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Real Issues : Real Solutions

DEC/JAN 2013

PRA International Educating and integrating patients

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com

Real Issues : Real Solutions

CONTENTS

04 PRA International

IN-FOCUS STORIES 08 St. Luke’s University Health Network 12 Shionogi, Inc 16 Connecticut Children’s Medical Center 20 MaineHealth (Maine Medical Center) 24 Community Medical Center, Inc. 28 Antelope Valley Hospital 31 Litzenberg Memorial County Hospital 34 Regional Mental Health Center 37 Tri-Cities Community Health

Kent Thoelke, Executive Vice President of Scientific and Medical Affairs

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40 Menifee Valley Medical Center 43 Okeene Municipal Hospital

DEC/JAN

2013

Biomedical Systems

PRA International

Clinical trial accrual in the United States runs around 3 percent and often takes a “keep your fingers crossed” approach. Up to the point of beginning clinical trials, drug development follows detailed research and design processes steeped in scientific methodology.

Congratulations, PRA on your continued success in transforming clinical trials! Biomedical Systems appreciates the opportunity to support your endeavors and looks forward to providing you with the well trained people, innovative technology, and global infrastructure that have earned us a position as a worldwide leader in the clinical trials industry.

Using data to design clinical trials When a protocol comes in from a sponsor company, PRA uses a team of specialists around the world to evaluate the feasibility of a clinical trial. Thoelke said PRA has resources in countries around the world consisting of regulatory specialists, physicians, PhDs, and others who help inform the company of the current standard of care, customary care, socioeconomic issues, taxation issues, import

One contract research organization (CRO) is working to change the landscape of clinicaltrial design and accrual. PRA draws on data from numerous databases in the United States and around the world to create a more targeted approach.

issues, and the regulatory landscape in that region. For example, the group looks at the practicality of following patients for 10 years in India or remote areas of China. PRA also has a team of data specialists who

“At PRA, we are at the forefront of leveraging data for decision-making in the clinical trial industry,” said Kent Thoelke, executive vice president of scientific and medical affairs. “We think an evidence-based approach to trial development is the best way to go.”

compile claims data, payer data, Centers for Medicare and Medicaid data, and World Health Organization data to design clinical trials for optimum accrual and efficacy.

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nervous system, oncology and hematology, rare disease, respiratory/allergy, scientific affairs, and infectious diseases. PRA conducts Phase I–IIa studies via its U.S. and European clinics with support from its two bioanalytical laboratories nearby. Always forwardthinking, PRA offers a Fast Track development program for these early-phase studies that can reach proof of concept six to 12 months faster than traditional models. PRA also executes complex, global Phase II-III studies across a variety of indications and its Late Phase Services group specializes in Phase IIIb, IV, and registry studies. The company is also expanding operations in emerging markets, including Asia, Latin America, and India, recently having opened a second office in China to facilitate the growing demand for studies in the Asia Pacific region. Growing within a highly competitive industry is

“We need to make the experience as positive as possible and become a partner with them.”

difficult, but Thoelke said PRA has seen significant growth within the past few years. Its size still allows the company to offer clients a more personal

monitoring of hospital and investigator data to

quickly, producing the same high-quality results.

relationship.

reflect safety, efficacy, and drug use.

But it takes time to become comfortable using that

patients will participate. But projections say that if

Educating and integrating patients

with life-threatening diseases, and we are asking

we could raise accrual to even 10 percent, we could

In addition to giving clients personal attention,

would not otherwise have to do,” Thoelke said. “We

decrease clinical trial time from three to five years

Thoelke said a key part of PRA’s business is patient

need to make the experience as positive as possible

down to one to two years, which could save millions

access and recruitment.

and become a partner with them.”

“We have been working to understand why patient recruitment in the United States is so poor,” Thoelke said. “Most estimates cite 3 to 6 percent of

“We encourage everyone to educate patients

of dollars in the drug-development process.”

“We remind [the CRAs] that these are people them to participate in a trial, to do extra work they

about participation and really integrate them into the process, rather than using them as a plug-and-

available to develop an evidence-based approach to

PRA is a mid-size CRO operating in more than 40

play model,” he said. “At the end of everything we

trial design and patient accrual and to enhance the

countries and conducting trials in up to 80 coun-

do, every protocol, there’s a person on the other

patient experience.

tries across all phases of pharmaceutical, biotech,

side of that report. It’s easy to get caught up in

and biosimilar drug development. The company

charts and data and forget that we’re actually sav-

costs millions or even a billion dollars, requires

provides services through all phases of clinical

ing patients’ lives.”

thousands of sites and lasts five years,” Thoelke

development. Therapeutic areas of focus include cardiometabolic disease, neuroscience and central

As part of the clinical-trial process, Clinical Research Associates (CRAs) perform most of the

By Patricia Chaney

Overall, PRA’s goal is to reform the clinicaltrial development landscape—using all the data

An expanding operation

methodology.”

“We can no longer sustain the model that

said. “With the technology available we can do what we’ve always done, but more efficiently and

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

02 | St. Luke’s University Health Network

industrial-engineering background that has been well-served in various health systems throughout his career, including the University of Wiscon-

St. Luke’s University Health Network

sin health system, the Sentara Health System in Virginia, and the University of Pennsylvania health system in Philadelphia.

St. Luke’s Anderson Campus in Easton, Pa., is a brand-new, 100-bed facility that just opened in November 2011. A member of the St. Luke’s University Health Network, St. Luke’s Anderson is the first new non-profit, acute-care, non-replacement hospital in Pennsylvania in 40 years. In its first six months of operation, its ER volume was twice what had been projected, while inpatient admissions were 50 percent greater than expected.

Edward Nawrocki, President

“It’s been a great experience recruiting the staff and hiring people who fit the St. Luke’s culture,” Edward Nawrocki, president, said. “What’s been very rewarding is working with 500 people to create a brand-new culture on a campus that our patients really like and in an environment that they really appreciate. That’s been very enriching.”

A $175-million investment Opening a brand-new hospital has many pros and Nawrocki has been president of St. Luke’s An-

cons, of course. Perhaps the nicest aspect, how-

derson since the hospital was first announced in

ever, is the luxury of newness, both with equipment

February 2011. He was president of St. Luke’s

and with culture.

Quakertown Hospital for seven years before accept-

The St. Luke’s University Health Network

ing the helm at Anderson Campus and has held a

invested $175 million in the Anderson Campus proj-

variety of leadership positions within the St. Luke’s

ect, with $25-$30 million alone invested in equip-

Network since 1999. Nawrocki brings with him an

ment for the campus, including the latest GE radiol-

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ensures the needs of the patients and staff in the emergency department are met. Thankfully, he added, being part of a larger system means the outpatient capacity can be absorbed at other St. Luke’s locations. St. Luke’s Anderson is already expanding the hospital, doing additional construction on the inpatient side so they can handle the unexpected demands. The board is also researching options to create space for additional capacity.

Establishing a foundation for the future Nawrocki sees great opportunities in opening a brand-new hospital. Instead of having to adjust a new team to fit into a previous culture, he and his team are able to establish the kind of foundation and culture for the hospital’s future that they envision. For example, from the beginning, they’ve upgraded the computer systems, largely McKesson, to comply with meaningful use. They’ve also been able to introduce significant initiatives around medication management. “When you have a new employee base to work with you can spend a lot of time on educating them

Community is important

about a culture of patient safety,” Nawrocki said.

St. Luke’s Anderson is currently serving as an

“We’ve spent a lot of time in our orientation to

international show site for GE radiology equip-

teach and implement best practices, including how

ment and for Knoll, a local furniture company. The

ogy testing equipment, a brand-new MRI 120-slice

to properly report incidents, track safety-related

construction of the campus also utilized many local

CT scanner, and Varian’s newest TrueBeam Linear

trends and try to resolve issues before they become

companies to keep much of the financial investment

Accelerator.

problems.”

in the local economy.

Among the challenges the hospital faces as

Nawrocki’s overarching goal is to make the

According to Nawrocki, the response from the

a new organization, Nawrocki cited growth as

Anderson Campus a destination for more than just

community has been nothing short of incredible.

the primary one. There are certain specialists St.

healthcare.

People love the design, he said, which is rewarding,

Luke’s Anderson is trying to recruit that are harder

For example, one initiative involves creating

since those involved with the planning took pains to

to attract than one may think, especially since the

walking paths on the hospital’s 500-acre property,

make the facility attractive both inside and outside.

lead time for hiring a physician is 12 to 18 months

along with a pond, a butterfly garden, and a rose

The community also likes how accessible it is, be-

from recruitment to inclusion on the medical staff.

garden. Nawrocki wants the hospital, the Cancer

ing located near key thoroughfares in the Lehigh

Nawrocki said managing this process can be dif-

Center, and the Medical Office Building on the An-

Valley.

ficult at times.

derson Campus to be a place where the community

Furthermore, balancing resources with the ER

can come to experience nature and tranquility.

and inpatient/outpatient demands can also be a daunting task. Nawrocki said St. Luke’s Anderson

“We’re trying to make this location more than just a hospital,” he said.

“People are happy that we’re here,” Nawrocki

Anderson will earn a reputation for quality, patient safety, and growing services and programs. “With 500 acres, this is going to be a significant healthcare site for the next several decades to come,” he stated. Nawrocki added that a brand-new facility offers a significant opportunity to make a difference through advanced technology and patient-centered customer service, something that may have been harder to achieve with an existing hospital. “From the day we opened, we have offered high level care and services to patients and visitors, providing them with more of a human experience as opposed to a healthcare experience.” by Pete Fernbaugh

observed. Over the next three to five years, he hopes to solidify that reputation, and he hopes that St. Luke’s

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

03 | Shionogi, Inc

A challenging first year Melloy said the last year has not been easy. Starting out, Shionogi had a portfolio of products that were relatively old and predominantly 505(b)2s. However, Shionogi has a pipeline of NCEs (new chemical entities) coming. “Right now, we’re really building the core competencies and capabilities for us to be able to launch our pipeline products and be very innovative with our launches,” she stated, using the analogy that the last year has been akin to flying a plane and building it at the same time. Although their financial resources were vast, their human resources were not. Melloy said Shionogi was in dire need of acquiring talent. “We did not have the luxury of developing talent because we’re still young, but attracting and hiring

incorporate them into their business within 35 days

talent was our mission.”

without missing a beat, something that is unheard

This challenge was remedied with the hiring of over 300 new employees. “I thought this was an upgrade opportunity,”

“I really believe that at Shionogi, every individual has an opportunity to make a difference both professionally and personally,” Melloy stated. “You

ucts and move up to the new NECs, best-in-class

get very few chances in your career to be at a place

products, hiring A-talent; however, it is more of a

where you can say, ‘My personal contribution made

start-up opportunity.”

a significant difference.’ We’re all in it together and

Now that their first year is over, Melloy sees Shionogi’s frantic start as being behind her and the

Deanne Melloy, Executive Vice President and Chief Operating Officer

of.

she said of her role. “Move off of the 505(b)2 prod-

One year later...

Shionogi, Inc.

acquired nine assets last year and was able to

everybody makes a difference.” “I don’t need a lot of people or resources,” she added. “I just need the right ones.”

future as a growth period. Because it was all so

Starting with the customer

When Shionogi Inc., was first established in the United States a little over a year ago by its Japanese parent company, Shionogi & Co. Ltd., it had the benefit of an 11-year presence in the U.S. marketplace. However, that presence didn’t actually become commercial until a recent acquisition.

new and because she had to make vital decisions

“It’s not about our agenda. It’s about our custom-

quickly, she said the biggest lesson she learned is

er’s agenda.”

As Deanne Melloy, executive vice president and chief operating officer, explained, the challenge now is in making the Shionogi brand competitive with other pharmaceutical brands.

some of the best talent in the industry, and the

“Most times, healthcare professionals and

company has been able to attract and bring into

patients aren’t thinking about our products every

the organization some of the top performers from

day like we do, and yet we assume that they are,”

across the pharmaceutical spectrum.

Melloy said. “By helping them understand why they

“We are establishing a new pharmaceutical culture that will lead to new ideas and strategies for growing brands in today’s complex marketplace,” she said. “We approach products as brands; it is not just about selling a product but establishing a brand.”

that it’s okay to make a mistake if you confront it and fix it as soon as you realize it’s a mistake. With over 500 employees, Shionogi now has

There are new products about to be filed and

And it is that principle upon which Melloy bases her leadership. Their customers, whether patients or physicians, are demanding value.

need our products or where our product fits in plays

prepared to come on to the market, some of which

more effectively than just trying the old-fashioned

will serve unmet patient needs. The organization

way of providing details and brochures about the

is gearing up for success. For example, Shionogi

product.”

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companies have spun off into smaller companies. It’s almost like they’re going backwards, she observed. “I think the opportunity still remains to be really good at one or two things,” she said. “You don’t have to be good at everything.” As Shionogi develops a portfolio that is more specialized, Melloy is focused on creating “transferrable skills,” learning from what they’re doing now and determining what can be transferred into the future to make a big difference. “There is an opportunity,” she said. “I believe

providing innovative medicines, Shionogi is

the pharmaceuticals industry is great to be a part

making a real difference in global health.

of. We have the opportunity to make a difference

At Centron, we are proud to be working with Shionogi on a new type of medicine that will impact the well-being of postmenopausal women around the world.

in the lives of so many people. There is opportunity It is incumbent upon them to establish a rapport with their customers, to understand the emotional component behind their needs, and to brand Shionogi’s products accordingly. This is why Melloy doesn’t focus on industry

within the pharmaceutical industry and the opportunity to create a pharmaceutical company that has a culture that will deliver extraordinary results.” by Pete Fernbaugh

trends. She’s trying to establish a new pharmaceutical culture. Doing this demands creativity and cutting-edge thinking. “It’s not doing the same old things the same old ways every single time,” she observed, offering this example, “I do not know of any healthcare professional who asks to see the glossy master visual aid. Yet we continue to produce them and expect different results. “It comes to the point when we have to take some risks and be forward thinking and try some new ideas,” she concluded.

Creating a cutting-edge culture The pharmaceutical business is still about the patients, Melloy asserted. She knows many believe that pharmaceutical companies have to be full-

centroncom.com

“I really believe that at Shionogi, every individual has an opportunity to make a difference both professionally and personally.”

service companies, but many of those full-service

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04 |Connecticut Childrenâ&#x20AC;&#x2122;s Medical Center

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Connecticut Childrenâ&#x20AC;&#x2122;s Medical Center When Kelly R. Styles considers how his role as vice president of information services and chief information officer has evolved at Connecticut Childrenâ&#x20AC;&#x2122;s Medical Center in Hartford, Conn., over the last three years, he reaches one conclusion. â&#x20AC;&#x153;My understanding of my role is that I am not a technologist,â&#x20AC;? he says.

Mr. Kelly R. Styles, Vice President of Information Services and Chief Information Officer

He reaches this conclusion despite the fact that Stylesâ&#x20AC;&#x2122; background for 25 years has been in technology. During his career, however, he has seen healthcare IT expand to the point where he, as CIO, is now a treasured part of the executive staff, a member of the team devising healthcare strategy and initiatives. He is the member who provides the data and information needed for longterm planning and decision-making. No longer does he handle the day-to-day issues of choosing which vendors and software the hospital will be using. His director-level staff is now held responsible for those decisions. â&#x20AC;&#x153;My job is to now ask the question, â&#x20AC;&#x2DC;What should we be doing around our strategy?â&#x20AC;&#x2122;â&#x20AC;? he explained.

9LVLW -XUDQ FRP

Juran Juran assisted Connecticut Childrenâ&#x20AC;&#x2122;s design and implemented a Quality Management System - the organizational structure, procedures, processes, and resources needed to manage for quality. Juran led process redesign teams in preparation for an Electronic Health Record and trained Lean Experts to lead projects resulting in improved patient safety, quality, and customer satisfaction; Lean facility designs; and reduced costs.

The evolution of Healthcare IT This transformation of his role at the medical center, Styles said, started taking place about three years ago, but has really crystalized in the last two years. Now, his main challenge is making sure that he is current with the thinking of the executive suite as they ponder such issues as whether or not the hospital should participate in ACOs. â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s the educational piece around the different policies that are coming out of Washington that I need to be clearly connected to,â&#x20AC;? he explained. â&#x20AC;&#x153;So even the things that have to do with President Obamaâ&#x20AC;&#x2122;s healthcare plan, I have to be versed on that.â&#x20AC;? He added, â&#x20AC;&#x153;CIOs canâ&#x20AC;&#x2122;t be about just tech any-

For example, Connecticut Childrenâ&#x20AC;&#x2122;s is now looking at growth and community-health strategies. Styles spends a great deal of his time considering how IT will plug into those strategies.

more. They have to be about policymaking both at

In short, Styles stated, â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m not solely responsible for technology anymore.â&#x20AC;?

the national level.â&#x20AC;?

an organizational level and at the state level and at

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

The last days of the Healthcare CIO In the three years that Styles has been at Connecticut Children’s, he has helped grow the department from 13 to 104 people, all of whom support the medical center. He has also presided over the development of a data center and a disaster-recovery center for the organization. Still, he believes that the biggest change for not just Connecticut Children’s IT department, but IT departments nationwide is still ahead, for he believes that individuals like himself—CIOs—are going to become as extinct as the dinosaurs in the next 10 years. “The position is evolving where CMIOs are truly

“It is the creative ideas that are coming from the staff itself and it is us being able to visualize how to implement those ideas.”

going to take on a greater role and become the eventual leaders of IT, especially if they can get the INDUSTRY PARTNERS Valet Park of America www.valetparkofamerica.com

“Managing those relationships from an IT stand-

business background, because it is clinical infor-

point is really important, because they, too, have

matics (healthcare’s business intelligence) that is

their own agendas, and you have to make sure that

changing our space,” he predicted.

everyone finds some way to compromise and move both agendas forward, and at some point they both have to match,” he observed.

A large portion of his information-gathering right

In other words, the pure technologist that is the IT person will no longer exist. “Medical professionals will truly have to understand the business as a whole, so you will find more

now is devoted to health-information exchanges

Listening to the end users

and answering the question, How is Connecticut

Styles also makes a point to listen to those who

Children’s going to share data with community

actually have to use the technology that IT is insti-

and nurses, is to look at the big picture, to under-

physicians? Styles regularly meets with local physi-

tuting. He said that many of Connecticut Children’s

stand the entirety of what is happening.

cians to discuss this very question and to jointly

nurses and physicians actively participate in the

develop a plan for information-sharing.

organization’s technological advancements. In fact,

and get their MBAs. They grasp clinical need, but

nurses, more doctors in the CIO chair.” His advice to all IT personnel, including doctors

Doctors and nurses, he said, need to go back

he is exploring mobile technology largely because

many need the added component of business acu-

care, so I think again as you’re in the executive

so many physicians were sending him articles on

men. IT professionals, on the other hand, need to

suite, you have to understand what that means to

how to make it functional in their environment.

realize that the current state of healthcare IT is

“There is this consolidation going on in health-

your organization and how your organization is go-

“It is the creative ideas that are coming from the

ing to react to that. Are you going to figure out some

staff itself and it is us being able to visualize how to

partnerships? And if you are, what does that mean

implement those ideas,” he said.

for information-sharing in the areas of financial, clinical, and research?” In addition to information-sharing, Styles focuses on managing relationships with consultants and other partners who provide services, such as

It is important, Styles asserted, that the end us-

about more than just hardware, software, and applications. “It’s the processes,” he said. “You have to have a handle on them. Understand what the healthcare

ers feel ownership of the process. If the latest inno-

processes are and how you will help the organiza-

vation is not an organizational initiative, it becomes

tion make changes as necessary.”

solely an IT initiative and not a clinical idea. “It can’t be IT driving innovation. We have to be

radiology, that the hospital is unable to provide

participants in that. Otherwise that message of ‘it’s

itself.

just IT’ will remain the same.”

by Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

05 | MaineHealth

Supporting the delivery of care

MaineHealth

Dr. Blumenfeld describes his role as CIO succinctly. He is there to make sure that IS supports MaineHealth’s business and vision of delivering care.

Dr. Barry Blumenfeld, Chief Information Officer

It used to be that hospital IT personnel sat at the back of the boardroom during meetings and were called on as needed, but had limited involvement in the overall planning of the hospital. As Dr. Barry Blumenfeld, chief information officer at MaineHealth, jokingly described it, they were the guys running around with screwdrivers and wearing strong glasses.

Very often, this means bridging the gap between

That stereotype is rapidly changing, though, as IT becomes the key to the success of healthcare institutions.

business strategies.”

MaineHealth, a not-for-profit integrated delivery system whose member hospitals and affiliate groups are spread throughout much of Maine, is no exception in this regard.

technology and business. “Again and again, the problem is that IS over the years has been viewed as a technology infrastructure, not an enabler of business strategies,” Dr. Blumenfeld said. “At times, it is even a driver of Of course, this tightrope act plays out in a myriad of ways. For one, IS must ensure that MaineHealth has the necessary infrastructure in place as the organization moves closer and closer to ACO and patient-centered homes. IS must also ensure that clinicians are able to connect and collaborate with each other as they deliver care in the most efficient manner.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

It also means that IS must empower and support

Dr. Blumenfeld lists medical research and academia

consumers by having a portal strategy, and it in-

as other drivers in IT, especially as they deal with

cludes examining the systems MaineHealth already

genomic information in medical records and how

has and evaluating whether substantive improve-

best to communicate patient-registry information

ments in quality need to be made, especially in

throughout the system.

areas that are stymied and have difficulty making headway with changing technology. But IS has another function, according to Dr.

There is also a greater push, he said, toward what he calls “business-intelligence work” or performing complex analytics on MaineHealth’s own

Blumenfeld. That function is to explain to people

data to evaluate how the organization is managing

why a technology-oriented project isn’t solely an IS

and impacting quality and costs.

project.

“It’s really helpful to have a fair amount of insight into the way healthcare is delivered.”

process or business process,” he said. “They don’t know much about why it’s so important to do things a certain way in clinical situations.” He advises young professionals to develop their business skills alongside their technical skills, making sure they understand concepts like accountable care, the mysteries of payment reform, and the ways in which clinicians interact on the floor and in operating rooms. “I think it’s important for them to become much more knowledgeable on business processes,

“There’s the tendency that whenever we make

Getting them to say “yes”

decisions, for instance, to implement an electronic

As Dr. Blumenfeld looks at his career, which started

resource,” he stated. “It does not hurt in any way to

health record, to make that an IS project when in

out on the physician side of the aisle, he pinpoints

know all of the vagaries of information technology,

fact, it won’t be successful without the direct guid-

one achievement of which he is most proud—getting

but as you move towards being a CIO, it’s not a set

ance and oversight of our clinical and operational

the MaineHealth leadership team to say yes to im-

of skills that you typically use. Instead, I think there

leaders,” he explained.

plementing a Shared Health Records system across

is a move towards CIOs having greater healthcare

all of their member hospitals and affiliate groups, an

or clinical insight.”

Finally, IS is charged with the complex matter of “just keeping up.” “Everyone talks about the costs of healthcare,

investment that shot upwards of $90 million. For a system that is so big and is barely centralized

and it is a cost-constrained industry,” Dr. Blu-

and is comprised of disparate parts, he pointed out,

menfeld said. “And yet there are ever-escalating

integrating systems across the entire IDN (integrat-

demands around things like security and privacy

ed delivery network) can be a challenging task.

and our ability to catch and preserve information

“I feel really proud of selling the business propo-

and the need to incorporate technology operations,

sition that was absolutely critical for us to take our

whether using iPads or iPhones, for connectivity. So

hodgepodge of systems and multiple vendors and

there are many technology demands in a very cost-

begin to forge a much more connected and much

constrained environment.”

more integrated system than we had in the past,” he

Drivers of healthcare IT

Dr. Blumenfeld pointed out that there are more physician CIOs than ever before. “It’s really helpful to have a fair amount of insight into the way healthcare is delivered.” by Pete Fernbaugh

said. “The changes in our software systems are affecting the entire healthcare system far beyond IS.”

Not only is accountable care driving healthcare IT,

With this accomplishment, Dr. Blumenfeld

but Dr. Blumenfeld said general payment reform is

also sees his role as expanding beyond IS and into

also pushing their resources, especially in a state

a more strategic function at the business table. In

like Maine where the population is rapidly aging

fact, he strongly urges aspiring CIOs to be more

and chronic diseases are prevalent. IT is constantly

than just a “good gearhead.”

looking at ways to deal in a cost-effective manner

not necessarily to view themselves as a technical

“There are a lot of guys out there that want to

with the medical needs of a homebound population

be CIOs and they know everything about switchers

that may see multiple providers.

and routers, but they don’t know much about clinical

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

06 | Community Medical Center, Inc.

Sampson Construction

Community Medical Center, Inc Community Medical Center, Inc., is a 24-bed critical-access hospital, serving Richardson County, Neb., which has a population of about 9,000. Despite being a small community hospital, CMC has remained financially strong. By partnering with other agencies and hospitals, the center has built up its healthcare program and expanded its electronic-health records in the hospital and primary-care clinic.

A large volume of Sampson Construction’s work has been in healthcare construction. Within the last five years, Sampson Construction’s project workload has included new construction on green field sites and additions and renovations to operational healthcare campuses. Our firm has completed over 60 healthcare projects exceeding one million square feet of experience with a specialized safety team who are leaders in healthcare campus construction.

Building relationships in the community Healing rifts in the hospital’s relationship with the community is one challenge that Ryan C. Larsen, chief executive officer, has faced since he first took the reins of leadership seven years ago. A few years ago, he began to increase communication with the community and bring the governing board into strategic planning. “We started to do community reports, appear to different groups, and holding employee forums,” Larsen said. “We wanted people to know we were open and willing to talk about issues. And we wanted key groups to know that we count on them to help us make decisions.” About three years ago, CMC built a new

Ryan C. Larsen, Chief Executive Officer

facility. As part of the planning process, admin-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

istrators went to staff, physicians, and the board to

This strategy has worked so far, as the emergency

make recommendations and get input for the new

room has received patient-satisfaction scores in the

building. Larsen said he also involved the board

90th percentile, with other areas receiving scores in

members in physician recruitment.

the 70th percentile and above. These are improve-

“I think our governing board members like

ments over past scores in the 40th percentile. On

knowing they would be a part of the decision-mak-

inpatient core measures, CMC has scored about 98

ing process,” he said. “They don’t always exercise

percent.

their voice, but they know they have one when they feel like it’s needed.”

Improving community health A large part of improving the hospital’s relationship with the community has been in meeting the com-

their obstetrics programs because it is typically a

munity’s health needs.

loss leader, but CMC determined it is a necessary

Richardson County has a set of health goals the hospital has adopted, and to achieve these goals, CMC has created initiatives to address the six is-

service for the community and has revamped the program. Another area of focus is orthopedics, which

“We need to work on being a partner to the community for health and wellness and shift our structure to support that goal.”

With good quality scores, the hospital has begun focusing attention toward improving its employee culture as well. Larsen has instituted communication techniques, team steps, and culture principles to ensure a positive working environment. Although the fate of healthcare reform is no longer in question, uncertainty still remains. Changes to critical access-hospital status are a big concern for smaller hospitals such as CMC, and the repercussions of those changes are as yet unknown.

sues identified by the district health department:

remains one of the most profitable service areas

provision of healthcare to an aging population; the

for the hospital. Larsen said that with increased

ensuring its financial stability, finding the right mix

increasing age of medical professionals, clinicians,

staff training and measures to improve efficiency,

of new medical staff as many older physicians look

and volunteers; access to adequate mental-health

CMC has seen gains in that division as well. With

toward retirement, implementing a hospitalist pro-

services; increasing age of population; transporta-

its unique surgical technique, the orthopedic group

gram, and furthering its work on improving overall

tion; and obesity, inactivity, and wellness.

sees patients from hours away, some who even

community health.

Even before the government started issuing mandates designed to improve people’s overall health before hospitalization, CMC was evaluating

bypass larger metropolitan hospitals in favor of CMC’s services. The hospital has also focused on falls and infec-

and implementing wellness programs. The hospital

tions. In an effort to improve on quality measures,

has an on-site family-medicine clinic and offers

CMC has hired nurse practitioners and physician

community programs, including diabetic-outpatient

assistants to fill a hospitalist role. The program

education; the Fitness Improved Together (F.I.T.)

is still in its infancy, but Larsen said it is already

program, which is focused on improving overall

gaining traction. To encourage staff to achieve the

health; a home-visitation program to promote

highest quality, the hospital offers incentives to the

healthy families and healthy children; a smoking-

physicians’ staffs who get compensation for achiev-

cessation program; health fairs; and other commu-

ing quality as well as productivity.

nity-outreach initiatives.

Addressing quality initiatives

Looking toward the future, CMC is focused on

“We need to work on being a partner to the community for health and wellness and shift our structure to support that goal,” Larsen said. by Patricia Chaney

Larson said the hospital looks beyond the individual core measures and at the entire patient experience. “We ask, ‘What is the likelihood you’ll receive

CMC has also been working on improving qual-

100 percent of every measure?’” he explained. “We

ity and core measures. The hospital started with

look at ways to get the whole experience right and

obstetrics. Many community hospitals have ended

tied that into employee incentives.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

07 | Antelope Valley Hospital

Out of the red and into the black

A better day places patients at the heart of everything we do.

Five years ago, Antelope Valley was fighting to survive. Mismanagement had rendered it almost

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bankrupt, not just financially, but also with employee morale. Its financial state was so bad that cutting 50 percent of costs wouldn’t have been enough. As Edward Mirzabegian, MHA, chief executive officer, related, the hospital had to concentrate on creating revenue streams. Mirzabegian, then new to his position, set up a revenue-cycle department and hired

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a vice president to oversee it. This vice president would report directly to him. It was a new approach, since revenue typically reports to the chief financial officer. But Mirzabegian felt it was imperative that he involve himself directly in these efforts, giving as much attention to revenue as he did to quality. “The most important element for any industry is really the revenue side of it, not the expense side,” he observed. “Right now, revenue cycle is a product line in the forefront of what we do, just like quality. If there’s no revenue, it doesn’t matter how much you cut costs, you won’t survive.”

Antelope Valley Hospital Antelope Valley Hospital is a $365-million, 420-bed facility that serves 1.2 million people in the greater area surrounding Lancaster, Calif., located about 60 miles north of downtown Los Angeles. Offering every service except transplants, Antelope Valley hosts the second-busiest emergency room in the state of California. Because of the mountains in the area, it is one of the only hospitals around, making the hospital’s operations busy and expansive.

Edward Mirzabegian, MHA , Chief Executive Officer

For example, Antelope Valley delivers nearly 6,000 babies each year, serves as the only trauma center for northern Los Angeles County, runs the EMS system’s base station for about 1500 sq. miles of the county, and hosts a stroke and STEMI center. Currently, the organization is working on a $42-million modernization and reconstruction of the hospital. This includes the addition of a Cardiovascular Center of Excellence and an upgrade of the imaging department.

Mirzabegian and his team rebooted everything about the hospital’s approach to revenue, resulting in almost 600 new steps and initiatives. The hospital

A complete turnaround

changed the way it billed, the way it charged, the

Since these methods were implemented, Mirz-

way it renewed all of the processes for collection

abegian said the hospital has done a complete

and reimbursement, and it reevaluated all con-

turnaround and is now $20 million on the positive

tracts.

side. Beyond the action plan he and his board

Mirzabegian also felt the culture at Antelope Valley needed to focus on becoming more customer-oriented. In fact, he felt the most important

implemented, Mirzabegian credits the teamwork of his staff. “Overall, everybody pitched in,” he said. “We

piece of the hospital’s recovery playbook was culti-

had the main goal of what to do, and we just

vating and nurturing the values they wanted to push

worked on that.”

within the organization. “As far as value, we’ve worked very hard to change the culture and how we treat each other,”

His main challenge now is repairing a decaying infrastructure. “This is a big challenge for me because it

he said. “And that is a very slow process, even

requires a lot of money,” Mirzabegian stated.

though we have taken big steps forward, but it is

“With the existing market and the current state

really a work in progress and there’s a lot still to be

of borrowing and financing, it’s really becoming

desired.”

difficult.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

08 | Litzenberg Memorial County Hospital

He and his board are also feverishly searching for the right talent to work at Antelope Valley. Because of various factors unique to California, it’s difficult to transplant people from other states, especially when they have other, less expensive options than Antelope Valley. As Mirzabegian succinctly put it, “Recruiting talent is a big problem here.” The hospital is prioritizing its investments according to departmental needs and new programs, like the aforementioned cardiovascular center. It is also retooling its surgery product line, making sure the instrumentation and equipment the physicians use is up-to-date. One recent addition was the da Vinci robotic surgical system. And even though producing revenue has been a priority over the last five years, Mirzabegian is quick to emphasize that patient safety is always at the forefront of everything they do. Along with 12 other hospitals on the West

reform, are really making it hard to run a hospital and provide the right care,” he explained. “Do

Coast, Antelope Valley is working with the Insti-

we need to change? Absolutely. Healthcare has

tute for Healthcare Improvement (IHI) to focus

to change in this country, because the way we’re

on “Patient- and Family-Centered Care.” In the

going, I doubt anyone will be able to afford it in the

past, Mirzabegian explained, the focus has been on

next 10 to 20 years. So things have to change. But

patients, but patient- and family-centered care is

the way the existing administration is proceeding is

geared to bringing families and patients together in

not the way to go.”

the delivery of care. “Most of the complaints we have received come from the families, not the patients. Families are often the ones filling out the surveys and answering

Nevertheless, he said Antelope Valley is competitive and still able to make a difference within its community. “We are on the map and we are a player within

the tough questions, not the patient. Everything is

the healthcare industry here, and we want to make

going to be geared toward communicating with the

sure that people know that our quality of care is one

family members, as well as the patients. So it’s a

of the best in the Los Angeles area. We want to be

new era with our patients, as far as the safety and

the hospital of choice for people within our market.”

Litzenberg Memorial County Hospital Apart from a few urban centers, most of Nebraska is rural. For critical-access hospitals like Litzenberg Memorial County Hospital in Central City, Neb., this presents the challenge of maintaining interdependence while cultivating affiliations with tertiary hospitals in more populated regions.

quality of care is concerned.” by Pete Fernbaugh

A hospital on the map and in the game

Tad M. Hunt, chief executive officer, has focused on building these bridges with tertiary hospitals during his first year as Litzenberg’s CEO, and he feels that the organization is forming strong bonds with other healthcare entities, as well as the surrounding community.

In spite of the hospital’s turnaround, Mirzabegian is not a rose-tinted optimist. He expressed great frustration with many of the current healthcare mandates that he said are “total obstacles to every-

Tad M. Hunt, Chief Executive Officer

thing that we want to do as an industry.” “The challenges we are facing, from the Afford-

He also cites positive benchmarks from his first year, such as the strides Litzenberg has made in operational and financial performance, the improvement of physician and medical staff relationships, and increased employee engagement.

able Care Act, ACO requirements, and healthcare

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

In October of this year, Litzenberg brought in-house

reform? How can Litzenberg maintain its interde-

general ultrasound and digital mammography for

pendence as a hospital without being completely in-

five days each week. Additionally, the hospital has

dependent of affiliations with other hospitals? How

been awarded a mammography grant that has

can it continue to evolve community involvement in

enabled it to go digital.

healthcare matters, keeping everyone involved and informed of healthcare changes?

Just recently, Litzenberg was awarded another

These are the questions Hunt asks himself and

grant to incorporate e-pharmacy into its care provision, something that will allow the hospital

his board about the future. There is no doubt, he

to upgrade its Pyxis systems, thus supplementing

said, “community is very important.” “The executive needs to be involved with the

pharmacy services.

Chamber of Commerce, participating in the eco-

Hunt is also looking to shore up vendor rela-

nomic involvement of other imperative programs

tionships. “I think that with healthcare reform and also with accountable care organizations, it’s very important that we have a strong affiliation with our vendors, either through a tertiary-hospital relationship and working with that or through just some type of a GPO relationship,” he said.

A focus on facilities As Hunt looks at the big picture, his goal is to build a replacement hospital for Litzenberg’s current facilities. The hospital is in the process of negotiating for some land as part of the project’s Phase One. So far, Hunt said, they’re very pleased with how the negotiations are going, even if they’re unsure of some key details, such as how much larger the

A focus on services

new facility should be. Hunt doesn’t see a need to

Hunt has placed a high priority on expansion of

increase the bed count so much as the looming

services during his first year as CEO. Currently,

necessity of offering more outpatient services and

Litzenberg is expanding its outpatient and imaging

adding a new rural health clinic.

services.

One of the models they’re examining is the

Outpatient is important, Hunt said, since more

medical campus model. This would add a dental

than 60 percent of the organization’s business

office, an independent physician practice, and other

comes from those services. Therefore, he is look-

ancillary healthcare services to the hospital. Should

ing to expand the operating room so Litzenberg

they go down this route, Hunt hopes to find part-

can perform more outpatient surgical procedures,

ners who would want to build their operations in

along with stronger trauma ER, laboratory, and

conjunction with Litzenberg and its values.

therapy services.

When the hospital does acquire land and starts

Hunt is also determined to outsource fewer of the hospital’s imaging services.

selecting architects and contractors, Hunt is looking to apply evidence-based design to the facilities.

“We have been very dependent on mobile services to provide a lot of imaging services,” he said.

As a new CEO, though, he is trying to take developments one step at a time, ensuring that he

doesn’t forget such current issues as operational performance, lowering net ratios, and securing better financing.

A focus on quality As participants in ACS NSQIP, HCAHPS, and CMS core measures, quality is a driver of the organization. “Quality is our number-one agenda item at all board meetings,” Hunt said. “We’re also working on a balanced scorecard which is looking at quality initiatives and financial operations.” Additionally, Hunt is trying to increase the culture awareness of his employees, along with better outcomes for patient care. Litzenberg participates in the Values Collaborative Program, a system that ties employee engagement into patient satisfaction. Finally, Litzenberg is expanding its relationship with BryanLGH Health System in Lincoln, Neb., with whom it already has an articulation agreement

in the community in order for the hospital to be successful,” Hunt said. “We need to show continual support of all community activities.” Litzenberg offers a full range of health-education initiatives for the community, using medicalstaff providers and allied health professionals to provide these services. Hunt himself holds monthly community-health forums to keep people informed of developments in healthcare and healthcare reform. Perhaps the most pivotal lesson he has learned in his first year, Hunt said, is the importance of developing close relationships with tertiary hospitals. “It’s important to create that feeling of interdependency so you don’t feel dependent or independent of any one organization, that you have the resources out there to be successful and meet the needs of rural communities across the country.” by Pete Fernbaugh

for transfers, to do revenue-cycle assessment. In conjunction with BryanLGH, Litzenberg is looking to provide short-term and long-term care resolution for revenue cycles. Litzenberg has also hired a revenue-cycle director to bring together billing and medical records .

A focus on community How are small hospitals going to continue evolving and surviving in light of ACOs and healthcare

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

09 | Regional Mental Health Center

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especially in this business if we want the kind of outcomes that we truly want, if we really want these folks to do well in the community and live independently and achieve the quality of life that we all strive for. They’ve got to understand what’s go-

We offer a wide range of insurance products for the changing marketplace. Since 1964, we have served our national client base with knowledge and expertise.

ing on and we have to have complete transparency in everything we do with folks. That’s the value that we’re trying to instill with our staff now, and we’re making some real progress in that regard.”

Our staff is ready to work with you on all of your insurance and risk management needs.

Everyone recognizes the wisdom of this ap-

Regional Mental Health Center In 2009, Regional Mental Health Center was formed from the consolidation of Southlake Center for Mental Health and Tri-City Community Mental Health Center. Since then, it has developed over a dozen locations in Lake County, Ind. Having 350 employees and a $35-$36 million a year budget, Regional is a full-service community mental health center that provides integrated care services for its clients. In fact, it is this integrated model of bringing physical wellness into the mental-health treatment process that has gotten it recognition as one of the foremost practitioners of mental healthcare in the country. With five group homes, approximately 90 HUD independent living apartments, four different outpatient sites that employ 30 staff psychologists and social workers, a few residential care units, a licensed 16-bed inpatient unit, 13 employed psychiatrists and one general practitioner, Regional approaches its mission with enthusiasm, innovation, and above all, compassion.

proach, he added, but it’s not the traditional manner in which mental healthcare is delivered.

An integrated environment of care

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“This has been a really tough environment for the last couple of years, with dwindling support from the state system, with dwindling support from the federal government system,” Krumwied observed. In Indiana, the state went through a fairly significant change in the Medicaid services that were available through mental-health providers. These changes curtailed some of Regional’s funding resources, forcing the organization to close a group home and downsize a day-treatment program. However, Krumwied said as Regional downsiz-

mental health was a partner in some of the physical

es in one area, it’s trying to improve and increase

ailments these clients have. In some cases, the

services in another area through alternative fund-

prescribed medications and lack of physical-activity

ing sources. The focus here is on integrating care

alternatives may have even contributed to these ailments.

A caring leader, a seasoned staff

needs, and wants,” Krumwied said. “The consumer

services by bringing primary-care providers into

has to be a partner in the course of their treatment

the mental-health facilities to treat chronically

When discussing mental healthcare of the sort

if we’re going to get the kind of outcomes that we

mentally ill clients who can’t run the healthcare

for the last 20 years means that the vast majority

that Regional provides, the values that its leader

want.”

maze efficiently. Some clients never even see their

of our chronically mentally ill patients have a pretty

healthcare providers for preventative measures.

serious attendant physical problem along with it

possesses are of great importance. Robert Krum-

Regional has a bifurcated staff where about

“They get scared away by the cost,” Krumwied

wied, chief executive officer, was the CEO of Tri-City

20 percent are over the age of 58 and 20 percent

before the consolidation and brings 22 years worth

are under the age of 30, “an industry phenomena,”

explained. “They get scared away by the bureau-

“Our lack of attention to their physical wellness

now,” he stated, listing diabetes, heart problems, and obesity as a few of the issues.

according to Krumwied. However, this age diversity

cracy. They get scared away by the unknowns. Their

Above all, he believes that it is important for

is also an opportunity to relate to clients on a more

level of understanding of the system is not nearly

dren’s services, trying to keep the children with

people in this niche of healthcare to possess an

personal basis, especially since the most seasoned

as sophisticated as ours, and it’s intimidating even

mental-health needs out of residential placement.

appreciation and a respect for the individuals they

members of the staff know what it’s like to receive

to us.”

As Krumwied explained it, they’re trying to wrap

of mental-healthcare experience to Regional.

are treating.

By bringing care in-house, Regional is trying to

services around the child, keeping them in their

“We just can’t do things to folks; we have to do

care for its clients’ physical and mental well-being.

community, in their natural environment, as op-

things with folks,” Krumwied explained. “And

Krumwied is candid in recognizing that for years,

posed to taking them out of it for prolonged periods

healthcare.

“In everything we do, we want to be sure that we are inclusive and informative of the clients’ desires,

Regional is also doing a lot of work with chil-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

10 | Tri-Cities Community Health

of time and expecting to seamlessly reintegrate them into society later on, automatically making up for years of education lost. “We spent a lot of time recently working with school corporations and welfare folks, working with them on the significant problems presented

“We’re making a lot of headway in that regard.”

by kids while keeping them in the community and while keeping their families intact,” Krumwied said. “We’re making a lot of headway in that regard.”

A mystery no longer By bringing physical-care services in-house, including a pharmacy on-site, Krumwied believes they have made the entire spectrum of care needed by all of their clients easier to manage. No longer does he have to leave work only to find a prescription blowing in the wind where a client dropped it as they were going to their car. “We’re trying to make life as simple as possible for them to get the same things done that we do on a daily basis so they can see what a difference this makes for them,” he said, adding that the outcomes have been amazing, with weight loss and diabetes management all showing signs of improvement. “We’re really into making this thing totally transparent, taking the mystery out of mentalhealth services for folks and truly bringing them into a partnership with us.”

Tri-Cities Community Health

by Pete Fernbaugh

Tri-Cities Community Health is a mid-sized Federally Qualified Health Center (FQHC) comprised of four facilities serving the communities that span the three cities of Pasco, Kennewick, and Richland in Washington. Within this population there are a fair number of migrant workers and citizens from outlying towns.

Al Cordova, Chief Executive Officer

Recently, the Affordable Care Act made it possible for Tri-Cities to be granted $7.4 million for the construction of a new state-of-the-art, 40,000 sq.-ft. health center. When Al Cordova, chief executive officer, came onboard in December of 2011, the center had already been opened and was proving itself to be a valuable asset to the organization.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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“I came here because of the mission,” he stated.

of care, where you have people assigned a per-

“I’ve already worked for some of the best health-

sonal physician, where you have a physician-direct

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time that I’m going to be here is to make this the

toward the whole patient orientation. So I think

premier FQHC in the state of Washington.”

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Tri-Cities is also at the tail-end of implementing

“You can imagine there’s just a lot of people out

an electronic medical record (EMR) system, and

there who can’t afford to have healthcare or have

it is renovating and expanding medical facilities.

insurance coverage,” Cordova explained. “So we

Furthermore, the Department of Health Resources

serve a population that truly does need a safety

and Service Administration has awarded Tri-Cities

net and that’ s why we have been able to qualify

$650,000 to establish a new community health cen-

for these projects, for these grants that we have

ter in Richland, an area that does not yet have one.

received and plan to receive over the next few

Tri-Cities also submitted a federal grant application

months.”

for $500,000 to establish two school-based health

Cordova’s background is varied and prestigious.

centers that will be located on school campuses.

He started off his career with Kaiser Permanente,

“We see ourselves moving into sort of a growth

where he served as an assistant hospital adminis-

mode,” Cordova said. “We have 17 medical provid-

trator and later as assistant medical group ad-

ers—physicians and nurse practitioners--and we’re

ministrator. This led him to positions with Harvard

planning to add more.”

and John Peter Smith Network in Texas, the latter

Four more physicians joined in September, Cordova

of which made him responsible for 21 community

added, and the budget calls for the recruitment of

health centers, 18 school-based clinics and 22 spe-

six more.

cialty clinics, all of which generated 700,000 visits

A patient population in need

each year. After retiring early and quickly becoming bored with retirement, he looked around for a role in

Cordova stressed that Tri-Cities has a significant

which he could be influential. He settled on Tri-

patient population who desperately need Tri-Cities’

Cities, mainly because it is an FQHC.

services. Close to 75 percent of the patient popu-

Cordova likes to tell people about his back-

lation the organization serves is under the 100

ground, not to earn bragging rights, but to show

percent poverty guideline.

them that FQHC CEOs tend to have a great deal of experience.

with what is deemed expected.” So far, he added, healthcare reform cannot be paid for on a per-unit basis. It’ll have to be paid for

The road to being the best is paved with many

by keeping people healthy and providing preventive

stop-gaps along the way. One of these is the sheer

care and case-management support.

volume of individuals who qualify for services, not

“It’s interesting how it’s coming back around.

to mention the revenue problems that come with

When I worked for Kaiser Permanente 25 years

30 percent of Tri-Cities’ patient population being

ago, the organization was already functioning as a

uninsured and not qualifying for Medicaid or other

patient-centered medical home. As an HMO, Kaiser

state-funded programs.

did operate with the notion of rationing care, but

When 33 percent of your patient population

to actually provide more of a holistic orientation,”

can’t reimburse you, Cordova said an emphasis on

Cordova said. “FQHCs are better-prepared for the

maintaining financial viability becomes essential.

future when we talk about coordinating care and

“These kinds of organizations are challenged because in order to become financially viable you’ve got to not only operate efficiently, but you’ve got to find ways to bring in some additional revenue.” Part of Cordova’s lofty goal is to make Tri-Cities

providing this holistic care and looking to meet the different needs of patients.” Not only does Tri-Cities provide primary medical care, but it also has a robust behavioral-medicine program, a detox facility, the WIC program,

appealing enough so that they can draw insured pa-

home-care services, and a chemical-dependency

tients to their services and with them, the revenue

unit.

that will offset the cost of treating those with no insurance. “When I talk about making this a premier orga-

“When we’re talking about moving toward the patient-centered medical-home model, we’re in a much better position to do that than let’s say a

nization, the landscape is changing for healthcare,”

medical group or a private practice, because they

Cordova explained. “We’re moving away from this

generally don’t have these other pieces and we

fee-for-service environment where we’re going to

do,” Cordova said. “We have the dental, the mental

get paid for quality outcomes and patient satisfac-

health, the outreach, the case management under

tion.”

one organization, and our communication and coor-

He is pushing Tri-Cities to adopt the patientcentered medical home model with the goal of

dination is good and can treat patients for a variety of medical problems.”

being certified as such by the end of 2013. In 2014, when healthcare reform has been fully rolled out,

by Pete Fernbaugh

Tri-Cities will also benefit financially since most of the now-uninsured will then have some level of insurance from which the organization can be reimbursed. “I think a lot of the focus does need to be placed on moving to this patient-centered medical home model where you’re not only coordinating but facilitating the provision of care across the spectrum

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

11 | Menifee Valley Medical Center

A “can-do” attitude Padilla has spent a large portion of his career working in health systems across many states. He has learned that the greatest value an executive can bring to an organization is a “can-do” attitude. From the moment he arrives at an organization, Padilla remarked, “I establish myself as someone who can turn operations around.” He strives to first, change the culture, transforming its foundation, getting its executive house in order, then moving on to relationships with physicians. “I have great physician relationships,” Padilla said. “I like working with physicians, and I like working with people. I’m a strategic leader and consider myself a visionary. It is important for me to always be looking at what type of services and new ideas we can implement in the hospital.” Right now, Physicians for Healthy Hospitals Inc. (PPH), owners of MVMC, is driving the hospital forward to becoming part of an ACO. To achieve this goal, Padilla is working on putting clinics in outside areas and bringing doctors into the building, where he can lease office space to them. His goal is to create Centers of Excellence, especially in the

Menifee Valley Medical Center There was a time when Menifee Valley Medical Center (MVMC) in Menifee, Calif., was struggling to improve its patient-satisfaction scores. “We were probably way in the cellar with our HCAHPS,” Gregory R. Padilla, administrator, said. Within seven months, however, the 84-bed MVMC, with a catchment area of approximately 150,000 people, staged a remarkable turnaround. “Now we’re trending up over the 50th percentile in most of the areas,” he said.

Gregory R. Padilla, Administrator

areas the medical center is currently developing,

“Healthcare reform has got to include collabora-

such as bariatric and spine. He believes that be-

tion with a network of physicians, as well as build-

ing a Center of Excellence will be vital in the new

ing specialty services in surgery,” Padilla said. “It

reform environment.

has a lot of big unknowns, but you’ve just got to put

“I think one big part of it is they’re going to be looking at quality of care, and what a better way to do that than to establish yourself as a Center of Excellence,” Padilla observed. Because MVMC is physician-owned, the execu-

yourself in a position to get ready for that.”

Preparing for the unknowns To prepare for these unknowns, MVMC has started

tive team is in constant touch with the physicians

picking up risk contracts or a per-member-

at monthly meetings. The arrangement enables

per-month (PMPM) contract, where the hospital

Padilla to aggressively pursue another one of his

agrees to a standard or set monthly payment

Press Ganey, the third party who monitors their surveys, has acknowledged this turnaround. In a letter sent to the leadership team, the organization noted that a significant transformation has been established within the system, one that has laid a solid foundation of culture change for the future.

goals--building a network of physicians.

from patients. It’s then MVMC’s responsibility to

cians. The primary goal of these efforts is to recruit

If a patient’s care is not properly managed, then

According to Padilla this culture change involved two strategies—a renewed focus on patient satisfaction and a drive to establish the center as a major competitor in a highly competitive area.

multi-specialty physicians.

the cost of that care could be higher than the PM/

In the last year, MVMC has recruited 20 physi-

case-manage these patients within the system.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

12 | Okeene Municipal Hospital

PM payment, essentially creating a situation where

“I’ve always had this philosophy that in this envi-

reimbursement does not cover cost for that month.

ronment, innovation is going to be important,” he

However, there’s a greater goal at work here,

added. “And when you go out in this environment,

Padilla said. “It doesn’t just mean case managing. It

you’ve got to be an innovative leader and you’ve got

also means keeping the patients in your network.”

to be adaptable to change because what you did

Beyond the patient base, vendor relationships

six months ago, especially with the new healthcare

are also changing, Padilla added. Hospitals are be-

reform, probably will not work in the future. You

ing more aggressive with their vendors, especially

need to know where you want to be in the future.

in orthopedics, where organizations are putting

You have to know how to get there from here.”

some services out to bid, even though they’ve had long-standing relationships with certain vendors.

by Pete Fernbaugh

It’s all about who will give them the best competitive price, Padilla explained, even in areas like surgery. Here, collaborating with the physicians is also very important; you need their buy-in on this strategy. “I think you’re starting to see this strategy through the United States,” he observed.

Making care about the patients Also in preparation for the unknowns, MVMC is increasingly focused on falls, restraints, and core measures. Padilla’s board is very involved in patient safety and quality matters, and they’re constantly looking at ways to improve their performance in these areas. For example, they implemented the use of high-low beds and stringent nursing protocols to reduce the risk of falls. PHH also trends various quality indicators and monitors the quarterly value-

Okeene Municipal Hospital

based purchasing report because it believes in the future, the healthcare reimbursement system will

Okeene Municipal Hospital is a 17-bed critical-access facility in Northwest Oklahoma that serves a community of 1200 and houses a primary-care clinic. To better serve its patients, two satellite clinics were established in surrounding towns, providing additional healthcare services to those in need.

increase its focus on a system based on pay-forperformance criteria. MVMC being in a competitive area, with hospitals only a few miles away, is another motivating factor to improving service. “Competition is good,” Padilla said. “And our challenge is going to be to gain market share, to establish the hospital in the area, and all of that is going to be contingent on the good service that we provide in the area.”

Shelly Dunham, Chief Executive Officer

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

INDUSTRY PARTNERS Hospital Equipment Rental www.swmedical.com

(HEN) in Oklahoma, an initiative of the Health

no results. After discussing the situation with the

Research & Educational Trust (HRET). The goal of

retired physician, he agreed to return to the hospi-

the network is to help hospitals adopt practices to

tal part-time until a new physician could be found.

reduce readmissions and harm to patients. Okeene has always been very conscious of

Developing partnerships across the state

After assessing the hospital’s physician needs, the Board of Directors at Okeene made the decision

quality care, and through the HRET, it is able to

to replace the retiring physician with a physician

track and identify areas for patient-care improve-

assistant (PA).

ments. The HEN contract involves intensive training

The hospital did an initial internal recruitment

programs to teach and support hospitals in making

search, but soon turned to a contingent-based firm

“Over the past several years, the Okeene Hospital

patient care safer and implement ways to measure

in Dallas that was able to provide three qualified

began experiencing increased difficulties when

quality improvement.

candidates for consideration. After interviewing all

transferring patients to larger facilities,” Shelly Dunham, chief executive officer, said. St. Anthony’s Hospital in Oklahoma City saw an opportunity to assist the smaller rural facilities with a streamlined patient-transfer process that

Dunham said the hospital generally performs well on its quality measures, but feels the numbers do not always accurately reflect the actual quality of care. “For example, when you only have four patients,

three, an offer was made and the new PA began seeing patients in June 2012.

Remaining strong for the community

would help patients return to their communities for

it only takes one low scoring item to knock down

Okeene faces many challenges as a rural facility

If a small or rural facility closes, the chances of

continuing care closer to home.

your overall score,” Dunham explained.

in today’s healthcare industry. Beyond Washing-

someone expiring on the way to a hospital farther

ton’s changing healthcare policies, the organization

away becomes a stronger possibility.

This streamlined process became known as

She also stated that compared to other Oklaho-

the Saints First Network. Okeene Hospital was one

ma hospitals, Okeene HCAHPS scores are typically

faces competition with two community hospitals in

of 12 rural facilities chosen to participate in the

very high.

towns that are each about 20 miles away.

network.

“Everything we do is community-oriented,”

“We are often a stepping stone for patients who need advanced care,” Dunham observed. “We are able to stabilize patients before they are transferred

and our hospital has benefited greatly from the

Staffing and recruitment challenges and successes

partnership,” Dunham said.

Dunham has been with the hospital for over 30

our best to keep our tax dollars at home by pur-

many community hospitals, and the future impact of

years and has served as CEO for 10 years. Recently,

chasing locally when possible.”

reform is uncertain.

“We were very fortunate to have been selected,

As part of the partnership, Okeene Hospital was able to implement EPIC, an electronic health

she was awarded the Advocacy in Action award

records (EHR) system, in the medical clinic in May

from the Oklahoma Hospital Association.

2012. It looks forward to installing the system in the hospital in early 2013.

Her lengthy association with Okeene is normal for the organization.

Dunham said. “We are located in the middle of town and are a huge supporter of small business. We do

In 2007, Okeene completed a $7.5-million build-

cally high debt numbers, and she is confident that the organization will do everything possible to make

to expand and update the existing building that was

sure that quality healthcare is available to those that

originally constructed in 1951.

need it, now and in the future.

process was an adjustment for all staff and initially

for many years,” Dunham observed. “We don’t typi-

The new facility includes additional patient

added additional time to patient appointments.

cally see a great turnover of physicians. With older

rooms, outpatient services, business offices, imag-

physicians looking to reduce hours or retire all in

ing, and lab.

all of the medical history has been added to the

the same time frame, it does pose a challenge.

Although having so many hospitals serving

system, appointment times have slowly started to

With the shortage of family-practice physicians

smaller communities may seem unnecessary,

return to normal. Physicians and nurses feel that

graduating, the ability to recruit in-house is almost

these rural hospitals are vital to the communities

EHR lowers their productivity during the day, but

impossible.”

they serve.

Okeene has used several different recruitment firms, both retained and contingent, in the past with

the move into a value-based system, and some

past charts.

disappointing results.

hospitals won’t survive the next wave of changes,”

by Okeene and the Hospital Engagement Network

Several years ago, a full-time physician decided to retire, but the search for a replacement yielded

by Patricia Chaney

“Many small facilities will struggle to make

ily available instead of having to search through Another important partnership was created

Dunham said that Okeene doesn’t have criti-

around the hospital and raised more than $300,000

“All of our current physicians have been with us

they do like having patient medical history so read-

Financial concerns are a primary challenge for

ing and renovation project. The community rallied

According to Dunham, the EHR implementation

However, once a patient has been seen and

to another facility. Although small, we are needed.”

Dunham said. “The sad part is that there will be huge gaps in rural areas.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

DEC/JAN

2013

Real Issues : Real Solutions

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