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Real Issues : Real Solutions

Children’s Hospital Los Angeles Conducting The Orchestra

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com

MAR/APR 2012

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Real Issues : Real Solutions

CONTENTS

06 Childrenâ&#x20AC;&#x2122;s Hospital Los Angeles

IN-FOCUS STORIES 10 Cottage Hospital 13 Davis County Hospital 16 Garfield County Hospital 20 Svelte Medical Systems 24 Orthopedic Surgery Center & Sports Medicine/ Marquez Orthopedics 28 Harrison Medical Center 34 Emerson Ecologics 38 Pikeville Medical Center

Elizabeth Cochran, MHA, Associate Vice President of Construction Design and Facilities Management

42 Clara Barton Hospital 46 Marpac, Inc 48 Parkview Adventist Medical Center 52 PrairieCare 55 Ramsell Holding Corporation 58 Hemosphere, Inc. 60 Sandoz, Inc.

HCE EXCHANGE

MAR/APR

2012

Conducting the orchestra

to accommodate patients, families, and caregivers

Elizabeth Cochran, MHA and associate vice presi-

and designed in such a way that all three can be ac-

dent of construction design and facilities manage-

commodated while in the same room together.

ment, was hired years after the project had started. Children’s Hospital Los Angeles brought her

determining these features. The hospital examined

onboard to coordinate the construction, activation,

some of the results that were coming out from the

and occupation of the building with timeliness and

Pebble Report and other children’s hospitals.

efficiency. When she arrived, steel was out of the ground, the hospital and install all mechanical systems.

asking children, in fact, what it is they would like to

Cochran’s first task was to determine whether the

see in a new hospital,” Cochran said. “And what the

current timeline for construction and building acti-

architects did is they used all that information and

vation was still feasible.

worked with the staff on what would be the most optimal use, not just on how the rooms would be

be assessed and then determining what status we

designed, but also how they would be used by the

were in terms of preparedness,” she said.

family, the caregiver, and what the patient would

scribes the process in terms of an orchestra leader conducting a large symphony. Her next step was to prioritize the order in

experience while they were in there.” For example, children wanted something to look at on the ceilings other than white tiles. Thus, graphic ceilings with clouds, butterflies, hot-air

which various areas of the project would be com-

balloons, and other scenes designed around nature

pleted. In this case, she was prioritizing 40 different

were developed so a soothing effect could be had

activities, including final equipment selection, tim-

on the patient.

ing of installation, setting up an infrastructure for

Whereas in the past, parents weren’t always

transition planning, and coordinating the integra-

allowed to stay and sleep in a child’s room, they are

tion of work among all the committees, whether

now encouraged to stay for as long as they want.

licensing, executive steering, patient-in-move,

Studies have found that this can be a stress reliever

patient care, or IT.

for both child and parent.

“All of these committees together worked on

Originally a 286-licensed bed hospital, the project added 317 more beds to the hospital for a total of 603 beds, making Children’s Hospital Los Angeles the largest Children’s Hospital in California.

to the design of the building, and there was a considerable amount of work with patient families and

Cochran spent her first 60 days on this and de-

In July 2011, Children’s Hospital Los Angeles completely occupied its new 460,000-sq.-ft. state-of-the-art facility for the first time since planning began in 1999.

“There was a lot of research that was done prior

and the construction team was starting to frame

“It was really a multitude of activities needing to

Children’s Hospital Los Angeles

Evidence-based design played a large role in

“Every room is designed that a parent may be

critical tasks,” Cochran said. “Each one had a large

able to stay and sleep with their child at the bed-

list of critical tasks on which they had to evaluate,

side,” Cochran said.

test, and complete assignments, so that at the end

Each room has its own restroom and entertain-

of the list, it ensured that everything was ready for

ment system that also serves as an educational

operationalizing our new hospital.”

programming center where the parents can access

Accommodating the occupants

materials that will help them better understand their child’s illness. Architects also developed a series of urban

If one word could be used to describe this new facil-

gardens on the grounds of the hospital that include

ity, it might be accommodation. Each room is zoned

patio settings where families can eat together and a

HCE EXCHANGE MAGAZINE

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changes in the designs at the last minute, and they Even the donor base went above and beyond in its support of the project. The hospital foundation raised $250 million of the $636 million needed for the new facility. Cochran, therefore, offers one piece of advice to other hospitals who are embarking on large-scale projects. “Hire the right teams,” she said. “It’s all about the teams—the architect team, the contractor and their team. It makes the biggest difference when you have executive-leadership support of the construction and project-management team. I’ve been on other projects, and some even bigger than this one, and that one thing made all the difference in successfully completing our goals together.”

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By Pete Fernbaugh

outlets for IVs. “In talking with families, one of the goals was to provide a place where families can be outdoors and relax or meditate, if you will, get out of the hospital and go into a green zone or an area that was not urban and was more relaxing,” Cochran said.

It’s all about the team As Cochran looks back on the process, she is amazed at how each phase flowed. Although the project wasn’t completely devoid of any flaws or hiccups, Cochran said it was one of the smoothest construction projects in her experience. There were no major redesigns or changes in spite of a short coordinated slowdown because of a budgetary matter. She credits the success of this project to the construction management, architect, and contrac-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

02 | Cottage Hospital

Cross training Maria Ryan became chief executive officer in 2010, inheriting a hospital that had experienced decades of financial struggle. But while surrounding hospitals have had to cut staff, Cottage Hospital has been

Cottage Hospital partners with Winthrop to leverage custom technology leasing solutions.

able to maintain staff and benefits through Ryan’s common-sense approach. She shudders at the thought of mediocrity, saying, “I only want to be associated with the best, and I demand excellence from myself.” The hospital enjoyed back-to-back financial gains with a greater-than four-percent margin in fiscal year 2011. Part of the organization’s success has been attributed to an increased emphasis on staff training. Cottage runs a lean operation, and nurses must be able to assist in multiple areas of the hospital. Thus, Ryan focused on ensuring that the staff was cross trained in many areas. All nurses have

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Basic Life Support certification and many have Advanced Cardiac Life Support and Pediatric Advanced Life Support certifications. The medical staff holds these certifications as well. “Because everything in nursing is so special-

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ized, it has taken years to accomplish training a staff that can work in multiple departments, but we are willing to invest in them,” Ryan said. When patient volumes are low in a particular

Cottage Hospital

area, Ryan will send staff for training at the local tertiary-care hospital for three months to get experience in a high-volume department. Ryan invested

Many businesses are required to do more with less, and for hospitals, this pressure increases every day. One small hospital in New England takes a common-sense approach to managing costs and patient care. Cottage Hospital is a 25-bed critical-access hospital in Woodsville, N.H., serving 26 small towns in the beautiful Upper Connecticut River Valley of New Hampshire and Vermont. There are approximately 40,000 people over age 65 within a 35-mile radius of the hospital. Medicare makes up about 50 percent of the hospital’s payer mix, requiring creative strategies for managing costs.

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in a computerized life-size mannequin patient, a SimMan, who can simulate a heart attack or trauma situation. The clinical directors are able to run different scenarios in the simulation lab to keep staff

deficiency,” Ryan said. “This room concept and

competent.

design contributed to a holistic view of patient care.

In an effort to maximize the use of patient beds and the experience of cross-trained staff, Cottage Hospital has established a concept known as Vari-

This flexibility really adds so much efficiency to a rural healthcare setting.” Ryan herself has a wealth of knowledge and

able Acuity Rooms. These rooms are equipped for

experience to draw upon. She began her career in

critical-care or medical /surgical patients.

nursing and holds a master’s degree in the science

“By incorporating this concept, nurses now

Maria Ryan, PhD, APRN, Chief Executive Officer

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of nursing, and she is an Advanced Practice Regis-

have immediate access to their colleagues, nursing

tered Nurse (APRN). Ryan also achieved a doctorate

assistants, and unit secretaries, which was a prior

in healthcare administration. She has been called

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

03 | Davis County Hospital

upon to use her medical knowledge and has often taken care of patients in emergency situations.

Simplifying efficiency Dedicated to retaining and attracting highly talented

Looking for growth

individuals and adding services, Ryan is always

With a high percentage of Medicare patients, it

Lean Six Sigma processes, Cottage Hospital has

can be hard for a small, rural hospital to find the funds for growth. Previously, Ryan said outpatient services had been the main source of income for the hospital, but inpatient volume has significantly increased. Most recently, Cottage Hospital has expanded its outpatient services by opening a medical and cosmetic laser center. Ryan said she was skeptical at first about whether the cosmetic side of the laser center would be successful in this economy, but she said the cosmetic side is now driving business more than the medical side. The center has also become a new access point for patients to learn about the hospital. “The laser center has made us a destination for people who haven’t used our hospital in the past,” she said. “We have a high level of customer service, and these new patients have come back for other services we offer.” To evaluate growth opportunities, Ryan said the leadership team is constantly looking at new strategies or services and often gets creative ideas from employee forums. She said one employee talked about community-supported agriculture during one forum, which spurred the hospital to increase its

looking for ways to increase efficiency. Through been able to maintain its staffing levels and create some new jobs as well. Ryan also said that while most rural hospitals around her have closed their birthing centers, Cottage Hospital has been able to maintain this service despite its poor payer mix. Future plans include adding a 10-bed secured geriatric behavioral-health unit. With the aging population in the community, patients have nowhere nearby to get help when they have behavioral-health issues. Ryan said the unit would be for short-term care and would focus on providing treatment and helping patients to return home. Looking toward the future, Ryan keeps her focus on simplification--simplifying processes to

Davis County Hospital

make workflow more efficient and simplifying the healthcare system to make receiving care easier for patients. “We really need to simplify how we function,” she said. “The healthcare system can be overwhelming for patients and their families. People get scared when they hear talk of a broken healthcare system, but there are people who care and who want to make a change.” by Patricia Chaney

purchase of local meat and produce. “This employee helped us to realize how impor-

Deborah Herzberg, Chief Executive Officer

tant we are to the community and that we needed to spread our economic impact around our area,” Ryan said.

Just because a hospital is located in a rural service area doesn’t mean it isn’t progressive and steadily evolving with the times. Davis County Hospital, a 25-bed critical-access county facility in the primarily rural southeast corner of Iowa, is a prime example. With approximately 13,000 people in its service area and annual revenues in the $24 to $26-million range, Davis County Hospital is the only critical-access hospital in Davis County. In June 2010, Davis County Hospital completed a large-scale renovation project that introduced a new patient-care area for inpatients and a brand-new ER. Key to the renovation was enhanced patient privacy and employee and patient safety, along with several significant upgrades in hospital technology and focused attention on implementing the best contemporary infection-prevention practices.

Steps like these, along with improvements in patient care, have turned around the hospital’s

The renovation also brought MRI services in-house, rendering the MRI mobile unit, so common in rural healthcare, obsolete for Davis County Hospital’s area. Additionally, the hospital opened a sleep lab to study an alarming number of patients in its area who suffer from sleep apnea and have the potential to develop cardiac disease or diabetes as a result.

reputation within the community. Ryan said during a recent visit to a nursing facility that is home to many of the hospital’s patients, people remarked on how much the hospital has changed over the years

Working with Communications Engineering Company (CEC), Davis County Hospital integrated a new nurse-call system and brought all of its other low-voltage technology onto one platform under CEC.

from a “band-aid facility” to a provider of choice.

Thanks to these measures, Davis County Hospital is a stand-out organization in the American rural healthcare scene. But Deborah Herzberg, chief executive officer, said this doesn’t exempt Davis County Hospital from the present and future worries that plague rural facilities and that threaten their very existence. Real Issues : Real Solutions

For example, three years ago, Davis County HospiÂ&#x160; QVXOWLQJ SDO &R %OX2

Guiding organizations to achieve results by

awakening the power in people.

or managing disease processes. The population is

tal took a â&#x20AC;&#x153;leap of faithâ&#x20AC;? with two other hospitals in

heavily elderly, and oftentimes, worse complications

the network and employed an orthopedic surgeon

develop because of this neglect. She is worried that

who could serve the needs of a large group of

politicians wonâ&#x20AC;&#x2122;t take into account the nurturing

elderly patients that simply did not want to travel to

and educational relationship that rural hospitals

the city, regardless of their personal needs.

have with their patients when it comes time for a Congressional vote on the critical-access hospital program. â&#x20AC;&#x153;I think there are a lot of things on the horizon

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that are going to be very important to us as rural Americans,â&#x20AC;? she stated.

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In addition to networking, continuous improvement, especially in all facets of patient safety, is a priority for Davis County Hospital, Herzberg said. Using HCAHPS as its guide, each department leader is given a question that theyâ&#x20AC;&#x2122;re required to answer and implement. Davis County Hospital is also partnered with Press Ganey for its patient-satisfaction

access hospitals. Davis County Hospital is already a

surveys and regularly studies the results.

part of the Mercy Des Moines Central Iowa Network Herzberg said Davis County Hospital is required

â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;re really focusing on those questions and how our patients are responding to those to make improvements in the care that we are providing to

to be a member of a network according to the

them, whether thatâ&#x20AC;&#x2122;s the sound around their room,

Critical-Access Hospitals Conditions of Participa-

or the food that they are brought as a part of our

tion, but the benefits go deeper. A network brings a

dietary services, or the care and the education

group of like-minded facilities together and enables

that the nurses provide for them,â&#x20AC;? Herzberg said.

them to share best practices and benchmark quality

â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;re constantly looking at that.â&#x20AC;?

scorecards and provide needed support for each other.

The perils of being underappreciated

Focusing on patient experiences

zberg said, is to network with fellow rural critical-

that consists of 16 other hospitals.

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â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s just figuring out how do we do it and how do we manage our resources effectively.â&#x20AC;?

â&#x20AC;&#x153;The networking that Iâ&#x20AC;&#x2122;m able to do with other

Herzbergâ&#x20AC;&#x2122;s nursing background motivates her drive for safety, and lately, sheâ&#x20AC;&#x2122;s been dutifully focused on being a positive influence within the

critical-access hospitals CEOs, even outside the

community. Her goal is to steer Davis County away

network, is very important because all of us are dif-

from an illness model to a wellness model. With a

As CEO since January 2006, Herzberg has sought to

ferent, we all have different strengths, so it gives us

limited revenue stream, however, this is a daunting

build a senior team that is dedicated to the core val-

the ability to share ideas,â&#x20AC;? she explained.

task.

Competition can produce isolation, though,

ues of integrity, honesty, commitment, persistence, and community. â&#x20AC;&#x153;Rural healthcare, I donâ&#x20AC;&#x2122;t believe, is appreciated enough,â&#x20AC;? she said. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m really concerned right

the limited resources that we have is probably a

Herzberg believes that competition shouldnâ&#x20AC;&#x2122;t be the

challenge that I think I feel a lot of pain in, because

priority.

we know what the right things are to do,â&#x20AC;? she said.

â&#x20AC;&#x153;Thereâ&#x20AC;&#x2122;s a tendency for all of us to want to

now about how our federal government is going to address these issues, and whatâ&#x20AC;&#x2122;s thatâ&#x20AC;&#x2122;s going to

compete for the market share, but I really think that

mean for the patients that we serve, because we

the key to moving forward with healthcare reform

know that the patients we serve in rural America,

and how we change healthcare has got to be col-

especially in our area, if they canâ&#x20AC;&#x2122;t get it done here

laborating together and how do we work together

at their local hospital or thereâ&#x20AC;&#x2122;s not a local health-

more, rather than competing,â&#x20AC;? she said. â&#x20AC;&#x153;How can

care option for them, they just donâ&#x20AC;&#x2122;t get it done.â&#x20AC;?

we collaborate better to make sure that our patient

Herzberg said that many patients in Davis

needs are being met and that we can still maintain

County Hospitalâ&#x20AC;&#x2122;s area do not focus on wellness

â&#x20AC;&#x153;Figuring out how we are able to do that with

but with the industry in an extreme state of flux,

â&#x20AC;&#x153;Itâ&#x20AC;&#x2122;s just figuring out how do we do it and how do we manage our resources effectively.â&#x20AC;? by Pete Fernbaugh

healthcare access in each of our communities?â&#x20AC;?

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

04 | Garfield County Hospital

Healthcare Resource Group Inc.

Garfield County Hospital Perhaps some of the hardest-hit hospitals these days are small, rural criticalaccess hospitals. Garfield County Hospital in Pomeroy, Wash., is currently facing significant challenges to ensure its doors stay open so it can continue to provide care to the community that depends on it.

Andrew Craigie, CEO

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Going Lean to cut costs About eight years ago the hospital began a culturechange initiative to create a more homelike environment and to improve efficiency. “We wanted our culture and environment to reflect the same warmth and charm of our community,” said Andrew Craigie, chief executive officer. “It has taken a long time, and it’s an ongoing process, but the culture change has been effective. We are

Garfield County Hospital services a fairly large geographic area with a sparse population of about 2,300 people. It sits near the border of Idaho, and the referral pattern leans toward that direction. For a rural hospital, Garfield County is fairly accessible, being located on State Highway 12. The public hospital has 25 beds, and it also offers a rural health clinic, an emergency room, diagnostic laboratory services, and physical therapy.

family-focused, and there’s not an institutional feel

Patients have access to regional medical centers about 40 minutes east toward Idaho and about an hour southwest toward Oregon.

areas.

about our facility.” In addition to culture change, Garfield County Hospital implemented Lean Six Sigma processimprovement methods across numerous operating “Lean has been fundamental to helping us achieve and sustain gains in the organization from

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

direct care to medical records to admissions to

“Medicare rates haven’t stabilized yet to reflect

and create an environment of care that fosters

revenue-cycle improvement,” he said.

the new bed count, so we have about an $800,000

productive relationships between the practice team

The Lean process has also influenced the

cash-flow loss because of this destabilization, even

and patients. The hospital is reporting outcome

hospital’s current efforts to meet meaningful-use

though we are almost exactly on budget this year,”

metrics for diabetes, cardiovascular disease, and

criteria. The hospital has identified a preferred

Craigie said.

other chronic conditions, and it is developing a

electronic medical records vendor, but is struggling

Even with changes and Lean initiatives, the

to find interim financing to begin the implementa-

hospital is facing financial struggles. Recently, the

tion process.

community has stepped up by approving a $750,000

Making ends meet Garfield County Hospital is still facing financial

tax levy to fund maintenance and operations of the facility until reimbursement stabilizes. During this period, Garfield County Hospital is

challenges, resulting in big changes to the orga-

doing everything it can to free up cash flow, while

nization. The hospital had subsidized the nursing-

trying to preserve staff. Most of the staff have taken

home part of the facility based on the needs of the

a reduction in hours, and executive staff, includ-

community, but in recent years, that service has

ing Craigie, has taken a 40-percent pay cut in the

become unsustainable. The hospital made the

interim.

decision to eliminate surplus nursing-home bed capacity by closing 20 of its nursing-home beds.

A member of the community

The hospital system expects this decision to help

The challenges faced by Garfield County Hospi-

bring greater financial stability based on utilization

tal are common to many rural facilities, which,

and reimbursement.

although small, are important members of the

Craigie said that in the early years, the nursing

communities they serve. Garfield County Hospital is

home was in high demand by the community, even

reaching out to the community to help it understand

though the contribution wasn’t enough to cover the

the struggles it faces.

cost of operating the nursing home. In 2007, the hospital began to see a decline in

using a chronic-care model. “As a rural hospital, we have a unique opportunity to affect the quality of health for our communities that urban settings don’t have,” Craigie said. “We have close relationships with our patients. They are our neighbors, our kids, our peers, and families. We have a special opportunity to serve and make a difference in the community we live in.” by Patricia Chaney

community, to make sure they understand that what we’re experiencing is not because the hospital

service area’s population has also declined dur-

is poorly run or ignoring its responsibility,” Craigie

ing the past decade as well, and state initiatives

said. “Our small rural communities are worthy of

encouraged people to find alternatives to nursing

the services we provide. If we weren’t here, our

homes by making it difficult for them to qualify

patients wouldn’t have services close to home. It is

for benefits or creating incentives for them to use

essential to sustain our rural health systems.”

alternatives. The deficit attributable to the nursing

Rural hospitals provide a unique setting for

home in 2010 reached $1 million, a large chunk of

community-based initiatives and close observation

the hospital’s $8 million budget. It became evident

of outcomes, particularly related to chronic condi-

that a reduction in beds was necessary.

tions such as diabetes. Garfield County Hospital

the hospital’s finances.

structured approach to managing those encounters

“We want to preserve our credibility with the

utilization, reaching only 70 percent in 2010. The

However, reducing the beds hasn’t yet improved

“We have a special opportunity to serve and make a difference in the community we live in.”

is implementing a health-home initiative in the primary-care environment to connect with patients

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

05 | Svelte Medical Systems

Improving stent delivery Svelte Medical Systems has developed an Integrated Stent Delivery System (IDS) that is the lowestprofile balloon-expandable stent in the market. The companyâ&#x20AC;&#x2122;s bare-metal stent, the Svelte Acrobat, has been released in Europe and Brazil. Svelte plans to start clinical trials in the United States this Healthcare Resource Group Inc.

year and is raising funds for a full OUS commercial

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launch and the U.S. clinical trial. â&#x20AC;&#x153;We have done a limited launch to put the product in the hands of physicians,â&#x20AC;? Pomeranz said. â&#x20AC;&#x153;So far we have gotten positive feedback. We have also seen some surprises in the use of the product that reduce procedure time and potentially improve recovery time for patients.â&#x20AC;? In a traditional angioplasty, patients have a catheter placed for a diagnostic check, then change out the diagnostic system and put in a new system

Svelte Medical Systems With many healthcare facilities cutting budgets and having to make harder choices about new technology, developing innovative products can be a challenge. One company has sought to introduce not only a new product, but also to re-engineer an entire procedure. Svelte Medical Systems has created a low-profile expandable stent that eliminates about 50 percent of the steps involved in a normal stenting procedure.

Mark Pomeranz, Chief Executive Officer

â&#x20AC;&#x153;Our company is the first in 15 years to look at how to improve the angioplasty procedure and stent delivery to the patient,â&#x20AC;? said Chief Executive Officer Mark Pomeranz. â&#x20AC;&#x153;Our product provides benefits to the physician, patient, and payer. We have innovated not only around the product, but also around the entire procedure.â&#x20AC;?

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medventure.com Delivering innovation. Elevating lives.

Real Issues : Real Solutions

to allow for the passage of the stent. Pomeranz said physicians using the Svelte Acrobat have put the product through the catheter used for diagnostic check, eliminating the need to change out the access system. And by making everything smaller, the access site for patients is smaller, lowering bleeding complications post-procedure. He also said fewer ancillary products are used along with the Acrobat. “We have seen a low amount of contrast agent

“We provide more innovation than just the incremental improvements here and there.”

“Once the hospital administration understands our story and realizes the product will save them time and money and provide potential safety benefits to their patients, they are open,” he said. “But there is resistance to bringing new products into hospitals because of the economic pressures in the healthcare environment.” He said Europe is a more challenging market than the United States. Svelte has developed partners in countries throughout Europe. This has been

being used, which is a benefit to patients, many of

essential to its initial success, because each coun-

whom have poor renal function,” Pomeranz said.

try has its own filings and approval processes that

Svelte has three additional technologies in

are nearly impossible to navigate without partners

various stages of development and testing. The IDS

The family has more than 200 patents related to

technology navigates the arteries like a guidewire

medical devices and has launched more than a

and offers time and cost savings to physicians. The

dozen medical companies in the past 20 years.

Hybrid Acrobat Stent contains variable-width struts

David Fischell is a physicist and stent designer,

to create a flexible design that can be crimped to a

while Tim Fischell is an interventional cardiologist.

low diameter on the IDS. Svelte is also developing a

Coupled with the family’s vast knowledge of the

Sirolimus-eluting stent that has non-inflammatory

market, the management team at Svelte has more

properties, making it less irritating to the ves-

than 90 combined years of experience in bringing

sel lining. The coating is being developed to have

medical devices to market.

the same drug-release kinetics as other products

The idea for the Svelte technology came while a

“We are taking the next step in driving benefits to the physician, patient, and payer.”

in those countries. Depending on the country, Pomeranz said Svelte will market either to a distribution partner or by direct sales. He said the initial target is the interventional cardiologist. “We work with the physician, giving them access to the product,” he said. “Once we have physician backing, we move onto the sales process with the hospital administration.” Pomeranz envisions Svelte Medical Systems

currently on the market and is fully absorbed once

family member consulted with Johnson & John-

becoming a key player in the angioplasty market

drug elution is complete.

son. In the 1990s, Johnson & Johnson decided to

with a full range of approved products available

pursue a different technology that mated well with

inside and outside the United States.

“We have initiated a clinical study on the drugeluting device,” Pomeranz said. “It has an amino-

the stent design of a smaller company Johnson

acid coating that will naturally bio-erode in the body

& Johnson had acquired. In 2007, the Fischells

cremental improvements here and there,” he said.

in about nine months. Current enrollment is going

licensed the IP from Johnson & Johnson and pur-

“We are taking the next step in driving benefits to

well, and we anticipate having follow-up data avail-

sued the technology on their own.

the physician, patient, and payer.”

Breaking into the market

by Patricia Chaney

able in the second half of this year.”

A family of entrepreneurs

“We provide more innovation than just the in-

Svelte has developed an innovative product that

Robert Fischell, Sc.D., and his sons, David Fisch-

changes the angioplasty procedure, but introducing

ell, Ph.D., and Tim Fischell, M.D., founded Svelte

change into a struggling healthcare market creates

Medical Systems in 2007 with a mission to “improve

its own challenges. Pomeranz said fundraising is

stent deliverability, reduce procedural time and

a major focus of the company and is more arduous

costs, and improve patient outcomes.”

now than it has been historically.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

06 | Orthopedic Surgery Center & Sports Medicine/ Marquez Orthopedics

“I enjoy independence in my practice,” Dr. Marquez said, “but there is an advantage to being part of a large hospital system. I have been part owners with the hospital for about 15 years, and the relationship with a multi-hospital system provides the advantage to my patients of having access to all the services they need on one campus and to my business from an insurance standpoint.” At his office, he is able to provide a full complement of services from X-ray, open MRI and other imaging services, to in-house physical therapy.

A reputation for quality and innovation Dr. Marquez primarily sees patients for total joint replacement and reconstruction. He has been serving patients in the Rio Grande Valley for more than 17 years and is a proponent of new technology and innovation. In 1999, Dr. Marquez designed and patented a

Orthopedic Surgery Center & Sports Medicine/ Marquez Orthopedics

mobile-bearing knee implant known as the RAM Mobile Bearing Knee. The design was developed in conjunction with Encore Orthopedics in Austin, Texas. As minimally invasive surgery becomes more common and more often requested by patients,

As many solo practitioners in today’s healthcare market find themselves merging with or entertaining employment opportunities with hospitals, finding a balance between independence and partnership with a large organization can be challenging. Dr. Raul Marquez, of the Orthopedic Surgery Center & Sports Medicine in Edinburg, Texas, seems to have struck a balance in being a solo practitioner that works with a large healthcare organization to provide cost-effective, high-quality orthopedic care for his patients.

Dr. Raul Marquez, Chief Executive Officer

Dr. Marquez’s practice is located on a medical campus that includes Cornerstone Regional Hospital, which is part of the South Texas Health System, a rehabilitation hospital, a gym, and physician offices.

Dr. Marquez has met this demand by utilizing a computer-assisted navigation system, the OrthoPilot Navigation system by Aesculap. As with robot-assisted surgery, the system helps remove human error in measurements or implant alignment, providing a procedure with long-lasting

Aesculap Implant Systems Aesculap Implant Systems focuses on delivering innovative orthopaedic solutions and maintains a surgeon/patient focus with the goal of improved operative procedures and patient outcomes for a better quality of life.

results. Dr. Marquez has been a leader in using the system and travels throughout North America, Europe, and Canada to train other surgeons on the implantation of prosthesis using the navigational system.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

Offering cost-effective care All medical organizations are being asked to do more with less these days, and orthopedics is no exception. Originally from Mexico City and operating hospitals in Mexico, Dr. Marquez has a unique point of view on the value of providing cost-effective surgeries. “Medical tourism is gaining popularity these days,” he said. “Patients can go outside the United States to receive the same operation for much less, about $10,000. Mexico, India, and countries in South America have strong medical tourism. But in the United States, patients are protected 100 percent with liability insurance and other guarantees. With medical tourism, they’re on their own.” To encourage more patients to stay in the United States for joint-replacement procedures, Dr. Marquez has developed a total-joint program that provides the surgery for a similar price to other countries. This requires him to negotiate with the hospital, the prosthesis manufacturers, and himself for his own fees. “We all have to come to an agreement on price, but it can be done,” he said. “My vision is to let phy-

“I have experience in the hospital side and office side, and I find that we are able to produce more affordable care by knowing the real cost of our work.”

These reductions do change the business model he has provided over the years, as patients face reduced access to care and Dr. Marquez must make more cost-conscious decisions on prostheses. “With less money available, it limits the type of prostheses and tools we are able to use in surgery,” he said. However uncertain the future may be, Dr. Marquez is dedicated to finding solutions for providing affordable care. He is focusing on expanding services and educational initiatives. His practice provides community outreach to patients, educating them on procedures and ensuring they have realistic expectations. He also provides educational programs that are

sicians know we can do the same procedures in this

focused on teaching physician assistants, nurses,

country for one-third the normal charge.”

and other allied health practitioners about expecta-

Bringing about these negotiations in light of re-

tions and costs. Dr. Marquez said it’s important that

duced payments and healthcare reform is extreme-

physicians also understand the true cost of surger-

ly difficult. Dr. Marquez said that as long as reform

ies and the difference in cost in providing those

continues to reduce fees for medical providers,

surgeries in a hospital. “I have experience in the hospital side and office

there is less incentive to be in the business. “Medicine is one of few businesses where we

side, and I find that we are able to produce more af-

are lucky if we maintain the same pay every year,

fordable care by knowing the real cost of our work.”

whereas many other employment sectors get yearly

by Patricia Chaney

raises,” he said. “Twenty years ago when I started total joint replacement, Medicare reimbursed about $3,000. Now, the reimbursement rate is about $1,200.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

07 | Harrison Medical Center

Harrison Medical Center Harrison Medical Center was founded in 1918 as a community hospital. In 2012, it stands as its area’s busiest medical center, consisting of two main campuses in the state of Washington, one in Bremerton and the other in Silverdale. A non-profit organization, Harrison also has locations in Port Orchard, Belfair, and Poulsbo, and a number of physician offices in the county.

Adar Palis, Executive Vice President and Chief Administrative Officer

The board has also authorized a number of physician-alignment initiatives, one of which is healthinformation exchange. “We’ve rolled out a health-information exchange in this community already, and we’ve

With 2,300 employees, 450 credentialed physicians (or 90 percent of their physicians), and 297 licensed beds, Harrison has the fifth-busiest emergency room in Washington and is a Level III trauma center.

connected a number of providers,” Palis stated.

As Adar Palis, executive vice president and chief administrative officer, was firm to point out, these statistics attest to the hospital’s steady focus on patient quality.

of care. It’s better for the patient. It’s better for the

“We want to fully extend this so they can share key clinical information back-and-forth for continuation physician, because then they’ll have all the information about the patient from different specialists and different doctors throughout the community.”

No challenge too great Palis said Harrison’s challenges are no different from other organizations, the overarching challenge being, of course, the uncertainty of health-

Company description Structured Structured is a leading information technology consultancy and systems integrator that has partnered with hundreds of clients throughout the U.S. to maximize the value of IT. For two decades, Structured consultants have collaborated with CIOs and IT departments to develop and implement technology strategies that drive measureable improvements throughout the organization.

care on the federal level.

“We have the best door-to-balloon time in the state of Washington.”

“We’re a non-profit organization so we take all patients whether they have insurance or not,” he said. “The government is going to cut Medicare. It’s going to be cutting Medicaid. Then you hear all of the stories about how many further cuts they’re

A board united

going to have. That really impacts a hospital like

Palis said that the hospital board as a whole is

building a 24-bed unit along with shelled space for

oriented around patient quality and is involved at

24 more beds. Silverdale will be given four more

Harrison.” To circumvent this as best as possible, Harrison

every step of the way. In fact, board members often

ORs, a larger ER, and a brand-new data center and

is focused on finding quality personnel and more

spend the first hour or two of each meeting talking

professional office building.

physicians. It’s also striving to more effectively pro-

about quality. “I’ve seen other boards, and they usually will focus on financial,” he stated. “Not our board. They focus much more on quality.”

Palis added that Harrison as a whole is about 75 percent complete when it comes to the implementation of EMRs. “We took a pause on that to obviously work on

mote its three service lines—orthopedic, oncology, and cardiovascular. Palis is involved in the promotion of the orthopedic and cardiovascular lines. This strategy

meaningful use, but once we attest for meaningful

involves partnering and aligning with physicians in

be expanding its Silverdale location by building

use within the next year, we’re going to begin roll-

the community.

a new tower on the campus. It will also expand it

ing out bedside barcoding and rolling out physician

orthopedic service line at Silverdale and will be

order entry,” he said.

As a result of prioritizing quality, Harrison will

Based on a thorough analysis of the client’s existing IT infrastructure and the overall business goals and objectives, Structured draws on its two decades of experience to articulate a roadmap defined by market-leading process, security and management solutions that align with the client’s priorities. In addition to its unwavering commitment to providing excellent customer service, Structured is known for its expertise in the core areas of IT most critical to the success of its clients, including application delivery and virtualization, information security, data availability and enterprise networking.

“An ability to partner and align with our physicians in the community for the benefit of the

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

Your technology decisions shouldn’t be a leap of faith.

Structured: Your Trusted Technology Partner Solutions and services for Harrison Medical Center

Faced with the increasing challenges of providing Healthcare IT services, Harrison Medical Center turned to Structured for technology leadership and industry expertise. Through a variety of engineering support services and turnkey solutions, Harrison Medical Center is now able to meet the demands of a fastpaced healthcare environment with technology excellence. With strengths in every discipline across the portfolio of healthcare IT, Structured is empowering clients to meet their goals today while ensuring the solution is ready to meet the challenges of tomorrow.

Information technology has played a vital role in the innovation of healthcare systems and is now critical to providing quality patient care.

Despite these advancements, healthcare practices still face intense pressure to control costs, while improving patient safety and quality of care.

Structured is a technology consultancy and system integrator that helps healthcare organizations maximize the value of IT investments to improve quality of care, operational efficiency, and address compliance mandates through the innovative use of technology.

Structured provides secure infrastructure, networking, wireless, storage and systems in industry-leading solutions for healthcare: · Strategy and regulatory compliance · Application delivery and virtualization · Information security · Data availability · Enterprise networking · Professional services

1.800.881.0962

www.structured.com

Structured For 20 years, Structured has been a proven partner

company freedom to truly advise its clients. It is a

to technology managers at healthcare institutions

consulting firm, systems integrator, and procure-

around the country. With offices in seven states and

ment organization focused on successfully engag-

the ability to support a global client base, Struc-

ing at the level that best serves its healthcare

tured’s goal is to assist healthcare providers with

clients.

increasing patient/clinical satisfaction by maximizing the value of an institution’s IT investments. Beyond being an IT service provider, though,

In short, Structured delivers the knowledge and expertise to empower healthcare organizations to meet the goals that they have today and

Structured is also a strategic healthcare-solutions

ensure that those solutions will expand into

partner, working in close collaboration with execu-

tomorrow.

tives, IT staff, clinicians, and administrators. “Technology is not just a tactical consideration

With healthcare changing rapidly, Fowler emphasized that Structured is focused on more

of your organization,” Ron Fowler, chief executive

than just the functionality of systems; they’re

officer of Structured, said. “It’s really quite central

focused on the core—the data that is at the heart

to your strategic plan. It determines how you’re

of healthcare IT.

going to address many aspects of your operations,

“We are committed to helping our clients

functionality, and customer service. IT leaders,

protect and manage the integrity of that data –

specifically in healthcare, are faced with myriad

ensuring its accuracy, consistency, and reliabil-

technology considerations and have increasingly

ity,” he said.

unique demands for their budgetary resources. This is where Structured can help.” Structured sees itself as a trusted adviser to healthcare providers on matters that include the

This belief that data is one of its clients’ most important assets is one way that Structured differentiates itself within the industry. “We need to understand how this data is going

design, configuration, deployment, and imple-

to move between different platforms, how it’s

mentation of technology solutions ranging from

going to get used effectively, how you’re going to

enterprise-wide networks to the cloud-ready infra-

secure it, and how you’re going to make sure it’s

structure. Structured provides expertise on topics

archived and backed up,” Fowler explained.

increasingly important in today’s business envi-

Second, Structured cultivates a culture that

ronment, such as mobility, data storage, security,

values engineering excellence. Fowler said that

cloud computing, and virtualization.

nearly half of Structured’s staff consists of highly

Structured offers organizations a wide-ranging technology-solutions portfolio that allows the company’s experts to look at the big picture and architect solutions across the entire healthcare technology infrastructure, avoiding the dangers of

trained solution engineers that have certifications, skills, and experience. “Those are really the building blocks of our organization,” he stated. With the industry facing multiple challenges,

a siloed IT approach. It has healthcare industry and

including cost reduction, stringent federal

operational experience in aligning IT with the true

requirements, siloed technology, and fewer

needs of the organization and its priorities, such

resources, Structured has positioned itself as the

as EMR, and deep technology and engineering ex-

healthcare provider’s guide and friend through

pertise across all forms of virtualization, including

murky waters.

client, application, server, storage, and network.

patients is definitely something I want to always be

To this end, he cites empathy, innovation, quality,

involved in,” he said.

and courage as his core values.

Furthermore, Harrison is attempting to meet

“All of us have been or will be a patient in a hos-

appropriate-care measures, perfect-care mea-

pital,” he said. “We should treat everyone that way,

sures, and stroke measures.

and how we would want to be treated.”

“We spend a significant amount of time working on that,” Palis said. “It’s a big focus for the organi-

by Pete Fernbaugh

zation. It’s a big focus for the service line.” For example, because stroke measures require ERs to have easy access to CT scanners, Harrison has sought to improve this area of its service line. Its EMR also has a number of triggers to help the center meet other core measures, such as reminders for certain kinds of documentation. Helpful in these endeavors is Harrison’s heart and vascular center, which is already recognized as one of the best in the state. “That’s an important investment that we’ve made as far as capital to build a three-room heartand-vascular center in the hospital,” Palis said. “We have the best door-to-balloon time in the state of Washington.”

A rising star Palis himself exemplifies Harrison’s passion for quality. A driving force behind the center’s threeyear endeavor to implement a $30.5-million electronic medical record, Palis was named one of the “Rising Stars: 25 Healthcare Leaders Under Age 40” by Becker’s Hospital Review in 2011 when he was serving as chief information officer, a role he held for four-and-one-half years. Now as executive vice president and CAO, Palis has two overriding standards for his leadership— the patients come first and quality matters. “The patients are the key here,” he said. “I really hope that we’re a safe place and a high-quality place for patients to be taken care of, a destination hospital for employees, and one of the best places that employees want to work.”

Structured’s consultative business model gives the

HCE EXCHANGE MAGAZINE

08 | Emerson Ecologics

Integrative Therapeutics Integrative Therapeutics is North America’s leading manufacturer and distributor of highquality, science-based dietary supplements for medical professionals and their patients. Every day, more than 50,000 doctors recommend our products to their patients—an indicator of trust, quality and value. We value Emerson Ecologics’ shared dedication to quality and are honored to have the Gold Partner status in the Emerson Quality Program. Together, we look forward to continuing to provide practitioners with the B.E.S.T. that science and nature have to offer.

Emerson Ecologics Emerson Ecologics was founded in 1980 by Joe Emerson to distribute highquality dietary supplements to integrative healthcare practitioners. A practicing nutritionist, Joe Emerson always held product quality as a top priority, and Emerson Ecologics continues to uphold this ideal in its vision today. In December 2003, Emerson was sold to an investor group who in turn sold the company to Liberty Lane Partners in January 2008. Liberty Lane, Emerson’s parent company, is a private investment firm in Hampton, N.H.

Lise Alschuler, ND

Emerson Ecologics acquired California competitor Terrace International Distributors (TID Health) in December of 2008 and in 2009, integrated the two brands together under the Emerson banner, using TID’s facilities as their west-coast distribution and call center. Emerson’s business also includes a newly opened distribution center in Colonial Heights, Va., and the company’s headquarters and customer-support center in Bedford, N.H. Andy Greenawalt became Emerson’s chief executive officer in early 2010 after joining them as the interim COO in mid-2009. One of his initial objectives was to enhance the physical and IT infrastructure of the company to position it for future growth. The distribution center in Colonial Heights was opened in August 2011 to provide additional space and capacity for expansion of Emerson’s product offering and customer base. This center is double the size of the previous New Hampshire distribution center and is more efficient. All three Emerson locations are cGMP compliant and have received NSF certification. Emerson has experienced double-digit growth in the last five years despite the United States’ economic challenges. “We’re in an important and growing industry,” Greenawalt said. “People are becoming more proactive in their approach to healthcare and are increasingly turning to integrated medicine and nutritional supplements to support their health. We are fortunate to support the healthcare community and patient wellness.”

Today, we have grown to become Integrative Therapeutics™. Over the years, we have matured to form one company. As always we continue to bring you the best dietary supplements that science and nature have to offer. Contact us to see how we can help you grow.

12-ITLLC-0212

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Remembering its niche

To uphold the highest standards for customers,

Emerson’s mission is to support practitioners with

Emerson monitors the brands they distribute for

the highest-quality products, educational resourc-

quality, safety, and regulatory compliance issues

es, and service solutions, but Greenawalt empha-

within the dietary supplement industry. To further

sized that at the end of the day, Emerson’s primary

reinforce quality standards, Emerson Ecologics

business is distribution. Investments in the name of

maintains the Emerson Quality Program℠ (EQP), a

expansion and infrastructure have been targeted to

voluntary supplier certification program that classi-

enhance Emerson’s core competency--its ability to

fies brands on Gold, Silver, or Partner levels.

distribute effectively and efficiently. This includes a

After conducting intensive on-site and docu-

robust enterprise-resource planning (ERP) system

mentation audits, as well as third-party confirma-

and new warehouse-management systems at both

tory testing of finished products, Emerson verifies

distribution centers.

brands based on their quality practices above and

He said that Emerson not only needs strong

beyond the requirements set forth in the Dietary

distribution centers that process orders quickly and

Supplement Health and Education Act (DSHEA) that

accurately, but it is essential to have an intelligent,

establishes the manufacturing requirements for

talented customer-support team as well as a broad

dietary supplements.

product offering in order to be the practitioner’s trusted one-stop source. “We don’t manufacture products, so we rely on

Developing its core “Our main customers are integrative healthcare

collaborative partnerships with the best brands in

practitioners,” Greenawalt said. “They range from

the industry,” he stressed. “If we’re not strong in

naturopaths, acupuncturists, and chiropractors to

those other three areas, we’re in trouble.”

MDs and osteopaths.”

HCE EXCHANGE MAGAZINE

With over 250 brands, Emerson focuses its product offerings on lines that are either practitioner-only brands, such as Pure Encapsulations, Integrative Therapeutics, and Metagenics, or general-market brands that are in high-demand from practitioners, such as Jarrow Formulas, New Chapter, NOW, and Garden of Life. For years, Emerson’s product offering has included probiotics, multivitamins, and fish-oil To improve health and reverse chronic illness by helping people achieve their genetic potential through nutrition.

supplements. Recently, Greenawalt said there has been increased interest in natural and organic skin

tor; in turn, we aim to provide that reassurance to

confident about the company’s ability to succeed in

and personal-care products, so Emerson has been

practitioners.”

this changing economic environment.

Greeting the future

clinics as well as individual practitioners based on

their healthcare practitioners’ advice when select-

Thus, Greenawalt has a very optimistic view of the

our strong distribution capabilities, customer sup-

ing supplements based on what their specific needs

future. Stricter regulations and a higher demand

port associates, and a very broad selection of the

are,” he explained. “Our goal is to support our

for quality products are weeding out the poorer

best products and services, all from one source.”

practitioners and provide them with the high-quality

industry players. The emphasis on nutrition and a

supplements they demand for their patients.”

newfound skepticism about the safety of products

adding these brands as well. “We believe it is important for patients to seek ooo&e]lY_]fa[k&[ge )(( 9n]fa\Y DY HYlY KYf ;d]e]fl]$ ;9 1*./+

Based on recent trends, this is a wise strat-

“Our goal is to support our practitioners and provide them with the high-quality supplements they demand for their patients.”

egy. According to the Nutrition Business Journal, dietary-supplement sales to the practitioner

practitioners. Because of this opportunity, Greenawalt wants to see Emerson take an even more proactive role

Because of healthcare regulation and a shortage

within the nutritional-supplement industry by mak-

of primary-care MDs, people are turning to other

ing the information about its products as concise

types of practitioners, such as nurse practitioners,

and digestible for its clients as possible. This will

naturopaths, and chiropractors.

enable practitioners to give quick answers about

nutritional supplements is becoming increasingly important to healthcare practitioners and their

these products, and patients will be able to make intelligent, informed decisions. He would also like to see Emerson continue to

patients,” Greenawalt said. “Safety and quality of

assist integrative medical practices with running

supplements are often in the news, which illus-

their businesses in a more efficient and effective

trates that consumers need additional verification

manner through Emerson’s service solutions.

to ensure them of the quality and safety of the brands they take. Patients need to rely on their doc-

by Pete Fernbaugh

has prompted people to place more faith in their

segment are growing at seven percent each year.

“The transparency and validity of quality for

“I think we have the capability to support larger

Given Emerson’s modernized infrastructure and expanded distribution capabilities, Greenawalt is

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

09 | Pikeville Medical Center

A formidable alliance A transformational point in the hospital’s history came in its alliance with the Cleveland Clinic’s heart-surgery program. “By having this affiliation, we can send our heart

INDUSTRY PARTNERS Amis Systems (American Medical Imaging Solutions) www.amissystems.com

surgeons to Cleveland for additional training or for continued education in a lot of new procedures that they’re developing,” May said. “We also send our

May that Pikeville was the first hospital in the coun-

operating-room technicians and nurses to Cleve-

try to purchase more than one 320-slice scanner

land for additional training, and the whole idea is

from them. This kind of technological advancement

that we will try to mirror the procedures the way we

helps the organization with its referrals.

do them here the way they do them in Cleveland.” Pikeville’s physicians and heart surgeons are

“We’ve only been into the tertiary-type care services for a few years, and you have to go back

credentialed at the Cleveland Clinic, and although

and try to break referral patterns where prior the

the alliance is still fresh, May said the hospital is

physicians had been sending them to some large

already seeing improvements in heart-surgery

metropolitan hospitals,” May explained. “We can

outcomes.

easily call on these physicians and tell them that

”The fact that they were willing to affiliate with

we’re not just as good as where they’re sending

us speaks well of our hospital,” May said. “I believe

them, but we’re better. We have better equipment

that alone has brought us some patients.”

and hopefully, better doctors.” It also helps with physician recruitment. Pikev-

Focused on technology

ille has a long list of doctors it is recruiting and has

Another way in which Pikeville has sought to distin-

been bringing in, on average, 25 doctors each year.

guish itself is through the technology it has to offer.

“Taking the stand that we do on our technology,

Recently, it purchased two 320-slice scanners from

it helps you recruit doctors,” May said. “They like to

Toshiba. At the time of the transaction, Toshiba told

come to places that have the latest technology.”

Pikeville Medical Center

Walter E. May, Chief Executive Officer

Pikeville Medical Center is a 261-bed acute and tertiary-care rural hospital located in Pikeville, Ky. Through diligent stewardship of its resources and devoted leadership, Pikeville has managed to defy many of the stereotypes traditionally applied to rural healthcare.

May said he strives to keep all technology up-to-date, and consequently, the hospital has some of the best medical technology and diagnostic equipment in the country and is now a regional referral center. Currently, the hospital is working through a $100-million expansion project that includes a new physicians’ office building and a 1200-car parking garage adjacent to the hospital.

A not-for-profit Christian organization formerly affiliated with the Methodist denomination, Pikeville changed its approach a number of years ago and began expanding beyond acute-care services and more toward tertiary-care services. Presently, it has all major specialties covered and has started recruiting for a multitude of subspecialties.

With over 100 employed physicians out of 280 credentialed physicians at the hospital and a staff of over 2300, May emphasizes that Pikeville isn’t trying to be the largest hospital; it’s trying to be the best.

“It’s made quite a difference in our hospital,” Walter E. May, chief executive officer, said. In 2000, Pikeville opened a new tower, and since then, technology has been a top priority.

Quality and safetyconscious In addition to a heavy focus on technology, Pikeville is very active on quality and safety matters. The slightest complaint from a patient is enough

0$1$*(' 35,17 6(59,&(6

to launch a full investigation into the matter.

â&#x20AC;&#x153;To the best of our ability, we try to satisfy the patients and look to see if thereâ&#x20AC;&#x2122;s something wrong with the system that can be tweaked or areas where our policies or procedures need to be improved,â&#x20AC;? May said. â&#x20AC;&#x153;Thatâ&#x20AC;&#x2122;s a constant, ongoing effort.â&#x20AC;? Such conscientiousness has gained national and state recognition for Pikeville. It has been named National Hospital of the Year two years in a row. Modern Healthcare Magazine ranked Pikeville seventh on its list of Best Places to Work in Healthcare in 2010 and fifth in 2011. In 2012, the Kentucky Chamber of Commerce named Pikeville one of the Best Places to Work in Kentucky. And U.S. News and World Report has named Pikeville one of the top-performing

â&#x20AC;&#x153;Those are quite a lot of honors for a hospital in whatâ&#x20AC;&#x2122;s considered a rural area to be getting.â&#x20AC;?

hospitals in the U.S. â&#x20AC;&#x153;Those are quite a lot of honors for a hospital in whatâ&#x20AC;&#x2122;s considered a rural area to be getting,â&#x20AC;?

His first stint as CEO outside of an interim position

would not be alive if I hadnâ&#x20AC;&#x2122;t taken some action

May stated.

came in early 2000 during the construction of the

that Iâ&#x20AC;&#x2122;ve taken,â&#x20AC;? he said. â&#x20AC;&#x153;I know Iâ&#x20AC;&#x2122;ve made a dif-

tower. After two years, he needed open-heart sur-

ference and what makes it even more special is

gery and made the mistake of returning to work too

that I can pass some of these people walking on

An unconventional executive

soon. Realizing that he wouldnâ&#x20AC;&#x2122;t be able to function

the street. They wouldnâ&#x20AC;&#x2122;t know who I was, and

May is a broadcaster, not a trained healthcare

at full capacity for a while, May recommended the

I donâ&#x20AC;&#x2122;t know who they are, but somehow that

executive, and owns around 10 radio stations.

hospitalâ&#x20AC;&#x2122;s COO. She held the role for seven years

makes it more special to me. â&#x20AC;&#x153;

He started on the Pikeville board of directors in

before taking another position in North Carolina.

1962. At the time, he was the youngest person to

At that point, May was hired as CEO again and has

ever serve on the board. He is now the longest-

held it ever since.

serving member. In 1990, he became Chairman of the Board and nurtured three CEOs and served as interim

by Pete Fernbaugh

He once thought broadcasting was his niche, but has since learned otherwise. â&#x20AC;&#x153;Iâ&#x20AC;&#x2122;m getting more satisfaction out of this than

CEO during transitional periods, taking no salary

I ever did being in broadcasting, because I know

for his efforts.

that there are people alive today in this region that

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

10 | Clara Barton Hospital

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The politics of modern healthcare

Clara Barton Hospital

Colson acknowledged that it is imperative for rural facilities to work closely with local and state legislatures, especially given the sizable representation urban healthcare organizations have within the

Clara Barton Hospital is a 23-bed licensed critical-access hospital in central Kansas. Located in Hoisington, Clara Barton serves a community of 3,000 people. Unlike most of its fellow critical-access hospitals, though, Clara Barton also offers surgical services, including general surgery, orthopedic surgery, and urological surgery.

political arena. As a critical-access hospital, many

Curt Colson, chief executive officer, came onboard in February 2011. A veteran of smaller, more rural hospitals, Colson brings a focused perspective to play on what it means to be a critical-access facility in 2012.

of life and that’s to the rural America that’s living

“We recognize we can’t be everything to everybody,” he stated. “My focus is really on what we do best and on trying to grow and improve that as opposed to bringing in some of the other services that can be found in some of the other surrounding larger hospitals.”

factors are always at stake. “I think critical-access hospitals have been in

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jeopardy ever since the day that they were initiated back in the 2000s,” Colson said. “But critical-access hospitals are meant to preserve and provide a way out here. We’re making sure that they’re provided care.” Clara Barton Hospital works closely with the Kansas Hospital Association, and Colson said he has found them to be a powerful advocate for both rural and urban hospitals. He has also found that

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

ton are to remain focused and steady. No political change can deny the fact that this hospital has been successful. After all, not every critical-access facility offers surgical services, but Clara Barton does. Colson wants to make sure its strongest parts remain healthy and vibrant. This will feed its success. He also wants to start marketing their quality of care in a more effective way. “That’s kind of a challenge when you’ve got the HCAHPS and some of the other benchmarking programs that make it difficult for you to compete with some of the big places just because of the number and the volume of certain services--heart attacks and whatever else--that we may not have as much of, and those numbers are not fairly represented to the public,” he explained. The stereotyped image of rural facilities offering less capable and less qualified care is simply not always true, Colson contests, but he said it’s a challenge to be the younger brother or sister to an the Kansas legislature tends to understand the

athletic superstar like the urban hospital. Nevertheless, Colson has had a great experi-

critical-access perspective, in spite of a Republican majority that sees the need for spending cuts.

ence as CEO since he arrived last year. “It’s been a blessing,” he said. “It’s a great com-

Unfortunately, when the legislature was looking at forming a healthcare supercommittee, the

munity in central Kansas and has a good staff and

representation on it was leaning more toward

good providers. It has people who care about their

larger urban communities than rural. However,

patients. So, it’s been a good transition.”

this underscores a frequent challenge that rural organizations experience on the federal level where

Recruiting the future

they have to fight to be heard.

As with many other U.S. healthcare facilities, Clara

“Rural America is a large part of the United

Barton is confronting the issue of staffing and re-

States, so you have to think that there’s got to be

cruiting qualified candidates, whether they’re phy-

some understanding even in states like New York

sicians, physical therapists, physician assistants, or

or Illinois or Massachusetts or Florida where there

nurses. Colson said the organization is also taking a

are rural parts,” Colson said. “So you think that

decades approach and looking beyond the horizon,

they have to recognize the importance of healthcare

trying to raise future healthcare professionals from

in those areas and that not everybody can be forced

the local community. Currently, the hospital is working with sixth-

into a large facility.”

owing program for local high schools and has seen an interest primarily in nursing, but also in certain physician specialties like neurology and urology. “We’re trying to grow local crops, I guess, recruiting local students into becoming doctors and nurses and maybe coming back to our community and providing those services,” Colson said.

Expanding market share In the next three to five years, Colson said he’d like to see Clara Barton gain a larger share of the market. Recently, another local hospital switched licensing to an ambulatory-outpatient hospital. This reduced available beds by 66 in the county, leaving the three local rural hospitals to pick up the slack. “There’s really kind of a lack of available bed space here,” Colson said. “Unfortunately, we’re limited by the confines of the regulations of criticalaccess.” Clara Barton has also discussed adding an ICU and growing surgical services to include more orthopedic and urology offerings. The imperative here, though, is to provide what the community needs and to provide it with quality. “Healthcare itself is important regardless of your community size and hospital bed count,” Colson said. “Healthcare access ought to be available to all of us, though sometimes that does bring challenges for those who are uninsured or underinsured. “But as a local community hospital, we do our very best to try to provide services regardless of one’s ability to pay, just so that we can make sure those people living in our rural community are taken care of and preserve the way of life that we all like here.” by Pete Fernbaugh

graders and conducting sixth-grade health fairs

Steady as she goes

in an attempt to get local students interested in

Despite the political challenges of being a health-

healthcare as a possible opportunity when they

care executive, Colson said his plans for Clara Bar-

start making future plans. It also has a job-shad-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

11 | Marpac, Inc

Marpac, Inc

they needed and simply purchase them. Now, it becomes a recommendation that is passed onto a product-evaluation committee, followed by a

Located in Albuquerque, N.M., Marpac, Inc., manufactures medical-tubesecurement devices, such as tracheostomy collars and adjustable endotracheal tube holders, for respiratory therapists, critical-care nurses, and home healthcare.

product-standardization committee, and on to

Although five percent of its business is international, Marpac is predominantly a U.S. company. Unlike its competitors, who outsource most manufacturing to China, Mexico, or the Dominican Republic, Marpac manufactures its products 100 percent within the U.S.

up for the big guys.”

“That’s not the kind of owner we have,” Jeff Alcalde, general manager, said. “He wants to have all the jobs here in the states, remaining competitive while manufacturing here.”

Jeff Alcalde, General Manager

purchasing. “We’ve seen our sales cycle lengthen just because of that process,” he said. “Also being a small guy, in all honesty, that whole system is really set It’s very common that a hospital’s value-added committee will have a representative from a large distributor onboard. Naturally, this lessens the chances that a smaller manufacturer’s products will be approved for purchase.

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Caretakers and patients come first Recently, Marpac released its new endotracheal tube holder, debuting it at the 2011 American Association for Respiratory Care (AARC) trade show. This product exemplifies the philosophy behind Marpac’s approach to business. “We do a really good job of blending the needs of the respiratory therapist--the caregiver--with the needs of the patient in coming out with new products,” Alcalde said. This consideration extends to the service side, where every order ships the same day. Marpac has no backlog and has had 100 percent on-time delivery for five years. “Our quality system is world-class,” he stated. ““People throw that around, but what it really means to us is last year we made 1.7 million units of products and we only had quality concerns on six.”

as a needle-mover. Alcalde would like to grow the company into a $10 or $50-million brand that will force people to pay attention. To sell its products, Marpac uses in-house salespeople and independent commission-only sales representatives around the country who sell Marpac’s products alongside ventilators and other higher-end equipment. Print advertising hasn’t really worked for the company, since Marpac occupies a specific, fragmented share of the marketplace. Marpac also sells directly through distributors, including Cardinal Health, Owens & Minor, and Tri-Anim. In 2012, the company will be establishing a larger Internet presence that will be focused less on sales and more on information. “We believe there’s a place out there that we want to create for people who want to learn more who aren’t clinically trained,” Alcalde said. “So if you’re going to have a tracheostomy performed on your child or on your parent, that’s pretty scary, and

Facing the corporate giants As with everything, there is a downside to this attentiveness. “It’s a Catch 22 in that once we’re your supplier, you never hear about us again, because things don’t go wrong,” Alcalde explained. “But it’s also tough for us to get people’s attention, because we’re a $2.5 to $3-million revenue company, so in the medical world, we’re peanuts.” Many larger organizations will look at Marpac and see a company so small, it’s difficult to view it

there’s really not a place to go and search that out and talk to people who have already been through that. We’re trying to create that space for people to do that in a little more congruent way than they do today.”

Trending homeward With all of these marketing efforts, Alcalde has noticed several trends. First is how centralized decision-making has become at hospitals. He said it used to be that a respiratory therapist or director of respiratory could determine what products

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the product that lasts the longest that gets chosen, because if you get reimbursed by each unit, you can have a product that doesn’t last as long and people don’t care as much,” Alcalde said. Finally, Alcalde has noticed that Marpac’s products are becoming more useful in the home-health setting, since people are being released from the hospital sooner. “We’re seeing our product line, the tracheostomy care, is becoming more and more of a homecare item also, as opposed to a strictly hospitaltype product and distribution,” he observed.

What Marpac offers These products, Alcalde said, offer quality of design and comfort. For example, its newest product, the ET tube holder, doesn’t require adhesive tape on the patient’s face to keep the tube in place, thus preventing pressure sores and skin breakdown. Like the track on a Ziploc bag, a caregiver only needs to slide the holder back and forth in order to adjust the tube. In addition to sensible products, Marpac also

its competitors are manufacturing overseas, what you see on the shelf is what you get. With Marpac, though, it’s not unusual to receive a request to customize one of its products for an unconventional patient. Because of Marpac’s size and domestic manufacturing, that product can be customized immediately and shipped the next day. “It’s not uncommon for me at all to be talking to a parent of a six-year-old child who has a tracheostomy and listening to what they need from us,” Alcalde said. “We really do want to earn the fact that we’re manufacturing in the states. We don’t want people to just throw money at us because we’re creating jobs here. We know we have to earn that right to add value manufacturing here, not just look for a thank-you kind of sale.” by Pete Fernbaugh

offers a quick turnaround on production. Because HCE EXCHANGE MAGAZINE

Real Issues : Real Solutions

12 | Parkview Adventist Medical Center

Parkview Adventist Medical Center One small community hospital in Maine has made huge strides in information technology, receiving national recognition for the implementation of its electronic medical records (EMRs). Parkview Adventist Medical Center is a 55-bed general acute-care hospital that sees about 1,200 annual admissions, receives about 12,000 emergency-department visits each year, and performs about 2,000 to 3,000 surgeries annually. As with many hospitals in the United States, Parkview has witnessed an increase in bad debts, with more uninsured and underinsured patients than before.

Bill McQuaid, Chief Information Officer

But despite its size and challenges, Parkview has made a firm commitment to technology. In fact, it was one of the first hospitals in the country to apply for and receive stimulus money for meaningful use. The hospital then met the criteria for meaningful use phase 1 in early 2011 and received $1.7 million for that achievement.

Nihon Kohden America Nihon Kohden America congratulates Parkview Adventist Medical Center for being the first hospital in Maine to utilize our latest generation of wireless telemetry monitoring to improve clinical workflow. With real-time waveforms and the automation of vital signs collection, clinicians can respond faster to critical changes in a patient’s condition and enable quicker interventions at the point of care.

Integrating a vision Before McQuaid became CIO in 2004, Parkview had been using a best of breed approach to technology, meaning that every single department, from pharmacy to labs to radiology, was utilizing different software on a different platform, while also trying to interface with each other. McQuaid started to look at the cost of switching to a single vendor. He did a side-by-side cost comparison on one platform versus multiple platforms. “What it showed is if we switched to a singlevendor solution, the product would literally pay for

Currently, the phase-2 requirements have been released by the government, but the final ruling on those criteria has not been issued. Parkview, however, is prepared to meet those requirements when they are finalized.

itself just on what we saved in maintenance alone in

“We are looking at all the different stages, and what we are doing is gearing the hospital to meet those measures when they are at a much higher standard,” Bill McQuaid, chief information officer, said, adding that they’ll probably receive all of phase-2 money on year-one requirements.

an immediate savings.

The hospital, he added, is “ramped up” and ready for e-prescribing and the patient portal. Furthermore, Parkview’s CPOE utilization is almost 100 percent for phase-1 standards.

five years,” he said. Parkview eventually settled on Meditech and saw “For us, all of a sudden we go to a paperless environment with our physician practice being fully integrated and having one EMR and only paying $130,000 compared to having really nothing, the bare minimum, and paying $386,000,” McQuaid said.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

Implementing high-tech solutions

Improving quality and safety

In addition to the EMR, Parkview has implemented

Parkview’s technology has enhanced the hospi-

other systems in its quest to stay at the forefront

tal’s quality and safety initiatives as well. In the

of medical technology. The hospital has partnered

third quarter of 2011, the hospital reached 100

with Imprivata, an IT security company that pro-

percent on all CMS Core Measures.

vides a fingerprint log-on that shuts down within a

Parkview was able to attain this, McQuaid

few seconds of the user backing away, increasing the privacy of medical records. In early 2012, Parkview also began the implementation of a patient-monitoring system for cardiac patients with the plan to go live in May 2012.

said, by combining IS staff with the clinical staff

“All I need is a positive, can-do attitude.”

and collaborating with nurses and physicians on templates built around the core measures. As a result, Parkview has been ranked the number-one hospital in Maine for medication

The system, by Nihon Kohden, features wireless

safety administration. The hospital was also the

telemetry monitoring designed to improve clinical

first in the state to offer bedside medication veri-

workflow. The devices monitor ECG, respiration,

fication.

and blood-oxygen saturation. Parkview is the first

physicians have noticed better reimbursements, especially with relative-value units (RVUs) and compensation. “We used to be a strip mall, meaning that you have this mall, but every single store operates a different way,” he stated. “What we decided to be is a Super Walmart.” Parkview has achieved all of this, McQuaid emphasized, without any consultants and with an IT staff of six. “All of my IT people have been trained inhouse,” he said. “All I need is a positive, can-do attitude.” by Patricia Chaney and Pete Fernbaugh

To further improve on quality and safety,

hospital in Maine to use this new product.

Parkview uses a software program called IHM

Parkview also plans to upgrade its imaging

to mine data related to core measures and other

department with new MR and CT technology, as

quality indicators. This software provides the qual-

well as furthering its use of the EMR and other IT

ity department with a report every morning.

products. It will be installing the OrthoView PACS

Parkview is also positioned to institute a

system and also offering an iPad app for physi-

patient portal that will allow patients to log into

cians to access radiology images.

a website and get all of their clinical information

In implementing all of this change, McQuaid

remotely.

said the biggest challenge can be convincing

“They’ll be able to see their problem list and

physicians to go along with the upgrades. To aid in

all the medications that they’re on,” McQuaid said.

this, Parkview has a physician-advisory board with

“This is going to put a lot pressure on the physi-

five or six physicians on it who are progressive

cians as well because they’re going to have to

with technology and who can communicate to the

cross their t’s and dot their i’s.”

other physicians the benefits of upgrades.

Importance of optimism

Ultimately, the physicians, not IT, are the ones who decide whether the upgrades will be manda-

It’s vital, McQuaid said, that healthcare profes-

tory. Having a chief medical information officer

sionals approach these changes positively. As

(CMIO) to act as an emissary helps with this,

Parkview has shown, this technology, if imple-

McQuaid added.

mented correctly, will improve an organization’s operations.

“We prove that we’re there for them, to make

Although he’s never noticed anyone saying

it as easy as possible, and a lot of it just has to do

that EMRs speed up a patient’s visit, he and the

with having a lot of communication with a physician,” he stated.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

13 | PrairieCare

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Managing rapid growth Although the organization is still relatively small, it has seen tremendous growth during the past two years. PrairieCare has three locations--Maple Grove, providing inpatient hospital and partial-hospital programs for children and adolescents; Edina, providing clinic and intensive outpatient therapy for adults; and Woodbury, with adult intensive outpatient and clinic visits for all ages. The organization is planning to add a fourth location with an additional partial-hospital program for children and adolescents. The Edina facility recently moved from a 10,000

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square-foot facility to a nearly 24,000 square-foot facility that will provide additional partial-hospital program capacity for children, adolescents, and families and an adult intensive outpatient program. In Minnesota, a hospital system needs legislative

PrairieCare

approval to expand inpatient capacity, and in 2011,

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PrairieCare received approval to build an additional 30 beds. The transition has been exciting, but it has also

Joel V. Oberstar, MD, Chief Executive Officer, and Chief Medical Officer

PrairieCare is a freestanding psychiatric healthcare system based in the Minneapolis/St. Paul, Minn., metro area. The organization provides a continuum of psychiatric services with an inpatient hospital, partial hospital programs, intensive outpatient programs, and traditional outpatient clinics.

been challenging to manage the growth. Ensuring that all stakeholders are consulted across multiple locations and ensuring that staff receives proper education has been a challenge with such rapid

â&#x20AC;&#x153;I have been struck by the unmet need in our area,

growth. PrairieCare instituted an online training

particularly for children and adolescents,â&#x20AC;? Dr.

PrairieCare aims to have a full array of services so that patients who transition between levels of care maintain continuity with staff. In mental health, trust between providers and patients is critical to achieving good outcomes. The highest level of care is inpatient hospitalization, followed by partial hospital. Partial hospital is offered for children and adolescents and involves about five hours of therapy and two hours of school a day, but the patients spend their evenings and weekends at home, so it is less disruptive for families. Intensive outpatient programs for adults and children involves about three hours a day of therapy.

tool to provide information to all providers across

Oberstar said. â&#x20AC;&#x153;I have been excited to work with cli-

all locations.

nicians and providers to expand access to care. We

â&#x20AC;&#x153;We find that continuity of care is helpful for patients and families,â&#x20AC;? said Joel Oberstar, MD, chief executive officer, and chief medical officer. â&#x20AC;&#x153;Patients are able to go from one level to another without having to meet a new group of people.â&#x20AC;? With the continuity of care offered at PrairieCare, the organization is placing more emphasis on evaluating clinical outcomes. Dr. Oberstar said PrairieCare is benchmarking length of stay, clinical outcomes, and cost of care. Strong efforts are made to ensure that patients receive high-quality care in as least restrictive a setting as possible. â&#x20AC;&#x153;We are poised to demonstrate outcomes in terms of hospitalizations and readmissions,â&#x20AC;? he said. â&#x20AC;&#x153;By having different levels of service, a patient can go from an outpatient clinic to three hours of intensive outpatient care rather than to a hospital, which is more cost effective and more pleasant for patients and their families.â&#x20AC;?

Recruitment is a challenge for many healthcare organizations, but Dr. Oberstar said PrairieCare

pride ourselves on being part of the community.â&#x20AC;? In Minnesota, suicide is the third leading cause

has been successful in recruiting talented psychia-

of death for children ages 10 to 14 and is the sec-

trists and staff, despite a national shortage of child

ond leading cause of death for individuals 15 to 34.

and adolescent psychiatrists. He credits the fact

PrairieCare works with the community to increase

that the organization is physician-owned and run as

education about mental-health issues. One of the

a major factor in bringing on new staff.

groupâ&#x20AC;&#x2122;s social workers spends much of her time on

Community partnership steers the future

education programs with schools and community groups. By still maintaining a reasonably small size, Dr.

PrairieCare remains committed to educating the

Oberstar said PrairieCare is able to also maintain

community about its services.

flexibility in tailoring programs to the communityâ&#x20AC;&#x2122;s

HCE EXCHANGE MAGAZINE

13 | Ramsell Holding Corporation

Ramsell Holding Corporation

needs. The organization is surveying former patients to create an evidence-based intensive outpatient program for young children with externalizing disorders, which include acting out, aggression, and mood dysregulation.

For the last 40 years, Ramsell Holding Corporation, based in Oakland, Calif., has provided pharmacy-benefit management services and technology solutions to federally qualified healthcare organizations, especially those that provide care for the underserved population.

In addition to working with schools and community groups, PrairieCare has a strong affiliation with the University of Minnesota Medical School, bringing in fellows and clinical faculty to practice. The affiliation also provides a framework for collaborative research ventures between university faculty and PrairieCare staff. The two organizations are considering a research project that would seek

“We pride ourselves on being part of the community.”

to identify predictors of response to an evidence-

As Tim Murrill, executive vice president of sales and marketing, explained, this is Ramsell’s niche, and in the current economy, these services are vital.

Tim Murrill, Executive Vice President of Sales and Marketing

based approach to managing externalizing disorders. All of this progressiveness is due in part to ambitious leadership and innovative solutions, making

“Our mission is to provide solutions to organizations that help underserved people get connected to the resources they need to live better lives,” Murrill said. “Over the past four years, the recession has created a growing need for the type of services and solutions that we provide. In this environment of high unemployment, fewer people have health insurance or the means to pay for healthcare. That means that more people are dependent on public-health and safety-net programs to access the care they need. That need is fueling our growth.” Ramsell assists federal, state, and local departments in managing a variety of safety-net programs. One of the largest programs Ramsell manages is the AIDS Drug Assistant Program, a national program that provides medication to those living with HIV/AIDS who do not have insurance or the means to pay for their own medication.

Dr. Oberstar’s confidence in PraireCare’s future anything but unfounded as it continues to influence and better the lives of people in its community. by Patricia Chaney

Currently, Ramsell manages these services for six states—California, Oregon, Washington, Colorado, Texas, and Delaware. These states account for more than 33 percent of the nation’s ADAP claims. Real Issues : Real Solutions

MTM allows pharmacists to stay in touch either in person or over the phone with high-risk patients to ensure that patients are taking the right medications and are adhering to the dosage schedules. Murrill said that adherency is a huge problem in this country and costs billions of dollars that wouldn’t have to be spent if patients were faithful in taking their medications. MTM enables pharmacists to evaluate what’s happening with the patients and also assess any drug-interaction issues that may result from several medications being taken at once. A number of studies have explored how intervention can save in overall healthcare costs. If a patient is faithfully taking medication for a chronic

HealthTrans an SXC Company

disease, such as HIV/AIDS or HEP-C, the disease

8300 E. Maplewood Ave Suite 100 Greenwood Village, CO 80111

itself should maintain at its current level. However, if an early-stage HIV patient falls off the medication for even six months, that disease can progress to full-blown AIDS, which can be much more expensive to treat. One study from the University of Minnesota showed the return on an investment in MTM to be 12 to one. “This is a pretty rich payback and is a win win,”

New products for a new time Increased demand for Ramsell’s services has enabled the company to develop three new products, the first of which is the 340B Management solution. The name is derived from the legislative number of an act that was approved 12 years ago to provide medications to the underserved at below-market prices. Because of 340B, these prices are sometimes 20 to 30 percent less expensive. However, the legislation mandates many requirements, especially in the area of reporting, for qualifying covered entities, such as health centers, that take advantage of it. Ramsell’s 340B Management provides a solution that helps centers utilize the program, while avoiding the bureaucratic headaches. After two years on the market, the 340B Management solution has proven to be highly successful. A second product is Ramsell’s Medication Therapy Management (MTM) solution that focuses on patient outcomes.

Murrill said. “Patient outcomes are improved and costs are reduced.” Finally, the Ramsell Correctional Application

Whether the inmate shows up or doesn’t show up

ability of them becoming productive citizens and not

for their appointments, feedback is immediately

reoffending,” Murrill said. “If we can reduce that

given to the program manager.

just in California by five percent, that would save

“This system comes out of our experience in working with the underserved population over the

slightly under $400 million just in terms of incarcerating those people.”

(RCA) is a web-based software service solution for

last 40 years,” Murrill explained. “It’s a high-risk

correctional institutions, such as jails and prisons.

population. There is a high incidence of diseases,

Focused on helping

While RCA could be characterized as a case-man-

like mental health, HIV/AIDS, HEP-C, among the

For 25 years, Murrill was involved in the private

agement system, Murrill said it is really more than

prison population. We have found that if you can

business sector, where the bottom line was every-

that.

provide that little bit of help in getting them con-

thing. For the last five years, he has been working

nected, and if they stay in treatment, if they’re

for Ramsell, which values improving outcomes and

RCA provides probation and parole agencies, cor-

healthy, if they have a place to live, and they have

helping the underserved live better lives. Murrill

rectional healthcare providers, and related correc-

the support they need, the chances of them recidi-

believes in the old saying, “Do good by doing well,”

tional-program managers with discharge planning

vating, reoffending and going back, are reduced

and he feels he is helping to do that at Ramsell.

and community supervision by connecting inmates

drastically.”

Following a pre-release interview with inmates,

and parolees with local community-based organi-

In California, for example, the current recidi-

“Our commitment, our passion, is to continue to focus on helping people,” he stated. “In addition to

zations that will provide the resources and support

vism rate is almost 70 percent. That means that

the economic benefits that that’s going to bring, it’s

the inmate needs.

seven out of 10 inmates who are released reoffend

a nice thing to know that we’re helping society and

and go back into the system, and they are sicker

this underserved population, and that feels good.”

“Whatever those issues are, this tool allows the agency to connect them and set up appointments

and more expensive to care for, if they don’t have

with those providers,” Murrill said. “And then,

that continuity of care while they are out.

there’s actually continuity of care that happens, and they are less likely to reoffend.”

by Pete Fernbaugh

“By getting these folks connected to the care and support that they need, there’s a higher prob-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

14 | Hemosphere, Inc.

Hemosphere received FDA market clearance for

Graft has the potential to reduce hospital infection

the HeRO therapy during the first half of 2008, and

rates via catheter reduction. The HeRO Graft has

its commercialization efforts began in mid-2008.

received the Innovation Award from Premier, the

Currently, there are over 300 physicians across the

nation’s largest group-purchasing firm and has

country trained to implant the HeRO Graft. Hemo-

been featured in over 90 publications.

sphere is approaching 5,000 HeRO Graft patients. Currently, Hemosphere’s distribution and commercialization efforts are exclusively in the United

ing quite young because of the rising epidemic of

States, but the company recently received ISO TUV

obesity, diabetes, and hypertension. While TDCs

13485/CMDCAS and EC certifications that pave the

provide a viable acute-access option for dialysis

way for expansion into European and Canadian

patients, they often are not only associated with

markets.

higher infection rates, but also higher intervention

Improving patient outcomes

rates since they need to be replaced so frequently. The HeRO Graft, much like a long bridge, restores

Beyond its innovative qualities, the HeRO Graft has

blood flow in the central obstructed veins to the

proven its ability to enhance quality outcomes for

peripheral veins, resulting in higher blood flow and

dialysis patients. Given that patients receive dialysis

renal clearance, superior patency, and intervention

treatment three times a week, the catheters pro-

rates in comparison to catheters.

truding from the patients’ neck become susceptible to carrying infections and other germs.

Hemosphere, Inc.

ESRD is a rapidly growing disease, particularly in a patient population that is unfortunately becom-

by Pete Fernbaugh

The Centers for Disease Control and Prevention (CDC) announced in spring 2011 that it would begin tracking and ranking hospitals based on their ability to manage the bacteremia rate. For dialysis

Hemosphere, Inc., is a medical-device company that is pioneering innovative subcutaneous-based access solutions that revolutionize care and restore quality of life for end-stage renal disease (ESRD) hemodialysis patients with compromised vasculature. As the company explains it, Hemosphere’s device, known as the Hemodialysis Reliable Outflow Graft or HeRO® Graft, is the only vascular-access device that is fully subcutaneous and clinically proven to provide long-term access for hemodialysis patients who have venous-outflow obstruction.

Eric Barber, Chief Executive Officer

“The number one driver of infections in hospitals is patients with tunneled-dialysis catheters (TDCs),” Patrick Wethington, chief executive officer, said. “The cost per infection ranges from $23,000-$45,000 with an average length of stay of 17 days. The HeRO Graft provides catheterdependent ESRD hemodialysis patients with a fully subcutaneous-access option, which has been clinically proven to lower the infection rate vs. catheters by 69 percent.”

patients, the HeRO Graft has been clinically proven to lower the bacteremia rate by 69 percent compared to TDCs.

A great partner for hospitals Wethington emphasized that Hemosphere is a great partner for hospitals who share the organization’s vision of catheter reduction to deliver safer, more effective treatment and management of dialysis patients. Ascension Health Ventures has invested in Hemosphere based on their belief that the HeRO

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

15 | Sandoz, Inc.

Sandoz, Inc. Falcon, as part of the Alcon acquisition by Sandoz’s parent company, Novartis. In 2010, Sandoz launched enoxaparin, the first ge-

Sandoz, Inc., is a global generic-pharmaceutical company and the number-two player in the global -generic industry. For the past several years, it has also been one of the fastest-growing companies within the industry.

neric version of the top-selling hospital drug, Lovenox®. “It was the first one-billion dollar generic injectable in the history of the industry,”

Don DeGolyer, president of Sandoz’s North American operations, said that the company’s mission is centered on providing high-quality, more-affordable pharmaceuticals to the world’s population.

Don DeGolyer, President

DeGolyer said, later adding, “As the industry moves to more complex therapies, we like the hand that we’re holding.”

With 24,000 associates worldwide, about 10 percent of whom are in North America, DeGolyer believes that Sandoz is well-positioned for a marketplace that is rapidly embracing generics.

An enterprise of quality and savings Sandoz is not just about the numbers, though, and DeGolyer is quick to emphasize its ardent

A complex and diverse pipeline

Finally, DeGolyer said that Sandoz has a biophar-

focus on quality and how that standard sweeps

maceutical development process that is constantly

across the company. Sandoz has populated

DeGolyer’s enthusiasm for the future seems to be

being refined, and the company, which is already

itself with research and scientific capabili-

rooted firmly in facts.

the global leader in biosimilars, is continuing to

ties that are characterized by experience and

invest in the space.

knowledge, whether it’s biotechnology or

“It’s a great time to be in the generics business,” he said. “It’s obviously a marketplace

Coupling all of these reasons with an aging

oncology.

that’s continuing to evolve, but the outlook in our

population who is living longer and experienc-

view is very attractive. And it’s especially attrac-

ing skyrocketing healthcare costs, DeGolyer sees

patients and helping patients to breathe easier,

tive for those companies that are well-positioned

an opportunity for generics to increase access to

suffer less, live longer and healthier lives,” he

with complex-product pipelines and differentiated

medicines and decrease costs. Currently, 78 per-

products.”

cent of U.S. prescription volumes are generics, but

“That’s what we’re excited about within the generic

research-based healthcare medicine company.

He listed several reasons for this optimism. First,

generics only consume 20 percent of the dollars.

marketplace,” DeGolyer said.

That’s what Sandoz is.”

over the next seven years, about $160 billion of

“I think we’ve got headroom there,” DeGolyer

“Ultimately, what we’re focused on are

said. “That’s at the root of a science-based,

Sandoz is also part of an industry that has

branded sales are going to fall off-patent, as their

enthused. “I think that we can see it well over 80

Competing and winning

saved the U.S. healthcare system $931 bil-

patents expire. Although the majority of this $160

percent generic penetration of the U.S. prescription

So, what magic key does Sandoz possess that has

lion over the last 10 years and also saves the

billion consists of small-molecule products, $40

volume.”

enabled it to carve out a niche of envy in a market-

system $3 billion each week, or, as DeGolyer

place of competitive intensity?

describes it, real savings that benefit real

billion of that will be for the larger-molecule products, or originator biologics.

Developing marketplaces

DeGolyer credits the company’s success largely

patients.

Second, the regulatory environment is showing

Not only is Sandoz well-positioned for the future, it

to adhering to common-sense values. First, he

solid progress. DeGolyer is hopeful that the United

is also well-prepared, as it explores various thera-

emphasized the company’s leadership, especially

times, generics can be a large part of the

States will authorize a workable new generic-drug

peutic categories in which to expand. For example,

on the complex-product side of the equation. As the

solution,” he said. “We see the U.S. generic

user fee in 2012.

the respiratory-drug industry, for health needs

generic industry moves out of the oral-solid phase

market evolving, and we see the outlook as

like COPD and asthma, is currently a $32-million

and more into a complex-product focus around

very attractive, especially for those companies

branded marketplace.

2014, Sandoz will already be well-positioned to

that are well-positioned with complex-product

compete, and succeed, in the market.

pipelines. And we see Sandoz as very well-

“It’s important because right now there are more than 2,000 products down at the Office of Generic Drugs that are backlogged, so that means

DeGolyer said that 50 percent of those dollars

Presently, it is the number-one biosimilar com-

“Even though these are tough economic

that there are patients in the U.S. who don’t have

will go generic by 2016. There are similar projec-

access to those high-quality affordable products,”

tions for the biosimilar marketplace. By 2015, it’s

pany, DeGolyer said, and it has a 50-percent share

complex-product leadership, because of our

he explained.

expected to be a two to three-billion dollar generic

globally in the highly regulated markets of North

enterprise value, and because of our focus on

For generic drugs, federal-review times take

market, but by 2020, it will be 10 times that, at $20

America, Europe, Japan, and Australia. Sandoz is

patients.”

more than 30 months, as opposed to a 10-month

billion. Sandoz is investing in high value and com-

the number-one injectables company in the generic

review cycle for the branded companies. DeGolyer

plex products, including respiratory products, so

industry and has the number-one ophthalmology

would like to see the review cycles be more or less

this trend presents a big opportunity for companies

business in the industry, which has been bolstered

equal.

like Sandoz.

by the recent addition of Alcon’s generic division,

positioned to compete and win because of our

by Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

MAR/APR

2012

Real Issues : Real Solutions

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