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Real Issues : Real Solutions

St. Thomas Elgin Expansion Project Supports Vision of Excellent Patient Care

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com

SEP/OCT 2014

Real Issues : Real Solutions

CONTENTS

06 St. Thomas Elgin

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IN-FOCUS STORIES 10 St. Joseph Mercy Oakland 16 Inova Fairfax Medical Campus 20 The West Clinic 24 Pampa Regional Medical Center 28 Methodist Le Bonheur Healthcare 31 Palm Beach Orthopaedic Institute 34 Virginia Gay Hospital 37 Outpatient Imaging Affiliates 40 Flint Hills Community Health Center 43 Dosher Memorial Hospital

SEP/OCT

2014

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ST. THOMAS ELGIN Focused on Integrating Care through Technology Transforming emergency-department care delivery and lowering wait times are major initiatives in many hospitals not just in the United States, but also in Canada. One hospital in Ontario has been taking major steps in improving emergency-department care by embarking on a three-year transforming care and expansion program.

CREATING A CULTURE SHIFT In 2011, St. Thomas Elgin General Hospital (STEGH), a 166-bed community hospital that serves the city of St. Thomas and eight municipalities within Elgin County, began a journey to develop a lean culture based on the Toyota Production System. Central to this culture is seeing the patient journey and experience of care through their eyes. This involves respecting the frontline staff and their knowledge and accountability, while providing them with the tools, leadership support, and decision-

making authority to solve problems and make improvements. Through these changes and its focus on the patient experience, STEGH has drastically reduced wait times and sustained them at levels that are now the lowest in the province of Ontario. One outcome from this initiative is increased volumes in the emergency department. STEGH is also planning to build a three-story addition to the hospital. It is the largest investment project the hospital has undertaken in its 60-year history.

Real Issues : Real Solutions

Caring for communities At Cerner, we know that health happens inside and outside of care facilities. That’s why we work with hospitals and related organizations to connect communities through all aspects of health and care. By integrating electronic health records (EHR) to provide one record, one patient, one plan of care, Cerner is changing how people use and share information, and how they think about health. Visit us at cerner.ca to see how, together, we can make health care all that it should be. © 2014 Cerner Corpo-

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EXPANDING TO CONTINUE THE TRANSFORMATION OF CARE The expansion project will add more than 100,000 square feet and will provide a new home for the emergency department, surgical suite, sterile processing department, and a 15-bed inpatient acute mental health unit, as well as ambulatory mental health services. The new building design, which goes out to tender in early 2015, will enhance privacy, comfort, and wayfinding for patients and workflow for staff and physicians.

Cerner’s health information technologies connect people, information, and systems, at approximately 14,000 facilities worldwide. Recognized for innovation, Cerner solutions assist clinicians in making care decisions and enable organizations to manage the health of populations. Cerner’s mission is to contribute to the systemic improvement of health care delivery and the health of communities. Taking what we’ve learned over more than three decades, Cerner is building on the knowledge that is in the system to support evidence-based clinical decisions, prevent medical errors and empower patients in their care.

“Our STEGH vision is to deliver an excellent patient care experience every time, which is what has driven the design,” said Paul Collins, president and chief executive officer. “We have been working to transform our care and our thinking about design through their eyes. This new facility will match the level of quality and compassion our staff are passionate to provide.”

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Your vision. Our expertise.

The design work is now complete, and the emergency-room design makes extensive changes to support the experience and improvement culture

Trained experts with tailored solutions

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Product and installation expertise

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“Our employee and physician teams have thinking about what patients value in their care experience and how their work processes will deliver that care,” Collins said. “The intent of the emergency-department design is to be person-centered, creating a connection with patients. We want to reduce patient and family anxiety, while providing personalized and rapid assessment and care.” To help reduce anxiety, the ambulance and

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two trauma rooms. A unique use of natural light throughout the addition is expected to aid in recovery and reducing patient anxiety. “We launched a Patient Experience Advisory Council this past year and patient advisors from this Council have been partnering with us to help in this design process, and their contributions have been

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invaluable,” Collins said. The Sterile Processing Department (SPD) is designed to enhance efficiency and streamline workflow for the 9,000 cases it manages annually. Two dedicated elevators will connect the SPD with the new surgical suite, allowing surgical equipment to flow directly between departments. The new facility features lean process redesign to streamline workflow and be more responsive to the patient experience, but one of the most challenging aspects of any design is planning for the future. “Designing any new facility is a complex process, particularly for high-tech areas like the emergency department and the operating rooms,” Collins said. “You have to think about how long this will serve the needs of the community and the health system. In healthcare, that time can be pretty short. We need to anticipate evolving tech-

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Real Issues : Real Solutions

nology and space requirements, which adds to the complexity of the design process.” The expansion project is expected to be operational in the autumn of 2017.

MOVING TO PAPERLESS Another major investment STEGH has made is its move to an electronic system for ordering tests, prescribing medication, and treatment. Its CPOE system was launched in January as part of a collaboration with eight other hospitals in the region. “Implementing an electronic system is a challenge in the way it changes workflow,” Collins said. “Clinicians rightly want the fewest number of ‘clicks’ to get through, a minimal amount of typing, and easily recognizable screens for finding patient information and executing orders.” The hospital is addressing the growing pains of an organization making the shift to paperless, but Collins said he sees the benefit in the system once

“We must continue to attempt to plan for five and 10 years ahead. Clearly, patients and families are leading the way. If we listen, the evidence shows that our care will improve and our costs will go down. We do best to focus on a few things at a time, learn how to do them really well, as opposed to trying to do too many things poorly.” BY PATRICIA CHANEY

it is optimized and customized for effective and efficient use by the frontline provider. Between electronic health records and the expansion project, STEGH is not only furthering its patient-centered goals, but also remaining forward-looking, trying to support the organization’s strategic vision. “One of the biggest challenges facing hospitals today is identifying those changes that are critical for our organizations to embrace,” Collins said.

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ST. JOSEPH MERCY OAKLAND

Focused on Integrating Care through Technology Healthcare technology is advancing at a breathtaking pace, and while it provides an unprecedented level of data and insight, pulling all of the available information together in a way that informs total care of the patient is challenging to achieve. One hospital in Pontiac, Mich., has found great success through integrating multiple systems in order to effectively use data to provide coordinated patient care. Jack Weiner, PharmD, FACHE, President and Chief Executive Officer

Real Issues : Real Solutions

02 | ST. JOSEPH MERCY OAKLAND

INTEGRATING ACROSS PLATFORMS TO IMPROVE PATIENT EXPERIENCE In May of this year, St. Joseph Mercy Oakland opened a new 208-bed patient tower that unveiled an updated healing environment with luxury features and all-private rooms. The tower was designed and decorated with patient comfort in mind, using natural light, Feng Shui principles, and artwork from local artists.

Patient Safety: Extend Your Reach

The keystone of the facility is the Intelligent Care System. The system brings together tools from eight technology providers to foster patientcentered care and improve satisfaction. “Electronic medical records systems have not taken technology to a point where, by integrating it, we can prevent falls, project where patients will be in 12 to 24 hours and intervene early, [and] help prevent people from having codes,” said Jack Weiner, PharmD, FACHE, president and chief ex-

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ecutive officer. The Intelligent Care System is meant to address these shortcomings. One feature of the system is a device attached to the patient’s wrist that continuously and remotely monitors five vital signs. The information is sent to nurses’ iPhones, where they also receive alarms, patient calls, and other alerts. This limits how often patients need to be disturbed during their stay. Another aspect of the system is the smart bed, which communicates directly with the EMR and clinical staff to help prevent falls and improve overall safety. Through an interactive entertainment system, patients are more involved in their care. They can receive information on their scheduled procedures, medications, patient education materials, and discharge instructions through the television in their rooms.

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Powerful Insights

“WE HAVE STREAMLINED OUR REPORTING INTO A PROGRAM THAT ALLOWS STAFF TO SEE HOW THEY ARE DOING IN AS CLOSE TO REAL TIME AS WE CAN GET.” USING DATA TO DRIVE CLINICAL IMPROVEMENT In addition to making patients more comfortable, the system is designed to improve clinical outcomes from falls prevention to lowering infection rates. The hand-hygiene compliance solution uses proximity sensors to monitor staff adherence to handwashing guidelines. “Through this solution, we can guarantee handiDASHBOARDS iDashboards is a leader in the data visualization space. Known for its ease of use and dynamic dashboards, iDashboards enables private and public healthcare organizations to make faster and better informed decisions. By applying effective business intelligence, healthcare organizations gain powerful insights into their data, KPIs and metrics, including total number of patients, emergency room wait times, patient satisfaction, nursing unit metrics and financials. Utilizing iDashboards daily, St. Joseph Mercy has increased transparency by displaying LCD monitors in medical/surgical units, giving the frontline staff access to real-time information by comparing metrics side-by-side across units. Performance of key initiatives and accountability throughout the organization have both improved, driving positive results.

washing will be done at the 90 percent or better level rather than the documented 25 to 45 percent level,” Dr. Weiner said. The integration of technologies allows for more monitoring of internal performance and overall operations of the organization. “Executives have struggled with how to convert a lot of data points into useful information,” he said. “We have streamlined our reporting into a program that allows staff to see how they are doing in as close to real time as we can get.” Using a program developed in partnership with a local company, iDashboard, St. Joseph Mercy Oakland can survey bottlenecks and efficiencies, process data on cost structure and operating characteristics, and evaluate performance data. iDashboard feeds all data systems into a graphics package with predetermined analytics to allow staff to view simple readouts of speedometers, dashboards, and graphs, which enables them to see overall data related to performance expectations as well as individual data to measure performance with peers.

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“WE DISCUSS EVERY METRIC AT OUR MONTHLY MEETINGS, NOT TO LOOK AT WHO FAILED, BUT WHY THE SYSTEM BROKE DOWN AND HOW WE CAN FIX IT.”

The country’s top healthcare executives have been turning to CenTrak’s Real-Time Location System (RTLS) to help solve their most challenging business issues. CenTrak offers an openplatform allowing for seamless integration with an organization’s current healthcare applications to provide accurate, certainty-based location data. Customized reporting allows hospitals to convert this data into useful information, improving patient care and staff satisfaction. Automating once-manual processes enables hospital leadership to improve workflow, clinical outcomes, and patient safety to yield greater value and ROI.

Real Issues : Real Solutions

“I AM BLESSED BY HAVING A TEAM OF PEOPLE WHO WANT TO EXCEL, TO BE INVOLVED IN THE ACCOMPLISHMENT.” “We discuss every metric at our monthly meetings, not to look at who failed, but why the system broke down and how we can fix it,” Dr. Weiner said. “We use a philosophy of supporting people rather than degrading them. We keep people involved at the broadest level and allow our people to have a say in how we address problems.” St. Joseph Mercy Oakland has also made investments in room-sterilization tools, using pulse light in operating rooms, procedure rooms, and any room with an infection, to enhance safety and avoid the activities that extend stays or lead to readmissions.

the progress it has made with implementing these ambitious programs.

MAINTAINING A CULTURE OF ACCOUNTABILITY AND PERFORMANCE

“I am blessed by having a team of people who want to excel, to be involved in the accomplishment,” he said. “The team is more likely to ask for

St. Joes has made huge strides not only in patient

forgiveness later than my permission upfront, and

care, but also in physician and staff alignment over

that’s the culture we’ve encouraged. We can do big

the past decade. Dr. Weiner said when he first took

things with that culture.”

over the hospital 11 years ago, staff morale was low. But through a commitment to cultural excel-

BY PATRICIA CHANEY

lence, the organization has completely turned around. It now has one of the largest stroke networks in the nation and has won national awards for quality and programs. “One key to changing the culture was to establish expectations,” he said. “When leadership doesn’t expect excellence, they don’t get it. When people start hitting targets and get proud of it, they keep going. It becomes more problematic to fail than to succeed. We also acknowledge people when they win, not just leadership.” Dr. Weiner credits the devotion of the people at St. Joes for the success the hospital has seen and

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INOVA FAIRFAX MEDICAL CAMPUS

Builds Physician Alignment, Standardization for Cost-Effective Care Healthcare organizations employ various strategies to promote physician alignment and create a collaborative working environment. Often, the primary element needed is trust, not just between physicians and hospital administrators, but also between physician groups and among the clinical staff. Patrick Christiansen, PhD, Chief Executive Officer, Inova Fairfax Medical Campus, and Executive Vice President, Inova Health System

In 2007, Patrick Christiansen, PhD, joined the Inova Health System as vice president of the Inova Heart and Vascular Institute. His primary goal then was to redefine the relationship physicians had with the organization. As chief executive officer of the hospital, he is now working to â&#x20AC;&#x153;reinvent hospital-based care.â&#x20AC;?

Real Issues : Real Solutions

03 | INOVA FAIRFAX MEDICAL CAMPUS

DEWBERRY Our architecture and engineering experts partner with healthcare clients to create efficient, flexible, and healing environments. Working with INOVA for more than 30 years, we understand the constant evolution and advancement in medical technology and we develop program requirements to meet future adaptability. Dewberry’s full-service capabilities deliver cutting-edge member and patient services for clients throughout the United States.

BUILDING PHYSICIAN ALIGNMENT THROUGH TRUST Inova Fairfax Medical Campus is the flagship facility of a regional healthcare system located in Northern Virginia that serves the Washington, D.C., metro region and surrounding areas. Inova Health System features multiple hospitals, primary and specialty care centers, a children’s hospital, and other care sites, as well as the 204-bed heart hospital. Seven years ago, heart and vascular physicians did not have a trusting relationship with the hospital administration and little trust across subspecialties. Dr. Christiansen wanted to create an integrated physician leadership model that aligned physicians with the organization’s vision. “The methodology of leadership at that time in 2007 was that decisions were made often without fully consulting the community-based physician groups,” he said. “Although they were often good decisions, they had a perceived negative impact on

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dardizing service-line methodologies was key to creating a high-functioning, high-quality, costeffective cardiac service line. Standardization based on the organization’s value proposition of quality, safety, and patient experience helps keep Inova Fairfax as cost effective as possible. The organization is currently performing a critical analysis to reduce waste and manage resources, as well as applying standardization to workflows in order to reduce clinical variation. In addition, purchase strategies for supplies and technology are being developed that will support cost targets. With nursing, Inova Fairfax has developed a model to “flatten” the organization and support its nurses who are working at the top of their license. For example, Dr. Christiansen said, in the nursing units, each nurse should only have one or two people between her or him and the chief nursing executive to ensure accurate, timely communication among all care-team members. In surgery, physicians complained about having a different procedural team every time they entered physician groups, which created a lack of trust.

an operating room. With team-based trainings in

Once we got the physicians into a room and focused

ORs and procedural areas, physicians will now see

on the patient rather than our collective individual

the same people, which increases trust among

needs, we were able to move forward with care

physicians and staff.

paths and decisions that supported patient care.” System’s five hospitals, but are anchored by the

ADAPTING TO CHANGING PATIENT CARE NEEDS

institute located on the Inova Fairfax Medical Cam-

With its focus on quality, safety, and patient experi-

pus. Through the collaborative spirit created under

ence, Inova Fairfax is looking to redefine hospital-

Dr. Christiansen’s leadership, the physicians began

based care by understanding what patients want

working together to build the service line across all

from their care experience.

Cardiac services are offered within Inova Health

“We need to be the best or in the top quartile,

subspecialties and locations.

STANDARDIZING CARE ACROSS THE ORGANIZATION

in some cases the top decile, in quality metrics that are important to the public,” Dr. Christiansen said. “But we also have to provide this quality at the

As CEO, Dr. Christiansen has applied the same

lowest cost. Consumers are researching health-

lessons he and his team learned from heart and

care as they do any other major purchase. We want

vascular services to service lines across the entire

the healthcare consumer to choose Inova as their

medical campus. In addition to alignment, stan-

provider of choice.”

Real Issues : Real Solutions

The hospital is in the midst of a physical plant redesign and $1.2 million campus overhaul with a new women’s and children’s hospital and an adult medical/surgical hospital with all-private rooms. Despite declining inpatient utilization, Dr. Christiansen said the investment is necessary because consumers

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are much more involved in their care and have high expectations for their care environment. Inova Fairfax is also growing its “premium services,” including oncology, heart and vascular, and neuroscience, with centers of excellence in

contributions of physicians and the added stressors they have that weren’t present 10 years ago. “As organizational leaders, we don’t admit

each service line. These services promote the latest

patients,” he said. “We have to create an environ-

in clinical and translational research, such as using

ment that meets the community and patient needs

the most recent genomic and molecular research

in a way that facilitates the success of our physician

to develop personalized approaches to cancer

colleagues along with the Institute for Healthcare

treatment.

Improvement Triple Aim.”

“We offer high-end physicians, providing superior care, grounded in research to develop person-

BY PATRICIA CHANEY

alized approaches,” he said. Along with expanding hospital services, Dr. Christiansen said hospital-based care can no longer be defined only as time of admission to discharge, but should be broadened to prior to admission through 90 days post-discharge. Inova Fairfax has developed corporate health services and a community-based coordinated-care division to promote population health. “Our care-management division works with inpatient providers to identify upon admission those patients who will need comprehensive services to keep them healthy in and out of the hospital,” he said. “We place people with chronic conditions under our transitional care model and offer outpatient services, in-home visits, telemonitoring, everything we can to keep them healthy and improve outcomes.” Inova Fairfax continues to grow and change to meet the needs of its community and thrive in a competitive environment, working together with physicians and developing strategic partnerships. To grow services and maintain alignment, Dr. Christiansen stresses the need to recognize the

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THE WEST CLINIC

Forms Three-Way Partnership to Transform Cancer Care Located in Memphis, Tenn., The West Clinic is a physician-owned, single-specialty oncology group that has forged a reputation as one of the United States’ foremost community oncology practices. Founded 30 years ago by local physician Dr. William H. West, The West Clinic was grown and established by two Memorial Sloan Kettering Cancer Care oncologists: Dr. Lee S. Schwartzberg and Dr. Kurt W. Tauer.

Erich Mounce, President and Chief Executive Officer

“Because the two of them have such strengths, Lee in the scientific clinical-trial background and Kurt with his ability to really make patients feel like they were being cared for in all aspects of oncology, the model was just a huge success and has grown phenomenally over the last 25 years,” Erich Mounce, president and chief executive officer, said.

Real Issues : Real Solutions

04 | THE WEST CLINIC

Exelixis, Inc.

The West Clinic currently employs or manages through contractual relationships 42 physicians

Exelixis is a biopharmaceutical company committed to developing and commercializing small molecule therapies with the potential to improve care and outcomes for patients with cancer. We congratulate our friends and colleagues at the West Clinic on the organization’s more than 25-year commitment to cancer research, and its important role in bringing multiple innovative new therapies through clinical research and into the standards of care.

within the group from multiple cancer specialties, including radiation oncology, surgical oncology, internal medicine, radiology, and palliative care and pain. The organization maintains 40 open clinical trials at any given time, allowing patients in Memphis to participate in drug therapies that aren’t available in most community oncologists’ offices, Mounce said. Over the last three years, The West Clinic has hosted more than 900,000 patient encounters and averaged 10,000 to 11,000 new patients each year at its eight sites, along with approximately 2,800 analytic cancer cases. “It’s grown to be a very large multi-site operation, but it’s been able to maintain its focus on research and on providing family care,” Mounce said.

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Clinic access to all of the resources it would need 25 years into the future, yet the partnership could not be construed as physician ownership. After exploring several different possibilities,

Your mission is quality care.

The West Clinic settled on a partnership with the University of Tennessee Health Science Center and one of Memphis’ largest healthcare systems,

Our mission is helping you achieve it.

Methodist Le Bonheur. Together, Mounce said, these patient-centric organizations would determine the paradigm of cancer care in Memphis going forward. They began with the formation of an Execu-

McKesson is proud to support The West Clinic

tive Cancer Council, the mission of which was to

Working together to support the entire pharmacy business, so that you can focus on what matters most – achieving better patient outcomes.

NCI-designated comprehensive cancer center over

www.betterbusinesshealth.com

confronts patients even to this day: having to go

develop a defractionated approach to provider delivery, with the ultimate goal being to build an the next 10 years. As Mounce said, a comprehensive cancer center would solve the dilemma that to multiple locations for different aspects of their

treatment. “It just seems to me that defractionizing healthcare and putting as much of those services in one place or on one campus makes all the sense in the world,” Mounce said. “It decreases overhead, you

A FUTURE OF SUSTAINABILITY AND COMMUNITY When Mounce was hired in 2010, the major ques-

don’t have multiple check-in and checkout access points, and you are allowed to float staff. Plus, the patients love it.” He added that Methodist Le Bonheur has

tion confronting the organization was the future and

agreed to direct essentially all cancer-related

how to maintain The West Clinic’s success for the

margin generated from oncology services 100

next 25 years, while continuing to create a legacy

percent back into cancer care for the underserved

within the community.

community.

A variety of strategic reviews revealed a conun-

In addition, because of its new relationship with

drum. The best direction for the Clinic was to form

Methodist Le Bonheur, The West Clinic negotiated

an all-in-one model that would include the con-

with its payers in advance to ensure they accepted

struction of its own cancer hospital. However, Ten-

its rate structure under a hospital-based model.

nessee state law and the Affordable Care Act had

This provided for essentially no increase in costs

both ruled that physicians could not own hospitals.

to the payers and more important, the Clinic’s

From these regulatory impediments grew the idea of a three-way partnership with two other organizations. This partnership would give The West

patients. Mounce expects the initial steps in the Council’s plan to be implemented within the next two years.

Real Issues : Real Solutions

CONFRONTING DISPARITIES OF CARE In Memphis, an African-American woman has a greater than 40 percent chance of dying from breast cancer than a Caucasian woman. Beyond the defractionization of care, the three-way partnership also hopes to confront such disparities of care in its region. This will require attempting to face some of the city’s social-economic issues head-on. A majority of the poor population in Memphis are African-Americans who are working for hourly wage jobs with limited transportation, which prevents them from accessing the available care. “Even though many of our patients realize something may be wrong, they typically do not present for care until they’re in a much later stage of cancer,” Mounce said. “And that, of course, creates the disparity in the mortality.” Working with Sandra Bailey, vice president of senior services at Methodist Le Bonheur, The West

CHN is also focused on educating the community and has begun sending West Clinic-trained liaisons into Memphis neighborhoods to instruct patients on the proper treatment of breast cancer. Furthermore, it has enlisted navigators to assist patients in being transported between care points. “The reason why this partnership has been so successful is because it got buy-off from the senior-most organizational aspects of each entity from the boardroom down,” Mounce said. “The wonderful thing about our program is that the program is not only working from [a] performance perspective, but it is the right thing to do for the Memphis community. Our goal is to dramatically change the way cancer care is delivered in Memphis and the Mid-South community. As a believer in disruptive innovation, we have just got to disrupt the process of how we’ve delivered healthcare to effect this change.” BY PETE FERNBAUGH

Clinic is an integral force within the Congregational Health Network (CHN), a network of churches in which members of the congregation take it upon themselves to pinpoint patients who need assistance in managing care. (Editor’s Note: An article featuring Methodist Le Bonheur and Sandra Bailey is included in this issue.)

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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.

Brad S. Morse, FACHE, Chief Executive Officer

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.

05 | PAMPA REGIONAL MEDICAL CENTER

Because of this outmigration, communication with the community became Morse’s primary focus. “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 everything together.”

ESTABLISHING A BRAND-NEW HOSPITAL Finding new staff wasn’t easy, Morse said. “We needed human capital in the worst way because we’re in a town of 20,000 people. We’re in a rural part of Texas, where, because of the growth in the oil industry, it’s hard to find local workers because they can make more money in the oil fields than they can doing construction and the skilled crafts.

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

We wanted to do everything we could to use local people, but sometimes we had to go outside of Pampa in order to bring those in 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 Pampa Regional brought in to replace departing or

have when we first started,” Morse said. “When

retiring physicians, the hospital would always be in

they came in here, they saw immediately that the

need of more new physicians simply because of the

hospital needed more doctors and more qualified

size of the community.

staff and needed new capital equipment.” Pampa Regional also needed renewed credibility with the community. Located approximately 60

“Any small town is going to go through that,” Morse said. Second, because of the state of the hospital

miles north of Amarillo, the hospital was Pampa’s

prior to Prime Healthcare’s acquisition, new em-

sole community provider, yet people were seeking

ployees and old employees were in need of educa-

medical care in Amarillo.

HCE EXCHANGE MAGAZINE

tion that would bring them up to speed with modern healthcare. Part of this education demanded that new equipment be purchased for the hospital. With $15 million from Prime Healthcare, Morse was able to bring in new radiology equipment that was all digital, expanding his team’s capabilities beyond that of most small-town hospitals. Morse also used the $15 million to purchase new surgical equipment and new laparoscopic equipment. Furthermore, a new cath lab for his cardiologists was installed, and the aesthetics of the hospital were overhauled, bringing in new beds and replacing the carpeting with flooring. He said Prime Healthcare’s efforts have upgraded Pampa Regional to a Level IV trauma center. “We basically made a brand-new hospital out of it,” Morse said.

WINNING OVER THE COMMUNITY Of course, these efforts would be in vain if the community responded with disinterest. Thankfully, Morse said, this isn’t the case. Pampa Regional was recently named the 2014 Business of the Year. “In this town, it’s hard to [win that award] because we’ve got a lot of oil companies that do very well,” he said. Verbal feedback has also been positive. “I hear from the community on an ongoing basis 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 still trekking to Amarillo for their care. Becoming the first choice of the community will take time, Morse said.

Real Issues : Real Solutions

“AS A HOSPITAL CEO, MY JOB IS ALMOST 100 PERCENT RELATIONSHIPS, SO I HAVE TO MAINTAIN THOSE RELATIONSHIPS WITH THE PHYSICIANS HERE, WITH THE COMMUNITY HERE, AND WITH THE OUTLYING HOSPITALS AND OUTLYING PHYSICIANS.” “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 is better and that’s not necessarily the case. All of the physicians that we have here now are all board-certified or boardeligible and very competent at what they do.” Additionally, Morse wants other healthcare organizations, such as outreach clinics, to feel confident that they can come to Pampa Regional and use the hospital’s resources. “As a hospital CEO, my job is almost 100 percent relationships, so I have to maintain those relationships with the physicians here, with the community here, and with the outlying hospitals and outlying physicians.” He said it’s important that CEOs abandon the traditional approach to administration, instead thinking through the eyes of the physicians. “What is it they need in order to be successful? Because they’re making less money, we’re making less money, but unless we have their support, we don’t have the admissions. We have to find ways to make them successful.” BY PETE FERNBAUGH

HCE EXCHANGE MAGAZINE

METHODIST LE BONHEUR HEALTHCARE

Embraces Spiritual Health along with Physical Health As the healthcare landscape changes, hospitals are focusing more on population management and initiatives to keep patients out of overly crowded emergency rooms. One healthcare system in Memphis, Tenn., is addressing the health disparities of one of its lowest-income sectors by building relationships in that community at the individual level. Sandra Bailey, Vice President of Senior Services

Real Issues : Real Solutions

06 | METHODIST LE BONHEUR HEALTHCARE

GROWTH OF OUTREACH

an outreach initiative to this zip code. She and her

Methodist Le Bonheur Healthcare is an eight-hos-

team established Wellness Wednesdays, a monthly

pital system with a strong faith-based foundation

screening and educational program held at a local

that influences all aspects of care. The system has

community center.

a Center of Excellence in Faith and Health, which

“For Wellness Wednesdays, we have volunteers,

includes the Congregational Health Network (CHN),

vendors such as insurers, and community provid-

a covenant between Methodist hospitals, commu-

ers come out to provide information,” Bailey said.

nity organizations, and nearly 500 congregations to

“One of our system hospitals sponsors the event

help patients navigate between healthcare facilities

each month with a specific educational theme such

and home.

as oral health, diabetes, or nutrition. We offer blood

About two years ago, the CHN began a hotspot-

pressure, cholesterol, and glucose screenings, as

ting process to identify geographic areas most in

well as body mass index. This monthly screening is

need within its market. It alighted upon the 38109

a major part of many patients’ health-maintenance

zip code, which had a disproportionate number of

program.”

cancer diagnoses and few healthcare offerings. Sandra Bailey, vice president of senior services,

With education being a large part of Wellness Wednesdays, the sponsoring organizations will

oversees transitions of care for the system and

bring in subject-matter experts and nurses to share

the extended-care hospital and began heading up

information on that month’s topic. Visitors, many

HCE EXCHANGE MAGAZINE

of whom are uninsured or underinsured, can learn about the Affordable Care Act and coverage options. The events also serve as a clearinghouse to uncover patient needs, aid them in attaining access to resources, and connect them with a primarycare provider. Bailey said about 100 patients come every month with many repeat visitors. The program started with a grant from Cigna and partnered with eight congregations within the zip code. Methodist gave about $1,000 to pastors of the partnered churches so the churches can offer to pay for patients’ medications or assist them with transportation to physician visits. The program partners with numerous denominations, including Jewish, Muslim, Christian, and Hindu faiths. Bailey said she is already seeing some patients who were being admitted to the hospital every 10 days now coming every 30 days and regularly receiving primary care.

BUILDING RELATIONSHIPS BASED ON TRUST Building upon the community response to Wellness Wednesdays, Methodist has added the Familiar Faces program, which uses a community health navigator and a faith community nurse to assist patients with more support. The nurse is in the community and often conducts home visits to determine patients’ needs, makes referrals to the appropriate agencies, and even drives patients to an initial primary-care visit. Her goal is to empower patients to accept responsibility for and manage their own health. The navigator is based in the community and approaches patients in the emergency room to ascertain their needs and uncover why they have repeat visits to the emergency room. For many patients, they have stopped taking their medications because they can’t afford food and prescriptions. The health navigator will connect the patient to a food bank or other community resource to help

them meet their personal and social needs. “After only a few months, we have already begun to see decreases in emergency-room visits, a decrease in hospitalizations, and are seeing patients believe in themselves again,” Bailey said. “I had a patient call me and say he can’t remember when someone put so much personal interest in him who didn’t know him. We have the resources to help people, so why shouldn’t we?”

EXPANDING THE PROGRAM Bailey credits the success of the program to the compassion and dedication of the volunteers and frontline staff who build the relationships with the patients. They truly care about the wellbeing of the people they’re helping. She hopes to obtain philanthropic support or shared-savings investments through insurance companies to make the program sustainable. “The better the data, the more interest we will have, and I hope other healthcare organizations would adopt something similar,” she said. “I think this type of outreach is the future of healthcare. When you can help individuals help themselves, you’re really promoting health and wellness. Healing is not just about getting people the right medicine at the right time. It’s helping them emotionally, spiritually, and mentally to deal with the situation at hand and learn the steps to deal with it better.” BY PATRICIA CHANEY

Real Issues : Real Solutions

07 | PALM BEACH ORTHOPAEDIC INSTITUTE

PALM BEACH ORTHOPAEDIC INSTITUTE

Pioneers Two Groundbreaking Initiatives Brian Bizub has been chief executive officer of Palm Beach Orthopaedic Institute (PBOI) in Palm Beach Garden, Fla., for the past six years after working for Tenet Healthcare in various hospital administrative roles for 12 years. When he joined PBOI, he brought a gift for customer service and value-added innovation to the physician-practice world.

Brian Bizub, Chief Executive Officer

HCE EXCHANGE MAGAZINE

In-Office Pharmaceutical Dispensing

coordinator looks at the surgery schedule and selects the appropriate brace based on the surgeon’s protocols for individual patients.

Why In-Office Dispensing?

Rather than meeting with the patient days before

• Improve quality of care

the surgery to explain the brace, the DME coordina-

• Improve patient compliance

tor meets with the patient and the caregiver on the

• Improve patient convenience

• Improve patient outcomes for HEDIS scores and “Five Star” ratings • Create revenue stream

day of surgery as part of the pre-operative process. The coordinator educates the caregiver on how to

• Reinforce patient-physician relationship

use the brace and explains to the patient why it is

• Attract new patients

critical to their recovery. “Usually the patient post-surgery isn’t going to be the person who is going to be dealing with the DME device,” Bizub said. “It’s going to be the caregiver. And you don’t necessarily get that person pre-operatively in the office.” The brace is then handed over to the recovery unit, where the surgeon can then position it on the

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patient immediately following surgery. Bizub said it

www.qcpmeds.com 800.284.2130 ext 225

adds value if the patient wakes up with the bracing already on and mobilized. It also increases compliance, a fact that caused hospitals, initially puzzled by the presence of DMEs in the recovery unit, to embrace the protocols. Since the physicians have implemented these

IMPLEMENTING A POST-SURGICAL DME PROGRAM Early on, Bizub and one of his colleagues noticed the lack of consistency throughout PBOI in administering braces to patients following surgery. Certainly, he said, bracing was part of the process, but

protocols, PBOI has gone from having high DME return rates to virtually no returns at all. Patients have a better understanding of why the brace is important to their treatment and outcome, Bizub said. “It was difficult to engage the physicians, but they quickly figured out that most patients want to

it was more of an afterthought than the mindset. However, durable medical equipment is vitally important for post-surgical outcomes, Bizub stressed. He and his colleague began to develop standardized protocols for integrating bracing into the surgical process, first by consulting each of PBOI’s 16 physicians, logging their ICD-9 codes for surgical procedures, and finding out which ones used braces and which ones didn’t, given the different schools of thought on DMEs. Bizub then created standardized order sets from their research. To carry out these protocols, he incorporated a DME coordinator into the surgical process. Each

Real Issues : Real Solutions

stay in bed, but when you provide them with the

their medication for only $10 more than the

security of the brace, they’re more likely to get up.

practice paid for it. It’s also more accommo-

Our goal is decrease pain meds, increase motion,

dating from a compliance standpoint, he said,

and improve outcomes. And the way that you can

because if the patient is participating in a step

do that is by giving the patient a sense of security,

program, many of the meds may not be on the

because if not, they’re going to sit and watch TV

formulary. Being in the physician’s office en-

and out of boredom eat, which will have the reverse

ables the conflict to be confronted immediately

effect.”

and resolved almost as quickly.

OPENING COMMERCIAL PHARMACIES IN PHYSICIAN GROUP PRACTICE OFFICES

Finally, patient confidentiality is preserved in a way that might not be possible in a public pharmacy. The primary challenge is credentialing,

Bizub’s second initiative has only been around for

since many insurance carriers do not recog-

approximately five months. The idea behind open-

nize physician dispensaries easily. However,

ing dispensaries in physician offices was initially

for those practices willing to go through the

introduced to him at an American Association of

process, in which an office must have a certain

Orthopaedic Executives (AAOE) conference.

number of denied claims to be seen as a dispen-

Thirty to 40 percent of all patients never go to

sary, the benefits are great. An office dispensary

the pharmacy because it’s time-consuming and

increases revenue and provides a value-added

takes on average 30 to 45 minutes to have prescrip-

service to patients, Bizub said, and these pa-

tions filled. Furthermore, most patients end up

tients begin to see you as a full-service provider

spending extra money while they wait at a phar-

in touch with the entire spectrum of care.

macy. The average spend is $12 per person. “If you have the patients in the office, it’s part

“The more that I can show the customer that they’re important to us and create a relation-

of the visit,” Bizub said. “And they can go to your

ship, the better the organization will become

pharmacy and pay the exact same price as another

and the larger it will grow, because PBOI has a

and be able to take the medication home. However,

reputation in the community for helping patients

the patient will always have the choice to fill their

and providing value-added services that make

prescriptions at their pharmacy of choice. It’s safer

it convenient and easy for them. PBOI has taken

because it’s prepackaged, so there are no errors.

out the challenges that frustrate patients who

Education is better because you have a dedicated

are dealing with pain. We make the experience

pharmacy tech who is educating patients on medi-

less difficult.”

cations and the potential side effects. And because of the strict guidelines of the state and the DEA, it’s

BY PETE FERNBAUGH

important to go through the labels.” He added PBOI’s dispensary has a failsafe system that requires three scans to ensure the correct medication is being dispensed and recorded. “Again, we’re not charging anything more,” Bizub said. “We’re adjudicating the claim through their insurance carrier. No different than if they were at a major retail pharmacy, such as Walgreens.” PBOI does a $10 markup on medication, so patients who lack pharmacy coverage can purchase

HCE EXCHANGE MAGAZINE

VIRGINIA GAY HOSPITAL

Provides Behavioral Healthcare to Low-Income Communities Mike Riege, chief executive officer of Virginia Gay Hospital in Vinton, Iowa, has been with the organization for 24 years, originally being hired as chief financial officer, then being promoted to CEO in 1992. Riege has presided over impressive growth during his tenure. In 1992, Virginia Gay had an annual budget of $4 million and 50 to 60 employees. In fact, Riege said he was able to manage each capital transaction personally because of the size of business at the time.

Mike Riege, Chief Executive Officer

Now, Virginia Gay employs 300 and has an annual budget of $35 million. It has also added four hospital-based rural health clinics, a home health agency, and a retirement housing development to its nursing home and hospital. Last year, it was recognized by iVantage Health Analytics with the HealthStrong Award for its quality outcomes, safety, and patient satisfaction. In 2013, its nursing home was named one of the best in the country by U.S. News and World Report.

Real Issues : Real Solutions

08 | VIRGINIA GAY HOSPITAL

Furthermore, Virginia Gay was the first hospital in Iowa to join the National Rural ACO. Unlike many rural executives who are faced with the increased possibility of being acquired or shut down, Riege is optimistic about Virginia Gay’s sustainability into the future and is enthusiastic about the direction of healthcare in the United States, especially as value-based care takes root. “I think it’s a neat time to be in healthcare,” Riege said. “I would equivocate this to very similar to 1965 when Medicare came into existence. It was something brand new, but at the same time it was something that was exciting. I look at healthcare reform as an exciting challenge and not a burden.”

MAKING EHR USABLE FOR EVERYONE Riege said Virginia Gay is currently planning the strategy by which it will become involved with an ACO. He and his staff are also preparing for ICD-10 and Meaningful Use Stage 2, which will be implemented in the medical clinics during the first quarter of the new fiscal year.

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However, the major challenge occupying the organization right now is streamlining its EHR and making it work on an individual basis for all of its providers. “Each user has different expectations of them and we’re trying to plan out the various problems that our users have with the systems, and we’re trying to make it work for everyone and trying to teach everyone how to use the thing, trying to integrate things like voice recognition, trying to make it a more efficient means of using electronic health records,” Riege said. Right now, the EHR has lengthened the time it takes to process patient visits in Virginia Gay’s clinics, which is frustrating for the doctors and midlevel staff. “It’s all growing pains in using this new technology, but we think that after a year or two of using it, people will consider electronic transcription as being the more efficient way of doing things as opposed to the old paper-based transcription,” Riege said. Realizing the various learning curves of the staff, Riege and the Virginia Gay leadership identified super-users of the EHR who would be able to help colleagues struggling with mastering the platform to navigate rough spots and develop shortcuts that work for them. “I’ve been lucky,” he said. “I haven’t had a group of nurses or a group of providers threaten to walk out because of the medical records we use. They understand these things are expensive, and we’ve allowed both the provider staff and the nursing staff to select the system that they want to use. So, we have some buy-in from them from that perspective. And they understand they have to make it work. We don’t have an endless supply of money to just get rid of the system because it has some quirks. Plus, all the systems out there have quirks. It’s just something you work through.”

TAKING A STRATEGIC APPROACH TO JOINING AN ACO As part of its preparation for ACO, Virginia Gay has been participating in a managed-care service that reimburses the organization for quality and patient satisfaction. Riege feels this has helped his staff

take the baby steps needed before the organization fully shifts to an accountable-care organizational structure. “We know come fiscal year 2017--Oct. 1, 2016—Medicare is going to be transitioning over to accountable care organizations as a means of reimbursement,” Riege said. The Iowa Medicaid system will be transitioning to ACO as well. “We have approximately a three-year window to learn how to operate in this system,” he continued. “So, my role as a leader is to try to understand how these systems work, which organizations would be the best for us to partner with, and making the commitment to go forward and trying to convince my board and my staff members and my medical staff that this is what we’re invested in and this is what we have to make work.” With 20 percent of rural hospitals under the threat of closure as value-based purchasing is implemented, Riege believes only the ones who know how to function in the new environment will maintain their independence. “It’s really up to us to understand how this whole thing’s going to work and making the time investment, along with everything else we have to do, to do our due diligence to try to figure out this whole system and be on the leading edge of it rather than the trailing edge of it. It’s like threedimensional chess. You try to put all of these things together to make everything work with your staff, with the government, with the private insurers, and with your patients. “There’s no blueprint for any of this,” he concluded. “The best thing we can do is keep the patient at the center of all of this. If we do that, we’ll be fine. It’s up to us as leaders to make healthcare reform work.” BY PETE FERNBAUGH

Real Issues : Real Solutions

09 | OUTPATIENT IMAGING AFFILIATES

OUTPATIENT IMAGING AFFILIATES

Tailored, Data-Driven Marketing Helps Grow OiA Over the years, the profitability of imaging services has shifted back and forth between hospitals and freestanding imaging centers. Decades ago, hospitals dominated the imaging market, primarily providing inpatient services with some outpatient. Creighton Cook, Senior Director of Business Development

David A. Dierolf, Vice President of Performance Development

In the late 1990s and early 2000s, outpatient radiology services shifted toward the freestanding market with a reimbursement advantage, and hospitals began losing more outpatient volumes to these freestanding centers. During the past decade, reimbursement advantages for radiology have shifted back to hospitals. However, with more of an emphasis being placed on cost of care, that advantage will likely be coming to an end soon.

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Designed to streamline workflow and simplify production.

Professional, easy way to produce medium for exchange in a universal, non-proprietary format.

Nautilus Medical

GIVING HOSPITALS A MARKET ADVANTAGE

Nautilus Medical is proud to be working with OiA for their image distribution and management needs. With 26 of the top 50 medical centers utilizing Nautilus software to move images to specialists, referring physicians and patients, we strive to be the leader in DICOM distribution management. Nautilus offers the highest level of security and features to give piece of mind with a single user interface.

Outpatient Imaging Affiliates (OiA) partners with hospitals or radiology groups to develop freestanding facilities and has 29 locations in 11 states, most of which are joint-venture operations with a few wholly owned facilities. (Editor’s Note: HCE previously spoke with OiA in 2009 about its joint ventures.) “When OiA was formed in 2000, the goal was to help hospitals gain an entrepreneurial edge and to

typically with the same equipment and same

recapture outpatient market share lost to competi-

radiologists providing professional services. With

tive entities,” Creighton Cook, senior director of

more patients having high-deductible health plans,

business development, said. “We believe freestand-

individuals are going to seek out these cost savings,

ing, off-campus imaging centers are the best way

as will payers.

to deliver outpatient radiology services because we

“Payers are very supportive of us and will often

offer cost and service advantages. Hospitals need

steer patients to our facilities by letting patients

to realize this discrepancy and develop a strategy to

know of the lower cost,” he said.

compete in this new and changing marketplace.”

OiA offers to build and operate value-based

Cook said an MRI at a hospital costs about

freestanding imaging facilities for hospitals, many

$2200, but at an OiA facility, it only costs $450,

of which are large academic medical centers, and

Real Issues : Real Solutions

provides them with billing and collections services,

cian. Most patients go where their physicians tell

marketing services, and other business services.

them to go, although that may be slowly chang-

Cook said OiA usually retains a minority ownership

ing as patients take more responsibility for their

to avoid being viewed as a competitor, but rather as

healthcare.

a facilitator.

TURNING AROUND A STRUGGLING FACILITY

Building trust with those physicians is the only way for OiA to gain referrals. Dierolf analyzes the state of OiA’s relationship with each practice in the market, whether the phy-

Although OiA usually develops partnerships, it also

sicians regularly refer patients, have never referred

owns 12 facilities, including a new venture in Ken-

patients, or have stopped referring patients.

tucky. OiA bought a struggling facility in Elizabeth-

“I can tell our liaison that we just saw a patient

town that was averaging two CT scans and seven

for the first time from this physician,” he said. “That

MRIs per day. Within a year, OiA has upped those

way, the liaison can tailor his message by thanking

volumes to four CT scans and 16 MRIs per day, with

the physician for sending the patient, asking about

plans to add ultrasound and X-ray.

service, answering any questions, and providing

As an overall rule, OiA seeks out markets before centers. It determined the struggling facility

them with a point of contact.” Dierolf said he views these marketing efforts as

was in a growing market with a vulnerable competi-

building the relationship from a prospect to some-

tor. In this rural area of Kentucky, the only radiol-

one who has tried the center once to someone who

ogy providers were based in the hospital, which

uses the center occasionally to a loyal physician

charged high rates.

who provides regular referrals.

Marketing efforts to referring physicians com-

“We want to move physicians across the con-

prise the primary strategy to improve business,

tinuum into the loyal camp,” he said. “We find that

and in a small town, it can be tough to change the

in all centers, the majority of our business comes

ingrained habits of local providers. Cook said OiA

from a small pool of loyal physicians.”

reached out to physicians within a 30-mile radius

OiA also uses physician data to identify the

of the center and emphasized that OiA can do the

top referrers, along with those who have poten-

same scan as a hospital for less than half of the

tial and need extra attention. Dierolf said much of

price.

the turnaround success that has been seen at the

“Sometimes it is a hard sell,” Cook said. “Many

Elizabethtown center has evolved from being in the

physicians still see patients as a $20 copay, but

field and talking to the right people. He said the

the light bulbs begin to go off when we talk about

people working at Elizabethtown have exceptional

high-deductible health plans. However, sometimes,

interpersonal skills and are dedicated to the job. He

we still have to wait for the physician to need our

just provides them with good intelligence to guide

services directly before realizing what that cost dif-

their marketing activities.

ference can mean to their patients.”

DEVELOPING PERSONALIZED MARKETING TECHNIQUES

OiA is constantly refining its marketing techniques to become more efficient in identifying potential and building connections within communities. It strives to keep the feel of a local center

Marketing to and building relationships with refer-

and never goes in as a national brand. So far, this

ring physicians is key to the success of any OiA

strategy has allowed the organization to continue

facility, and Cook feels the company has a great

growing with steadily increasing volumes.

data-driven strategy that is highly effective. David Dierolf, vice president of performance

BY PATRICIA CHANEY

improvement, heads up these marketing efforts primarily by giving the salesmen on the ground the data they need to tailor messages to each physi-

HCE EXCHANGE MAGAZINE

FLINT HILLS COMMUNITY HEALTH CENTER

Achieves Impressive Outcomes with Dental Program When Phillip Davis first came to Flint Hills Community Health Center in Emporia, Kan., three years ago after spending eight years with Community Health Center of Central Missouri as chief financial officer, he walked into an organization that was suffering from a shortage of funds and staff morale. Phillip Davis, Chief Executive Officer

Flint Hills was losing money, specifically $200,000 the year before Davis’ arrival, and layoffs were becoming inevitable in spite of the organization’s best efforts to avoid them. The Center’s stability had been threatened by the 2009 recession and the loss of grant dollars from both the federal government and, as the primary provider of health-department services for Lyon County, from the state government. “It is hard when you lose a grant to let staff go that are tied to that grant,” Davis said. “What I was seeing was these grants were going away, but the staffing remained the same. And so, there were some hard decisions to look at and study.” In the summer of 2012, Flint Hills laid off six employees in order to get its costs under control. But this unprecedented move for the Center was the gateway to its recovery. Originally operating under a budget of $6 million a year, its budget has now grown to $9 million a year. The steps it took to reclaim its stability as an organization is perhaps best demonstrated by its dental program.

Real Issues : Real Solutions

10 | FLINT HILLS COMMUNITY HEALTH CENTER

Safety First. Quality Always.

CONFRONTING PERFORMANCE GAPS IN DENTAL PROGRAM In August, the DentaQuest Foundation bestowed its Safety-Net Solutions “Centers of Excellence” Award on Flint Hills Community Health Center at the annual National Oral Health Conference. Two years ago, DentaQuest needed five Kansasbased organizations to participate in an in-depth study of their dental programs that would conclude with recommendations on how to improve each program. “Dental was going well at that time, so it wasn’t that we were failing at it,” Davis said. “But anytime you can get someone to come in and look at operations and give suggestions on how to improve them, we’re open to that.” DentaQuest sent a consultant in who looked at scheduling, billing, costs, efficiencies, staffing,

We stake our reputation of being a premier health care mechanical, electrical, and service contractor with every project we undertake. Our company and our customers expect nothing less.

and performance measures, especially Flint Hills’

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no-show rate. The consultant met with the dentists individually and with the dental assistants and hygienists as a group. A team was then formed that included dental and frontline-staff representatives who were tasked with making recommendations to the Center using July 1, 2011, to Dec. 31, 2011, as their

Incidentally, the no-show rate tumbled from 20

baseline.

percent to 13 percent.

Flint Hills promptly implemented the team’s on the July 1, 2013, to Dec. 31, 2013, baseline, it

THREE KEYS TO THE DENTAL PROGRAM’S TURNAROUND

was discovered the Center had achieved a 27.29

Davis said there were three keys to Flint Hills’

percent increase in gross charges with a 32 percent

success under DentaQuest’s guidance: engaging

increase in net revenue, which was all the more

the providers, earning buy-in from the staff, and

impressive when compared to an increase of 7 per-

reducing no-shows.

recommendations, and in the final report, based

cent in expenses over that same period of time. Flint Hills also achieved a 17 percent increase

“Reducing the no-shows was one thing,” he said. “I may know my schedule as a patient for

in visits, and revenue per visit went from $111 to

the next month, but six months from now, I’m just

$125. Cost per visit dropped from $105 to $96.

guessing.”

“We were able to do that with the same number

Instead of scheduling appointments several

of providers,” Davis said. “A lot of that was schedul-

months out, Flint Hills began only scheduling one

ing correctly, using the hygienists throughout the

month out, opening a new week for scheduling

system at the level they were needed, and then

every Monday. Two days before an appointment,

reducing the no-show rate as well.”

the Center will call the patient and request con-

HCE EXCHANGE MAGAZINE

firmation by noon of that day. If the patient fails to

integrate dental and behavioral health services with

confirm, that slot is opened up to another patient.

primary care at both locations.

Davis said this required a degree of training

Unfortunately, a significant portion of federal

for the patients, who weren’t happy about the new

funding under the ACA is set to expire at the end of

policy. Delicate scripting was required to ensure

fiscal year 2015, which would be a rather large hit

that every team member communicated the same

for the organization, Davis said. The state of Kansas

message to irate patients.

has also cut its income tax, so the organization is

“I can tell you that patients were in my office talking to me about this,” Davis said. “But it had

examining how this change of revenue will affect it. “Community health centers are very important

to be the same message every time they talked

in filling the gap in coverage for those patients

to someone. And that was key, too. The patients

that have nowhere else to go,” he stressed. “We’ve

couldn’t come to me and I would say, ‘Yeah, we can

spent years providing high-quality healthcare

get you in right now.’ No, because that just under-

regardless of who the patient is, and we’re striving

mines everything, so the consistent message that

to continue doing that, whether it’s a state repre-

was there improved it. The next time they called in

sentative who comes in or an unemployed family of

and confirmed their appointments.”

five. They’re going to receive the same high-quality

HOPING TO AVOID A FISCAL CLIFF

healthcare.” BY PETE FERNBAUGH

Generally, Flint Hills has a healthy payer mix, Davis said, with 9 percent on Medicare, 33 percent on Medicaid, 28 percent private insurance, and 30 percent self-pay. Having opened a new access site in Eureka, the Center is currently working to

Real Issues : Real Solutions

11 | DOSHER MEMORIAL HOSPITAL

DOSHER MEMORIAL HOSPITAL

Wants to be the Friendliest Hospital in N.C. As many hospitals across the country redefine their mission statements to reflect the importance they are placing on quality-driven care, one critical-access hospital has united its physicians and employees around the simple mission of being the friendliest, most patient-centered hospital in North Carolina. Tom Siemers, FACHE, President and CEO

HCE EXCHANGE MAGAZINE

to a popular vacation island, Dosher sees tourists Murchison, Taylor & Gibson, PLLC www.murchisontaylor.com

as well as residents, and urgent care is another way in which the hospital can meet the needs of its patient population, both permanent and transient. In November, the hospital will open a new

CREATING A SENSE OF COMMUNITY Dosher Memorial Hospital, located in the coastal

Wound Center that will include two hyperbaric medicine chambers with full-time coverage by physicians trained in wound management. But the foundation for growth always begins

town of Southport, has strong quality scores on all

with the medical staff, Siemers said. Even before

core measures. About two years ago, its leadership

the hospital embarked upon the critical step of re-

felt the hospital should focus on creating a stron-

cruiting new physicians, he recognized the need to

ger sense of community between its patients and

unite the medical staff and to establish programs to

caregivers.

build relationships between the hospital and provid-

In late 2012, Tom Siemers, FACHE, became president and chief executive officer of Dosher and

ers as well as among the providers themselves. Siemers started a working group of specialists

immediately turned his attention to redefining the

and primary-care physicians who met regularly to

organization’s culture, starting with its mission

talk about what they have in common. He said one

statement and leadership.

specialist remarked to him that it was the first time

“Like many organizations, Dosher had a compli-

in two years he had engaged in conversation with

cated mission statement full of bullet points no one

the primary-care physician who had been referring

could remember,” Siemers said. “We simplified it

patients to him.

to one sentence everybody can remember, and the staff has embraced it.” To achieve its goal of being the friendliest, most

The working group also assisted in the establishment of a platform for employing primary-care physicians. Dosher now employs five primary-care

patient-centered hospital in North Carolina, the

doctors and two mid-level providers, with plans to

10-5 rule was implemented immediately: Smile at

add five more physicians and four nurse practitio-

someone within 10 feet and speak within five feet to

ners or physician assistants this coming year.

make sure everyone is greeted when they walk the halls.

PREPARING FOR GROWTH As reimbursement continues to contract, Dosher

Furthermore, Siemers set up medical staff meetings in a community center a couple of times a year, where physicians could socialize and break down silos to talk effectively about challenges.

ety of projects, the most extensive of which is

ENGAGING STAFF IN COST CONTAINMENT

an $11.5-million renovation and expansion of its

With high quality scores, a focus on patient-cen-

patient-care unit to provide a more modern setting

tered care, and physician alignment in place, man-

for inpatients. The new unit will offer 25 private in-

aging costs is Dosher’s most recent priority. The

patient rooms with enhanced technology, security,

growing number of retirees moving into Brunswick

and comfort for patients and families. The project

County also means a steadily increasing percent-

includes a 12,000 square-foot renovation and 6,000

age of Medicare patients and the need to operate as

square feet of additional space.

lean as possible.

has positioned itself for growth through a vari-

The hospital has also opened an urgent care

Rather than implementing vast, sweeping

center, which operates with extended hours and on

changes from the leadership, Dosher sought to en-

weekends. Being a coastal town and the ferry point

gage all hospital employees in its financial efforts.

Real Issues : Real Solutions

were good, but didn’t necessarily translate into a reduction in operating costs.” Siemers said the employees found $3,000 in savings by changing coffee creamers and saved $20,000 by eliminating the delivery of bottled water to most areas. In all, the employee’s ideas generated more than $615,000 in savings.

MAKING TOUGH DECISIONS FOR THE FUTURE Despite the success of the cost-containment initiative, it became increasingly obvious that Dosher’s cost structure was not sustainable. According to a North Carolina Hospital Association study of the state’s 20 critical-access hospitals, Dosher had 47 more FTEs than the median of all other hospitals. After extensive analysis and consideration, in late August the hospital’s trustees made the difficult decision to offer early retirement to qualified Employee engagement has been part of the cultural

hospital employees, cut back on the number of

change at Dosher, which adheres to the Studer

part-time and contract staff, and reduce the hours

model, along with evidence-based medicine and

of several other employees.

what Siemers calls “evidence-based leadership.” During quarterly employee forums, the Dosher

Staff reductions are tough for employees and the community, Siemers said, but making the diffi-

leadership shares the hospital’s financials and

cult decisions now will allow the hospital to pursue

quality scores and discusses challenges within the

its long-term plans for growth and continued ser-

organization.

vice to the communities it serves.

This communication led to the development of

“In today’s world, you have to be able to com-

the Three Teams, One Goal project, the mission of

pete financially and in quality,” he said. “You have to

which was to find ways to save $600,000 in operat-

team build and bring in the right people to advance

ing costs in one year. All of the ideas were sug-

the organization. There’s no simple way to success.

gested by the employees, Siemers said.

The simple answers are gone from all of us.”

To create the teams, the hospital’s three senior leaders chose two directors for each team and tried

BY PATRICIA CHANEY

to combine administrators with clinical directors. Then the leaders assigned department heads and staff members to the teams. Teams would meet as a group and work through ideas for saving money. “It was eye opening to find out what people knew and didn’t know,” Siemers said. “We started talking about the differences between balance sheets and income statements and how some ideas

HCE EXCHANGE MAGAZINE

SEP/OCT

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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