Compass Group, is the nationâ&#x20AC;&#x2122;s only food service company exclusively dedicated to providing food, nutrition

at the existing 40-year-old facility.

The Jewish Home does maintain a three-year plan with consistently updated goals to ensure the stability of the organization. The plan includes

Home. The program, which is licensed by the Con-

Pursuing four primary goals

necticut Department of Social Services, offers the

With plans to build a new facility and grow home-

best staff and create a positive work environment;

full spectrum of long-term care needs at home.

care services, the Jewish Home for the Elderly is

ensuring fiscal stability; and developing new busi-

prepared to maintain market share and position

ness.

on an innovative venture called Senior Choice at

Morrison Senior Living is proud and honored to continue our long relationship of service to the residents and staff at Jewish Home for the Elderly.

improve upon the services that are already offered

â&#x20AC;&#x153;Through Senior Choice at Home, we provide

four primary goalsâ&#x20AC;&#x201D;providing the best quality to residents and clients; making sure to recruit the

care to people at home, no matter what level of

itself for the future. Banoff said the Jewish Home

care they need, for the rest of their lives,â&#x20AC;? Banoff

operates successfully with the support of the com-

is to be a one-stop shop for all senior needs. Family

said. â&#x20AC;&#x153;It is a great way to package everything we

munity and the quality of the staff. But along with

members can call if a loved one needs short-term

offer.â&#x20AC;?

these factors, third-party reimbursement is a real-

care, longer in-home care, personal emergency

ity of the business, and fiscal management is never

systems, or any other needs.

Senior Choice at Home is a membership-based program that allows members to receive a lifetime

far from Banoffâ&#x20AC;&#x2122;s thoughts. As with all healthcare organizations, the Jewish

The primary service vision for the organization

â&#x20AC;&#x153;We will continue to make sure we are that single-point resource for family members on any need

and dining services to senior living communities.

of services, including personal-care coordination,

Our Atlanta-based company serves approximately

home-health care, emergency-response systems,

Home isnâ&#x20AC;&#x2122;t sure what to expect from the future

they have,â&#x20AC;? Banoff said. â&#x20AC;&#x153;Whatever the message is,

370 senior living clients in 41 states including

and guaranteed assisted living and long-term care,

until more clarity is evident in reform measures.

we have resources to be a high-quality provider of

if needed.

But, Banoff said, he does not intend for the Jew-

that service.â&#x20AC;?

some of the largest and most prominent senior living communities in the United States.

Although home care is preferred, some patients still need the services provided at a nursing home.

5801 Peachtree Dunwoody Road Atlanta, Georgia 30342 1-800-2CLIENT | www.iammorrison.com

The Jewish Home is under contract to buy land to

ish Home to become part of an Accountable Care Organization (ACO).

by Patricia Chaney

â&#x20AC;&#x153;An ACO is not our role in the marketplace,â&#x20AC;? he

build a new facility. The new Jewish Home would

said. â&#x20AC;&#x153;We operate in the Medicare world and are

be built under the household model, rather than an

dedicated to one segment of the population. The

institutional model, providing residents with a more

size and scope of our organization is not equipped

home-like atmosphere.

to take on the full financial responsibility of another

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

05 | Overlake Hospital Medical Center

“We have a new wired and wireless network,” she said. “We built a new data center, and we’ve been moving all of our old servers and old architecture into a virtualized server environment in the new data center. We are implementing virtual desktops throughout the clinical areas in preparation for our

Your Cloud. Transforming the Cost, Quality and Delivery of Patient Care.

move to electronic medical records.” In the application areas, Albright said they have made significant investments in radiology, breasthealth, and cardiology imaging systems, as well as implementing an ambulatory EMR and beginning to upgrade to a new inpatient EMR. The lack of

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integration and enterprise functionality in the two major vendors, in addition to other “best of breed” specialty systems, resulted in a change of course. “We made the choice, instead of continuing

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down the path of implementing clinical documentation, CPOE, and physician documentation in our inpatient environment with the current vendor, that

we would halt everything and perform a detailed due diligence, which resulted in the decision to implement Epic across the enterprise,” she explained. VMware

Overlake Hospital Medical Center Located in Bellevue, Wash., Overlake Hospital Medical Center is a 349-bed, not-for-profit regional medical center and the first Level III Trauma Center on the Eastside of Washington. A rapidly growing organization, Overlake just increased its Neonatal Intensive Care Unit (NICU) by an additional 12 beds and is expanding its clinical environment to include primary, urgent, and specialty care.

Jody Albright, Vice President of Information Services & Chief Information Officer

With Overlake’s rapid expansion has come an increased demand on information services and infrastructure. Jody Albright, vice president of information services and chief information officer, said this has meant a complete upgrade of the hospital’s environment.technology, but the physicians, staff, and leadership are dedicated to quality, service, and teaching.

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She added that Overlake is implementing a healthcare information exchange for its community of physicians who may already have an EMR platform other than Epic. Overlake will also continue to maintain its long-term relationship with Philips in imaging.

Confronting a changing paradigm With healthcare’s consistently changing paradigm, Albright said it is important that CIOs clearly understand the strategic direction and requirements of their hospital and where it is going, how it’s going to get there, and how IT can help define the achievement of those goals. “Healthcare is an interesting environment where there are more niche applications than I think I’ve seen anywhere else without data-exchange standards to help them talk together,” she said. “There are so many different requirements,

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

Albright will serve as a consultant and a member of

IT organization was also reactive and had relatively

the executive steering committee.

low morale and engagement. Then, on Albright’s

“The implementation of a system is about the business,” Albright said. “How it is going to improve the business, and having it led by a business owner is a requirement for success.”

The trends of change

thirtieth day as CIO, there was a network outage, and one of the hospital’s main routers caught on fire. With only one back-up left in the system, she was able to maintain hospital operations, but she soon discovered that the entire hospital network was filled with equipment that had not been manufactured for

Albright sees virtualization as the next definite

the last six to eight years and had not been sup-

trend in healthcare IT. This is a drastic change from

ported for four years.

the past. “It used to be that many of the applications

As a result, components were being purchased from whoever had them, resulting in an infrastruc-

couldn’t be virtualized and were created for one

ture that was cobbled together with an “if-it-ain’t-

specific architecture and capability,” she said.

broke-don’t-fix-it” mentality.

“The vendors are waking up and doing a great job

“Overlake knew it had a problem and hired a

actually enabling their applications to be virtualized

consultant to put together a five-year plan for infra-

either on the server end or the front end.”

structure replacements and upgrades and key infor-

Then, there’s the increased involvement of the

mation system implementations at the hospital that

end user. Albright said the goal now is to make the

also included replacing the network,” she said. “The

clinician as skilled in the software and proficient on

network outage just really lit the fire under the orga-

the technology as the IT specialist, simply because

nization. It basically kick-started everything running

the clinician is reliant on the technologies from the

at that point and we’ve been running ever since.”

time they arrive until the time they leave. Finally, critical for healthcare’s future is the

Now, she said they have an organization filled with can-do people. Compared to the national level,

transfer of data from one system to another and

this mid-sized regional hospital is significantly above

having an overarching standard by which that

the national benchmarks for IT engagement and

transfer is conducted.

below the Solucient benchmarks for costs.

“If you look at manufacturing design, auto

“Everybody is engaged as we move forward and

the question is how you get the infrastructure in

industry, airplane, shipbuilding, they not only have

look to the future,” Albright said, adding, “It’s an

place that is going to be nimble and stable enough

data exchange at a 2-D level or textual level, but

exciting time in healthcare right now. It’s a time of

to be able to support these activities as they’re

they have data exchange at a three-dimensional

incredible uncertainty and change and that opens so

defined.”

level,” Albright said.

many opportunities.”

To this end, IT must be a part of the executive

The ability to achieve this standard, not just

teams that identify which technologies will move

on a localized level, but also on a national level

them forward, Albright stated. For example, at

in healthcare, should be easy, she added. But for

Overlake, the Epic implementation will be directed

some reason, it hasn’t been easy at all.

by the vice president of quality under a new title, Systems Change Management. Richard Bryan, vice

Changing the culture

president of systems change management, is lead-

When Albright came to Overlake three years ago,

ing the implementation as an organizational change

the infrastructure was old and had experienced

management program, not as an IT project. As CIO,

minimal investments in the previous six years. The

by Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

06 | Saint John’s Health Center

Famous for care and services Licensed to have 268 beds, Saint John’s has a staff of 1600 with 900 physicians on-board. They are known for oncology, and a significant part of

how it has transformed Saint John’s ER. “If you came in to our emergency room,” she

Cancer Institute, which takes research findings and

sional staff, but also by volunteers who really

translates them into direct patient care.

become your angels. They stay with you through the entire ER process to comfort you and also to be the

whether it’s total joint replacement of the knee,

conduit of information, and the conduit of informa-

the hip, or the spine or sports-medicine orthopedic

tion can be medical. If you don’t understand what

operations. Furthermore, their cardiovascular ser-

was said, they would explain it to you in a very calm,

vices are well-established, especially in the areas

understandable manner and then keep the commu-

of heart surgery, electrophysiology, and invasive

nication loop with your family.”

Because they are a community-based hospi-

Saint John’s efforts to stay patient-centered has led them to adopt the Lean program, which is help-

tal, women’s health is important to Saint John’s,

ing the hospital lessen any unnecessary repetition

and they are seen as the primary-care provider

of any process that they put the patient through,

for women in the region, serving in such areas as

thus reducing waste.

childbirth, breast cancer, gynecology, osteoporosis, and menopause.

Lou Lazatin, Chief Executive Officer

Lazatin takes great pride in this program and

said, “you will be received by not only our profes-

cardiology.

Seventeen years ago, the original Saint John’s Health Center was damaged in the 1994 Northridge Earthquake in California. Since that time, the state legislature has passed significant laws regulating the standards for how hospitals should be built with the intent on making them seismically safe.

ER program.

that program is the world-renowned John Wayne

Saint John’s is also known for orthopedics,

Saint John’s Health Center

Volunteer Program for Saint John’s Angels of the

Awarded many times over

“We’re trying to achieve better efficacy for the patient and at the same time, be responsible as far as resource utilization,” Lazatin explained.

ognized. The hospital has won several significant

Applying aviation to healthcare

national awards from such prominent organiza-

Another way in which Saint John’s has taken

Saint John’s renown is well-earned and well-rec-

tions as HealthGrades, who named them one of

healthcare safety to a new level is with the Mach-

Beginning in 1997, Saint John’s began demolishing old buildings and constructing new facilities. Five years ago, a new patient tower, the Chan Soon-Shiong Center for Health Sciences (CSS), opened, and last year, the Howard Keck Center became operational. In the fall of 2012, the front entrance to the new Saint John’s Health Center will be completed, making the hospital virtually brand-new.

the nation’s Top 50 Hospitals in 2011; Professional

150 program. Emulating aviation’s very rigorous

Research Consultants, from whom they received

safety program, Saint John’s hired two fighter pilots

several four and five-star awards; and Los Angeles

to work with one of the hospital’s key surgeons on

Magazine, which ranked the top physicians in L.A.

applying what happens in the cockpit to what hap-

County with more than 10 percent of the list being

pens in the operating room.

“We’re very pleased about the opening of the new hospital and being able to use the two core buildings, the Keck Center and Chan Soon-Shiong, for the last year,” Lou Lazatin, president and chief executive officer of Saint John’s, said.

comprised of Saint John’s physicians. In 2011, the American Hospital Association

In a cockpit, the flight crew always emphasizes communication. There’s a checklist for safety be-

(AHA) gave Saint John’s one of its 2011 Hospital

fore the airplane takes off the runway, and there’s

Awards for Volunteer Excellence (HAVE) for Best

a level of cross-check to make sure that what’s

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

Vendor-Neutral, Vendor Management It Means Bigger Savings & Smaller Liability With Staffing If you procure temps and independent contractors for your organization, you already know how much costs are rising in this area. If you don’t know about the rising compliance risks as well…you’d better learn fast. The risk-list is a long one, starting with contracts, insurance compliance by the firms who supply your contract workers, lawsuits by disaffected contractors, credentialing, background checks, certificates and licenses and proper IRS classification of these workers. One reason risks are growing is because healthcare organizations often deal with dozens of temporary-worker suppliers—in some cases, more than a hundred! Consider all the extra work involved in using all those suppliers. Consider that each supplier has its own methods of ensuring compliance. There’s no single standard to protect hospitals from misclassifying these workers. There’s no single standard of credentialing. The advent of Vendor Management Services (VMS) in the 90’s helped a bit. Often, however, the VMS company simply sent its own candidates to fill temp positions, ignoring those from competing firms. The result? The highest-caliber candidates weren’t always hired. Patient care—as well as the hospital’s reputation could have suffered significantly. Now, however, progressive healthcare organizations are migrating to vendor-neutral VMS partners who don’t place the majority of workers from within their own firm. As a result, these healthcare organizations have a leg up on the competition…because they get to choose from among the best candidates and continue working with their trusted suppliers. REAL COST-SAVINGS Texas Children’s Hospital (TCH), in Houston, instituted a vendor-neutral VMS program with RightSourcing in October 2009 – and saved more than $2 million in the first two years. In some areas, such as travel nurses and payroll services, the savings were in excess of 18%. TCH saved more than $550,000 on contractor conversions to full-time staff…while converting 100 temps to full-time, and increasing its “fill” ratio to 99%. Just this past year, they were able to fill 850 orders for contingent staff. “We began to think about changing our system a few years ago,” says Ed Lewis, Assistant Director of Supply Chain at Texas Children’s. “Each of our departments was searching for contract workers on their own, at times even signing their own contracts. We actually had in excess of fifty different contracts from fifty different staffing agencies. We began to realize that we didn’t have control of the situation.” Ed Lewis says the change has been dramatic. “We eliminated different pay rates paid for the same staffing. In addition, the vendor-neutral component has enhanced the quality of the candidates.” YOU’RE RUNNING SOME RISKS If you’re classifying your independent contractors as 1099’s, but treating them more like employees—telling them what to do, when

to do it and how to do it—you could be facing serious trouble from the IRS. You could be facing some serious trouble from state authorities, as well. Companies have been hit with major fines and penalties for these misclassifications. We in healthcare have a huge red target on our backs…because we use so many IC’s and temps. The financial impact can be disastrous. In addition, imagine the public relations consequences if your company is hit by the IRS or state regulators or dragged through the courts by disgruntled independent contractors who insist they were treated as employees. Melinda McDonald is Vice President of Child Health Corporation of America, a business cooperative of 43 free-standing pediatric hospitals. “We started with a vendor-neutral model at the end of 2009,” she says. “In addition to costs, as pediatric hospitals, we were also concerned about compliance issues with contingent workers. We’re always concerned about adherence to IRS and state regulations, adherence to Joint Commission regulations, licenses being up-to-date and thorough background checks. We’re all aware of the headlines about people with criminal records who’ve been working in hospitals around the country.” RightSourcing manages the credentials for visiting professionals, volunteers and students. The hospitals benefit from the temp-to-hire policy, which allows them to determine first-hand the skills of contract staff and convert the best ones to full-time staff when there’s an opening. WHY VENDOR-NEUTRAL “We wanted a vendor-neutral program,” says CHCA’s Melinda McDonald, “partially because we didn’t want to lose our existing suppliers. We found that some companies called themselves vendor-neutral, but they really weren’t.” Average program savings at CHCA hospitals are now exceeding 15% annually. The five member-hospitals now in the program have realized savings of over $8 million this year. The hospitals passed all DOH, TJC/DNV audits. They converted 161 temporary consultants into full-time hires. And, surprisingly, non-clinical temporary staff (primarily IT) account for 48% of contract staff; only 38% is nursing. “When your reputation is on the line every day,” says Texas Children’s Hospital’s Ed Lewis, “you want as many qualified candidates as you can get. And you don’t get those candidates by working with only one preferred provider.” The trend toward a vendor-neutral model is all about patient-care. Vendor-neutral companies have your best interest at heart…not theirs. You can start seeing results as early as the first week! Vendor-neutral VMS offers healthcare companies the best of all worlds. Cost-savings. Protection against liability and a choice of quality candidates. For a system buffeted by the winds of change, it’s none too soon.

communicated is verified verbally. Also, the pilot

and cosmetically damaging techniques where

is trained to listen to any of the concerns the flight

removing a tumor often results in a patient shaving

crew may have.

their head or having a large, burrowed hole on the

Lazatin said that Saint John’s has replicated this system in their OR. Surgeons, anesthesiolo-

skull. Lazatin also works with her nurses to adopt

gists, the lead nurse, the scrub tech, and any other

floor practices that improve the patient’s healing

supporting members of that team are all involved in

environment.

the initial process of determining what the patient

After 10 p.m. on the floors, for example, noise

is there for, marking the surgical site on the patient

is minimized significantly. Lazatin’s goal was to get

with the surgeon, and explaining to the patient and

away from the noisy hospital environment, replac-

the entire care team what will happen before the

ing it with the after-hours silence of a homelike

patient is anesthetized.

atmosphere. This initiative has been so effective,

“It was a mandatory training program for all our surgeons, anesthesiologists, and all of our surgical staff, and our goal is, obviously, zero-percent error rate,” Lazatin said.

Making innovation common practice Beyond innovative training programs, Lazatin encourages her physicians to experiment and explore new surgical techniques.

patients have asked, “Is anybody here?”, in response to the quiet. “I take ideas from other industries and put them into practice at Saint John’s, because at the very end of it, I want the hospital experience to not be any different from our daily experience,” she said. “The new Saint John’s is focused on breakthrough medicine and inspired healing.” by Pete Fernbaugh

Dr. Daniel Kelly, director of the Brain Tumor Center at the John Wayne Cancer Institute, uses a method where brain tumors are removed through a natural orifice, such as the nose, a minimal slit around the eyebrow that won’t force them to have to shave it, or at the back of the ear. The goal is to move away from large invasive surgical techniques

800.660.9544 www.RightSourcingUSA.com

Leanne Oatman, Vice President of Business Development, RightSourcing, can be reached at LOatman@RightSourcingUSA.com for additional information.

HCE EXCHANGE MAGAZINE

07 | The Robert Wood Johnson Foundation

Advanced AV

The Robert Wood Johnson Foundation The Robert Wood Johnson Foundation is the nation’s largest philanthropic organization that is dedicated solely to the public’s health. Founded in 1973, RWJF’s mission is to improve the health and healthcare of all Americans. According to Anne Weiss, team director and senior program officer, one of the Foundation’s greatest assets is the way in which it helps to create leverage for change.

Since its establishment in 1985, Advanced AV has demonstrated a commitment to long-term customer relationships and constant training and growth opportunities for its industry-leading personnel. Advanced AV has long proven its dedication to transforming clients’ technology objectives into reality. Today its engineered systems can be found in boardrooms, conference centers, classrooms, auditoriums, and many other venues that have benefited from the company’s sound, video, and networking expertise.

Currently, one of the Foundation’s signature initiatives is Aligning Forces for Quality, a program that confronts vexing problems in healthcare quality and cost on a local level. This program is the product of more than a decade of experimental highs and lows, during which time RWJF has been working to address these issues. For example, the foundation supported early

Headquartered in West Chester, Pennsylvania, Advanced AV has evolved with the advancement of technology into a specialized integrator of professional audiovisual systems for business, education and government in the mid-Atlantic region of the U.S. as well as servicing their clients globally.

Anne Weiss, Team Director & Senior Program Officer

Organizing forces for quality

efforts to measure healthcare quality and oversaw early pay-for-performance experiments. It has also played a high-level role in developing a chronic-care model that is rethinking the delivery of care outside of the hospital, especially to those with chronic illnesses. Additionally, RWJF has championed the

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

of 2011, they’ve launched the third strategic phase

She added, “Payment reform is becoming an in-

Weiss is confident that RWJF’s locally based ap-

in Aligning Forces and are working in 16 target

creasing part of their tool kit.”

proach to healthcare change is the catalyst that will

markets around the country, four of which are

drive future reform.

metropolitan areas. In these markets, the leader-

Reducing racial and ethnic disparity

ship teams consist of the providers, the purchasers,

Another aspect to Aligning Forces, Weiss said, is

have an aligned partnership of the people that

and the consumers.

the reduction of racial and ethnic disparities in

deliver care with the people who are paying for the

care. She believes that people do not always rec-

care, the business community and the health plans,

ognize the degree to which minorities are not given

and a meaningful engagement by the consumers,”

the same quality of care from their system.

she said. “It takes those stakeholders working

states while the others are multi-county regions or

Centered around three core strategies RWJF works with each team on three core strat-

“There are clearly a lot of social and economic

“Transformational change in healthcare is essentially local and will not be possible if we don’t

together to really create the incentives and support

incorporation of safety techniques that originated in

egies--measuring and making public information

factors that contribute to those problems,” Weiss

for change. You cannot do it alone, no matter how

other industries into the hospital environment.

about the performance of their system (e.g., how

clarified, “but it’s also clear that some of the solu-

healthy your bottom line is.”

In spite of the foundation’s diligence, though, Weiss

good the clinical care is, the patient’s experience

tion lies in the healthcare system.”

said staying ahead of the problems is a staggering

of care, and the cost of care); engaging providers

task.

in quality improvement and building providers’

and ethnic information of their patients to analyze

capacity to improve quality; and working to engage

patterns of care. Many times, when providers think

of change was not keeping pace with the growing

consumers in being demanding of better care, be-

there aren’t any disparities in their system, Weiss

urgency of the problem,” she explained. “There’s no

ing responsible for their own care, and being more

said an analysis of the data proves otherwise.

silver bullet. There’s no one thing you can do to fix a

effective consumers of care.

“We were first of all frustrated that the pace

The lynchpin of these three strategies is infor-

broken system.” Factor in the intensely local aspect of health-

mation.

RWJF encourages providers to analyze the race

In 2009, Saint Luke’s Health System and Truman Medical Center became sites for two of RWJF’s initiatives focused on reducing disparities,

“They all turn on information,” Weiss said.

one aimed at improving cardiac care for minority

comes difficult to implement blanket change across

“They all turn on people agreeing to measure and

patients and the other focused on aiding hospitals

the delivery spectrum. Because of this, RWJF

be transparent about how the healthcare system

in learning how to more effectively deliver language

adjusted its strategy from national to local.

in their market is performing. That really is the

services. So far, Weiss said, these initiatives have

transformational step, and I’m really proud of the

been a huge success.

care, along with differences in systems, and it be-

“We decided to adopt a strategy that would identify a limited number of target markets or

progress we’ve made.” Recently, RWJF has increased its emphasis on

communities and bring to bear all of the different

Working for 2015

lessons and approaches that we’d developed in that

encouraging communities to experiment with pay-

RWJF has set a deadline of 2015 for Aligning Forces

first generation,” Weiss said. “We really believe and

ment reform.

for Quality. At this point, the initiative’s effective-

“The current way that healthcare is paid for in

we’ve learned that you have to bring together the

ness will be examined. “We are intensely focused on 2015 ,” Weiss

people who give care, the people who get care, and

this country really aggravates the problems of poor

the people who pay for the care. No one of those

quality and high cost,” Weiss said. “If communities

said. “We are all about getting these 16 commu-

kinds of stakeholders alone could fix these prob-

can come together and talk about ways to have real

nities to a place where we can tell a story about

lems. They needed to work together. They needed

leverage over quality and cost in their community,

how, with very different assets and in very different

to align their efforts. ”

then they’re not waiting for the federal government

markets, they all improved quality, took on the cost

to mandate changes in reimbursement policy by

curve, and improved patient experience.”

RWJF launched four pilots in 2006, then went national with Aligning Forces for Quality in 2007. As

by Pete Fernbaugh

Medicare.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

08 | CHRISTUS Santa Rosa Health System

Children’s Hospital, three CHRISTUS Santa Rosa Phy-

organizations like us who do provide that charitable

sicians Ambulatory Surgery Centers in San Antonio,

care, and it’s becoming more and more difficult to

and a CHRISTUS Santa Rosa Physicians Ambulatory

deal with cutting reimbursements in today’s soci-

Surgery Center in New Braunfels.

ety,” Rodriguez said.

The only Catholic faith-based, non-profit health

Furthermore, carrying forth Jesus’ earthly

system in San Antonio and New Braunfels, CHRIS-

healing ministry presents demands and expecta-

TUS Santa Rosa is one of three hospitals in Texas to

tions that secular-based organizations may not feel.

receive HealthGrades’ Distinguished Hospital Award

Essentially, compassion becomes the Associates’

for Clinical Excellence over seven successive years.

calling card.

For two consecutive years, HealthGrades also named CHRISTUS one of America’s 50 Best Hospitals. Rodriguez oversees the City Centre Hospital and

“Not that we’re more compassionate than other organizations,” Rodriguez said, “but it’s engrained in everything we do, so I think that individuals that

also administers CHRISTUS Santa Rosa’s short-stay

come to us really experience God’s healing pres-

surgical hospital in Alamo Heights.

ence.” As a registered nurse, Rodriguez explained this

An active and expanding system

Treating people with dignity and respect

Founded in 1869 by the Sisters of Charity of the

For Rodriguez, everything about his leadership ties

Compassion takes on a whole new meaning and

Incarnate Word of Houston and San Antonio, this

back to CHRISTUS Health’s core values of dignity, in-

affects the patient in a holistic, but unusual way.

non-profit organization has expanded to include

tegrity, excellence, compassion, and stewardship. He

“I think the reason people come to us is

five full-service hospitals—CHRISTUS Santa Rosa

holds CHRISTUS Santa Rosa to a high standard, seek-

because they want to experience that, and I think

Hospital in Alamo Heights, which opened in January

ing to have these values applied not just to patients,

that’s why people want to work for us, because they

2012; CHRISTUS Santa Rosa Hospital – City Centre

but to Associates as well.

want to be part of that experience also and to be

in the historic downtown area; CHRISTUS Santa

As the nation’s leading charitable-care provider,

spiritual perspective affects how one, as a caregiver, approaches issues related to birth and death.

able to deliver that to our patients,” he said.

Rosa Hospital in the Medical Center; CHRISTUS

CHRISTUS has set an incredibly high standard for

Santa Rosa Hospital in New Braunfels; and CHRIS-

itself, especially in an age of cutting reimbursements.

TUS Santa Rosa Hospital in Westover Hills. Also

“From a regional perspective, we have more folks

Excited about change and reform

included in the system is CHRISTUS Santa Rosa

who are uninsured or underinsured and who turn to

Some healthcare executives approach healthcare reform with fear and trepidation. Rodriguez sees it as an opportunity that spurs excitement within him, especially when it comes to matters of quality care

CHRISTUS Santa Rosa Health System

and patient safety. “It’s an opportunity for us as an industry to redefine ourselves, and I would say that translates throughout our region,” he said, a region where

Many healthcare organizations have a stated mission, but few attempt to expand that mission into the spiritual realm, taking the mantle of Jesus Christ as their standard and example. CHRISTUS Santa Rosa Health System is a member of CHRISTUS Health, a Dallas, Texasbased, Catholic health ministry that spans not only the United States, with a concentration on the Gulf Coast region, but also spans internationally into Mexico. CHRISTUS Health’s mission is explicit—“to extend the healing ministry of Jesus Christ.”

Jerry Rodriguez, Vice President & Administrator

As an important contributor to the CHRISTUS family, CHRISTUS Santa Rosa strives to carry out this mission in a variety of South Texas communities, including San Antonio and New Braunfels. For some healthcare executives, being part of a system may seem restrictive and restraining, but for Jerry Rodriguez, vice president and administrator of CHRISTUS Santa Rosa Health System, it’s like being part of a large family. Members may not always agree, but in the end, they’re united around a common purpose and focused on supporting each other.

they are growing. Therefore, CHRISTUS Santa Rosa is focused on National Patient Safety Goals and all of its evidence-based practices and core measures. CHRISTUS Santa Rosa is also looking at preventable –infection initiatives. Being in a culturally diverse area, Rodriguez said that CHRISTUS Santa Rosa strives to respect every person’s needs and dignity, even if those needs are faith-related demands such as the kinds

INDUSTRY PARTNERS Verathon Medical www.verathon.com

TUS Santa Rosa sees patients as being a member of their family, Rodriguez said, all of which ties back into the overall system’s vision. “Jesus was not biased in who He healed and who He cared for, and I believe that’s very much the same for us,” he stated. “We’re given that responsibility; a responsibility to continue the calling three founding sisters accepted more than 142 years ago.”

Being a national role model In addition to respecting Associates and patients, CHRISTUS Santa Rosa, like its parent system, is intent on being a role model. Already a role model when it comes to offering uncompensated national care, Rodriguez believes that in the future, people will wonder how the overall CHRISTUS Health System continues to be a viable organization with its mission and charity care, while still providing quality excellent care. “We are already the industry leaders in many areas,” he said. “I think more and more people will look to CHRISTUS Health as a role model. I think they will look to us on the quality side and the service-excellence side.” Rodriguez added that he believes CHRISTUS Santa Rosa is there to perform a very special work in the community. He sees CHRISTUS Santa Rosa as blessed to be in its various communities, and he feels the communities are blessed to have CHRISTUS. And always, he said, the motivation is striving for excellence in a compassionate, courteous way. “Our mission really directs us in everything we do.” by Pete Fernbaugh

of food a patient can eat. Key medical personnel are also trained in matters related to diversity. CHRIS-

HCE EXCHANGE MAGAZINE

09 | Empirical Technologies Corporation

Empirical Technologies Corporation INDUSTRY PARTNERS

The primary mission of Empirical Technologies Corporation is the development of sensor technologies that monitor the physiological behavior of humans and animals. The company has been heavily involved in combatcasualty care for the Office of Naval Research, and in 2009, Empirical won over one million dollars in funding to develop a combat-casualty care monitor that would measure a person’s heart rate, beat-by-beat continuous blood pressure, respiration rate, hemorrhaging, and dehydration. David Gerdt, Chief Executive Officer

This monitor would eventually be known as CareTaker, and as Chief Executive Officer David Gerdt explained, it would become the cornerstone for Empirical’s goals and ambitions.

Valtronic (440) 349-1239 | www.valtronic.com

“The more parameters you can get out of one instrument,” Gerdt explained, “the better chance you have to diagnose different medical problems. A lot of monitors these days just monitor one thing, and for detection of dangerous vasospasms due to accidents or surgery. “These systems required a small, inexpensive beat-by-beat blood-pressure monitor, and

Studying CareTaker’s potential When CareTaker’s development was finalized,

humane and innovative endeavor that has attracted worldwide attention.

tive use mostly in MRIs, since MRIs currently have

Expanding research and development

no alternatives for beat-by-beat blood-pressure

In 2010, Empirical won another $1.7 million in fund-

measurement. Empirical now has 25 of these units

ing from the Office of Naval Research via the Office

in seven countries around the world and another 25

of the Secretary of Defense for improvements and

units involved in clinical trials designed to study the

clinical trials related to CareTaker’s use. Empiri-

early detection of preeclampsia, the replacement of

cal also began production prototypes of CareTaker

arterial catheters, spinal–tap anesthesia monitor-

and completed clinical trials from 50 blood donors

ing for difficult births among the morbidly obese,

showing the sensitivity of CareTaker’s hemorrhage

and surgical operations.

detection. Empirical conducted dehydration studies

Empirical began selling the device for investiga-

Empirical was also able to show in a clinical

in Singapore and at the University of Montana, and

trial that CareTaker tracked central blood pressure

right now, the company is monitoring 50 patients

as opposed to peripheral blood pressure. Addition-

in ICUs against arterial catheters as part of a study

ally, the company conducted tests funded by the

related to obtaining FDA approval for CareTaker.

National Institutes of Health (NIH) to show that

In 2012, CareTaker will be used at the University

CareTaker could be used for continuous monitoring

of Texas Medical Branch in a study of algorithmic

of blood pressure during dialysis, a safety feature

fluid resuscitation that will benefit from beat-by-

necessary for home dialysis.

beat blood pressure. The company plans to build

In a blind study at the University of Virginia

arrhythmia classification and detection into the

Hospital, Empirical detected and located five of five

device. CareTaker can determine atrial fibrillation

aortic aneurysms all from signals obtained at the

in as little as 10 heartbeats and should auto-diag-

wrist.

nose congestive heart failure, which is the greatest

In a separate, but related use of CareTaker’s

single cause for hospital readmissions.

technologies, Empirical has recently spearheaded

Late in 2010, the company won $850,000 from

a project to detect equine blood pressure and heart

the Army to build a rheoencephalography sys-

rate. Because a horse’s pain can only be mea-

tem, now going into clinical trials, for the neuro-

sured by elevated blood pressure and heart rate,

monitoring of traumatic brain injury from explosive

CareTaker has proven to be uniquely useful in this

blasts. Clinical trials will also assess this system

CareTaker filled that bill,” Gerdt said. “It is the first rheoencephalography system that is totally noninvasive.”

A field of unlimited possibilities Over 10 years ago, Gerdt and his two Empirical colleagues received a solicitation from the Defense Advanced Research Projects Agency (DARPA) to find a remote method to determine whether soldiers or marines in combat areas were dead or alive before a medic or corpsman was sent in on a rescue mission. “Twenty-five percent of warfighters who are killed are going after other warfighters who have already died,” Gerdt said. Once Empirical began the study of remote vital signs, Gerdt and his team found that there was more and more to be done with remote detection, and from there, the company’s technology grew into personal healthcare needs at home, far from the battlefield. Once CareTaker is FDA-approved for the wider market, Gerdt foresees the device having an immense impact on healthcare. “I think the biggest impact we’ll have is for diagnosing illnesses at home and keeping people out of the hospitals,” Gerdt said. The goal is to introduce a multi-parameter vital-signs system that will be inexpensive and can sit in the bathroom closet next to the thermometer,

that’s never good enough for remote diagnosis.” CareTaker, however, can be worn while a person is sleeping and shows the user every time they have an apnea arousal. Software analysis counts the arousals and detects their severity by measuring the continuous blood-pressure changes due to these events.

Replacing arterial catheters Starting in 2012, Empirical’s ultimate goal is to replace most arterial catheters altogether. Gerdt said that the cost of the mechanical parts in an arterial catheter, plus the cost of the surgeon, is more than the cost of their unit. About one percent of arterial catheters cause blood-borne infections or clots. Infections can cost from $30,000 to $65,000 to cure, and blood clots are similar with both resulting in more time in the hospital, more drugs, more pain, and excessive danger to the patient. “Most arterial catheters are simply not necessary with a noninvasive device,” he said, “and CareTaker presents a way to perform the same functions.” CareTaker is also small and light and able to sit on the back of a wrist. It has a battery charge that lasts for 24 hours and can now stream data continuously to an Android phone, which continuously sends that data to a Cloud server. “We see it as a device that would bring a lot of medical diagnosis into the home,” Gerdt said. With the physician or nurse, it could be used to remotely adjust or modify drug dosages and it could be used to treat patients remotely, especially in rural areas.” by Pete Fernbaugh

all with cellular radio connection to a Cloud server.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

10 | HealthBridge Children’s Hospital

specialty programs. That opportunity has brought in physicians from Baylor College of Medicine and the University of Texas, a feat no other local children’s hospital has accomplished in Houston. Both medi-

INDUSTRY PARTNERS RecoverCare www.recovercare.com

cal schools also have resident and medical-staff participation in the hospital.

Excellence in specialty programs What separates HealthBridge from other children’s hospitals, though, is the level of care it provides in specialty programs. The hospital has a step-down pediatric intensive-care unit, general pediatric beds, and an acute pediatric rehabilitation unit. This has allowed the HealthBridge team to focus on developing niche inpatient programs that add value to the community. HealthBridge’s current inpatient programs include respiratory care, obesity, sleep medicine, wound care, behavioral pediatrics, and general

HealthBridge Children’s Hospital

medicine. In 2012, HealthBridge hopes to add palliative care and feeding to that list. HealthBridge has also been excelling with quality outcomes for its specialty programs. Be-

The future of healthcare involves lower reimbursements, higher quality standards, and interdisciplinary teams caring for patients with complex or chronic conditions. HealthBridge Children’s Hospital in Houston, Texas, has been operating in this model for more than a decade. The 40-bed specialty acute-care hospital runs efficiently, uses multidisciplinary teams to treat patients from birth to age 21, and has solid outcomes.

cause of this, it has earned The Joint Commission Gold Seal of Approval. For example, in the area of hospital-acquired ventilator-associated pneumonia rates, HealthBridge’s goal was 1.70, but as of November 2011, its year-to-date average was 0.00. For hospital-acquired urinary catheter/associated urinary-tract infections, HealthBridge set a quality goal of 3.50 with its YTD as of November 2011 being 0.00. And for its hospital-acquired pressure-related

Joseph W. Rafferty, Chief Executive Officer

wound rate, the goal was 0.13, but November also saw a YTD average of 0.00. But it’s not just the medical care that makes HealthBridge exceptional; it’s also the organiza-

Nurturing a team-oriented environment

patients,” he said. “We have people who work

Chief Executive Officer Joseph Rafferty says the

their families. Many of our children have special

hospital’s success comes from the dedication of

needs, and these families have very difficult lives.

staff and physicians to treating a unique set of

We are honored to help these families.”

together for the common good of these patients and

patients.

It is that sense of mission and dedication

“We look for individuals who are aligned with

that Rafferty looks for in HealthBridge staff and

the mission of our organization, are excellent at

providers. The physicians that come to the hospital

providing care, and who care deeply about our

are offered unique opportunities to build and run

tion’s focus on behavioral disorders. The hospital has been building a behavioral pediatric team and receives many patients referred from larger children’s hospitals who have complex medical issues and complex behavioral problems. These patients receive care for their medical conditions, but they are also treated by a behavioral team that includes a psychologist, psychiatrist, case

manager, and others. HealthBridge has a full-time psychologist on staff, a factor that is extremely uncommon for most small community hospitals.

Operating within its means While many organizations are dreading healthcare reform and are looking at ways to become more streamlined, HealthBridge has always had to work within its means to provide efficient, high-quality care. Like most children’s hospitals, about 70 percent of the patients are insured via some form of Medicaid. “We are very concerned about the upcoming Medicaid reimbursement cuts,” Rafferty said. “Fortunately, we have always controlled our costs well, and as compared to other children’s hospitals, our costs are only a fraction of the cost to the Medicaid/Managed-Care Payers. The Payers will want to partner more and more with our facility as their budgets shrink. We are positioned well for the upcoming changes in the U.S. healthcare system.” Working in teams and managing chronic conditions to avoid or limit re-admissions are also common goals healthcare organizations are working toward and goals that HealthBridge has been achieving since its opening in 1999. “I believe we are a model for other hospitals,” Rafferty said. “We can all provide exceptional quality care to patients in an efficient, cost-effective manner.” HealthBridge Children’s Hospital is part of the Nexus Health Systems, a provider of post-acute medical care and transitional care. Nexus was recently named one of the Houston Chronicle’s Top Workplaces. For more information or to make a referral, call (281) 293-7774 or visit their website at www.HealthBridgeHouston.com. by Patricia Chaney

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

11 | J&B Medical Supply

J&B Medical Supply

Providing care to seniors is a rapidly growing sector of healthcare, and the desire of most seniors is to care for themselves at home for as long as possible. J&B Medical Supply, Inc., is a medical distribution company that has focused on allowing seniors to do just that -- and to do it affordably.

Stephen Shaya, M.D., M.S., Medical Director

sults in quality, outcomes, and cost savings through its model. “We have a program with Michigan’s Medic-

Established in 1994, J&B Medical Supply has since become one of the fastest growing and most successful medical distribution companies in the world. The family-owned business sells one million items from nearly 900 manufacturers. J&B provides medical supplies to healthcare businesses, supplies to individuals, and even distributes pet medications. The company has also expanded its reach outside the United States with offices in the Middle East and work in Panama and Latin America.

aid system that has saved Michigan $80 million

“When we started, our focus was on business to business, things that go in hospitals, nursing homes, pharmacies,” said Medical Director Stephen Shaya. “About eight years ago, we began shipping products to homes. That is a growing market, and we made a business decision that that was our future.”

tainty, Shaya said it is still a time to thrive. How-

The company’s mission is to “provide its customers with the widest variety of medically related products with the highest level of quality and customer services at the most economical prices.”

over five years,” Shaya said. “We have also seen increased quality of care, improved outcomes, and even helped weed out some fraud and abuse in the system.” Although the healthcare market is full of uncerever, thriving requires new ways of doing business, and quality should always be the top priority for any decisions. “Quality drives demand,” Shaya said. “A lot of people are taking approaches to cut corners, but quality should always be at the forefront. It’s what differentiates healthcare from many other sectors.”

Driving technological innovation J&B Medical has invested heavily in technology, particularly in technology that allows patients to

Fitting into the healthcare landscape

Traditional business customers may not be happy

Shaya said there are 77 million people over age 62,

with the new model, but the customer base is

and they spend on average about $1000 a month in

consistently growing for the consumer side of the

ya stated. “We have invested heavily in telemedicine

the products J&B Medical provides. The traditional

business. With healthcare expanding because of

and e-commerce.”

model has a product traveling from the manufac-

reform, more people are gaining medical coverage.

turer to a distributor to the healthcare provider. The

J&B Medical’s model is based mostly on Medicaid,

in healthcare for years, but J&B Medical offers a

providers then supply the medical care and bill the

which has different reimbursement than Medicare.

cutting-edge telemedicine solution. J&B Medical

be cared for at home in a high quality and more

The services and products J&B Medical offers

insurance company. J&B Medical, Shaya said, has

sustaining manner. “This is an important time for innovation,” Sha-

Shaya said telemedicine has been a buzzword

is the parent company of Health Net Connect, Inc.

become a hybrid of distribution and fulfillment and

are going to be a large part of healthcare in the fu-

(HNC), a designer, manufacturer, and distributor

provider.

ture, Shaya asserts. Although specific requirements

of telemedicine solutions, software, hardware, and

have yet to be defined, he said providers are more

remote patient monitoring. In the spring of 2011,

ability to provide medical care telephonically,” he

likely going to be responsible for keeping people

HNC released the HNC VideoDoc™. The system

said. “Manufacturers would have to provide clinical

out of hospitals. Caring for patients at home is less

allows healthcare providers to remotely monitor

and utilization management to go directly to the

expensive than caring for them in a hospital or a

patients anywhere in the world and conduct real-

consumer, so they partner with companies like us.”

long-term care facility. J&B Medical has proven re-

time virtual house calls and virtual rounds. Based

“We brought our expertise combined with the

“This is an important time for innovation.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

“We feel our telemedicine solutions are cutting-edge and provide a solution that allows providers to really connect with people in their homes.” upon empirical research and data, HNC estimates it will reduce the rate of hospital re-admissions by nearly 70 percent. The VideoDoc™ system monitors heart, lung, and blood functions for congestive heart failure, diabetic, and chronic obstructive pulmonary disease patients, as well as high-risk pregnancy and dermatology. Health Net Connect telemedicine products and solutions integrate patient vitals, including blood pressure, electrocardiogram, pulse oxymetry, weight/body mass index, blood glucose, and spirometry, plus diagnostic tools with HIPAA compliant video consultation. “People are going to be living longer and staying in their homes longer,” Shaya said. “We feel our telemedicine solutions are cutting-edge and provide a solution that allows providers to really connect with people in their homes.” With the future basing itself in working remotely with patients and customers, J&B Medical still puts a high value on building relationships with customers, businesses, and manufacturers. The company views these relationships as partnerships that help each business grow and save customers-not to mention the healthcare system—money. No matter what reform brings, Shaya said J&B Medical is prepared to be a strong force within the market. For more information, HNC can be contacted directly at 855-2-VIDEODOC (855-284-3363), or visit them on the web at www.healthconnectlive.com. by Patricia Chaney

HCE EXCHANGE MAGAZINE

12 | Kissito Healthcare

Caring for overlooked populations Clarke has a unique perspective on providing care, having spent his career primarily working with populations that are overlooked. He founded Kissito in 1991 after losing his job at a large hospital system. He said he has always had a passion for the elderly and nursing homes offered an entrepreneurial opportunity. Kissito now has two divisions--Kissito Healthcare, which operates nine geriatric-care facilities in the United States, and Kissito Healthcare International, which includes regional-health delivery systems in Ethiopia and Uganda, as well as education and healthcare programs on four continents. The company’s mission statement reads, “Kissito Healthcare exists for the betterment and care of human life.” Clarke applies this to all patients,

Kissito Healthcare Geriatrics contains a growing population and as a result, is a growing area of healthcare in the United States. Even more than other sectors of the industry, geriatrics is also facing the need to do more with less. The Center for Medicare and Medicaid Services has already reduced payments for skilled-nursing facilities by 11 percent. Despite cuts, Tom Clarke, founder, president, and CEO of Kissito Healthcare, says reform is one of the best things that has happened to the healthcare industry.

Tom Clarke, Founder, President & Chief Executive Officer

whether they’re malnourished pediatric patients in

In Virginia, Kissito has been designated as a Pro-

Africa or elderly individuals in U.S. nursing homes.

gram of All-inclusive Care for the Elderly (PACE)

Overseas, Kissito Healthcare International

provider in Roanoke. This program allows Nurs-

partners with government institutions to develop

ing Home Certified Elders to remain at home and

regional health delivery systems. Initiatives focus

receive home-based care services. Kissito reports

on sustainability and outcome replication with at-

that participants in the program experience 50 per-

tention to maternal and child health and nutrition

cent fewer hospital days and more than 90 percent

programs.

fewer nursing-facility days. Clarke is expecting Kissito to become more

Keeping patients at home and out of institutions

involved in managing patient populations and work-

Kissito Healthcare is focusing its efforts on more

without having to have a physical space.

home care and trying to move patients out of nursing facilities.

ing with providers across a large geographic area “We expect to see less building capacity but more patient-care delivery system capacity in the

“We tend to institutionalize our elders when

coming years,” he said. “We will execute our model

“I haven’t read the 3,000 pages of legislation,” he said. “To me, that’s not the impact of reform. The legislation is the grenade lobbed into the healthcare system to cause change. Providers are moving toward coordination of care, partnerships, and more rational ways of providing care.”

we can’t care for them at home,” Clarke said. “But

that focuses on self-management skills for patients

many patients are able to be cared for at home,

in their homes and community.”

He argues that healthcare organizations operate in silos. Kissito is part of the post-acute care silo, but even within that arena, the current system offers no consistency. Providers are offering the same care, but depending on their classification, providers receive different reimbursements, with skilled nursing and home care receiving the least amount of money.

services to reassimilate people into their communi-

future of healthcare, with more coordination, ef-

ties.”

ficiency, and focus on what is best for patients.

As the industry changes, Clarke expects to see more hospitals partnering with post-acute care facilities, and the ones with the best outcomes are the most likely to survive. “The five-star system for rating nursing facilities and the CMS core measures are the best things that have ever happened to our profession,” Clarke said. “Executives everywhere are focused on outcomes, which benefits our patients. I know nursing-home outcomes are better because of these measures.”products with the highest level of quality and customer services at the most economical prices.”

and we want to go into nursing homes and offer

Kissito has purchased home-health operations

In terms of reform, Clarke looks forward to the

“I think we can be proud of our healthcare

to help expand services that allow the elderly to live

system in America,” he said. “If we keep focused on

at home. A large part of caring for patients at home

patient outcomes and being part of a larger system,

involves educating patients and their caregivers.

rather than operating in silos, our system will be

A stay at a Kissito facility should average about 37

better than it’s ever been.”

days, focusing on recuperation and rehabilitation. Patients and their caregivers are also engaged in a

by Patricia Chaney

health-awareness and education program.

HCE EXCHANGE MAGAZINE

13 | Mid-South Regional Blood Center

Facing indirect pressure from reform Garrick said the relationship with hospitals has changed in recent years, especially as hospitals have fallen under stricter budget restraints. All areas of healthcare have had to find ways to cut costs and looking at blood supply has been no exception. â&#x20AC;&#x153;As thereâ&#x20AC;&#x2122;s more pressure on hospitals, we are looked at more as a vendor rather than a partner,â&#x20AC;? Garrick explained. â&#x20AC;&#x153;Some decisions about where blood is being sourced from are not made by the blood bank, but by people who are managing the supply chain at the hospital.â&#x20AC;? Garrick said the industry has seen changes in how blood is being provided to different hospitals. As many hospitals are owned by heath systems located outside the region, Mid-South supports only about 10 percent of hospitals not based locally. â&#x20AC;&#x153;We have lost the support of a couple of hospitals owned by larger chains outside the region, as purchase decision was based more on price than service and the ability to meet specific patient needs,â&#x20AC;? Garrick said. As hospitals face more pressure to cut costs, so does the blood center. The center has had to

eliminate positions, having had three reductions in force in the past two years. For long-term viability, the center has looked at further ways to improve efficiency and cut costs. Furthermore, as with many healthcare services, Garrick is also seeing more mergers and consolidations of independent blood centers. Mid-South is exploring its options to partner with other organizations. â&#x20AC;&#x153;We would like to be independent with our own local board to drive the organization,â&#x20AC;? he said. â&#x20AC;&#x153;But we also realize we need to be competitive, be more streamlined, and cut costs as best we can. In the next five years, I see us being affiliated with other centers that would make us more efficient and give us more stability and support our ability to provide blood lo-

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while rural centers tend to have more donors than need. So Mid-South has contractual relationships with rural centers that can over-collect.

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Despite pressures to cut costs, the need for blood is

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ongoing, so Mid-South has to evaluate its collection methods and where to invest in growth. Garrick said

Mid-South Regional Blood Center

the center is outgrowing its existing facility and will need to make investments in a new center to house its

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manufacturing and distribution operations. Also, the mobile-collection side of the business

About 70 percent of people will need blood before they hit age 70, but fewer than 10 percent of the general public donates blood. The American Red Cross is the largest national blood collection agency, but smaller, independent centers are vital to providing blood to local hospitals and health systems around the United States. All in all, these smaller, independent centers provide more than half of the national blood supply.

J. Daniel Garrick, Chief Operating Officer

The Mid-South Regional Blood Center in Memphis, Tenn., is a non-profit volunteer blood center. It provides about 70 percent of the blood used by patients in its 20-hospital service area that covers 15 counties in the Mid-South region. The center acquires about 50,000 volunteer collections each year. Chief Operating Officer J. Daniel Garrick said the company began as a recruitment arm for the local hospitals and became an independent blood collection center in the 1970s. â&#x20AC;&#x153;We have a good relationship with hospitals, and we stay focused on hospitals locally, which gives us a competitive advantage,â&#x20AC;? Garrick said.

tornado hit Joplin, Mo., in May 2011, for example,

continues to grow, creating a need for more buses,

Mid-South worked with its sister center in Joplin to

trailers, and vans. The center used to collect about

supply blood to nearby hospitals. The center then

70 percent of donations at fixed sites and 30 percent

saw an outpouring of people wanting to donate, but

through mobile units, but that has changed to about

Garrick emphasizes that the desire to give blood

50/50.

should continue even when thereâ&#x20AC;&#x2122;s not an immedi-

Bringing the collection site to donors is likely going to be an important part of the business going

ate disaster. â&#x20AC;&#x153;Blood donation is critical to healthcare, and

forward, as centers need to maintain an adequate

itâ&#x20AC;&#x2122;s something that has to be done continuously,â&#x20AC;?

supply at all times. The need for blood becomes pres-

Garrick said. â&#x20AC;&#x153;Blood is perishable, and it has to be

ent in the publicâ&#x20AC;&#x2122;s mind when disasters hit, and local

replenished before disaster hits. It doesnâ&#x20AC;&#x2122;t do any

centers like Mid-South are poised to support hospitals

good if blood is not on the shelf.â&#x20AC;?

within their region. Larger suppliers may have depots, but when time constraints are a factor, blood may not

by Patricia Chaney

have the ability to be transported in time. Regardless of the future, the need for blood donation will always exist, and Garrick looks toward ways centers can better work together. When the devastating

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

14 | Northeast Regional Medical Center

Looking the part

their families, and the providers. Barber said it’s

dic surgeons and see a lot of orthopedic cases, so

Northeast is working floor-by-floor to upgrade the

also a way to track who their providers are, relay

we added raising the toilets by two inches to our

facility and make it look like a Top 50 hospital. The

any notes to or from the family, and monitor the

renovation plans.”

medical center has made huge strides in a little

patients’ pain level and how their recovery is pro-

over a year. In 2010, Northeast did a $3.9-million

gressing. Furthermore, the nurses’ stations were

Nine Principles as a part of its commitment to ex-

renovation of the obstetrics/nursery unit, which

reconfigured to be more user-friendly, since nurs-

cellence. The Nine Principles provide “a roadmap to

includes five labor and delivery rooms and 10 post-

ing students, nurses, residents, physicians, and

help leaders navigate the journey to developing an

partum rooms, and a $2.7-million expansion in the

therapists would all be sharing one station.

excellence-based culture.”

Also in 2011, Northeast added a new cath lab

Critical Care Unit, taking it from six beds to 10. The

Northeast has embraced the StuderGroup’s

“A huge part of quality in healthcare is the

facility also built a new cardiology clinic in partner-

and a new 64-slice CT scanner. All in all, these

patient perception of how they were treated when

ship with Missouri Heart.

projects total $3.5 million in capital expenditures.

at a hospital,” Barber said. “We have a strict focus

“We have had challenges with aesthetics and

on that with our implementation of the Studer

Eric Barber. “If we are acting like a Top 50 hospital,

Committed to service excellence

we should look like one, too. Our remodel was long

Northeast plans to maintain its status as a top hos-

tive change that has come from these principles.

overdue and brought our look up to match our clini-

pital through quality and patient satisfaction. Even

Our culture makes it more enjoyable not only for

cal expertise and service.”

in planning the renovations, administrators consid-

patients and families, but also for employees and

ered patient needs. It is routine for administrators

medical staff.”

outdated technology,” said Chief Executive Officer

In 2011, the hospital renovated two med-surg

principles. It has helped us shape the culture of our hospital, and it’s been exciting to see the posi-

Barber said these efforts position the hospital

units that were comprised of 49 patient rooms and

at the hospital to make rounds to newly admitted

98 beds. Upgrades included the installation of two

patients each morning. During one round, Barber

for a pay-for-performance scale and ensure that

flat-screen televisions in each room, one for each

met a patient who said the plans for renovation had

Northeast is exceeding the national standard in

patient, and the addition of laminate flooring and

overlooked the toilet seats, which were too low for

HCAHPS scores and core measures.

patient handrails throughout the units.

patients to sit on, especially after a joint surgery.

boards at the patient bedsides that are meant to

gentleman, and sure enough, they weren’t func-

Teaching and recruiting in a rural setting

facilitate communication between the patients,

tional,” Barber said. “We have three busy orthope-

Northeast Medical Center serves as a teaching hos-

“We looked at the toilets after talking with this

The hospital has also added communication

pital for A.T. Still University, the nation’s founding school for osteopathic medicine; Truman State University; and the University of Missouri. Northeast

Northeast Regional Medical Center

offers residencies in nine specialties with about 35 residents and interns on rotation. The partnership with A.T. Still University has

Being one of America’s 50 Best Hospitals doesn’t mean you have to have the best-looking facility, be a huge hospital, or have every piece of the latest high-tech equipment. Becker’s Hospital Review chooses hospitals for the list based on a commitment to putting patients’ needs first and providing high-quality care. Northeast Regional Medical Center, located in rural Kirksville, Mo., is a 115-bed teaching hospital, offering nearly every healthcare service short of neurosurgery and open-heart surgery. The hospital was named to Becker’s Top 50 in 2011 and in 2009, to Thomson Reuters Top 100 and was also an Everest Award winner in 2009.

Eric Barber, Chief Executive Officer

Northeast is a small hospital in a rural community with no hospital of comparable size within 60 miles. The medical center is part of Community Health Systems, based in Franklin, Tenn. Northeast is housed in a facility built in the 1970s and as a result, hasn’t had all of the latest technology, but the physicians, staff, and leadership are dedicated to quality, service, and teaching.

Most recently, the hospital has added an orthopedic

helped the hospital attract new physicians, and

surgeon with a sports-medicine focus, a urolo-

Barber is excited about future opportunities as the

gist, and an ENT physician who recently finished a

university will be adding a dental school by 2013.

fellowship in otology. These specialties continue to

“We are poised for some sustainable growth,”

expand the services Northeast can offer, and Bar-

he said. “The dental school will benefit everyone in

ber looks forward to a future of growth that reflects

our community and improve our ability to continue

the high-quality care the hospital provides.

to attract talented physicians to our medical staff.” Physician recruitment is especially challenging

by Patricia Chaney

at rural hospitals, but Northeast’s reputation has helped attract new medical staff. “Being in a rural setting, it can be difficult to have a full complement of specialists,” Barber said. “But we have had a lot of success adding new members to the medical staff who have had a profound impact on making sure we’re providing the services our community needs.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

15 | Bellflower Medical Center

Bellflower Medical Center

accountable for the performance of those departments. Choo inherited a staff with many years of ser-

As financial pressures get stronger, many healthcare facilities or hospitals undergo drastic changes or shut their doors, while others call in experts. Mike Choo, chief executive officer of Bellflower Medical Center in Southern California, has particular expertise in turning around struggling hospitals, and in 2009, Bellflower hired him to turn around their organization.

vice to the hospital. In fact, some of the physicians

“When I came on board, Bellflower needed improvements, not only financially, but also aesthetically, along with a huge need of equipment upgrades,” Choo said. “Some of our equipment was at least 15 years old or more.”

among the staff here,” Choo said. “They have been

have been on staff for 40 or more years. Part of the turnaround was to foster the relationships among existing staff, not to start over with completely new employees. “There is a camaraderie and collaboration together for so long and work closely together. Yes, they do battle at times, but it is out of their desire to make things better.”

Mike Choo, Chief Executive Officer

Upgrading the hospital After stabilizing the leadership team, Choo focused efforts on cosmetic and equipment upgrades. The

Demanding more for the hospital

E.R. area, cafeteria, re-vamped parking facility, front lobby, and nursing and conferencing areas,

Bellflower is a 144-bed acute-care hospital with

along with patient rooms. This facelift was accom-

an emergency room, medical/surgical suites, a

panied by a new paint job throughout the hospital’s

behavioral-health unit, and labor and delivery

interior and exterior.

services. It provides care to patients in Bellflower and surrounding areas, but faces steep competition. Bellflower is one community hospital in a concen-

“Healthcare needs drastic improvement.”

hospital received a facelift with a newly remodeled

“The hospital looks like a very different facility from what it did two years ago,” Choo said. The next challenge was upgrading equipment.

trated area of numerous small cities with their own

Controlling costs is always at the top of any execu-

community hospitals. The hospital is one of four

tive’s to-do list, but with creative bargaining and the

owned by Pacific Health Corporation.

support of a larger parent company, Choo was able

These enhancements have played a major role in

to receive upgrades in technology. Bellflower has

turning around Bellflower’s fate and making the

er has overcome about 90 percent of the challenges

installed a new C-arm, anesthesia machines, and a

hospital more efficient. Focusing on employee

it faced when he joined the executive team. He

nurse-call system. Bellflower is also purchasing a

satisfaction and the working environment has also

said the first step to a turnaround is to do a 30-day

Stryker machine for laparoscopic surgery, among

carried over into patient care.

evaluation and strengthen the “inner core” of the

other equipment.

During the past three years, Choo said Bellflow-

hospital.

“If you truly need equipment to provide care to

“With the power of our leaders, cosmetic upgrades, and new equipment, we have created a

patients more efficiently, you have to get it,” Choo

safe, comfortable environment for staff that trans-

ship team, so that was the initial focus,” he said.

said. “In the past, the hospital would wait two or

lates into making patients and visitors feel comfort-

“Building strong leaders radiates out to other areas

three years to get equipment they truly needed

able as well,” Choo stated.

of the hospital.”

but was just waiting for the funds to pay for it. Our

“The inner core at Bellflower was our leader-

credit line isn’t the best, but we can make pay-

Looking toward the future

cromanaged rather than having control over their

ments. You can talk about getting financed for six

Fortunately for Choo, Bellflower had excellent

departments, so Choo said he gave leaders back the

months to a year or make payments in that time

patient safety and quality that allowed him to focus

authority to run their areas of expertise and be held

and have the equipment.”

on the staff. The quality reputation has continued.

The leadership staff had previously been mi-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

16 | The Pediatric Connection

Services focused on children

BIO-PATH MEDICAL GROUP Pathology and Cytology Services

The Pediatric Connection provides clinical respiraAccording to Choo, Bellflower was evaluated by

Hospitals, Surgery Centers & Physician Offices Specialists in Hemato/Oncologic, Dermatopathology & Gastrointestinal Pathology Since 1978

tory therapy with evaluation, support, and teach-

numerous surveys in 2010, including the Joint Com-

ing for children with pulmonary complications and

mission, and received excellent results on them all.

their parents or caregivers. The company also has

MISSION STATEMENT Bio-Path Medical Group is dedicated exclusively to patient care through our high quality, comprehensive anatomic and cytologic pathology laboratory. We offer the newest technologies available in diagnostic Tumor Testing and Pap Smear Screening. As a leader in patient care our dedicated and caring staff achieves this mission within a healthy and pleasant environment.

falls and infection prevention, wound care, diabetic

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17150 Newhope St. Suite 117 Fountain Valley, CA 92708 p: 714.433.1330 | f: 714.755.2984 CLIA ID No. 05D0974660 | Lic. No. CLF 11663

Current patient-care initiatives include patient

private-duty nurses with RNs or LPNs who work eight to 10 hours a day in homes.

care, and stroke treatment in the emergency room.

In addition, the company provides support

As with all facilities, Bellflower is looking to

for families transitioning from the hospital to the

the future of reform and further cost- cutting. As

home-care setting. Bailey said that although respi-

a for-profit facility, Bellflower doesn’t have access

ratory therapy has been the primary service offered,

to foundation grants or funds that many nonprofit

feeding and nutrition services are a growing sector

facilities are able to raise. At the same time, about

of the business. The Pediatric Connection has a reg-

60 percent of the hospital’s population is indigent.

istered dietitian on staff to answer questions related

The hospital is a Patient Safety Net hospital that

to enteral nutrition and feeding pumps.

does provide some funding from the state. said. “It comes down to reimbursement. You can’t

Commitment to staff and community

group all healthcare facilities into one group and

Providing care to medically fragile children is a

then begin cutting. Private hospitals are cut to the

difficult area of healthcare, especially home care.

bone. Some of the larger nonprofits have room to

Adult home care is often an expected part of life,

trim, but not everyone. An efficient discussion of

but, as Bailey said, “you expect children to live and

healthcare needs to look at nonprofits, for-profits,

have fun.”

“Healthcare needs drastic improvement,” Choo

hospitals with 100 beds or less, and other tiers.”

Recruiting and retaining staff that live the vi-

Choo does not agree that accountable-care

sion and love children is a big part of The Pediatric

organizations (ACOs) are the future of healthcare, but more a buzzword. “Leaders need to analyze the data and evaluate

Connection’s mission. To keep staff engaged, the

Beth Bailey, Co-Founder & Co-Owner

owners and managers greet the staff every morning

reform based on their realm of healthcare and their capacity,” he stated. “Equipment and technology are not getting cheaper. We need to look at how we

The Pediatric Connection

can stabilize, rather than continuing to decrease reimbursement.” by Patricia Chaney

The Pediatric Connection, based in Richmond, Va., is an innovative company that keeps not only its patients, but also its employees at the heart of day-to-day business life. Founded in 1998, The Pediatric Connection was developed when Beth Bailey and her co-founders, Bruce Green and Marcia Hickory, set out to create a company that would provide care specifically for children in the home by offering respiratory equipment, supplies, and private-duty nursing. Bailey had previously worked for a company that provided pediatric equipment and supplies, but found a gap in the nursing support for these patients when they returned home. With offices throughout the state of Virginia and one office in Georgia, The Pediatric Connection’s sole focus is on caring for children with complex medical needs by providing equipment and nursing support for them in the home. The company’s respiratory therapists will meet children and their families at the hospital to train them on using respiratory or feeding equipment and will also go home with them. “We know how to take care of little ones,” Bailey said. “Home-care companies for children are few and far between. We have the expertise to take children and their caregivers home from the hospital and make their life easier. Our clinical and support staff are driven and committed to the patients they serve.”

Real Issues : Real Solutions

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cal rehab hospital, and this year, we sponsored our

families as much as possible in finding another way

first 5K run,â&#x20AC;? Bailey said. â&#x20AC;&#x153;There were 108 runners,

to care for their child.â&#x20AC;?

and we raised $10,000 for Child Savers, an organiMOOG Medical Devices Group

heighten the suspense every year, the owners never

MOOG Medical Devices Group is one of the worldâ&#x20AC;&#x2122;s leading suppliers of Infusion, Disposable Pain, and Enteral Feeding pumps. Small, highly accurate, and truly portable, our â&#x20AC;&#x153;EnteraLite Infinityâ&#x20AC;? offers active freedom to ambulatory enteral patients. Our â&#x20AC;&#x153;Infinity Orangeâ&#x20AC;? is optimized for safe formula delivery with small volume feeding needs (reducing breast milk waste.) Visit us online at moog.com/medical.

Medicaid cut already-low reimbursement rates

zation that shares a similar passion and mission for

across the board for home care in 2010. The rates

kids.

for private-duty nursing have only been raised one

The staff recognition and community sup-

time since 1992. Many children receiving care at

port have helped The Pediatric Connection grow

The Pediatric Connection receive some Medicaid

mission,â&#x20AC;? Bailey said. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s not just the big gifts or

its reputation locally and nationally. The company

assistance, since they often cap out on their private

trips that keep them, but they know they mean a lot

received the Greater Richmond Chamber of Com-

insurance for home care. Studies show that children

to us, and we try to show that every day. Our staff

merce Impact Award in 2010 and was recognized

who go home recover faster and have a better qual-

loves children, and they develop close relationships

in Boston, Mass., as one of the top 100 growing

ity of life.

to the families they serve. They have supported

companies by the Inner City 100 in 2011.

tell the staff where they are going. â&#x20AC;&#x153;We want to keep our staff rallied around our

parents through some really bad times.â&#x20AC;?

â&#x20AC;&#x153;It is my fear that rates will get so low that we canâ&#x20AC;&#x2122;t care for these kids at home, which would hurt

in its community by sponsoring events, feeding the

Navigating care in tight times

homeless, and hosting its own events. Six years

As with all healthcare companies, particularly in

optimistic and confident in both the mission and

ago, The Pediatric Connection began participating

home care, The Pediatric Connection has faced

values of her company and is determined to fight

finds it important to â&#x20AC;&#x153;celebrate everything,â&#x20AC;? from

in Make a Difference Day, a national day of help-

challenges with reduced reimbursement. Even at

for the health and well-being of the children and

holidays to awards.

ing others, sponsored by USA Weekend Magazine.

an early stage in the companyâ&#x20AC;&#x2122;s history, Bailey said

families they service.

This year, The Pediatric Connection chose to raise

one of the most difficult lessons was learning to say

money for Child Savers, a local nonprofit.

no to some cases.

The Pediatric Connection also plays a big part

and maintain an open-door policy. Bailey said she

The Pediatric Connection takes the staff on a one-day trip every year to reward them for their

â&#x20AC;&#x153;In previous years, we made a difference in the

hard work and dedication. In 2011, the trip was to

the child and their family,â&#x20AC;? Bailey said. Although the challenge is great, Bailey remains

by Patricia Chaney

â&#x20AC;&#x153;When you have a sick child, itâ&#x20AC;&#x2122;s hard to say

Washington, D.C., for the annual scavenger hunt

lives of the moms of our patients, cleaned a local

no,â&#x20AC;? she said. â&#x20AC;&#x153;But we have to in order to continue

and a river boat cruise on the Potomac River. To

elementary school and gardens, gave back to a lo-

providing care to the patients we have. We assist

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

17 | Southampton Memorial Hospital When people come to a hospital, he says, they may

each direction before arriving at another hospital

not be knowledgeable in the scientific aspects of

that delivers babies. He would like to grow this pro-

care, but they are aware of the common courtesies,

gram in the coming years and is actively recruiting

such as hot food, personable treatment, clean facili-

physicians for OB.

ties, and attentive care. “It’s just the basic blocking and tackling of

tiative that encourages women in the community to

healthcare - treating people how they would want to

band together to maintain a healthy mind, body, and

be treated.” he said.

spirit. The initiative offers a variety of activities and

In a rural community, these “basic things” become more important since everybody knows everybody.

INDUSTRY PARTNERS The Schumacher Group www.schumachergroup.com

events that are designed to address various health issues specifically affecting women. Furthermore, the hospital has taken the

investments in imaging. In the last couple of years, the hospital went on board with digital mammogra-

30-Minute Pledge for its ER. This pledge vows

phy and a new fetal-monitoring system, GE Centric-

that you give that extra type of hometown care

to have a clinical professional evaluate a patient

ity, for the OB unit.

because you’re always going to be dealing with

within 30 minutes of checking in.

“I really think in a place like this, it’s important

somebody’s brother or somebody’s sister or uncle

Not just a business

Southampton also offers its Healthy Woman ini-

“We’ve committed ourselves to that, and it was

or father,” Wright stated. “In a small community, I

easy for us, because I believe we were already

think it’s a lot easier for you to tarnish your repu-

meeting that door-to-doctor outcome in under 30

Furthermore, Wright said they’re looking to recruit in such core-specialty areas as pulmonology, critical care, cardiology, and GI.

tation. Word gets around a lot faster if you’re not

minutes,” Wright said, adding that he views ER effi-

Waiting for reform

For Wright, his passion for providing quality

doing your job or going that extra mile to take care

ciency as a powerful marketing tool for the hospital,

Although many healthcare professionals have their

healthcare isn’t limited by the size and scope of an

of people. “

and one that can be used to prevent people from

gripes about reform, Wright isn’t among them. He

leaving Southampton’s service area to go else-

describes himself as being in “wait-and-see” mode.

where.

Ultimately, he feels that reform could benefit their

organization. He believes that healthcare at one

Although Southampton’s services are general,

time had fallen behind the curve in offering excel-

it does offer some specialty services, especially in

lent customer service to its patients. However, now

obstetrics. For the last five or six years, the hospi-

with the focus on HCAHPS ratings, core measures,

tal has conducted about 300 deliveries each year.

and other quality indicators, hospitals recognize the

Wright said this definitely fills a need in the market,

Advantages of a corporate arm

importance of listening carefully to the consumer.

since one would have to travel at least 30 miles in

As a member of Community Health Systems, Inc.,

hard times, any coverage is good coverage, which

(CHS) Southampton has the benefit of a corporate

can make a positive impact on the hospital,” Wright

arm that can provide assistance in just about any

said.

Southampton Memorial Hospital

area, whether it’s contract management, physician recruitment, or quality. “We’re fortunate to have a corporate structure,

The difficult economy of the last four years has impacted communities in profound and life-altering ways. For much of its history, Franklin, Va., depended on the local paper mill as its economic lifeblood. Through a variety of private owners, including most recently, International Paper, the mill was a community hallmark, the number-one employer in a rural area whose livelihood depended more on agriculture than industry.

Phil A. Wright, Chief Executive Officer

economically troubled area. “When you’re in a place like Franklin that’s got high unemployment and a lot of folks experiencing

Believing in the future In spite of the challenges Southampton is facing

folks that we can call upon, resources that we can

right now, Wright foresees a bright future. Interna-

call upon to assist us in accomplishing our goals,”

tional Paper recently announced that the mill is not

Wright said.

going to be completely abandoned, and portions of

CHS is working diligently to implement meaningful use and bring all of its 135 hospitals onto the same platform. Southampton has already imple-

it will be repurposed, bringing 200 to 300 jobs back into the area. “Franklin has gone through some tough times,

mented an EMR in its physician clinics to much

but I truly believe better days are on the way, and

success.

we definitely have a great town, a great hospital that

In 2010, this legacy came to an abrupt halt. Suddenly, the mill was shut down, and 1200 people were left unemployed and uninsured with a future that couldn’t be bleaker.

“We were a little hesitant,” Wright said. “We

people can come to, and we’ll constantly be trying

thought the physician population would give us a

to improve all of our services that we have so that

little pushback, which some did, and that’s to be

people can feel good about utilizing our facility.”

Southampton Memorial Hospital, always the number-two or number-three employer in the city, suddenly became the number-one employer. This is a responsibility the organization takes very seriously, in addition to its role as the sole healthcare provider in the immediate area.

expected, but for the most part, they’ve jumped

Licensed for 90 acute-care beds and 131 long-term beds, CEO Phil A. Wright describes Southampton as a good old-fashioned community hospital that offers a little bit of everything, including high patient-satisfaction scores and high core-measures outcomes.

on board, and they actually like it. It’s made them

by Pete Fernbaugh

more efficient. It’s a lot easier for them to navigate through their day with that EMR.” Largely thanks to their CHS association, Southampton has also made some recent and significant

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

18 | Upstate University Hospital, SUNY

Upstate build better relationships with the private

Upstate is the only provide of pediatric oncology in

nonacademic medical community in Syracuse.

the area.

Upstate is also in discussions with the county of building it out differently so it will offer a wider

Managing care under high regulatory demands

range of services from assisted living to specialized

McCabe explained that running a hospital in New

nursing-home care.

York is a unique challenge because of the state’s

to take over its 538-bed nursing home with the goal

The hospital has also broken ground for a cancer-center addition that will serve as an outpatient

INDUSTRY PARTNERS Airside Technology Corp. www.airsidetech.com

highly regulated environment. “Maybe about three percent of my budget comes

“We think the smaller hospitals in the periphery

facility designed to house all of Upstate’s cancer

from the state of New York, and yet being a part

of central New York are going to have more and

services in one location. This is important, McCabe

of the state of New York, I’m burdened with their

more difficulty staying in business on their own,” he

said, because the hospital has a regional reputation

procurement process and their contracting pro-

explained. “We’re already picking up the care for

and a regional draw for oncology services. Right

cess,” McCabe said. “I’m a totally unionized labor

many of the things they either don’t want to or can’t

now, everything is too spread out across the cam-

force where all of those contracts are negotiated

provide anymore.”

McCabe said that Upstate has been striving to

pus to maximize efficiency.

by the state. They’re not negotiated locally, so I get

upgrade its facilities and technology over the past

The center will feature an intraoperative MR suite

stuck with someone negotiating the rate increase

increasingly involved in establishing clinics, using

several years. Recently, Upstate opened a children’s

and a three-room hybrid space with one space de-

for benefits and then no dollars coming my way to

telemedicine, and training physician assistants,

hospital and expanded its inpatient space. It has

voted to MR, the other to an operating room, and the

pay for it.”

nurse practitioners, and residency graduates to

purchased an ambulatory-surgery center that sits

last space to biplane angiography equipment.

Upgrading for the future

adjacent to the hospital and is closing up an acquisi-

“Patients will be able to move freely on the table

He jokes that three percent of his dollars and

miles away from Upstate, but still being referred to Upstate by their local hospitals.

from angio to OR to the operative suites,” McCabe

With healthcare reform looming on the horizon, Mc-

licensed hospital in Syracuse. This will add capacity

said, adding that the center will also offer special-

Cabe expects more complications to ensue. He said

to their system, McCabe explained, and it will help

ized pediatric services. This is important since

healthcare reform is the reason why Upstate is ac-

“We’re trying to be good regional citizens,” he said.

quiring smaller medical organizations around them

Prior to serving as Upstate’s CEO, McCabe

as part of an ongoing effort to position themselves

spent 30 years as an emergency physician. McCabe

as a larger system instead of an isolated academic

feels it is this background that has prepared him to

center.

confront the demands of modern healthcare.

Even though healthcare reform is meant to

Dr. John McCabe, Chief Executive Officer

provide care in areas where patients are 60 or 90

100 percent of his rules come from New York State.

tion of Community General Hospital, a 300-bed

Upstate University Hospital, SUNY

To that end, McCabe said that Upstate will be

“Emergency physicians know everybody be-

cover the uninsured, McCabe said there is already

cause we deal with every specialty,” he said, “so

Located in Syracuse, N.Y., Upstate University Hospital is Central New York’s only academic medical center and its largest employer. Affiliated with State University of New York (SUNY), Upstate is also a component of the Upstate University Health System, a $1-billion-a-year enterprise with the hospital accounting for $650 million of the budget.

so much Medicaid disbursed in New York that the

there’s no rock around here that I haven’t turned

uninsured population is relatively small, thus mak-

over in my 30 years of being in the emergency

ing hospital reimbursements in New York smaller

department. Furthermore, I’ve always had 15, 20,

than in a state like Texas.

30 patients at the same time, so it’s easy to juggle

“The academic centers are all worried about

multiple things. And emergency physicians tend to

what’s going to happen with disproportionate-share

The system itself offers training in four medical disciplines through its colleges of medicine, health professions, nursing, and graduate studies. Reaching 1.8 million people, 4,200 of the system’s 9,460 employees serve Upstate University Hospital.

have to make decisions on incomplete information,

payments or the federal payments for uninsured

so I’m very comfortable with getting 80 percent

and underinsured,” McCabe explained. “The idea

of what I’d really like to have and then making a

is they’ll go down as insurance goes up, and places

reasoned decision with other people.”

Dr. John McCabe, chief executive officer of the hospital, said Upstate is vital for the region, especially since geographically, it sits in the center of New York and some of its core patients live 80 or 90 miles away.

like us depend upon that because of teaching load

“If you look at the geography, we play an incredibly important role,” he said. “If we were not here, there’s a large swath of New York State that would be uncared for, so we are an important cog for the citizenry, and we really view ourselves as a growing regional academic medical center.” Therefore, staying abreast of healthcare’s changing paradigm is critical for Upstate.

and the indigent patient population we see.”

by Pete Fernbaugh

Expanding regional influence In the next three to five years, McCabe said Upstate is focusing on becoming more regional, especially as smaller organizations flounder.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

19 | Clifton-Fine Hospital

The nature of being rural Oftentimes, rural facilities are the lifeblood of the community and the only source from which residents can receive care. Despite this need, being rural doesn’t always pose the most attractive option for hospitals who are trying to recruit outside healthcare professionals to their organization. Also, providing the necessary primary-care services to a limited patient base is challenging. Robert P. Kimmes, chief executive officer of CliftonFine, said it is, in fact, one of the biggest challenges that the hospital is confronting right now. Furthermore, federal demands can be taxing. As an independent hospital not affiliated or owned by a larger health system, independence has its advantages, but meeting healthcare reform and IT requirements stretches resources. Also, reimbursement cuts affect the organization greatly. “We have a fairly large Medicare and Medicaid

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population,” Kimmes said. “And with state and federal cuts toward these programs, that’s been a

tom@charlesriveradvisors.com | 603-559-1410

challenge trying to be proactive and increasing ef-

www.charlesriveradvisors.com

ficiency and looking for other revenue sources and reducing expenses.” He added, “This is not anything unique to a ru-

Clifton-Fine Hospital

ral hospital compared to an urban hospital. We’re all facing these challenges right now.”

An abundance of positives Located in northern New York in the Adirondack Park, Clifton-Fine Hospital is a 20-bed critical-access facility with an attached primary-care clinic. Being situated in a rural location poses multiple challenges for Clifton-Fine, not the least of which is geography. Clifton-Fine’s service area comprises 700 square miles, and its remoteness makes the hospital the sole healthcare provider in the region with other healthcare entities at least an hour away.

Thomas Pelis, Assistant Vice President of Facilities & Planning

As a popular vacation spot, the area’s population is fairly small year-round, running at approximately 6,500 during the off-season and doubling during the summer with an influx of seasonal residents and travelers.

For every challenge that continues to confront Clifton-Fine, Kimmes feels the organization is re-

INDUSTRY PARTNERS Medical Liability Mutual Insurance Company www.mlmic.com (212) 576-9800

sponding in a successful and meaningful way. For example, the hospital is fully staffed, and in spite of location, the recruitment of medical providers has

Currently, the hospital is in the process of convert-

met with overwhelming success.

ing from public ownership to 501(c)(3) or not-for-

This growth has been met with expansion. In

profit ownership. According to Kimmes, this will

late 2010, Clifton-Fine finished construction on a

help the hospital save money in the biggest way.

new medical clinic that is attached to the hospi-

As a public entity in New York, the organization

tal. That project led them to resurrect a dormant

and its employees are required to participate in the

foundation and increase the hospital’s fund-devel-

state pension plan. The cost to fund pension plans

opment activities, a move that has also proven to be

has increased significantly in the last few years in

an enormous success.

New York, and these costs are passed on to the

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

20 | Andrew Technologies LLC

public agencies and public hospitals who partici-

Unlike some of his counterparts, Kimmes views

pate in the program.

meaningful use with relish. It is because of mean-

By converting to private non-profit, Kimmes

ingful use that the hospital has been able to get

said Clifton-Fine will no longer be obligated to

a new IT system for the entire organization, he

participate in the state pension plan, thus saving

explained. And because the incentive payments are

a large amount in employee-benefit expenses by

given to critical-access hospitals in a lump sum,

creating a traditional 403(b) retirement plan for

significant technology investments have also been

employees.

made.

“We’re not dropping our employee retirement

“It’s allowing us to install a new IT system,

plan,” Kimmes clarified. “We’re just converting it to

where we may not have been able to afford to do

a different model that will save the organization a

that without the incentive payments,” Kimmes said.

lot of money.”

Building a foundation of quality and safety

All about community Like most rural administrators, Kimmes views the surrounding community as key to the hospital’s

Apart from the pension plan, Kimmes said New

success. He cites a recent capital-fundraising cam-

York offers a few state programs that assist Clifton-

paign for the construction of the new medical clinic

Fine in benchmarking its quality measures. For

as evidence of this. The total cost of the project was

example, the hospital participates in a quality and

$2.5 million. Clifton-Fine set a capital-campaign

safety program that is funded through the New

goal of $750,000.

York Department of Health’s Office of Rural Health.

Thanks to the generosity of the hospital’s neigh-

This program has quality indicators that serve as

bors, the organization surpassed this goal in fewer

a benchmark for all of the state’s critical-access

than eight months.

hospitals. “Through that, we are given tools that help us

“I believe that really is a testament to the support the hospital receives from the community,”

set indicators, both quality and patient-safety indi-

Kimmes said. “We were amazed at the support we

cators and also financial and productivity indicators,

got toward our capital campaign.”

that we can actually benchmark against ourselves, that we can benchmark against NY State’s other

by Pete Fernbaugh

critical-access hospitals and other hospitals around the country,” Kimmes said. Clifton-Fine also participates in HCAHPS, even

Andrew Technologies LLC

though critical-access hospitals are not obligated to do this. However, Kimmes believes that someday critical-access hospitals will be required to participate in HCAHPS and reimbursements will be based

With existing technology that can be cumbersome and uncomfortable for both surgeon and patient, the field of liposuction is ripe for innovation and advancement.

off that participation. “We are consistently above the national average in the HCAHPS’ monitors’ indicators,” he said. “It

Andrew Technologies LLC, established in 2007, is readying a new device known as HydraSolve™ that has the potential to revolutionize this surgical procedure and with it, meet a growing consumer demand for aesthetic body contouring.

has been a very good tool for us to use to see how we compare to other hospitals, and we have been doing very well.”

Tom Albright, Chief Executive Officer Real Issues : Real Solutions

The eye of the solution

order to complete the job. The surgeon tradition-

IHydraSolve™ has its roots in ophthalmic technol-

ally thrusts the cannula rather forcefully into the

Paving the way for other innovations

ogy that was already developed for gentler cataract

subcutaneous space at a rate of approximately two

Albright said the same scientific approach has been

surgery by the company’s founder, Dr. Mark S.

to three thrusts per second in order to cut the fat

postulated to work with little adaptation for viscer-

Andrew, and his wife Mylina Lincoln-Andrew.

into small enough pieces for aspiration.

al-fat extraction. Visceral fat is not underneath the

The Andrews’ cataract technology was acquired

HydraSolve™ takes the opposite approach by

skin; it is inside the body and is primarily attached

by Alcon, the large eye-care company, and launched

moving the cannula much more slowly. Albright

to the kidneys and to intra-abdominal organs and

in 2003 as part of its cataract-surgery offerings in

said their device actually moves the cannula in a

the mesentery. Excess visceral fat is believed to be

its Infiniti® Vision System. The Andrews’ invention

more methodical manner, averaging one thrust

the primary cause of insulin resistance and type 2

presents a warmed saline-based targeted tissue-

every one to two seconds. This means that the

diabetes.

liquefaction system for dissolving cataract tissue

surgeon is usually moving the cannula at less than

without breaking down the collateral tissue.

one-fourth the speed of typical liposuction proce-

with a pointed device like a cannula,” Albright said,

dures.

“because a typical liposuction cannula has very

Dr. Andrew then leveraged this same scientific approach from cataract surgery to develop the technology for HydraSolve™.

A goal for growth and data

Albright said that so far HydraSolve™ has received good feedback in clinical cases. Targeted plastic surgeons who are experts in lipoplasty have

“No one has ever considered extracting that fat

sharp edges since the cannula has to carve through the fat.” Andrew Technologies’ cannula is a purposefully

been trialing the prototype devices and giving feed-

blunted instrument, making it different from exist-

Tom Albright, chief executive officer of Andrew

back to Andrew Technologies on improvements that

ing cannulas. In a benchtop trial, Albright said that

Technologies since mid-2011, said the company

are continuously being made, as well as providing

they’ve shown the device can also liquefy excised

would like to grow the business over the next three

clinical perspective on how the product compares

visceral fat. There is a patent pending for this ap-

years by attracting plastic surgeons who specialize

to existing technologies.

plication.

in liposuction to this new and highly efficient device.

“We don’t have the benefit of head-to-head clin-

“This is a breakout area that we think could

HydraSolve™ appears to be easier for surgeons to

ical trials yet, but we do have very adept and critical

potentially reverse insulin resistance and prevent

use and gentler on patients than traditional devices.

feedback from these leading plastic surgeons who

the onset of diabetes in targeted patients,” Albright

Andrew Technologies possesses a 510(k) clear-

have trialed our product in over 40 patient cases,”

said. “So we feel like this is something that could

“What we have found is that there are an awful

Albright said.

actually transform our technology into more of a

lot of potential patients that are very interested in

therapeutic application from where it is today as an

liposuction,” he said, “and although the liposuction

aesthetic medical device.”

market today is quite large, it appears that there

ance through the FDA, and soon, the product will be made available in a controlled release to selected

According to Albright, Andrew Technologies

sites from around the United States. These sites

has discovered that most of these plastic surgeons

are recognized as leaders in liposuction and plastic

are suggesting that HydraSolve™ is going to be

surgery. It is Andrew Technologies’ intention to

much faster than the existing technologies. A few

search before a claim would be submitted to the

U.S. that are very interested in liposuction, so we

generate clinical data from these selected plastic

surgeons have even gone so far as to estimate that

FDA and other agencies.

assume there is a large pipeline of people that are

surgeons, so that experts beyond the company will

HydraSolve™ will be 25-40 percent faster in terms

be able to demonstrate the full clinical utility of

of extracting similar volumes of fat during surgery.

HydraSolve™.

Across the board, Albright said that all of these

Advanced technology, more patients

plastic surgeons are telling them that surgery is

In the United States, liposuction has been around

advanced technology that could demonstrate sig-

to launch the product more broadly in the United

much less exerting with HydraSolve™ and that it

for several decades, and it is estimated there are

nificant benefits for patients and for surgeons, that

States and begin the ROW launch efforts.

enables them to remove fat in a more controlled

about 400,000 cases per year in the United States.

our doctors and providers will be able to meet more

and precise fashion.

Devices that have come out in the past have at-

of this anticipated need.”

By the third quarter of 2012, Andrew is looking

Efficient and gentle

“The surgeons are also reporting very little

Of course, this use would require more re-

are about sevenfold more adult consumers in the

waiting for better technology, better results, less pain, and reduced complications.” He added, “We feel that by bringing out a more

tempted to integrate newer energy sources to help

Liposuction is a very vigorous surgical treatment,

bruising, very little blood loss, and very little pain,

with the liposuction procedure, but Albright ex-

and it requires the surgeon to rapidly thrust the

as well as fairly rapid recovery for the patient,”

plained that they haven’t actually delivered marked

cannula forwards and backwards over and over in

Albright said.

clinical benefits for surgeons or patients.

by Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

21 | Asheville Specialty Hospital

“We help patients adapt to life-changing events,”

pilot project at Asheville has been so successful that

Desotelle said. “In some cases, things aren’t going

Mission Hospital began using the product as well.

to get better, and those are difficult conversations to

“We are always trying to ensure we are doing things

have. But it is rewarding to work with the patients

that improve the care for our patients, while balanc-

in our hospital and to see those miracle patients

ing costs,” Desotelle said.

who recover and walk out of here.” ity and patient safety through a number of mea-

Adjusting to a changing environment

sures. Infection control has been one area of prog-

Patient care is always top priority in any healthcare

ress for the hospital. After implementing a program

facility, and Desotelle keeps clinical excellence as

to prevent urinary-tract infections, the hospital went

his primary personal value. Having been a nurse

six months with no UTIs.

before moving into administration, Desotelle brings

Asheville has made great strides in improving qual-

Focusing on quality and outcomes One criticism of long-term care facilities has been a lack of oversight or reporting on quality measures

By being part of Mission Health System, Asheville Specialty Hospital is able to implement an elec-

medical staff and in implementing administrative

This is rapidly changing, and Asheville Specialty

tronic medical record, follow national patient-safety

decisions that affect patient care.

Hospital participates in quality benchmarks along

guidelines that are used by the system, and follow

with comparable hospitals. Although data is limited

guidelines for ventilator bundles and infection-con-

ence in many different markets, and with today’s

for long-term care facilities, Asheville reports

trol bundles. Asheville has also implemented Lean

economy, he believes it is important to always ask,

quality measures with Thomson-Reuters. This al-

quality initiatives. Bedside medication administra-

“Why are we doing this?” He said sometimes he

lows the organization to compare benchmarks with

tion is a future goal, and barcoding has shown great

may receive resistance to the question, but with

other similar hospitals.

improvement in patient and nursing satisfaction.

strict regulations and lower profit margins imposed

Patient falls have also gone down because nurses

on the industry, all ways of delivering care must be

are more often in the room with patients.

evaluated.

“Our biggest focus is on quality,” said Chief outcomes, good scores on employee and patient

Another major improvement has been in wound

Proud Supporters of Asheville Specialty Hospital

He has been a travelling nurse with experi-

Asheville operates on about a three-percent

satisfaction, and a high percentage of our patients

care. About a year ago, the hospital began using

margin. Medicare has instituted rules stating that

go home. We have a strong clinical program.”

a protein-rich plasma product called Autologel by

the hospital can only accept up to 75 percent of its

Cytomedix. Desotelle said the patient outcomes

patients from one hospital. In Asheville, this regula-

for Asheville. Usually patients come to the facility

have been “phenomenal” with a 34-percent cost

tion is extremely cumbersome. Asheville Specialty

after a catastrophic medical event.

savings over traditional wound-care therapies. The

Hospital is just down the street from a 700-bed

Sending patients home is a big accomplishment

RESTART THE NATURAL HEALING PROCESS

a certain level of compassion in working with the

that most hospitals have been following for years.

Executive Officer Bob Desotelle. “We have excellent

Complex wounds may need biological stimulation to start the natural healing process

Patients known to be sensitive to components and/or materials of bovine origin are contraindicated. See instructions for use.

www.autologel.com phone 866-CYTOMED

tertiary referral center, but if it accepts more than 75 percent of its patients from that hospital, it can

Asheville Specialty Hospital

get penalized. “The regulatory environment is a big burden for our industry right now,” Desotelle said. “As an industry, we haven’t been good about stating our benefits. But more research is available now show-

Bob Desotelle, Chief Executive Officer

Historically, long-term care hospitals have struggled to articulate their value and position in the healthcare market. Recently, these facilities, which already advocate high-touch over high-tech care, have faced even steeper reimbursement cuts and regulatory limitations. But long-term care facilities play an important role in healthcare and are steadily becoming more involved in reporting quality and outcomes to maintain their place in patient care.

ing that we can save Medicare money. Our program

Asheville Specialty Hospital is one such facility. It is a 34-bed acute-care hospital and part of the larger Mission Health System based in the mountain region of Asheville, N.C. A joint venture between Mission Health System and Community CarePartners, Asheville is certified by Medicare as a long-term care hospital and runs an average census of about 25 patients.

length of stay. Looking at discharge procedures is

incorporates rehabilitation and acute-care concepts in a way that saves money.” As with any facility, Asheville is looking at ways to improve costs and manage patient care. It has brought in a hospitalist group to develop consistent patient management and to effectively manage

to community,” Desotelle said. “We have begun involving palliative-care programs, and improving communication with patients and their families to help them make an informed decision about their care.” “We have challenging times ahead of us, and we are all struggling with the realities,” he added. “We have to find a better way to provide care at a lower cost, while maintaining quality along with employee and physician satisfaction. We have to change the practice and look at all options to get better outcomes less expensively.” by Patricia Chaney

also a concern. “We have higher acuity discharges, and what nursing homes will accept varies from community HCE EXCHANGE MAGAZINE

22 | Community Care Physicians, PC

Keeping patients at the forefront

individually, but standardizes care and contains costs,” Morris said.

IMorris, who is also a practicing pediatrician, said

In keeping with the patient-first mission, Com-

that patients are at the heart of change in health-

munity Care Physicians, which is physician-owned

care.

and operated, is designated as a Patient-Centered

“We see the face of medicine changing, and

Medical Home. In 2009, it was awarded Recognition

it is going to be highly dependent upon organiza-

by the National Committee for Quality Assurance

tions managing a patient-centered approach rather

(NCQA) Physician Connections ® - Patient-Centered

than a physician-centered approach,” Morris said.

Medical Home Program. Sixteen of the group’s

“Patients are leading the charge of the future of

locations earned the highest of three possible levels

healthcare.”

of achievement. Community Care Physicians is

For a multispecialty practice, this can be chal-

currently resubmitting for NCQA accreditation to

lenging with reductions in healthcare budgets and

acquire Level III Recognition for its 20 primary-care

barriers to patient access to care. Many patients

locations.

in the group’s community are uninsured or under-

As a Patient-Centered Medical Home, physi-

insured. Morris said the group has looked at ways

cians at Community Care Physicians follow patients

to increase access to care, such as walk-in hours

through the entire spectrum of care.

beyond the traditional 8 a.m. - 5p.m., and through

“We have been engaged in a process with lo-

a network of urgent-care centers, including the

cal payers to re-engineer primary-care practice

area’s first Pediatric Urgent Care Center specifically

processes to support the patient-centered medical-

designed for newborns to children age 18.

home model,” Morris said. “We use the electronic

“It is a challenge to reach our community the way they want to be reached, a way that sees them

medical record to track patients from interactions in our office to coordinating specialty care and minimizing emergency room and hospital visits. The EMR helps us reduce duplication of services across

Community Care Physicians, PC

Dr. Barbara Morris, Chief Executive Officer & Medical Director

BST LLC www.bstco.com

Morris said the group started using iPhones two years ago. This allowed providers to access a remote version of the full medical record. Physicians could see summary data of the patient’s chart, most recent vitals, problem lists, allergies, and medications, allowing them to respond to calls from the emergency room or other situations outside of the office. These applications have been transferred to the iPad, and Morris said the group is looking at developing new tools specifically for the iPad. “We will continue to embed technology in the delivery of care,” she said. The next big thing for Community Care Physicians would be electronic visits, allowing real-time encounters with a physician to follow up on medication issues or other simple discussions that can oc-

specialties.”

cupy a great deal of time for physicians and patients

Keeping all locations on the same path

see-and-touch encounter. Morris said the virtual

With many individual groups brought under a large

In these challenging times, several smaller healthcare organizations and independent practices are merging together into larger multidisciplinary groups. In Albany, N.Y., one group has nearly refined this practice into a science.

INDUSTRY PARTNERS

umbrella, technology has been key to making Community Care Physicians work effectively. The organization is comprised of individual private practices that have joined the larger group. Morris said the practices range from a single physician working in a

With 40 locations, 19 specialties, and about 200 providers, Community Care Physicians, PC, provides care to four counties in what is known as the Capital Region. The organization forms a large primary-care network with family medicine, internal medicine, and pediatrics, as well as specialty services including laboratory, adolescent health, audiology, breast care, diabetes education, surgery, occupational medicine, prostate health, obstetrics and gynecology, physical therapy, podiatry, dermatology, and urology. Community Care Physicians also operates urgent-care centers and imaging centers, offering medical imaging, interventional radiology, and radiation oncology.

house-like setting to larger practices with 12 physi-

“Our mission is to provide a system of affordable and easily accessible healthcare to patients and our community,” said Dr. Barbara Morris, chief medical officer and executive vice president.

EMR for the past six years and is now moving on to

cians. But all of them use the same EMR. Morris said the organization is working to organize the individual groups within their specialties to standardize processes and quality metrics. Pediatrics, family-care medicine, and internal medicine are already divisions, with more to come. Community Care Physicians has been using an other technology such as kiosks, self-registration, and a patient portal. The organization is also ahead

and that don’t necessarily require the traditional visits are part of the organization’s five-year plan that centers on growth and technology. Growth is a continuing strategy for any organization, and Community Care Physicians is looking at ways to bring in more patients. The five urgentcare centers are one way to drive new foot traffic, along with radiology services. Mergers with other small, independent practices will continue to be part of the organization’s growth plan as well. “We have a lot of diversity in the types of practices we have throughout the area,” Morris said. “We have unique access points to drive organic growth. We believe keeping everyone connected with the EMR is the best way to provide the best quality of care to a large group of patients with one patient record.” by Patricia Chaney

of the curve on using mobile devices.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

23 | Community Health Access Network +& $G ),1 SGI +& $GB B),1B SGI

Bridging socioeconomic factors “Many of the health-center patients are underserved and underinsured,” Kirsten Platte, executive director, said. “Approximately 26 percent of those patients are Medicaid patients; 32 percent of those are uninsured; and 19 percent of those are minority patients. Many health-center patients are very sick and have chronic disease and many of those have comorbidities, meaning they have more than one chronic disease.” Many of CHAN’s members not only offer medical care, but also have to address socioeconomic issues when providing this care. These issues may include transportation, a factor that oftentimes determines whether or not the patient can get to the health center for their appointment. Language barriers are also an issue. The health centers are required by law to have a certified translator for those patients for whom English is a second language. This can consume a large part of a center’s budget depending on its location and the diversity of the area. One center in Manchester, N.H., Platte said, supports more than 60 different languages within its patient base. Its

Community Health Access Network

service area, though, consists of only 6,760 patients.

Being federally funded “What’s unique about the FQHCs is their unique

Kirsten Platte, Executive Director

Community Health Access Network (CHAN) was founded in 1995 as one of the first Health Center Controlled Networks (HCCN) in the country. To this day, it remains the only Health Center Controlled Network (HCCN) in New Hampshire.

patient base,” Platte said. “Besides the under and

As one of the few states yet to implement Medicaid

uninsured, they also serve a substantial amount

Managed Care, Platte said the implementation will

of insured patients. Because FQHCs are federally

help to improve patient outcomes, while bringing

funded, there are certain standards of care that

healthcare costs down.

A non-profit entity, CHAN is a member organization of Federally Qualified Health Centers (FQHCs). It is comprised of 10 health-center members at 22 sites to include Full and Affiliate members. Of its six Full members, five are located in New Hampshire and one in Texas. All use CHAN’s centralized electronic health records (EHR) infrastructure as well as its practice-management (PM) billing system. CHAN’s EHR and PM systems also support two Healthcare for the Homeless programs in New Hampshire.

to detail, and utilization of clinical data to support

Focused on data support

improvements in patient care is really important

CHAN continues to focus on supporting the EHR

for the health centers, whereas other providers

and PM IT infrastructure for its members. Most

may not have to meet the same quality criteria, as

recently, CHAN’s focus has included support of

they’re not federally funded.”

its members in meeting the requirements for the

health centers with various funding, but recently,

meaningful-use program. This program offers

CHAN’s EHR supports 65,000 active patient records. Two of CHAN’s Affiliate FQHC members, located in northern New Hampshire, host their own EMR database that supports approximately 21,000 patients.

because of budget constraints, health-center fund-

monetary incentives to eligible providers, such as

ing has been cut by up to 40 to 50 percent, depend-

doctors, dentists, nurse practitioners, and pediatri-

ing on the center. New Hampshire is preparing to

cians for utilizing electronic medial records (EMRs)

implement Medicaid Managed Care in July 2012.

in a “meaningful way.” Platte believes that the

must be met and reported on. Quality, attention

The state of New Hampshire also supports the

Centers for Medicare and Medicaid Services (CMS)

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

24 | Our Lady of Lourdes Regional Medical Center

existing CHAN staff and infrastructure are the tools

making it more secure by installing security-orient-

that will support meaningful use, offering a more

ed software and hardware. Federal funding from

efficient and effective providers/patient experience.

the Health Resources and Services Administration

While many organizations are scrambling to

(HRSA) have made this possible.

catch up to EMR technology, CHAN implemented its

“When you host protected patient health infor-

first EMR in 2000, so Platte said they have had the

mation (PHI), you are responsible to make sure that

luxury of time for developing their own EHR infra-

information is secure,” Platte said. “That’s been a

structure to include electronic forms that support

big focus of ours over the last 18-24 months.”

various types of patient visits and data collection. CHAN has also compiled a robust data ware-

Fostering “coopetition”

house with an extensive assortment of historical

In 2008, CHAN received the Nicholas E. Davies

clinical data. On a nightly basis, data from the PM

Award from the Healthcare Information and Man-

billing system and the EHR are downloaded to

agements Systems Society (HIMSS) in the Com-

the data warehouse. This allows for more robust

munity Health Organization category for improving

reporting and enables reports to be posted on a

healthcare through the use of IT. CHAN is still the

report server that members can access indepen-

only HCCN in the country to date to have received

dently.

this award. “There’s a certain amount of competition among

CHAN’s next capital project is to develop an offsite Business Continuity/Data Recovery center. It

our members, but the collaboration plus the com-

will be a smaller version of the existing infrastruc-

petition (i.e., coopetition) is really what helps drive

ture and will serve as a back-up in the event of an

quality,” Platte said. “Our end goal is improved pa-

emergency.

tient outcomes and enhanced patient care, and we

“If the system here were to go down due to some disaster or event, there should be a seamless transition over to the other site,” Platte said. “It won’t support all the users that we have, but

support the IT tool and infrastructure which allow our health-center members to focus on that.” by Pete Fernbaugh

Our Lady of Lourdes Regional Medical Center

will support the priority users, so the providers can continue to see patients and have access to their

After 60 years in the same facility, multiple additions, and a shifting market, one hospital in Louisiana made the move to a new $211-million replacement facility.

electronic charts.” One of the core-system criteria for meaningful use is the generation and transmission of permissible prescriptions electronically, known as e-pre-

In June 2011, Our Lady of Lourdes Regional Medical Center opened its brand-new doors on a 45-acre campus across town from the original facility site.

scribing. The outlined measure demands that more than 40 percent of all the permissible prescriptions written by the eligible provider are transmitted electronically using a certified EHR technology. CHAN has possessed this ability for the past two years. Platte said the organization is refining the process, running reports, and identifying which providers aren’t meeting the 40-percent criteria. “We’re quite ahead of the curve,” she stated,

Barbara Feske, Vice President of Management and Support

“Our campus had been added onto about 17 times, and we had outgrown the facility,” said Barbara Feske, vice president of management and support. “The facility was located in an older area of Lafayette, but most of the growth was happening on the south side of town, so we chose a location that would better place us to grow throughout the Lafayette market.” Lourdes didn’t abandon the original site. It still uses these medical-office buildings for imaging services, outpatient rehab, a fitness center, business-office functions, and doctors.

“which is encouraging.” CHAN has also spent a great deal of time over the past two years shoring up its infrastructure and

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

To provide comfort for staff and patients, the

ƉƌŽƵĚůǇ ƉĂƌƚŶĞƌŝŶŐ ǁŝƚŚ >ĂĨĂǇĞƚƚĞ 'ĞŶĞƌĂů DĞĚŝĐĂů ĞŶƚĞƌ ĂŶĚ K ĂǀŝĚ ĂůůĞĐŽĚ͘

less. We find a need and bring healthcare services

facility was designed with a front-of-the-house/

to those patients. We placed a school-based clinic

back-of-the-house concept. The front-of-the-house

in an area where high-school students had limited

includes registration, the gift shop, the cafe, the

access to care. We also partner with churches to

chapel, and other patient and visitor areas. The

coordinate resources for parishioners.”

back-of-the-house features staff access through

Being an active part of the community has been

a secure corridor that also has medical records,

central to Lourdes’ mission and was reinforced by

credentialing, and the physician lounge.

the building of its new facility, which was the largest building project in Lafayette history. Feske said

Technology integration

the community welcomed the building project and

In addition to the hybrid surgical suite, the new

appreciates the large investment that Lourdes has

facility features upgraded technology. Lourdes has

made in the community.

management systems for pharmaceuticals and

“We are proud to have the opportunity to make

with the electronic medical record in every room.

Feske said. “We have been here for 60 years, and

Lourdes has a da Vinci robot and made investments

this facility is our commitment to be here for 60 more years. Making this kind of financial investment in the community is important to everyone here.”

Building for growth ǁǁǁ͘ůĞŵŽŝŶĞĐŽŵƉĂŶǇ͘ĐŽŵ

As previously noted, the Our Lady of Lourdes Replacement Hospital, located off Ambassador

and clinics. It is part of the Franciscan Missionaries of Our Lady Health System that operates four hospitals in the state and is grounded in the Roman Catholic faith. The faith-based aspect of the organization drives much of the after-hours, primary-care, and specialty clinics Lourdes operates in the community. “Caring for those in need is part of our culture,” said Elisabeth Arnold, director of marketing and communications. “We have beautiful clinics where we treat the underinsured, uninsured, and home-

chase also expanded the information-technology infrastructure to support expanded electronic medical record systems. “We designed the facility with a logical plan for growth,” Feske said. “As we need increased capac-

ence for the organization and prepares it for future

Patient-centered design

ity to expand to over 300. In addition, the project

ishes through the hospital and 20 satellite centers

operating room in the region. The technology pur-

ity, we already have it thoughtfully planned.”

opened with close to 200 beds and has the capacOur Lady of Lourdes serves patients in nine par-

available today, including the first surgical hybrid

Caffery Parkway, establishes a larger market presgrowth. The nearly 400,000-square-foot facility

A mission to care

supplies and medical equipment that integrates

a difference in the lives of people in Lafayette,”

included a 104,000-square-foot medical office building that is already 100-percent occupied. The first level includes public functions such as the chapel, gift shop, administration, pharmacy, and prep/decontamination. Best practices in the medical industry drove the architectural design, resulting in a procedural platform on the second floor that saves valuable time in trauma cases, offers the highest patient-safety standards, and touts flexible-bed concepts for the most efficient flow of care. A 24-room intensive-care unit is located just above on the third floor. A $28.5-million technology investment equipped the most advanced surgical and procedure suites

The replacement hospital includes numerous features designed with patient comfort and safety in mind. With vibrant colors, green space, and natural light, the hospital presents a soothing atmosphere for healing. The hospital has rooftop gardens, bal-

to support its neuromedical services. The procedural platform on the second floor features an all-digital program with a High Field 1.0 Open MRI and a 3-Tesla MRI in the medical office building. Feske said Lourdes took advantage of the new site to add a pneumatic-tube system throughout the hospital as well. Along with smart- and automated-building systems, the hospital ensured it has enough generator capacity to run the facility for 12 to 14 days. With the investment of a new facility, Our Lady of Lourdes is poised to serve its patient base long into the future as it grows alongside its community. by Patricia Chaney

conies, a meditation garden, and a family kitchen in some areas. Arnold said even the angle of the hospital on the property was evaluated based on the best way to utilize natural light. “In some ways we went back to basics, which are essential to patient safety,” Feske said. “These basics include location of sinks for hand washing as an infection-control measure and the placement of hand rails in the rooms. Corian countertops were used in patients’ rooms as an infection-control measure as well.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

25 | Southeastern Regional Medical Center

Reaching out to provide community care As in many communities with a similar patient population, SRMC sees many patients in the emergency department--nearly 80,000 contacts per year. The emergency room has 45 beds, but, with a daily census sometimes reaching over 200, wait times have been an issue for the hospital. Therefore, SRMC has an urgent-care facility in the works along with other community clinics to help alleviate the burden on the ER of patients coming in with minor issues. In addition to the hospital, SRMC has 29 outpatient clinics that provide primary care, general

Southeastern Regional Medical Center

surgery, and specialty services. The medical center has undergone a multi-million dollar project to build a Southeastern Health Mall complex at a local mall. This year, the complex will open a Weight Loss

As a rural hospital, Southeastern Regional Medical Center (SRMC) has made significant advances in the care it provides to its community despite noteworthy challenges. The medical center has 452 licensed beds and offers acute care, intensive care, and psychiatric services. It has a freestanding hospice house and long-term care facility.

Andrew Schwartz, MS, MD, FACS, FCCP, Vice President of Medical Affairs & Chief Medical Officer

SRMC is located in Lumberton, N.C., a rural area in the southeastern part of the state, about 40 miles south of the Fort Bragg Army base. According to Andrew Schwartz, vice president of medical affairs and chief medical officer, the patient base presents unique challenges in terms of providing wellness care and reducing readmission rates. The community has a fairly high illiteracy rate and many patients with limited education, along with a high proportion of obese patients and many smokers. Lumberton is in one of the unhealthiest counties in the state and among the unhealthiest in the country. “We have case managers and social workers involved in the discharge process, but many patients don’t understand their follow-up care,” Schwartz said. “With the education level of our patients, there is an overall lack of compliance. We are highly focused on our discharge processes.”

Center, an Express Lab, Pharmacy Care Clinic, and Community Health Services/Diabetes Education Community Center. A surgical center will open in March, and an urgent-care center and retail pharmacy are also planned for the facility. “The complex will provide patients the convenience of receiving multiple services in one location,” Schwartz said. “We are also hoping the urgent-care center will reduce some of the burden on our emergency department and allow us to lower those wait times. The hospital is just down the block from the complex as well.” An ambulatory surgery center is also in the reach outside the primary service area of Robeson

Making gains in employee satisfaction and quality

County, SRMC continues to look for opportunities in

Recruiting a solid workforce in a rural area is

areas beyond Robeson County.

challenging for any organization, but SRMC

works for SRMC, to be opened in 2013. To expand its

Because many patients coming to the hospital

maintains about a 12-percent turnover rate

Coupled with the health-risk factors of its patients and being one of the poorest counties in the state, SRMC’s patient mix is about 75-percent Medicare/Medicaid and self-pay. But despite these challenges, SRMC offers a wide range of services, including cardiology, and is steadily adding more.

don’t have a primary-care physician, the clinics are

after the first year of employment. To help keep

a necessity to see patients early and try to reduce

this low, the medical center is a Studer facility,

hospital admissions. For patients in the hospital,

following the Studer Group principles for creat-

SRMC has paid special attention to its hospitalist

ing a culture of excellence.

SRMC has full cardiovascular capabilities, including invasive and non-invasive cardiology and cardiac surgery. It has received recognition from HealthGrades for cardiac care and patient satisfaction, as well as achieving Magnet designation.

program over the past four years and has instituted

Southeastern received the HealthGrades 2012 Distinguished Hospital Award for Clinical Excellence. To be considered for this award, hospitals need to be ranked in the top 5 percent in the nation in terms of in-hospital mortality and complications. It has partnerships with Duke Medicine to provide medical oncology services and with UNC-Chapel Hill to provide teleneurology care.

In the previous fiscal year, the hospital

a full-time intensivist program. Furthermore,

brought on 13 new providers, including three

Southeastern is able to go into underserved areas

orthopedic surgeons. These new providers

with its Mobile Medical Clinic.

have expanded the services the hospital pro-

HCE EXCHANGE MAGAZINE

26 | Winchester Hospital

vides, adding hand surgery and minimally invasive

this year and is on track to meet meaningful-use

shoulder surgery.

criteria. Looking forward, Schwartz said SRMC is

“Part of our growth plan is to make sure we identify and secure physician leaders,” Schwartz

focused on growth and positioning itself in the marketplace as a healthcare destination.

said. “When I came on board in January 2011, my

“We will continue to explore how we can be

primary focus was to facilitate relationships and

competitive and continue to recruit subspecialists

grow partnerships between the medical staff and

and grow our services and bring new approaches to

the hospital. I believe these partnerships are be-

healthcare to the communities we serve.”

coming stronger.” SRMC employs the majority of physicians on

by Patricia Chaney

staff, and Schwartz has to help ensure that the physicians are engaged and aligned with the medical center. “We have to go forward as partners,” he said. “If

Winchester Hospital

we don’t bring physician leaders into the boardroom and share in leadership and strategic development, we won’t be successful.”

When an organization is looking to gain space for its services and specialties, but expansion is out of the question, the hub-and-spoke model can be an effective solution to this dilemma.

Before moving into administration, Schwartz was a practicing cardiothoracic surgeon, a background that, as an executive, allows him to empa-

Winchester Hospital has developed a hub-and-spoke approach as its growth has prompted it to extend into the community and provide more services for its patient population. A 229 licensed-bed regional hospital in the suburbs of the Boston, Mass., area, Winchester Hospital consists of a main site and 37 satellite locations that house everything from clinical services to physician offices.

thize with physicians. In addition to maintaining a happy medical staff, SRMC is focused on providing quality care for patients. The facility participates in numerous databases for quality benchmarking, as well as following core measures, medication safety, medication reconciliation, and HCAHPS scores. The electronic medical record is a large part of SRMC’s future strategy. It plans to launch CPOE

Robby Robertson, Vice President of Facilities & Real Estate Services

In 2005, Winchester acquired property at 620 Washington Street, and since then, they have been involved in the major undertaking of converting the site into a prime satellite location for the hospital.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

prised of a series of smaller projects that go into

can get a job done faster and at less cost under

achieving the end results.

construction-management methodology.”

When examining site logistics, Robertson analyzes

He added, there are still challenges, such as dust

how the site lines up with Winchester’s service

control, vibration monitoring, air-quality testing,

area, never forgetting that convenience for the

etc., but overall, this method is a welcome change

patients and providers is a key factor. Some physi-

from the past.

cians he said will need to travel to the hospital, their office, and a satellite location, such as a surgery center. This must be accounted for. Once a site is selected, Robertson said the issue

The newer technologies are a little more complex

of permitting from the city or the town becomes the

and require more precision between the manufac-

focus. He advises factoring this process into the

turer, the engineers for the project, the materials

project timeline, because obtaining the necessary

management and procurement experts within the

approval can be lengthy.

facilities, and the construction manager, Robertson

For example, the first project at 620 in 2006 needed a special permit for a radiation oncology

said. “I also think that the advanced technologies

linear accelerator. The next project, in 2009, needed

have to be given consideration up front in the

permits for development of a comprehensive

design to make sure that you have the appropri-

cancer center, which required extensive planning,

ate space, clearances, and ceiling heights for the

architectural design, and renovation of the pre-

equipment,” he stated.

existing building that had services in it that couldn’t be shut down during construction. “All of this needs to be taken into account as

Also, building more flexibility into sites, especially to be proactive and visionary, is vital. Everyone knows technology is going to change rapidly,

you move forward into project planning,” Robertson

Robertson observed, and you have to plan on

said. “I think most importantly, we conducted focus

changing every five years or so.

groups to get the patients’ perspective so that early on in the design we had a solid understanding of

A strategic approach

Accounting for advancing technologies

that.”

“You don’t want to be going backwards when you need to advance,” he said.

to four points. First, be aware that the approval process can sometimes be longer than you’d like and plan accordingly. Second, know that very rarely will an organization purchase a building or property or seek to renovate an existing area without there existing logistical issues. Plan to work around departments that can’t shut down and always need to be operational. Third, emphasize infection control and know your risks. “You really have to take all the right steps to ensure that you’re doing the right thing and there are no negative effects,” he said. Fourth, communication is vital among the construction management team, the subcontractors, and even the vendors. “People upfront will say it’s a lot of time, but it saves you a lot of headaches and a lot of conflicts,” Robertson said. “I personally find it very, very exciting that there are challenges, but if you are thinking ahead and you have good communication, I think you can overcome them.” by Pete Fernbaugh

ership in Energy and Environmental Design (LEED)

real-estate services for Winchester, explained, the hub-and-spoke model is employed when hospitals

Robertson has come to favor construction manag-

its employees, community, and patients. When he

have outgrown their site’s facilities and buildings.

ers on projects over the traditional general contrac-

looks at the numbers, Robertson estimated that 75

The organization will then strategically relocate its

tor. The main advantage, he said, is having the con-

percent of what Winchester is doing on projects is

services to other portions of the area. One loca-

struction manager integrated early in the process

LEED.

tion will serve as the hub, where imaging services,

to work on design with the architect.

lab, physicians, and necessary modalities may be

“The major difference I feel that’s an advan-

standards. Early on, Robertson said, the hospital embraced it and felt it was the right thing to do for

“The value of a LEED focus is tremendous,” he said. “We believe in it. It’s a little extra work. There’s a lot more paperwork. But it’s worthwhile.”

housed. Then, the hospital will develop spokes that

tage is everybody works as one team under the

extend farther out into the community with physi-

construction-manager methodology,” Robertson

cian offices, lab drawing stations, and many other

explained. “Under construction management, you

tion in two areas--Existing Building Renovations

services.

all work together as a team, you all establish the

and New Building Addition.

When considering expansion options, Robertson

spoke, and healthcare facilities in general, down

Winchester is also a major proponent of Lead-

Construction managers vs. general contractors

As Robby Robertson, vice president of facilities and

Four keys to success In short, Robertson boils his approach to hub-and-

The 620 site is aiming for LEED Gold certifica-

budget, you all have ownership on the job, you all

said he first starts out by examining site logistics.

have rewards and successes on the job. It’s a much

He said a project is multidimensional and com-

friendlier atmosphere and is more efficient. You

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

JAN/FEB

2011

Real Issues : Real Solutions

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