EXCHANGE
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Real Issues : Real Solutions
Phoenix Children’s Hospital Benefits from Partnering with Largest Competitor
HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com
JUL/AUG 2014
Real Issues : Real Solutions
CONTENTS
04 Phoenix Children’s Hospital
HCE EXCHANGE
IN-FOCUS STORIES 08 Saint Luke’s Health System 12 Citizens Medical Center 16 PinnacleHealth West Shore Hospital 20 American Family Care/Doctors Express 24 Ravenswood Family Health Center 27 West Virginia United Health System 30 WES Health 33 Coastal Family Health Center 36 Pampa Regional Medical Center 39 Sedalia Surgery Center
JUL/AUG
2014
PHOENIX CHILDREN’S HOSPITAL Benefits from Partnering with Largest Competitor As partnerships become more critical to a healthcare organization’s success, leaders need to be open-minded and ready to think outside of the traditional paradigms of healthcare collaborations.
Bob Meyer, President and Chief Executive Officer
In Phoenix, Ariz., one hospital made an alliance that has benefited two organizations and led to tremendous growth, along with improved care for patients.
Real Issues : Real Solutions
CONSOLIDATING IN A UNIQUE MARKET Phoenix Children’s Hospital is situated within a rather unique market in Maricopa County. Much of Arizona is rural, yet about 80 percent of the state’s population lives in Maricopa County, including more than one million of the state’s 1.6 million children. The population alone allows for the hospital to be able to offer high-end programs, and for the past four years, the hospital has been ranked among the best children’s hospitals in the country in four of 10 programs on U. S. News & World Report’s Best Children’s Hospitals list. But Phoenix Children’s Hospital wasn’t always able to achieve such prominence. The market used to be disjointed, filled with many players and stiff competition. President and Chief Executive Officer Bob Meyer decided to disturb the market and bring about more unity, at least for pediatrics. Dignity Health and Banner Health are the two primary health systems that serve multiple facilities in the county. St. Joseph’s Hospital, part of the Dignity Health network and Phoenix Children’s Hospital’s biggest competitor, was faced with the prospect of building a new children’s hospital to remain competitive with Banner Health. Meyer approached the facility and began a dialogue to combine forces: St. Joseph’s would transfer its pediatric hospital, a 180-bed hospital within a hospital, to Phoenix Children’s Hospital in exchange for a 20 percent membership interest. This collaboration, which closed in 2011, saved St. Joseph’s from building a $300-million facility that could not be supported by volumes and allowed Phoenix Children’s to expand its programs and focus on what it does best--caring for children. “The area was prime for consolidation, and the agreement allowed us to build a real children’s hospital that provides high-quality care and competes nationally,” Meyer said.
GROWING SPECIALTY PROGRAMS AND BRANCHING OUT By consolidating the market, Phoenix Children’s Hospital grew to being among the top 10 in the na-
tion in terms of volume for Cancer, Cardiology and Heart Surgery, Neurology and Neurosurgery, and Orthopedics. Furthermore, it has constructed a new technologically current facility to provide state-ofthe-art care to its patients. The hospital has centers of excellence in six major programs: cardiology, hematology/oncology, neurosciences, trauma, neonatology, and orthopedics. Meyer said each service line is evaluated in terms of its volume, which has to be large enough to make it relevant to the market and have reasonably good economics. The hospital also has smaller programs that provide care for patients with HIV, sickle cell, diabetes, and cystic fibrosis. Phoenix Children’s has been growing internally as well, adding a new 11-story bed tower in 2010 and branching out into the community. With most of Arizona outside of Maricopa County being rural, the hospital has built four ambulatory facilities and is growing telemedicine and remote clinic links.
HCE EXCHANGE MAGAZINE
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The hospital is now about halfway to its goal of raising $40 million for constructing a new emergency department and level 1 trauma center.
HIRING AND TRAINING A STRONG WORKFORCE Recruitment and retention are big factors within any healthcare organization, especially amid growing fears of a workforce shortage. Meyer said he has seen some abatement of the shortage, but he would like to see an increase in local talent. The majority of pediatric specialty fellowship programs are east of the Mississippi and require a larger recruitment effort to lure those trainees out West. Meyer said Phoenix Children’s Hospital actively supports the medical and nursing schools locally and has expanded its teaching program, residencies, and fellowships. In his more than 10 years at Phoenix Children’s, Meyer has helped to build the employed physician group as well. “The employed medical group is a key strategic asset for us,” he said. “As we expand geographically, we need to have talented practitioners to fill those facilities.”
MANAGING REFORM AND MEANINGFUL USE Only a few provisions of the Affordable Care Act specifically benefit pediatric care, but Meyer said the hospital worked closely with Arizona’s governor to get approval of a Medicaid expansion. Maricopa County has many undocumented immigrants, but most of the children are U.S. citizens, making them eligible for Medicaid. Meyer said Phoenix Children’s doesn’t have a large program with uncompensated care as can be found in adult hospitals, but under-reimbursement through Medicaid has been an ongoing financial concern for the facility. “We have a good, cooperative working environment with the government in this state,” Meyer said. “Not getting the Medicaid expansion would have had huge negative consequences for hospitals, but we had a governor who saw the benefit and was willing to push for the expansion.” Phoenix Children’s Hospital is also making investments in electronic medical records, with most of the basics already in place throughout the hospital. The facility chose Allscripts for its EMR vendor and has customized many elements to pediatrics. Meyer said the hospital built its own pediatric dose range checking system that it now sells to
Allscripts
other Allscripts clients. Currently, it is expanding the EMR to ambulatory facilities.
Today’s healthcare market requires a new approach to innovation. Allscripts clients, including Phoenix Children’s Hospital are innovating to meet the needs of today’s market and anticipate what’s needed to achieve long-term success. For example, through the custom creation of Medical Logic Modules (MLMs) available in Sunrise by Allscripts, Phoenix Children’s Hospital greatly decreased adverse events in its patient population relative to IV infiltration and reduced the number of high-level, irrelevant adverse drug alerts.
Phoenix Children’s is now well-situated within its market and is able to focus on developing the highest-quality programs for the pediatric community. Meyer said forming collaborations with adult care is part of the hospital’s future strategic plan, along with ensuring that patients continue to receive seamless care as they age out of the facility. He plans to keep an open mind and maintain the same forward thinking in coordinating adult care as he did with children’s care. “Traditional ways of thinking and paradigms are
Additionally, through Allscripts Open platform, Phoenix Children’s Hospital connects the commonly-used Child Health and Development Interactive System (CHADIS) forms to their Sunrise system and passes discrete data bi-directionally. True innovators who succeed in today’s market use solutions like Sunrise by Allscripts for a proven competitive advantage.
falling by the wayside,” he said. “Most children’s hospitals are afraid of being acquired, yet we acquired our largest competitor. You have to keep an open mind and be flexible.” BY PATRICIA CHANEY
SAINT LUKE’S HEALTH SYSTEM
Creates Unified System of Care Silos of care based on specialty have long been a trademark of the healthcare world. As more hospitals are merging to form larger systems, however, new models of care are needed to break down these silos and develop methods of care delivery that provide a seamless experience to patients across multiple hospitals. Katherine A. Howell, RN, Senior Vice President, Chief Nurse Executive
In Kansas City, Mo., Saint Luke’s Health System has an excellent reputation with more than a century of experience providing care to the region. With the latest changes in the healthcare industry, the organization re-evaluated its care-delivery structure in 2012. As a result, Saint Luke’s has spent about two years developing a model of coordinated care, primarily within nursing, across its 10 hospitals.
Real Issues : Real Solutions
02 | SAINT LUKE’S HEALTH SYSTEM
BREAKING DOWN THE SILOS OF NURSING CARE
In her role as chief nurse executive, Howell over-
“We were looking toward a new system design
health disciplines, and she led the majority of the
to ensure we delivered the highest value to our
structural changes to those departments. The first
patients,” said Katherine A. Howell, RN, senior vice
step was refocusing clinical-education specialists
president, chief nurse executive. “We brought out
and nurse educators on pursuing a level-of-care
key goals related to developing systems of coordi-
accountability.
nated care, rather than silos, to create an inte-
sees all of the nursing and many of the allied-
Now, two clinical-education specialists are
grated clinical enterprise. We were good at leading
dedicated to critical care to ensure nurses in every
vertically, but we needed to lead horizontally. That
critical-care unit have the same competencies. This
is what makes you patient-focused.”
approach is taken across all services.
This design change required a massive shift in
In addition to education, another change in
the way the organization was structured, one that
management was to give the chief nursing officers
would steer Saint Luke’s away from a hospital-
of each hospital accountability for one specialty
centric approach and toward a “level-of-care” ap-
across the system. This was in addition to their
proach. This involved creating consistent standards
hospital duties. For example, one CNO has account-
of care, competencies, education, staffing stan-
ability for critical care in all facilities, one for sur-
dards, and data management across all entities.
gery, and one for neonatal care, allowing them to
“We wanted to make sure that a patient who
look at these service lines as providing one single
walks into any Saint Luke’s hospital will get the
standard of care that breaks down those aforemen-
same high standard of care,” Howell said.
tioned silos.
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all facilities. Phase 1 of this implementation was completed on March 28 with seven hospitals going live. The next phases are now being planned for implementation and include the regional hospitals, ambulatory clinics, and revenue cycle. The final goal is to have an integrated, longitudinal EMR.
Howell said having the same competencies and training across all facilities allows the system to share resources. This strategy works well for Saint
EXPANDING THE REDESIGN ACROSS THE SYSTEM
Luke’s, since it is not spread over a vast geographic
Restructuring an entire organization in this
area, even though it has numerous physician prac-
manner isn’t easy, and it’s not always immediately
tices and other sites in addition to the hospitals.
accepted by staff. It’s important, Howell said, that
Nurses also receive financial incentives in order to be considered a shared resource. They are
the project be driven by the CEO with a clear vision and open lines of communication.
assigned to a tier, so a tier-3 neonatal nurse can
Even though Saint Luke’s brought in consul-
serve in any NICU in the system and will receive
tants to help guide cost savings and provide struc-
higher pay.
ture, Howell said the leadership was key to helping
“Sharing resources through our Central Staff-
everyone work through the disruption.
ing Office allows us to be more flexible and avoid
“We have to have leaders who can lead through
overstaffing for the ‘what-if,’” Howell said. “We
tumultuous change,” she said. “You have to think
have about 250 employees in the central work pool.
through logically where you want to go. You can’t
This has brought down our agency costs and unit-
cause this kind of disruption without a clear end
staffing costs.”
game.”
To further improve collaboration, the system is implementing the Epic suite of products so it
One of her frequent roles is to connect the dots for employees, reminding those whose role was
Real Issues : Real Solutions
drastically retooled why and what the big picture is for the organization. “I make big requests to support departments or talk to individuals who have had their roles changed, and I have to remind them that we are doing this to allow our frontline staff to deliver care in a cost-effective manner so that we can continue to thrive as a health system,” she said. In the first full year of implementing this clinical integration, Saint Luke’s has realized $25 million in cost savings. Going forward, the system will continue to expand the integration, bringing on clinicians as well. Clinicians are rewarded for their work in helping to provide a more clinically integrated enterprise. Howell said the more they show improvements in clinical care at the bedside or help spearhead an effort that has a system-wide impact, the higher their pay will be. “There is a lot of work to be done, and we will be working on our inpatient care model,” she said. “The inpatient care model has not changed a lot,
“THE INPATIENT CARE MODEL HAS NOT CHANGED A LOT, AND WE NEED TO LOOK AT HOW WE CAN REDESIGN IT TO BE MORE EFFECTIVE AND GIVE PATIENTS A GREAT EXPERIENCE.”
and we need to look at how we can redesign it to be more effective and give patients a great experience.” BY PATRICIA CHANEY
HCE EXCHANGE MAGAZINE
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CITIZENS MEDICAL CENTER
Renews Focus on Behavioral Health Improving behavioral healthcare is a vital part of treating the whole patient and is an area with which many hospitals struggle, especially when it involves integrating behavioral health with the rest of their service line. Stephen Thames, Chief Executive Officer, Citizens Medical Center
David Way, Associate Executive Director & Corporate Integrity Officer, Gulf Bend Center
One Texas hospital is partnering with a mental health provider to coordinate care and better serve its patient population.
Real Issues : Real Solutions
03 | CITIZENS MEDICAL CENTER
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RECOGNIZING THE GAP IN BEHAVIORAL HEALTH CARE Citizens Medical Center is a 344-bed not-for-profit acute-care hospital in Victoria County, Texas. It has a referral area of approximately 140,000 people in Victoria and the surrounding counties. Like many hospitals, its ability to provide adequate mental healthcare to patients was limited to mostly those patients with severe issues. “There has been a gap between patients that meet the criteria for inpatient psychiatric services at a long-term psychiatric institution and patients that don’t qualify for inpatient services, but may not be safely discharged from the emergency department or acute-care setting,” said Stephen Thames, chief executive officer of Citizens Medical Center. The emergency department has been the default location for patients with a behavioral-health crisis that often leads to a medical crisis. In fact, many patients have been brought to the emergency department before being taken to jail. HCE EXCHANGE MAGAZINE
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Ultimately, the hospital treated the patient’s medi-
utilize waiver funds in order to improve patient care
cal condition, but not the underlying mental-health
overall.
condition.
The Gulf Bend Center is one of 39 mental health
Thames said situations were also presented
centers covering the state, and one of only a hand-
to the hospital in which the physician didn’t feel
ful that has built projects for patients with comorbid
comfortable discharging the patient, but the patient
conditions rather than remaining siloed into provid-
wasn’t sick enough for inpatient care. Very few
ing only mental health services. This placed it in an
patients would seek mental healthcare on their own
ideal position to develop a cooperative relationship
after discharge.
with the hospital.
Conversely, the Gulf Bend Center, a mental
“Once a dialogue began, we realized we had
health and intellectual and developmental dis-
a great opportunity to work together to provide a
abilities facility, found that many of its patients had
valuable service to the patients and the community,
comorbid conditions such as diabetes, congestive
and in the process, both organizations would spend
heart failure, or obesity and needed medical care.
less money and better utilize the waiver funds,”
CREATING A PARTNERSHIP ACROSS MULTIPLE ORGANIZATIONS
Thames said. “The hospital needs to prevent readmissions, unnecessary admissions, and reduce the burden on the emergency room; the Gulf Bend Center
The two facilities began working together after
needs to get patients in for treatment,” David Way,
Texas implemented a Medicaid 1115 waiver. This
associate executive director and corporate integrity
transformational waiver encourages facilities to
officer at Gulf Bend Center, said. “We are serving
begin integrating services in an effort to provide
the same person, and coming together to treat the
patients with higher-quality, more efficient care.
whole patient in the end rewards the patient, the
In turn, healthcare organizations would receive
agencies involved, and our organizations, which
financial incentives.
have more funds to reinvest into services.”
Since one of the areas of emphasis in the waiver
To help bridge the gap Thames mentioned, Gulf
is behavioral health, Citizens Medical Center and
Bend Center was awarded a grant from the Texas
Gulf Bend Center began discussing how to best
Department of State Health Services and a match-
Real Issues : Real Solutions
ing local in-kind grant from Citizens Medical Center that allowed it to create an outpatient extended observation unit at Citizens for patients who fail to qualify for inpatient care, yet need evaluation, intense counseling, or medication review. Patients can be referred from the emergency department, acute care, or a mental health clinic and can stay 12 to 48 hours. Citizens Medical Center’s matching funds cover lease space and nursing services. The hospital’s on-site behavioral health consultation group provides discharge planning and assists Gulf Bend’s qualified professionals with evaluation. “The patient wins because they now receive the appropriate level of care in the least restrictive setting,” Way said. “Being in the hospital also helps us reach patients at the moment they need us most. If they leave the hospital without an evaluation, we are more likely to lose them.” Although the hospital and Gulf Bend are the primary parties involved, this venture has helped local law enforcement, EMTs, and hospital providers and staff to successfully treat those in a mental health crisis. Law enforcement officers can now bring these patients directly to the extended observation unit, which alleviates the burden on the emergency department. Gulf Bend may also send a professional to the officer’s location to triage the patient.
DEVELOPING SYSTEMS TO FUNCTION IN A CHANGING HEALTHCARE INDUSTRY The advancements made in behavioral healthcare are just one of the ways in which Citizens Medical Center is changing the way care is delivered even as it embraces the true meaning of healthcare reform. Citizens is developing an accountable care organization model and moving toward becoming a patient-centered medical home. The organization has pulled together the resources of 12 nursing homes, home health providers, a retail pharmacy, durable medical equipment, Gulf Bend, and others to coordinate care, manage dollars, and avoid waste in redundant administrative fees. These alliances will help the organization improve operations in a pay-for-performance world. Thames and Way strongly believe that integrating services and streamlining the continuum of care is implementing the true intent of the Affordable Care Act and represents the best practice going forward. “You cannot bring about change by reworking what we’ve been doing,” Way said. “There has to be a paradigm shift.” BY PATRICIA CHANEY
HCE EXCHANGE MAGAZINE
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PINNACLEHEALTH WEST SHORE HOSPITAL
Opens in Record Time Thanks to Engaged Team Building a new hospital is often fraught with complications, delays, and management woes. However, PinnacleHealth System, based in Harrisburg, Penn., managed to avoid many of these pitfalls with the construction of its West Shore Hospital in Mechanicsburg, Penn.
Michael A. Young, President and Chief Executive Officer
HCE interviewed Michael A. Young, president and chief executive officer of PinnacleHealth, on May 30, 2014. At that point, the West Shore Hospital had only been open for a week and already its emergency department had achieved its 24-month projection in seven days and the 108-bed, $120-million, 188,000 sq.-ft. facility’s inpatient utilization was at the six-month projection level. This is an even greater feat considering the entire building—from planning to construction to opening—took 12 months. .
Real Issues : Real Solutions
04 | PINNACLEHEALTH WEST SHORE HOSPITAL
855.432.9663 ENGINEERS
PLANNERS
www.dawood.cc
SURVEYORS
Congratulations to PinnacleHealth and its Management Team for its stewardship and service to the community in the opening of the West Shore Hospital. Dawood Engineering is proud to partner with PinnacleHealth on the design of the West Shore Hospital, expanding the footprint of quality healthcare in the region. Dawood, founded in 1992, is a multidisciplined consulting firm offering services such as Land Development, Municipal Services, Land Survey, Transportation, Traffic Engineering, Environmental Services and Geotechnical Engineering. Corporate Office: Enola, PA 717-732-8576 Locations: Pennsylvania • Ohio • Texas • West Virgina • Massachusetts
Dawood Engineering, Inc.,
FILLING FOUR SERVICE HOLES Young has been with PinnacleHealth for three
Dawood Engineering, Inc., founded in 1992, is a multidisciplined consulting firm, with over 225 employees. As a community-minded company, we were proud to be part of the design team for the West Shore Hospital located within sight of our headquarters. Our employees and neighbors will receive quality care from PinnacleHealth in a state-of-the-art facility in our hometown. Dawood provided land development, survey, geotechnical engineering, permitting, municipal coordination, traffic engineering, and construction support on this project.
years. A native of central Pennsylvania, he brought with him an acute awareness of the healthcare needs in the region. Prior to opening West Shore Hospital, PinnacleHealth already had three campuses and more than 50 additional locations, and the non-profit system had earned a historically solid reputation for highquality healthcare at a low cost. It led the region in low infection rates, low readmission rates, and high clinical outcomes. But, Young said, our leadership “knew the day of taking economic risks was around the corner, so a big piece of that was finding the holes in the puzzle where we needed PinnacleHealth services that were focused on quality and cost.” The management team delineated four service holes that needed filling: its primary-care network,
HCE EXCHANGE MAGAZINE
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cess to personally ensure PinnacleHealth secured the ideal contract. The team collaborated with physicians on setting up the operating rooms and catheterization labs. They consulted every location within the system to ensure service lines weren’t being unnecessarily duplicated, and only one set of architectural plans was drawn up, not the usual three or four. “Our management team really did a spectacular
its hospital network, getting its ACO approved by
job at bringing in the latest programs in technology
Medicare, and establishing a primary-care center
at a fraction of the cost of what we’re seeing around
in Perry County, a traditionally underserved rural
the country,” Young said.
region north of Harrisburg.
Of course, unexpected challenges arose to test
The freestanding West Shore Hospital helped
the team’s resolve. First, when the project was 70
the team fill the first two holes and solved an
percent completed, PinnacleHealth realized that
access problem for patients who used Pinnacle-
operations had to be moved up by 90 days. Without
Health’s ambulatory site off the East-West highway.
wincing, the team managed to move it up 85 days,
“Patients who used to come to our tertiary hub from an hour away could now make it to this new hub in 35 or 40 minutes,” Young said.
having already absorbed the costs. And second, after purchasing the best patient monitors GE had to offer, the IT team discovered
With the location secured, the management
this particular model would create compatibility
team zeroed in on the timeframe with aggressive
issues with PinnacleHealth’s other patient-moni-
targets. Young knew the team’s biggest challenge
toring platforms. By rapidly upgrading the system’s
would be the budget, and PinnacleHealth’s pay-
platforms, the IT team swiftly resolved this compli-
ers were putting tremendous pressure on them to
cation.
bring the project in at a certain pricing level. Rigorous negotiations began, and the guaran-
The new hospital’s IT infrastructure is now so advanced, West Shore is preparing to introduce
teed maximum price model was employed. Young
Google Glass into its Emergency Department within
remained involved in the contract negotiation pro-
months, Young said.
Real Issues : Real Solutions
In both cases, Young thought the nightmares
“Our purchasing people and our facilities people
were going to be longer and scarier. “But it came
asked contractors, IT companies, and steel compa-
together in the end. It shows that when you work
nies to provide extraordinary pricing, service, and
as a team, you can really make spectacular results
delivery items. We found out, if you don’t ask, you
happen.”
don’t get it, and people are afraid to ask. But we be-
TAKING A HANDS-ON APPROACH
lieve every dollar you save is a dollar you can spend somewhere else.” The West Shore Hospital came in at a fraction
The final two holes in PinnacleHealth’s four-part
of the price tag usually attached to projects of this
strategic plan are now almost filled. Its ACO was
magnitude. The $30 million dollars PinnacleHealth
approved and started operation in partnership with
saved can now be invested in other projects, such as
Susquehanna Health in Williamsport, Penn., on
the new cancer center it will be opening at the West
January 1. Between the two systems, 38,000 cov-
Shore campus in August.
ered lives are in the ACO. In the fall, PinnacleHealth will be opening a
“It’s the philosophy of getting people engaged and getting very clear understanding upfront,”
full-service primary-care center, Medical Profes-
Young said. “It saves a lot of distraction, time-
sional Center, in Perry County, looking to reach
wasting, and confusion down the road by getting the
an underserved population that routinely ranks
clarity upfront. It saved us hundreds of thousands
64th out of 67 counties in Pennsylvania for mortal-
of dollars on architects and saved us millions on
ity, smoking, obesity, diabetes, and childbirth and
change orders. It got everybody on the same page.
cardiac challenges.
And at the end of the process, we opened, and the
Young credits the organization’s rapid progress
hospital is almost full.”
to an involved and active leadership team. “We’ve made tremendous strides in three years
BY PETE FERNBAUGH
by being hands-on,” he said. He also credits an institutional philosophy code-named “Just Ask” for empowering his team to lower costs while maintaining quality.
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AMERICAN FAMILY CARE/DOCTORS EXPRESS It’s All about the Patient Randy Johansen has been employed with American Family Care (AFC) for 22 years and has served as president for the last 10 years. He was employed at a for-profit hospital when Dr. Bruce Irwin, founder and chief executive officer of AFC, hired him to spearhead a growth strategy for the company. Dr. Bruce Irwin, Founder and Chief Executive Officer
Randy Johansen, President
Throughout his more than 30-year career, Irwin has focused on accessible primary, urgent care, family practice, occupational medicine, and emergency care. His first comprehensive healthcare center, the Hoover clinic, was opened in Birmingham, Ala., in 1982. The Hoover clinic provided the template for American Family Care’s eventual national presence. When Johansen joined AFC in June 1994, it had five clinics. Today, AFC has over 100. “What impressed me about American Family Care was the mentality,” Johansen said. “It was one of patient satisfaction, taking care of the patient. We’ve never worried about making a profit. If we offer what people need and we do it better than anybody else, the profit takes care of itself. And that has been our mentality: patient satisfaction, high-quality care, treating them appropriately.”
05 | AMERICAN FAMILY CARE/ DOCTORS EXPRESS
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REALIZING AFC’S POTENTIAL FOR GROWTH American Family Care has two divisions. First, there are its clinics. With 48 clinics already established, new locations for these clinics are being added rapidly in 2014 alone. So far this year, nine new clinics have been opened and an additional nine are expected to be added by the end of the year, bringing the total of AFC clinics to approximately 60. The second division of AFC was recently formed: AFC/Doctors Express, a franchise of urgent-care centers. (Editor’s Note: HCE previously covered Doctors Express in 2011.) With 72 locations spread across 22 states, AFC acquired Doctors Express in April 2013, rebranding it as AFC/Doctors Express. By year’s end, those 72
HCE EXCHANGE MAGAZINE
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locations will have added 13 new clinics for a total
solution of affordable, accessible, and high-quality
of 85 locations. In 2015, AFC expects to add another
care,” Irwin said. “This is critical because as our
15 to 20 AFC/Doctors Express clinics.
nation’s healthcare model continues to evolve, the
AFC also recently entered into an affiliation agreement with Baptist Hospital in Montgomery, Ala. Baptist has turned over its five Montgomery-
number of insured patients without a primary-care physician will increase.”
the AFC PriMed label. AFC already has three clinics
THE COMMONSENSE BEHIND AFC’S GROWTH
in the Montgomery area.
According to Johansen, the secret behind AFC’s im-
area PriMed Clinics to AFC for co-branding under
Johansen said this agreement reflects the lat-
pressive success is two commonsense strategies:
est step in AFC’s growth strategy: affiliating with
have great people in place and prioritize patient
hospitals in a specific area.
satisfaction above all else.
“We’ve never done that before,” he said. “And
“If you look at the management of American
we’re seeing where hospitals have become more
Family Care, I’ve been here for 22 years, our chief
and more interested in trying to work out an af-
financial officer has been here for 14 years, most of
filiation arrangement with physicians or physician
the people in the operations side have been here for
groups, such as ourselves, in trying to reach differ-
multiple years,” he said. “…[S]o we have a strong
ent areas of their market.”
management team in place that knows what they’re
AFC believes it can help hospitals meet the quality requirements of the bundled-payment
doing and knows how to go about it. “We also believe that we have the best model
system in a way that will ensure their continued
for urgent-care facilities. We’re primary-care
presence in their marketplace, while preventing
driven. We’re not just walk-in. We want to take care
readmissions.
of you in your follow-up visit as well as your initial
“As we expand our national footprint and
visit.”
broaden our reach, we provide Americans the
Real Issues : Real Solutions
Each clinic has multiple surveys it offers to patients
explaining what occurred, why it occurred, and how
for feedback. These surveys are accompanied on
it will be fixed in the future.
the back-end by an incentive program for employees known as PS, for patient satisfaction. Implemented three years ago, the PS Program has been “tremendous in terms of getting our
Two years ago, Johansen said AFC’s patientcomplaint rate was 1.1 complaints per 1,000 patients seen. It now stands at .47 complaints per 1,000 patients.
people to focus on patient satisfaction and being
As part of the PS Program, the Ambassador
motivated to take care of that patient and making
Program was formed, where employees and physi-
sure that a patient complaint doesn’t get out of the
cians ask patients who are happy with the service
clinic,” Johansen said. “If there’s someone who’s
AFC has provided to recommend AFC to their
unhappy in the clinic, take care of it now so that it’s
friends and families. The premise of the Ambas-
addressed before they walk out the door.”
sador Program was established upon Irwin’s belief
There are three primary criteria AFC has in place for its employees: patient volume, patient satisfaction, and timely clinical service. When an
that the best source of new patients is referrals from current patients. “When patients walk through our doors, they
employee satisfies these three criteria, they are
can rest assured they will receive the best acces-
rewarded with a quarterly bonus.
sible primary care, urgent care, family care, and
The 10/15 Rule requires AFC employees and
occupational medicine,” he said. “It is our mission
physicians to check in on a patient at least every 10
to provide the best healthcare possible, in a kind
to 15 minutes after they’ve been taken back to an
and caring environment, while respecting the rights
examination room.
of all patients, in an economical manner, at times
Furthermore, AFC pushes for its employees to acquire all demographic and insurance information correctly the first time. Johansen said a negative
and locations convenient to the patient.” BY PETE FERNBAUGH
image is cultivated when the simplest information is entered inaccurately. Complaints are also handled efficiently by a patient advocate. Everyone named in the complaint is required to respond in writing to the patient,
“IT IS OUR MISSION TO PROVIDE THE BEST HEALTHCARE POSSIBLE, IN A KIND AND CARING ENVIRONMENT, WHILE RESPECTING THE RIGHTS OF ALL PATIENTS, IN AN ECONOMICAL MANNER, AT TIMES AND LOCATIONS CONVENIENT TO THE PATIENT.” HCE EXCHANGE MAGAZINE
23
RAVENSWOOD FAMILY HEALTH CENTER
Finds Strong Partner in Community In the midst of the prosperous Silicon Valley is a smaller pocket of East Palo Alto where one community health center is making tremendous gains in providing care to patients most in need. Since it opened in 2001, Ravenswood Family Health Center has grown from a start-up clinic to being the recipient of national recognition for its primary-care model, a model that integrates medical, behavioral-health, and dental services into a patient-centered medical home.
Luisa Buada, Chief Executive Officer
Ravenswood serves a population of African-Americans and Latino and Pacific-Islander immigrants. Nearly half the population of the center’s catchment area earns incomes under 200 percent of the poverty line.
Real Issues : Real Solutions
06 | RAVENSWOOD FAMILY HEALTH CENTER
“We created a blue-ribbon task force of county leaders, political leaders, community advocates, community healthcare institutions, and donors to
GAINING COMMUNITY SUPPORT FOR A HEALTH CENTER Chief Executive Officer Luisa Buada started as a
raise money,” Buada said. “The city donated a piece of land in the industrial part of town for $1 per year, which we then cleaned up.” The industrial area was projected to become the
consultant to Ravenswood when the center was just
downtown for the city, and the clinic and comple-
beginning and became the CEO at the start of the
mentary nonprofit services for low-income families
second year of its operations.
were the first to establish themselves. Ravenswood
“A number of important institutions in the community understood the necessity of having a community health center here,” she said. The federal government, however, only pro-
put in about 13,000 square feet of modular units for the clinic and nonprofit organizations. The Lucile Packard Children’s Hospital (LPCH) was a major partner in this endeavor. The hospital
vides about 20 percent of funding for federally
worked with the community center to help improve
qualified health centers. The Peninsula Community
its management of asthma and reduce the burden
Foundation, which later merged to become Silicon
on the emergency room of children coming in with
Valley Community Foundation, and other commu-
asthma crises. LPCH, now Stanford Children’s
nity healthcare partners helped raise money for
Health, continues to provide funding and deliver the
Ravenswood.
babies of Ravenswood’s prenatal patients.
HCE EXCHANGE MAGAZINE
25
EXPANDING SERVICES AND BUILDING A PERMANENT LOCATION The modular units were intended to be used for five years until a permanent location could be built. Ravenswood has about 80,000 visits per year that include health education, referrals, medical, dental, and mental health and was in need of expansion. The center recently poured the building foundation for a $32-million, 38,000 square-foot permanent clinic that will house radiology services, optometry
Regardless, Ravenswood is managing these chal-
services, and a pharmacy.
lenges with the implementation of an EMR and
The center plans to expand its education and
PCMH Level 2 certification, but sometimes, Buada
training programs. It already is a site for pediatric
said the electronic requirements take away from
residents and will be adding family practice and
patient care.
internal medicine residents in the new facility. The dental clinic moved into a newly constructed
“We need to be able to provide care in a meaningful, qualitative way with patients, but we are
facility in 2010 that is in a separate building. It also
still paid on a volume basis, so we have to operate
trains dental residents, students, and hygienists.
that way,” she said. “Many providers feel they are
Buada said Ravenswood has raised all but the last $1 million of the current building project. “The new clinic will allow us to grow to 22,000
managing care technologically and not personally and intimately. Commitment to quality and a caring patient relationship for underserved populations
patients,” Buada said. “There are still a lot of people
is what drives providers to come to a clinic like
in the area who don’t have access to healthcare.”
Ravenswood.”
MANAGING CHALLENGES WITH REGULATORY REQUIREMENTS
ogy work with patient care is having coherence in
As with many community health centers, Raven-
Buada said the clinic reviewed all of its workflows
swood operates on a tight budget and seeks ef-
and then adapted them for the electronic system.
ficiency in all aspects of care delivery. Although an
Buada believes the key to making the technolthe management team. Before adopting its EMR,
This process required a great deal of training
electronic medical record provides great benefits, in
and preparation in advance of the launch and fund-
a resource-challenged, nonprofit environment with
ing for extra staff to support the EMR launch. The
many other challenges, the EMR requirements can
clinic continues to grow and develop its EMR and
be a burden.
expects to achieve PCMH Level 3 with the larger
“The demand for regulatory requirements
clinic.
today in terms of meaningful use, patient-centered
“We have tremendous faith in the possibilities,
medical homes, team care, and other certifications
and we operate from having a vision,” Buada said.
add incredible costs in documentation for report-
“We will be able to fulfill our mission no matter
ing,” Buada said. “We have had to add a staff-
what. We work to instill that value with everyone in
development department for ongoing training and
the organization.”
a decision-support department to mine all the data being created by the EMR.”
BY PATRICIA CHANEY
Real Issues : Real Solutions
07 | WEST VIRGINIA UNITED HEALTH SYSTEM
WEST VIRGINIA UNITED HEALTH SYSTEM
Develops Plan to Regionalize Services for Geographically Isolated Population West Virginia United Health System (WVUHS) has a tough mission, particularly in today’s healthcare market: to serve a typically underserved population that is geographically dispersed.
Christopher C. Colenda, MD, MPH, President and Chief Executive Officer
The not-for-profit health system is the second-largest employer in the state and serves north central and eastern West Virginia, mainly the mountainous region between the Potomac River and the Ohio River. The system consists of six hospitals throughout northern West Virginia from the Potomac River in the East to the Ohio River in the West. WVUHS includes the academic medical center of West Virginia University Hospitals, the state’s major safety-net hospital that has a children’s hospital, behavioral-medicine facility, and a trauma center; a multi-specialty ambulatory center; and an over 450-member faculty practice plan. The other community hospitals in the system have networks of owned physician practices or tightly aligned staff physicians and providers.
HCE EXCHANGE MAGAZINE
27
tion of infrastructure and align business practices including our brand. We need to determine what our expansion strategy should be, not only in terms of facility growth and acquisition, but more importantly, how we build a deeper primary and specialty care presence across the continuum of care in both our primary and secondary markets to meet the needs of our population, as well as our financial and academic responsibilities,” Colenda said. “West Virginia is a rural state and our patients have traditionally had challenges with access to care and health disparities. I am focused on ways to reduce disparities, improve access, and improve quality for people not typically the beneficiaries of those services.” Expanding and remaining financially secure are extremely difficult goals to balance for WVUHS. The system has high levels of Medicare, Medicaid, and self-pay patients, which requires the board and CEO to be involved in local and state government to advocate for patients. “Government organizations within the state fund much of our mission through Medicaid and the state insurance plan,” Colenda said. “The state extended Medicaid, which was good for the residents. It allowed more people access to coverage and reduced our charity-care burden. Early results of the impact of
DEVELOPING A STRATEGIC PLAN UNDER NEW LEADERSHIP Christopher Colenda, MD, MPH, stepped into the
Medicaid expansion have shown increases in Medicaid gross charges and a reduction in self-pay patients among those who seek services at WVUHS.”
a three- to five-year strategic plan. Before becom-
CREATING ALIGNMENT WITH PHYSICIANS ACROSS THE REGION
ing CEO of WVUHS, Colenda served as chancellor
The system has a mix of university faculty, private
for health sciences at West Virginia University,
physicians, and employed physicians and is always
which placed him on the board of the health system
seeking ways to coordinate services across the
for five years. He continues to serve in that role until
continuum of care. Colenda said he has recently seen
his replacement is named.
an increase in younger physicians seeking employed
role of president and chief executive officer six months ago and has undertaken the development of
Key elements of the system’s strategic plan
relationships with the health system, and part of the
are to optimize system organizational and business
strategic plan includes recruitment, retention, and
structures, expand services and improve access to
building greater provider depth and alignment of phy-
care across the state, generate alignment among
sicians in primary and secondary markets.
physicians, and determine an approach to the risk
“We make sure our employment relationships reward physicians with benchmarking compensation
and insurance side of care delivery. “We need to think about how to best optimize our structure to eliminate unnecessary duplica-
for quality as well as productivity,” Colenda said. “We are developing a menu of opportunities for alignment,
Real Issues : Real Solutions
whether through employed relationships, strongly
he added. “As the largest West Virginia health-
aligned relationships, or faculty physicians.”
care system, incentivizing alignment of providers,
WVUHS has also developed joint ventures
facility administrators, payers, and patients that
between several hospitals to improve specialty
rewards cost-effective, patient-centered, evidence-
services and has developed attractive recruitment
based, and quality-driven care in a rural state with
packages for specialists and primary-care physi-
significant access challenges is the holy grail for
cians. Given the challenges of recruiting talent to
WVUHS.”
underserved areas, Colenda said those packages have been fairly successful.
MANAGING RISK AND BUILDING ON SUCCESSES
Looking forward, Colenda is submitting strategies for all of the system’s goals to the board for approval and expects to have an implementation plan in place soon. He keeps a details-oriented focus on ways to build up the healthcare provided to
With the insurance and managed-care side of
the state with an eye on the overall effects of having
the industry changing, Colenda said determin-
a quality health system not just for patients, but
ing a strategy for risk is an important part of the
also for economic development.
system’s future. “Typically, the system has focused
“Our state government and business leaders
on strategies that reward market share and clini-
are passionate about how to expand the economic
cal volumes. We simply must understand how to
and resource base of the state,” he said. “We want
develop appropriate strategies and system-wide
to be part of that solution through delivering high-
implementation plans on risk assumption for pa-
quality healthcare to those who choose us for their
tient populations served by the system. In so doing,
care.”
we will need to adapt to some form of shared-risk arrangement with the insurance industry.
BY PATRICIA CHANEY
“Right now there is a lot of push and pull between providers and insurance companies,”
HCE EXCHANGE MAGAZINE
29
WES HEALTH
Provides Behavioral Healthcare to Low-Income Communities More than 30 years ago, Philadelphia, Penn., began to recognize the necessity of not only providing quality behavioral healthcare, but also providing it in a way that gave low-income patients the resources they needed to be higher-functioning citizens in their communities.
Dennis Cook, President and Chief Executive Officer
By the 1990s, the series of organizations that had been established to fill this need were struggling to stay viable and suffering from inconsistent leadership and no federal funds. WES Health System was born out of this turmoil, and with proper management and fiscal oversight, it has been able to grow and thrive.
Real Issues : Real Solutions
08 | WES HEALTH
HAVING A COMMUNITY OF SUPPORT FOR MENTAL HEALTH The quality of mental health services, particularly for low-income populations, varies across the country and has always been a challenge to fund and to work into the larger healthcare system. In Phila-
ADVANCED SERVICES
delphia, the city and its political leaders recognized that WES Health System provided a necessary service to its residents and was committed to helping the organization grow. Dennis Cook, president and chief executive officer of the system, took the reins in 1996, and the organization has grown from four local clinics to
OUR DIFFERENCE IS REFRESHING
providing services in 40 locations, including schools, community centers, and 17 stand-alone clinics. “With the help of the Chief Financial Officer, I established appropriate spending controls, and
154 Dunksferry Road Bensalem, Pennsylvania 19020
we were able to stabilize the organization with the patience of the city and elected officials,” Cook said.
t.215.638.9612 | f.215.638.9634 e.advancedsv@aol.com www.advancedserve.com
“When I started, almost every service was in provisional status, and within two years, we were able to improve the quality of our clinical services and get them licensed.” Once the organization was financially stable, Cook said the board held a retreat to create a vision of what WES could become. “We felt our talent was in providing services in an urban environment to low-income people who,
place to live, going to school, feeling safe in their
for various reasons, were noncompliant with their
communities. Behavioral health is one of the last
treatment plans,” he said. “Many of our patients
things you can get them [to] focus on with all
have other issues to deal with--eating, finding a
those other issues, but we have a lot of experience helping those patients.”
STRETCHING ITS REACH TO HELP THOSE IN NEED WES has also expanded to Illinois, Delaware, New Jersey, and most recently, Georgia. Cook said the organization has sought out opportunities to provide services to patients in this urban demographic. Furthermore, WES has opened four clinics in Chicago and has added physical health services to its behavioral health line-up. It has also become credentialed with private health insurance carriers so that the agency can extend its services to the working population.
HCE EXCHANGE MAGAZINE
31
“We found cases where, for example, a person
“We will be able to provide one-stop health and
with alcoholism also had cirrhosis of the liver and
housing shopping for a population becoming more
needed physical health services as well as sub-
and more in need of services like this,” Cook said.
stance-abuse services,” Cook said.
He said WES’ success is largely because of the ded-
The organization is opening a new Chicago
ication of the community and the providers to come
location that will provide more services to a pre-
to these clinics. The health system invests a great
dominantly Hispanic population and will include a
deal in training its staff, especially physicians who
Health Start program and Better Birth Outcomes
choose to move up into management roles. In doing
program for mothers and children in their first
this, physicians must learn how to budget, manage
year.
staff, and contain costs in addition to continuing to
In Georgia, the state sought out behavioral
satisfy the demands on their clinical skills.
health providers to help it create a network of clin-
“I am always amazed by the dedication of the
ics for the purpose of providing care to people with
individuals who choose to take care of the people
intellectual disabilities.
most in need and least able to afford care,” Cook
“Previously, it was alleged that patients with
said. “It is an honor for me to take what skills I
intellectual disabilities were managed in a hospital
have and use them to create an environment where
with people diagnosed with depression or schizo-
the organization can thrive and the clinicians can
phrenia,” Cook said. “It was determined this was
provide their services.”
clinically inappropriate, and we are excited about establishing an office in Georgia.”
BY PATRICIA CHANEY
GROWING SERVICES AT ITS HOME BASE WES Health System has 40 clinical programs and provides multiple mobile services to reach patients where they are. The organization has always provided full services to children and adults, and it now provides physical health services to all. “Now that we are in schools, community centers, and homes, our no-show rate has gone down,” Cook said. “Getting people to come in is one of the biggest hurdles to providing care to this population.” At its original location in Philadelphia, WES is undergoing a $13-million project to provide affordable housing for seniors. The organization is renovating a 70,000 square-foot building that will contain more than 100 apartments for seniors on the upper floors and a physical health clinic, a behavioral health clinic, and a home health agency on the first floor.
Real Issues : Real Solutions
09 | COASTAL FAMILY HEALTH CENTER
COASTAL FAMILY HEALTH CENTER
Undergoes Complete Restructuring of Leadership When HCE last covered Coastal Family Health Center in 2011, we talked with Ms. Angel Greer, MPH, chief executive officer, about the various goals the organization had set with respect to providing care, upgrading technology, and recruiting physicians as an FQHC under healthcare reform. Since that conversation, the 35-year-old, 230-employee Coastal Family Health Center has pursued a courageous initiative, completely transforming its network that spans 14 different locations, not including administrative sites, in three Gulf Coast counties in Mississippi.
Ms. Angel S. Greer, MPH, Chief Executive Officer
REORGANIZING THE ADMINISTRATIVE INFRASTRUCTURE Greer has been with Coastal Family for 14 years
director also had difficulty unifying the providers, since he was unable to provide on-site one-on-one contact because of his practice schedule. At the administrative level existed a centralized
and has served as CEO for the last three. She said
decision point where many departmental directors
the fundamental challenge facing the organization
were looking to the CEO to make decisions typi-
was communication.
cally made at the clinic level, Greer said. “Because
“I would consider us a small organization, but
of the siloed departments, there was no clear-cut
because we’re so spread out, we have difficulties
go-to person to try to figure out what was the best
with communication and making sure everyone is
resolution and not have an affinity for their particu-
on the same page,” she said. “Trying to get ev-
lar department.”
eryone together in one place at one time is often difficult.” As Coastal Family was originally structured,
Realizing the dire implications of this arrangement in light of national reform, Greer and her executive team took several ambitious steps to
each department was run by a director who served
restructure and reorganize Coastal Family Health
as the chain of command for everyone under them.
Center beginning in the second quarter of 2013.
Oftentimes, this meant clerical directors would
For one, the team did away with all supervisors.
make decisions that contradicted what the nurs-
Instead of laying these professionals off, however,
ing supervisors were doing. And both departments
they reassessed each person’s strengths and
usually clashed with the medical director and the
weaknesses to determine where they could better
providers. As a practicing physician, the medical
contribute to the organization and its patient-care
HCE EXCHANGE MAGAZINE
33
The coverage you need. The guidance you trust.SM outcomes. Greer said they developed roles and
Insurance and Risk Management Solutions
responsibilities for the former supervisors based upon their unique talents and interests. Second, Coastal Family brought in masters-
for the
level practice managers to replace the position of
Heathcare Industry
cation, all ancillary support staff, from lab to nurs-
supervisor. With one practice manager at each loing to clerical to dental assistants, are now managed and supervised on-site. The practice manager
Preston Francis
gives direction, coordinating and collaborating with
Certified PPACA Professional C ifi d PPACA P f i l Employee Benefits Preston.Francis@regions.com
the providers to meet their needs. Finally, Coastal Family took a look at its administrative infrastructure. For the first time, Greer
2014 Regions. Regions Insurance, Inc., is an affiliate of Regions Bank. Insurance Products are: Not FDIC‐insured | Not a Deposit | May Go Down in Value | Not Bank Guaranteed | Not Insured by any Government Agency | Not a Condition of any Banking Activity.
hired a chief operating officer for the organization. They also created an executive team to support the office of the CEO. “On a weekly basis, this executive team is looking at productivity, looking at what’s going on inside of the organization as well as outside of the
“ON A WEEKLY BASIS, THIS EXECUTIVE TEAM IS LOOKING AT PRODUCTIVITY, LOOKING AT WHAT’S GOING ON INSIDE OF THE ORGANIZATION AS WELL AS OUTSIDE OF THE ORGANIZATION.”
organization,” she said. “The work that we’ve been able to accomplish since we started meeting in September of last year, the amount of projects that we’ve been able to either begin and complete, and in many cases, the improvement in the organizational knowledge, the improvement in the management and leadership decision-making, even at this soon of a time after this change has been made, has been so rewarding. The board has commented on just how significant the change has been in a positive way.”
SEEING IMPROVEMENTS AFTER A SHORT TIME Immediately before implementing the restructuring initiative, Coastal Family conducted an organization-wide patient-satisfaction survey, and
Real Issues : Real Solutions
the results were dire, Greer said. In January of this
change that image. With the national budget the
year, another survey was conducted, and the indica-
way it is and with reimbursement changing the
tors signaled that Coastal Family was moving in the
way it is funding, everything is changing. Health-
right direction.
care in Mississippi doesn’t seem to be getting any
“The providers are much happier,” she said. “They get their needs met quickly. They get their
better at the moment. “It’s here we change our mindset about how
issues resolved efficiently. The patient satisfaction
we’re going to put all these puzzle pieces togeth-
has turned around. The morale has improved. Com-
er—improved outcomes, integrated care, patient
munication has improved.”
satisfaction.”
When asked for advice to her executive col-
Through the changes Coastal Family Health
leagues who are implementing similar initiatives,
Center has been willing to make, Greer wants to
Greer said, “Admit that you can’t do it all.”
be an example of an efficiently run, successful
“Honestly, with all of the changes that are coming with healthcare reform, with the changes
FQHC. “Without the margin, there’s no mission, and
that will be coming down the pike with reimburse-
so we must focus on being efficient and achieving
ment,” she continued, “we really have to take a
success in the way of improved lives and improved
look at what we’ve done in the past and what hasn’t
outcomes.”
worked. We’ve got to figure out how to make it work for the future if we’re going to remain viable.
BY PETE FERNBAUGH
It’s going to really take a team. Each one of us has skills, and along with those skills, we have weaknesses. Creating a knowledgeable and competent team that is open and honest, that’s how we’re going to be successful.”
TRANSFORMING THE PERCEPTION OF FQHCS Looking ahead, Greer has another goal in mind: to change the image of the federally qualified health center. “Largely, community health centers are seen as completely government-funded organizations that aren’t run efficiently or as a feasible and sustainable business model,” she said. “I would like to
“IT’S HERE WE CHANGE OUR MINDSET ABOUT HOW WE’RE GOING TO PUT ALL THESE PUZZLE PIECES TOGETHER— IMPROVED OUTCOMES, INTEGRATED CARE, PATIENT SATISFACTION.” HCE EXCHANGE MAGAZINE
35
PAMPA REGIONAL MEDICAL CENTER
Works to Restore the Confidence of Its Community When Brad S. Morse, FACHE, arrived at Pampa Regional Medical Center in Pampa, Texas, two years ago, following Prime Healthcare Services’ acquisition of the organization, he knew his job as chief executive officer was essentially to rebuild the hospital from scratch. After all, this was Prime Healthcare’s mission as one of the nation’s foremost hospital management companies: saving hospitals, saving jobs, saving lives. And Pampa Regional needed saving.
Brad S. Morse, FACHE, Chief Executive Officer
Real Issues : Real Solutions
10 | PAMPA REGIONAL MEDICAL CENTER
A surgeon must have the most effective imaging devices in place to focus on what matters most—The best possible patient outcome.
Richard Wolf Medical Instruments is proud to be a part of the exceptional patient care provided by Pampa Regional Medical Center. www.richardwolfusa.com
CONFRONTING THREE PRIMARY ISSUES Prime Healthcare’s first step after acquiring Pampa Regional was to send in its experts to do an analysis of the hospital and to evaluate what was needed to turn it around. “We really didn’t know what we did and didn’t have when we first started,” Morse said. “When they came in here, they saw immediately that the hospital needed more doctors and more qualified staff and needed new capital equipment.” Pampa Regional also needed renewed credibility with the community. Located approximately 60
1159-06.01-0814USA
“We had to communicate about the changes that were being made at the hospital and the differences between what was here before and what was here now,” he said. “This was paramount in bringing the people back and getting them to trust the hospital again.” Finally, Pampa Regional needed a capital infusion that would enable it to completely overall its equipment. “These are the three things you have to have to run a hospital: the people, the confidence of the community, and the right equipment to take care of it,” Morse said. “So we basically had to bring
miles north of Amarillo, the hospital was Pampa’s
everything together.”
sole community provider, yet people were seeking
ESTABLISHING A BRAND-NEW HOSPITAL
medical care in Amarillo. Because of this outmigration, communication with the community became Morse’s primary focus.
Finding new staff wasn’t easy, Morse said. “We needed human capital in the worst way because
HCE EXCHANGE MAGAZINE
37
we’re in a town of 20,000 people. We’re in a rural
fully, Morse said, this isn’t the case. Pampa
part of Texas, where, because of the growth in
Regional was recently named the 2014 Business
the oil industry, it’s hard to find local workers
of the Year.
because they can make more money in the oil
“In this town, it’s hard to [win that award]
fields than they can doing construction and the
because we’ve got a lot of oil companies that do
skilled crafts. We wanted to do everything we
very well,” he said.
could to use local people, but sometimes we had
Verbal feedback has also been positive.
to go outside of Pampa in order to bring those in
“I hear from the community on an ongoing ba-
to make it happen.” As Pampa Regional hired new staff, there were two primary realities it had to face. First, no matter how many new physicians
sis how proud they are and how glad they are that they can stay here for their healthcare now.” However, this doesn’t mean the community is completely won over yet. Many residents are
Pampa Regional brought in to replace depart-
still trekking to Amarillo for their care. Becoming
ing or retiring physicians, the hospital would
the first choice of the community will take time,
always be in need of more new physicians simply
Morse said.
because of the size of the community. “Any small town is going to go through that,” Morse said. Second, because of the state of the hospital
“Those patients are coming back slowly but surely, but it’s going to be something that we work at every day. Most people from a small town are always going to think the next town bigger
prior to Prime Healthcare’s acquisition, new
is better and that’s not necessarily the case. All
employees and old employees were in need of
of the physicians that we have here now are all
education that would bring them up to speed with
board-certified or board-eligible and very compe-
modern healthcare.
tent at what they do.”
Part of this education demanded that new
Additionally, Morse wants other healthcare
equipment be purchased for the hospital. With
organizations, such as outreach clinics, to feel
$15 million from Prime Healthcare, Morse was
confident that they can come to Pampa Regional
able to bring in new radiology equipment that
and use the hospital’s resources.
was all digital, expanding his team’s capabilities beyond that of most small-town hospitals. Morse also used the $15 million to purchase
“As a hospital CEO, my job is almost 100 percent relationships, so I have to maintain those relationships with the physicians here, with the
new surgical equipment and new laparoscopic
community here, and with the outlying hospitals
equipment. Furthermore, a new cath lab for his
and outlying physicians.”
cardiologists was installed, and the aesthetics
He said it’s important that CEOs abandon the
of the hospital were overhauled, bringing in new
traditional approach to administration, instead
beds and replacing the carpeting with flooring.
thinking through the eyes of the physicians.
He said Prime Healthcare’s efforts have
“What is it they need in order to be success-
upgraded Pampa Regional to a Level IV trauma
ful? Because they’re making less money, we’re
center.
making less money, but unless we have their
“We basically made a brand-new hospital out
support, we don’t have the admissions. We have
of it,” Morse said.
to find ways to make them successful.”
WINNING OVER THE COMMUNITY
BY PETE FERNBAUGH
Of course, these efforts would be in vain if the community responded with disinterest. Thank-
Real Issues : Real Solutions
12 | SEDALIA SURGERY CENTER
SEDALIA SURGERY CENTER
Sedalia Surgery Center is a Reminder of the Importance of ASCs Located in Sedalia, Mo., Sedalia Surgery Center is a fully accredited, fully equipped ambulatory surgery center that is highly valued by its local community. Once the community becomes aware of its services, that is.
Phyllis Fischer, Administrator
According to Phyllis Fischer, administrator, among the biggest challenges confronting ASCs is the unfamiliarity that not just patients have with her type of facility, but also legislators. The Ambulatory Surgery Center Association has worked hard to rectify this, she said, but there is a great deal of education left to be done.
HCE EXCHANGE MAGAZINE
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MEDIVATORS, Inc/ www.medivators.com
A WINNER IN QUALITY AND IN PATIENT SATISFACTION Fischer first joined Sedalia 10 years ago, starting as an office manager and ascending to the role of administrator five years ago. During her time as administrator, she has led the organization in achieving exceptional patient-satisfaction scores. As a result, Sedalia has seen an increase in its return rate and has been the recipient of the APEX Quality Award for Patient Satisfaction & Overall Care for five consecutive years. Sedalia’s success with patient satisfaction has to do with its commitment to quality, down to the very last detail, Fischer said.
As an ASC, CMS surveyors pay Sedalia a visit every three years. On its last visit, CMS zeroed in on a few environmental issues in the center, namely rust on the equipment wheels and oxygen tanks in the operating room. While this may not seem like a huge problem on the surface, Fischer said, the cost of replacing this equipment or calling in the vendor to remedy the rust issues was prohibitive. “As a preventative measure, we began to investigate ways we could take care of the rust without having to spend a lot of money purchasing new equipment,” she said. “We thought about sandblasting, so we contacted a local person here who did that type of work.” She and her team then repainted and retouched the equipment and oxygen tanks to give them a fresh look. When the surveyors returned, they were impressed by the efficiency and economy of Sedalia’s solution and by the team’s willingness to tackle this issue on their own. Fischer listed two benefits resulting from the effort: repairing the breach in quality and potential for infection that could have proliferated from the rust and the significant improvement in appearance for the organization. Looking ahead to the future, Fischer said Sedalia is planning to expand upon the number of procedures it is already offering as a multispecialty facility. For example, the organization is looking to add vein procedures and widen its orthoscopic service line.
Real Issues : Real Solutions
FIGURING OUT STORAGE AND INSURANCE ISSUES At this juncture, Sedalia is confronting two primary challenges: limited storage and the insurance exchange. Since there is no incentive or initiative for ASCs to go electronic, Sedalia does not have an EHR. “Being a small facility, it’s just an expense the board did not want to undertake at this time, and since they were all struggling with it in their own practices, they didn’t want to go down that road until we have to,” Fischer said. Nevertheless, buildings weren’t constructed with storage in mind, she added. “We are trying to reduce storage issues, so we do scan. We started with our most current files and have now transitioned to where they’re able to shred, so that’s
will then immediately transition to discussing re-
helping with our storage problems.”
ducing rates of reimbursements to hospitals rather
Currently, the board is also debating whether to go in-network with a major insurance carrier. Previously, a facility could benefit from being
than increasing rates of reimbursements to ASCs. She wishes a happy medium could be found. “We are 56 percent Medicare, and so the
out-of-network. But now, patients are choosing
procedures that we do play a large part in how we
high-deductible plans to keep the premiums at a
do financially since certain procedures just don’t
lower cost, and it makes it harder for patients to go
reimburse as well. The association has done a re-
out-of-network and for facilities to negotiate with
ally great job of speaking with the legislators and
the patient so that they are not penalized for choos-
informing them. And I think it’s just a matter of con-
ing your facility, Fischer explained.
tinuing to provide that education. We as ASCs have
“So, we lose those cases. An issue with going in-network with a carrier is that you actually get
to make our voice heard as well.” In the meantime, she hopes that Sedalia can
reimbursed substantially less than you do when you
play a role in informing the public at large about the
are out-of-network.”
benefits of an ASC.
Therefore, the question for Sedalia and its board,
“I just don’t think people in general realize what
comprised largely of physicians who own the cen-
an ASC is all about until you actually visit one. We
ter, has become, Which is more beneficial? Being
have an awesome staff that is very personal. Pa-
in-network or staying out-of-network?
tients are not treated like another number. They’re treated like individuals. Until they’re here, however,
A LITTLE-KNOWN BENEFIT WITHIN THE COMMUNITY ASCs provide their communities with convenience
it’s just not common knowledge.” BY PETE FERNBAUGH
and quality. Fischer said most legislators will acknowledge the cost savings created by ASCs, but
HCE EXCHANGE MAGAZINE
41
JUL/AUG
2014
HCE Exchange Magazine EDITORIAL Editor: In-Focus Pete Fernbaugh Contributing Writers Teresa Pecoraro Jacqueline Rupp David Winterstein Meghan White Patricia Chaney Kathy Knaub-Hardy Editorial Associates Levent Nebi Deepa Bhatia Lori Ryan Anami Mittal ART DEPARTMENT Art Director Kiki Ikura Associate Art Director Devdutt PRODUCTION DEPARTMENT Production Director Russell Ford Production Associate Ivan Bogdanovich SALES DEPARTMENT Sales Associates Rahul Bhende
HCE EXCHANGE
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Real Issues : Real Solutions
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