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Real Issues : Real Solutions

Capella Healthcare Forging Partnerships that Make Communities Better

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com

MAY/JUN 2014

Real Issues : Real Solutions

CONTENTS

04 Capella Healthcare

Willamette Valley Medical Center was the top-performing hospital in Oregon relative to pay-for-performance last year. Shown here (from left) are: Jan Mellgren, accounting; Juan Rangel, RN; Rosemari Davis, CEO; Stan Wiens, laboratory; Jamie Bartley, RN; Kym Snively, admitting; and Elda Gonzalez, housekeeping.

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Cover: Featured on the cover is Capella’s Willamette Valley Medical Center (McMinnville, OR) which has been recognized nationally for its high quality care. They are one of just 182 hospitals in the nation to be named a Top Performer on Key Quality Measures for three consecutive years by The Joint Commission. The past two years they’ve been named one of the nation’s strongest hospitals in The Hospital Strength Index™. Read more about how they’ve done this at CapellaHealthcare.com/SuccessStories.

IN-FOCUS STORIES 08 Restore Medical Solutions 10 Boston Medical Center 14 Clinical Laboratory Partners 18 Maine Center for Cancer Medicine & Blood Disorders 22 Northern Nevada Medical Center 25 Adelante Healthcare 28 Interim LSU Hospital 32 Physicians Care Surgical Hospital in Royersford 35 Roseland Community Hospital 38 xG Health Solutions, Inc. 41 The Floating Hospital 44 Department of Veterans Affairs

MAY/JUN

2014

CAPELLA HEALTHCARE Michael Wiechart, President and Chief Executive Officer

Forging Partnerships that Make Communities Better Capella Healthcare may be in the business of acquiring and partnering with community hospitals for the sake of building strong local healthcare systems, but the organization has not embraced some of the approaches common in today’s marketplace. Rather, Capella approaches all potential partners, in the words of Michael Wiechart, president and chief executive officer, with a different kind of “due diligence.” Capella wants to make sure it is right for the community and that the community is right for it. “We are differentiating Capella through quality and--because we are a smaller company-every single hospital in our family is vitally important,” he said. “So we aren’t looking to acquire hospitals simply for the sake of growth. If we can’t add value for the hospital and the community or the hospital doesn’t have the commitment it takes to improve quality, then we’re not going to waste our time or theirs.”

Taking care to the next level at Capital Medical Center (Olympia, WA) involved a strategic collaboration with nationally renowned UW Medicine. Shown here signing the agreement this spring are (from left) Michael Wiechart, president and CEO of Capella Healthcare, Johnese Spisso, UW Medicine chief health system officer, and Jim Geist, CEO of Capital Medical Center.

Based in Franklin, Tenn., Capella currently owns and/or operates 13 acute-care and specialty hospitals across six states. Known for its creative and collaborative partnerships, Capella has been recognized for two consecutive years by Modern Healthcare as one of the nation’s fastest-growing healthcare companies. Wiechart has been with the organization since 2009 when he came over from LifePoint Hospitals to serve as senior vice president and chief operating officer. In January, as part of a succession plan, he stepped into the president and CEO role. His early initiatives have involved repositioning the company internally to navigate the challenging waters of healthcare reform and to advance the transition from volume to value. “While we’re seeking to grow externally, we want to make sure that we are reprioritizing and focusing internally on the most vital initiatives that are going to help our current family of hospitals succeed,” Wiechart said. “We’re going to continue our growth because our hospitals are differentiating themselves in quality, service, and constituent satisfaction.”

EVALUATING THE CURRENT NEED The last six months have involved a comprehensive

SEEKING SUPPORTIVE COMMUNITIES Wiechart agrees that there is a rush around the nation to buy up hospitals. This level of haste often leads to regret, and regret is not on Capella’s agenda. The organization takes a disciplined approach both to acquisitions and to partnerships, he said. “We have to make sense of a potential partnership with a community. That community has to feel comfortable with Capella. We have to be in agreement about the changes that have to occur to be successful in the long-term. And the only way to get to that mutual conclusion is a significant investment of time and energy as together we evaluate the opportunity.” In evaluating new markets, Capella is seeking organizations in which the community strongly supports the hospital and understands the value that partnering with Capella will bring. Naturally, in some communities, there is resistance to an out-of-town entity seeking a role in the community. “That’s a natural reaction, and we understand that,” Wiechart said. “The best approach is to simply let them get to know what we’ve done with other community hospitals.”

evaluation of Capella’s present holdings and the full gamut of services those facilities provide, Wiechart said. The desired goal was to pinpoint service gaps. This has resulted in additional investments in quality and service that are designed to recalibrate Capella’s resources in a way that will enhance the support it provides to its hospitals. Wiechart’s goal is to add one to two new hospitals each year for the foreseeable future, but only if those hospitals are the right partners. “We will continue to be very selective,” he said. “We think that the ‘best fits’ for us as a company are those hospitals that are big enough to make a significant difference in the region they serve, yet sized relative enough to be nimble and effective in this dynamic environment.”

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In communities where the hospital traditionally has been not-for-profit, Capella needs to make sure the community understands charitable care will not be affected, even though the partnership will make the hospital one of the largest taxpayers in the community. “In our work with non-profit and faith-based hospitals in a number of markets, we’ve been able to demonstrate objectively that our hospitals’ policies and procedures on charity care as well as the percentage of uncompensated care we provide is virtually identical to theirs,” Wiechart said. “Frankly, this surprises a lot of people. Additionally, we reinvest 100 percent of net cash flow back into our hospitals. Aggressively addressing those areas of misconception is especially important to our employees and physicians.” Capella also asks itself if the community hospital is prepared to be better. “We can provide the tools, leadership resources, and capital investment, but none of that matters as much as the local commitment to become the best,” he said. “When that’s the basis of the transaction or more importantly, the relationship, that’s when you can really see significant improvement results in all aspects.” Capella has improved its physician-satisfaction scores over the last six years from the 13th percentile to the 55th percentile, and those scores as well as its hospitals’ composite employee-satisfaction scores and quality scores outrank many of its

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said. “So when we’re faced with resistance, it’s my not trying to take away from you or to reinvent your hospital. What we’re trying to do is provide resourcversion of itself, to become all that it can be.”

PARTNERING FROM A POSITION OF STRENGTH For Capella, the collaborative landscape is just as important as the competitive landscape. “As healthcare evolves toward a more collaborative landscape as opposed to a purely competitive landscape, we’re thinking about how we can best partner with other providers for success, enabling our hospitals to partner from a position of strength,” Wiechart said. Capella has been recognized nationally for its creative, collaborative partnerships. In Tennessee, for example, Capella partnered with faith-based Saint Thomas Health, a member of Ascension Health and a Catholic ministry that is the largest non-profit health system in the United States. That partnership led to a joint venture involving four hospitals in middle Tennessee. In March, Capella announced a collabora-

Southwestern Medical Center (Lawton, OK) has made remarkable strides since joining the Capella Healthcare family of hospitals as one of its four legacy hospitals in 2005. Last year they received two “best workplace” honors: named by Becker’s Hospital Review as one of the nation’s “100 Best Places to Work in Healthcare” and by The Oklahoman as a “Top Workplace” in the state. Pictured from left are: CEO Steve Hyde, CNO Steve Owens, CQO Dinah Lazarte, HR Director Danny Hale, CM Director Lanya Doyle and CFO Wayne Colson. Read their story at: CapellaHealthcare.com/SuccessStories

tion with a nationally renowned academic medical center in Washington, UW Medicine, and one of its legacy hospitals, Capital Medical Center in Olympia, Wash. “This partnership marries a top academic medical center that has very strong primary-care resources with a best-in-class community hospital,” Wiechart said. “This unique collaborative partnership will become a case study for how an outstanding community hospital can provide world-class care without compromising the unique attributes

Robins & Morton is proud to partner with Capella Healthcare to build quality facilities that beneﬁt the communities you serve for many years to come. robinsmortonhealthcare.com

for which it is most appreciated: compassionate personal care delivered close to where people live and work.” He added that these partnerships are not prescribed. Instead, they’re always about what makes the most sense for that community. Capella’s goal is to help a community hospital achieve its full potential, becoming the best it can be for the people it serves. BY PETE FERNBAUGH

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RESTORE MEDICAL SOLUTIONS, INC.

Shawn Flynn, President and Ryan Ramkhelawan, CEO

www.restore-med.com

Hospitals Can Restoreâ&#x201E;˘ ACA Compliance The Patient Protection and Affordable Care Act, known as PPACA or ACA for short, is arguably the most influential driver of policy and operational decisions by hospitals across the country. Hospitals are aggressively working to maximize revenues under new regulations and payment methodologies. In FFY13, Medicare began replacing a small portion of traditional Medicare payments (1 percent growing to 2 percent by FFY17) with the Value Based Purchasing (VBP) model for hospitals based on specific quality and service measures that reflect national best practices and outcomes. Examples include delivery of certain medications within specified time frames, reduction of hospital readmission rates, REDUCTION OF HOSPITAL ACQUIRED CONDITIONS, and more.

Real Issues : Real Solutions

02 | RESTORE MEDICAL SOLUTIONS, INC.

Let’s look at reduction of hospital acquired condi-

patients who have to be readmitted to their care

tions a little more closely. Effective July 1, 2011,

due to contracting one. So who or what is to blame?

ACA required the Secretary to issue Medicaid

Dirty surgical instruments are common culprits,

regulations prohibiting federal payments to states

and therefore, many hospitals are rightfully imple-

under section 1903 of the Social Security Act for any

menting process improvement strategies within

amounts expended for providing medical assistance

their Operating Rooms (OR) and Sterile Processing

for healthcare acquired conditions. These non-

Departments (SPD).

payment policies for provider preventable conditions (PPCs) include healthcare acquired conditions

“As a hospital administrator, my first concern

(HCACs) and other provider preventable conditions

is the safety and well-being of the patient. The

(OPPCs). Some of the minimum set of conditions,

prevalence of surgical site infections (SSIs) is one

including infections and events, that states must

of grave concern that is being addressed by hospital

identify for non-payment are:

administrators across the country. The ‘State of the Art’ Modular Sterilization Tray System designed by

Surgical Site Infection Following: • Coronary Artery Bypass Graft (CABG) – Mediastinitis, • Bariatric Surgery, including Laparoscopic Gastric Restrictive Surgery, • Orthopedic procedures, including Spine, Neck, Shoulder, and Joint Replacements.

Restore Medical Solutions will not only make the sterilization process more efficient, but potentially lead to decreasing potential SSIs due to a reduction in debris, biofilm, and bioburden on surgical instruments.” ~ Michael D. Wright, FACHE

Restore Medical Solutions, Inc. recognizes that

How is Restore Medical Solutions helping? If you

surgery plays a huge role in the ACA as it pertains

have ever worked in an OR or SPD, you are already

to maximized payments vs. non-payment. It is

familiar with the jumbled basket of dirty surgical

Restore’s mission to focus on products and tech-

instruments that find their way from the OR to the

niques that will promote a higher level of efficiency and productivity, enabling our nation’s hospitals to deliver quality healthcare to all.

“Every second is important when someone’s life is in danger, so the last thing a surgeon needs to worry about is where his or her instruments are or if they were cleaned appropriately. We are proud to bring our system to market knowing that it will help save lives and contribute to lowering the cost of healthcare.” ~ Shawn Flynn, President The reality is that Hospital Acquired Infections (HAIs) can affect nearly everyone. Chances are you know someone who has contracted one or you know someone currently hospitalized who is fearful of contracting an HAI at that facility. There is no doubt that your local hospital is being affected as well, since they are no longer being reimbursed for

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SPD for decontamination, sterilization, and repro-

challenges firsthand in their own SPD, Ryan and

cessing following every surgical procedure. Any

Shawn developed the Restore Modular Sterilization

SPD Tech can tell you the challenges of sterilizing

Tray System, and the solution was born. Co-founder

and reprocessing surgical instruments because

Shawn Flynn received his initial medical training

there are chronic problems that every SPD faces.

in the military as a Surgical Assistant. There he

Some of these are dealing with broken or missing

was cross-trained in SPD as well and realized the

instruments, needlesticks acquired while separat-

value of the OR and SPD functioning as one unit. He

ing the basket of dirty instruments, and worst of all,

was surprised to find that in the civilian world, the

the difficult-to-clean instruments. There are many

units many times function separately. Restore™

hardworking and dedicated SPD and OR person-

endorses the practice of the OR restringing instru-

nel that live with antiquated equipment, and they

ments at the point of use in the OR. This solitary

recognize the need for a better, safer, and cleaner

action makes it easier to recount instruments on

system. Enter Restore Medical Solutions.

the back table and accurately account for them. It also enables a quicker and safer inspection in the

“I like them, I think it’s a great idea, perfect for storage purposes and easy to use. I really like the

SPD, which in turn delivers cleaner instruments to the OR in a more efficient manner.

system. The instruments are cleaner and there are time savings associated with it”.

While FDA and AAMI standards recommend that instruments go through the washer in an open

~ Brandi Brooks,

and upright fashion, prior to Restore™ there was

Sterile Processing Manager

not a product on the market that facilitated this,

Baptist Memorial Hospital, Memphis

which is in–situ to the containment device. With the instruments in an open and upright fashion, it is

Restore™ was co-founded by Ryan Ramkhelawan

easier for the SPD Tech to inspect and reassemble

and Shawn Flynn, who both have medical back-

instruments, thereby lessening the touchpoints

grounds, including experience working within the

within the surgical sterilization continuum. Fewer

SPD of the largest Level One Trauma Center in the

touchpoints translate into fewer sharps-related ac-

Southeast. Shortly after experiencing these chronic

cidents for staff, reduced capital budget for repairs

Current hospital sterilization process

Restore Medical’s Modular Sterilization Tray System

Real Issues : Real Solutions

and replacements, decreased assembly time, and

Significant milestones to date for the company

increased focus on inspection and functionality.

include the successful closing of their $2.5 million

The bottom line is: fewer touchpoints translate into

Series A financing, international patent portfolio

more patients being seen and receiving better qual-

development, ISO 13485 certification with CAM-

ity healthcare, as well as increased revenue for the

DCAS, independent laboratory validation of mar-

hospital. Now that’s a win-win.

keting claims, company website launch, securing

Since receiving its FDA Clearance in August

assembly/distribution/office space, successful IQ/

2013, Restore™ has primarily been marketing its

OQ/PQ, and FDA clearance of Restore’s Premarket

Modular Sterilization Tray System within its local

Notification.

Memphis-based market. In particular, the Restore™ system is currently in the middle of a time-

“Our partnership with INNOVA and MB Venture

and-motion study in a local SPD setting, which,

Partners will propel us to incredible heights. Our

once complete, will be published as a White Paper

experience in healthcare and the financial support

that focuses on the efficiencies realized by imple-

from our partners gives us the ability to help fight

menting a system that includes AAMI and FDA-

against raising healthcare costs. Our product will

recommended features in modular tray and racking

allow hospitals to clean and re-sterilize surgical

devices like the ones manufactured by Restore™.

instruments in a more efficient and safer way.”

Additionally, the Restore™ system has already

~ Ryan Ramkhelawan, CEO

shown a ~99.99 percent reduction of bioburden on surgical ring-handled instruments during third-

Restore™ will definitely change Sterile Processing

party cleaning validation studies.

forever, and Restore™ is an exciting young com-

“Our product will allow hospitals to clean and re-sterilize surgical instruments in a more efficient

pany to watch. You can keep up with the latest news on the company website at www.restore-med.com.

and safer way,” says co-founder Ryan Ramkhelawan, whose background includes developing process improvement strategies that decrease the number of surgical complications.

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BOSTON MEDICAL CENTER

Enhancing Efficiency through Design and Construction Many exciting changes are happening in the way care is delivered at the bedside, but with efforts to contain costs and increase efficiency, facilities and support services are being transformed as well. Boston Medical Center (BMC) in Massachusetts is in the early stages of implementing a $270-million clinical campus redesign to support patient care delivery and reduce overhead costs for the organization.

Robert Biggio, Vice President of Facilities and Support Services

BMC was formed in 1996 by the merger of two full-service hospital campuses located only two blocks apart. This created a “split” campus rife with inefficiencies. A major part of the real-estate strategy is to redesign the campuses to reduce overlap and upgrade facilities. The to-do list includes expanding the emergency department, creating a cohesive women’s and children’s facility, consolidating intensive-care units with appropriate adjacencies, designing a state-of-the-art radiology department adjacent to the ED, and creating a single interventional procedure site, among other upgrades. Robert Biggio, vice president of facilities and support services, said he expects the project to save approximately $25 million annually in overhead costs.

03 | BOSTON MEDICAL CENTER

Levi + Wong Design Associates Levi + Wong Design Associates is a multidisciplinary design firm, offering architecture, landscape architecture, interior design, and planning services to the full continuum of health/senior care clients. Our patient centered designs are reflections of the mission and values of each individual facility. Upon completing Boston Medical Center’s $240 million master plan, Levi + Wong Design is serving as architects and interior designers on the BMC Yawkey Building lobby, cafeteria, and The Birthplace relocations and renovations. Each design mirrors BMC’s motto of “exceptional care, without exception”.

USING INTEGRATED PROJECT DELIVERY FOR COLLABORATION For the primary inpatient facility project, estimated at $130 to $140 million, BMC is using an Integrated Project Delivery (IPD) approach. This will be the first full healthcare-related IPD project done in Massachusetts. According to Biggio, IPD brings together the designers, owner, and contractor much earlier in the project, and they sign one three-party contract. The charges for each consultant are stripped down to actual cost, and all profit that is traditionally added to contracts is instead placed into a central pool shared on a percentage basis by each of the parties who have put their profit at risk. That pool is at risk throughout the project, motivating everyone to remain aligned to the common

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goals. All consultants are relocated onsite for the

“People have tried to guess what’s coming, so they

length of the contract to encourage collaboration

install things thinking they will be needed,” he said.

among the teams.

“A better approach is to build in flexibility without

Biggio said BMC has a dedicated 9,000 squarefoot colocation space for up to 90 staff consultants

incurring the cost today of adding extra elements.” He said most projects at BMC build flexibility

and owner’s representatives to meet, work, and

into the size of spaces and access to spaces for

interact. BIM 3D technology makes this approach

getting equipment in and out. He also said ceilings

possible, allowing everyone to work on one 3D

in the operating rooms are another area to add

model of the entire project rather than individual

flexibility, as more equipment is being hung from

drawings.

above rather than planted on the floor.

“So far, I am sold on this process,” Biggio said. “The level of collaboration and integration this process encourages is impressive. We are leaning

As far as sustainability, Biggio said he takes a more “meat-and-potatoes” approach to LEED. “If you get too focused on LEED points, you may

toward this being our standard going forward on

lose sight of the fact that some technologies being

large-scale projects.”

installed are difficult to maintain,” he said. “Many

INCORPORATING EVIDENCEBASED DESIGN AND SUSTAINABILITY

facilities are built with the intention of how they should be used rather than how they are actually used. We focus on the way systems will be maintained and operated and make sure that what we

Biggio said BMC tries to take a logical approach to

incorporate into the buildings at the outset are

building projects that accounts for future needs and

aligned with those efforts, then provide training.”

environmentally friendly elements, but it always

Some energy-efficient options cited in LEED

keeps in mind that the space has to be usable for

are not utilized, rendering them no longer efficient,

those providing care.

a lesson Biggio learned the hard way.

Building in flexibility is one area where Big-

BMC recently completed a LEED Silver ambu-

gio said the organization tries not to overestimate

latory care facility. Once he dug into the mainte-

to the point where it incurs additional cost in the

nance and operating strategies, the building was

present.

no longer as efficient as hoped. BMC has since

Real Issues : Real Solutions

gone back to modify the control sequences and

creates obstacles in our attempts to be fluid the

programming and is now able to realize the full

way reform is asking for.”

potential of the energy-efficient technologies going forward.

CHALLENGES IN A CHANGING ENVIRONMENT

All in all, Biggio said the main focus of any facilities project should always be on the patients and those providing care. “Buildings are tools we provide clinicians to meet certain objectives or goals to provide excep-

Cost containment and regulations are a chal-

tional care to our patients,” he said. “We need to

lenge in all areas of healthcare, and facilities are

make sure we fully understand what those goals

no exception. As the market turns around, build-

and objectives are and to design facilities that align

ings costs are on the rise. With most organizations

with and support them.”

modifying existing facilities, the main push is to support efficiency across the spectrum in the way

BY PATRICIA CHANEY

care is delivered. Facilities are an overhead cost, so the more efficiency driven into the system, the more resources are available to care for patients. In Boston, state regulatory design and construction guidelines present a challenge to achieving maximum efficiency. The Facility Guidelines Institute publishes guidelines for healthcare construction, but Massachusetts has adopted those guidelines as requirements, requirements that don’t always translate into what’s most effective for healthcare. One example Biggio gave is in the women’s and children’s department. The average daily census for the nursery is two babies. However, the state requires the hospital have one bassinet in the nursery for every maternity room plus one, a total of 31 bassinets for BMC. “You have the industry telling you what’s best for practice, but the requirements for how you build space haven’t caught up,” he said. “Being required to follow these standards in a stringent manner

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CLINICAL LABORATORY PARTNERS

Surviving and Growing in a Changing Marketplace When HCE last spoke with James Fantus, president and chief executive officer of the independent, full-service Clinical Laboratory Partners in Connecticut, in 2011, we discussed the history of the organization and how it had bounced back from near-financial ruin. We also talked with Fantus about the difficulty of regulation on the organization. James Fantus, President and Chief Executive Officer

In the ensuing years, the shifting landscape of healthcare has only become trickier to navigate, Fantus told us. “Insurance companies and employers are starting to profile providers against each other,” he said. “In other words, if an employer is trying to save money on their healthcare costs, he looks for who has the lowest lab fees and the lowest X-ray costs and pushes his employees to go there, and if they go anywhere else, they have a co-pay they have to pay. They steer people to where they have to go.” He’s seeing this occur with greater frequency, along with an increase in high-deductible plans that prompt patients to challenge physicians on the care they’re receiving. As a result, he is focused on becoming the high-quality, low-cost provider insurance companies and employers want, while ensuring that anti-steering language is placed in health-system contracts. Regardless of these trends, he said, his goals remain the same: continued growth of market share, especially since volume is going to taper off; greater competitiveness at the insurancecompany level; and improved distribution networks so third-party payers will be partners rather than adversaries working against them. .

COORDINATING CARE THROUGH DATA MANAGEMENT Fantus said CLP has just finished work on a data

makes sure you get the care you need when you need it.” He added that the healthcare industry has

warehouse of all patient lab information. Currently,

lagged behind all other industries when it comes to

CLP holds 12.5 million patient records and 65 mil-

disseminating information, something that is also

lion test results.

complicated by HIPAA regulations, which make it

“There’s a big push to coordinate care,” he said. “And coordinating care means that somebody

complicated to share info. “But nonetheless, if you coordinate somebody’s

is managing your healthcare from one end to the

care, not only are you going to ensure they get

other. This requires a navigator like a PCP who

appropriate care and that they get their follow-up,

Real Issues : Real Solutions

04 | CLINICAL LABORATORY PARTNERS

but you’re also not going to need a second labora-

the labs in CLP’s five-hospital system in order to

tory test because you didn’t see the first doctor’s

bring down operational costs. Currently, CLP only

test,” Fantus explained. “If the care is coordinated,

manages two of these labs.

you only need the test once, not two or three times, which occurs frequently now.” To achieve this, a robust data program is

“Whenever you say consolidation, people think job loss,” Fantus said. “That’s not necessarily so, but it will result in us being more efficient. We

needed, he continued. “We’ve developed a data

don’t have any idea just yet what it all means. We

warehouse of all of the lab test information on ev-

just know that doing the same thing in multiple

ery patient that we see whether they’re an inpatient

places has got to cost more than doing it in a single

in one of four hospitals or seen at a doctor’s office

place.”

anywhere in the state.” CLP draws data into the warehouse, sorts, and

He would also like to expand CLP’s services into neighboring states, but this is no easy task

organizes it by patient so that any physician with the

since insurance companies aren’t yet across state

right authorization can have access to the database

lines and every state has its own insurance groups.

and see a patient’s complete lab history.

The key here, Fantus said, is building up CLP’s

“When it comes to one of the key trends in

testing capabilities so it would be able to serve as

healthcare, lab tests are involved in 70 to 75 per-

a lab resource to hospitals that currently have to

cent of medical decisions,” he said.

send tests to national labs because they can’t do

Fantus feels this goes a long way toward coordinating care. It also helps with third-party payers,

them in-house. He would like to conduct about 80 percent of

since it’s a value-added service. Even if it costs a

any test a hospital would have to refer out. He said

little more than a national lab, CLP provides a com-

CLP is probably in the 50 to 60 percent range right

prehensive database that helps physicians man-

now. Once they get 80 percent, they’re free to go

age test utilization and reduces overall healthcare

into other states, because then they bill hospitals

costs.

not insurance companies. Fantus is also looking to open up additional

REDUCING OPERATIONAL COSTS THROUGH INTEGRATION

patient-access points. His goal is 25 new locations,

With the data-warehouse project completed, Fantus

across the entire state of Connecticut.

an achievement that would give CLP coverage

has turned his attention to integrating with each of

“WE DON’T HAVE ANY IDEA JUST YET WHAT IT ALL MEANS. WE JUST KNOW THAT DOING THE SAME THING IN MULTIPLE PLACES HAS GOT TO COST MORE THAN DOING IT IN A SINGLE PLACE.” HCE EXCHANGE MAGAZINE

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Improving the lives of patients.

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FIGHTING TO SURVIVE IN A DIFFICULT CLIMATE Under Fantus’ watch, over 500 new jobs were created by CLP that didn’t previously exist. “When I got here, we were the biggest money loser of all of the organizations owned by our parent company [Hartford HealthCare] and today we are the most profitable owned by our parent

Website: www.usdiagnostics.roche.com

company. If we’re not the biggest lab in our state, then we’re pretty close to it and that includes the national labs that have a footprint here.” CLP also went from serving 500,000 patients to 1.6 million non-hospital patients per year. But even

“I’VE ALWAYS BEEN ABLE TO SEE THE FUTURE AND BEEN ABLE TO PLAN TO GET THERE AND NOW THE FUTURE IS KIND OF MURKY.”

with this success, Fantus is just as hesitant as his colleagues about healthcare’s future. “I’ve always been able to see the future and been able to plan to get there and now the future is kind of murky. I’m just going to have to use a little bit more intuition and take a little more risk in getting there. I’ve been a survivor my whole career, and I’m bound and determined that we’re going to survive the new changes and challenges that the rapidly changing healthcare environment is bringing upon us.” BY PETE FERNBAUGH

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MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS Fostering a Culture of Collaboration for the Future of Oncology As the largest private practice in Maine, the Maine Center for Cancer Medicine & Blood Disorders (MCCM) has four locations throughout the state: Biddeford, Brunswick, Sanford, and Scarborough.

Steven L. D’Amato, Executive Director

Steven L. D’Amato has been MCCM’s executive director since 2011. D’Amato is a pharmacist by training, and early in his career, he developed the hospital oncology pharmacy program for Maine Medical Center in Portland. After spending 23 years in the hospital system, he was hired as a fulltime oncology pharmacist at the Maine Center for Cancer Medicine & Blood Disorders. D’Amato said he learned how to manage oncology services on the job, mainly through attending multiple national meetings and immersing himself in the specialty’s business and finance sides. When MCCM’s first executive director left for other opportunities, he accepted the position as an interim, eventually transitioning into the role on a permanent basis. As a board-certified oncology pharmacist through the American College of Clinical Pharmacy, D’Amato brings both a medical and a business perspective to MCCM.

05 | MAINE CENTER FOR CANCER MEDICINE & BLOOD DISORDERS

PARTICIPATING IN THE COME HOME PROJECT Currently, D’Amato said MCCM is involved in sever-

positive feedback from the patients. The patients absolutely love it.” Data from every call and intervention at each of

al progressive and innovative projects, not the least

the seven participating practices is captured elec-

of which is the Come Home Project spearheaded by

tronically by the software company, Net.Orange,

New Mexico Oncology Hematology Consultants, Ltd.

and aggregated and presented to CMS.

and Dr. Barbara L. McAneny. Funded by a $19.8-million grant from the

“The whole design of the Come Home Project is to demonstrate to CMS that community oncology

Center for Medicare & Medicaid Innovation, the

can provide a quality cost-effective service for the

program includes MCCM, the New Mexico Cancer

public and to develop alternative payment models,”

Center, and five other like practices. Come Home

D’Amato said, adding that he plans to continue with

is managing patient toxicities through the develop-

the Come Home model even after the grant has

ment and implementation of standardized triage

expired.

pathways for all types of symptom management. The overarching goal of Come Home is to bring

MCCM is also working with WellPoint and IBM to develop its Watson technology for medical-on-

patients to the clinic in real time for urgent-care

cology management. MCCM’s physicians have been

visits rather than forcing them to use the ER or

engaging with IBM engineers for over a year.

be hospitalized, thus reducing admissions and

“The goal is to bring Watson to a place where it

readmission rates. The patients are managed by a

could be a powerful support tool for the clinical on-

dedicated nurse triage team who determine how

cologist in helping to analyze the world’s literature,

their pathway of care should be executed. If the

along with the patient’s demographic and complete

team does have to admit patients, the clinic can do

medical profile, to give the clinician a sense of what

so by a direct admit, thus bypassing the ER.

the best treatment would be for that patient,” he

The physicians participating in the Come Home Project have also developed standardized treatment pathways for disease management. The adherence to these pathways will also be measured. D’Amato said that part of this program involved

explained. “It’s a way’s off, but it’s a very exciting project.”

INTEGRATING CANCER CARE WITH PRIMARY CARE

extending clinic hours on weekdays and opening the

D’Amato said MCCM is developing a survivorship

doors on weekends, and so far, it has been hugely

pilot project that will integrate cancer care with pri-

successful.

mary care from the outset of a patient’s treatment.

“It’s not an easy thing to accomplish. There’s

“When we have a patient come into our clinic

a lot of staffing and scheduling issues that come

who has been diagnosed with a malignancy, we

into play to implement such a system, and we’ve

establish a plan of care,” he said. “The idea is after

done that effectively. The biggest plus has been the

the second or third visit where the patient presents

HCE EXCHANGE MAGAZINE

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RECEIVE INTELLIGENCE ON LEGISLATIVE, REGULATORY AND POLICY CHANGES THAT JOIN TOGETHER WITH OTH ARE CHANGING THE LANDSCAPE FOR COMMUNITY ONCOLOGY LEARN HOW TO NAVIGATE AND OPERATE MORE EFFECTIVELY INYOU A STRONGER VO GIVE Through ION Solutions national meetings, educational webinars, thought leadership materials and more, THISKEY NEWRESOURCES ENVIRONMENT.AND TEMPLATES TO JOIN TOGETHER WITH OTHER TOaffecting ACCESS you’ll gain insight on the issues PRACTICES that are holistically community oncology care, such as: You will receive presentatio GIVE YOU A> Shift STRONGER VOICE IN THE COMMUNITY.Get a better understanding of how site of care decisions are made, in site of care such as how oncology communicate to key consti > Understanding of the essential health benefits and health insurance exchanges acquire patient referrals. Plus, receive the support you need to evaluate your practice’s ab Campaign partners for Com > Lowered blended reimbursement rates readiness to deliver value, including operational policies, procedures and best practices. You will receive presentations and templates, backed by aggregated and validated data, to help oncology care – the manuf > Supreme Court decision to uphold the Affordable Care Act receive will resonate with s communicate to key constituents about the value of keeping oncology care in the community setting. > Cuts to sustainable growth rate (SGR) Campaign partners for Community > 2% Sequestration (ASP + 4%) Counts have the depth of knowledge from all perspectives of

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Oncology Supply For more than 35 years, Oncology Supply has distributed chemotherapy and supportive care products to independent oncology practices nationwide from our corporate office/distribution center in Dothan, AL. Our goal is to exceed expectations by delivering responsive, innovative solutions to help our business partners positively impact cancer patients’ lives. Proven excellence in customer service, stability in the marketplace, and our honest, ethical, reliable interaction with practices and manufacturers differentiates us from competitors. Oncology Supply is the exclusive distributor for ION Solutions group purchasing organization and we are owned by AmerisourceBergen Corporation. Bringing technology to the forefront, Oncology Supply’s Nucleus Inventory Management System is the market leader in accurately tracking and controlling inventory and providing extensive reports utilized to improve practice efficiency.

ESTABLISHING A NIMBLE AND ADAPTABLE CULTURE During his time with MCCM, D’Amato has worked with the organization’s president, Dr. Tracy Weisberg, to internally instill within MCCM a culture of quality, compassion, innovation, and accountability. Integral to this culture change was the establishment of a leadership team able to be nimble and adapt to the many changes in oncology. “We’ve really done a good job to put our house in order,” D’Amato said, “to make sure we have all of the quality personnel that we need, and that’s from physicians on down, and to make sure we have the right players who embrace our vision and goals.” Moving forward, he wants to extend his team’s

to us and starts treatment is that we establish a

effectiveness to foster a collaborative spirit with

follow-up appointment with their primary-care phy-

other healthcare entities in MCCM’s service areas.

sician where the oncologist can lay out the treat-

“As we all know, payment reform is upon us,

ment plan for the PCP. We involve the PCP from

and I think that we all need to work collaboratively,

the beginning with the patient’s treatment plan so

whether it’s in a hospital system or private-practice

there’s that tight integration between primary care

system or community system. We all have to work

and medical oncology.”

together, regardless of your interest and your busi-

To further cement this collaboration, MCCM

ness model. There has to be an alignment to bring

plans to work with primary care to integrate medi-

down the costs in healthcare. It’s integration of

cal records to enhance information exchange.

medical records, partnering with different organi-

“The thought here is you eliminate duplication

zations on how to deliver the best cost-conscious,

of tests and also bring the PCP in tune with the

high-value quality care possible, and to establish

patient’s treatment to more effectively manage that

metrics that can be measured to ascertain that the

type of patient’s care and avoid any complications,”

things that we’re doing are working.”

D’Amato said, adding that MCCM’s ultimate goal is to be a certified oncology medical home.

BY PETE FERNBAUGH

HCE EXCHANGE MAGAZINE

NORTHERN NEVADA MEDICAL CENTER

Building Upon a Solid, Secure Foundation Alan Olive has been with Northern Nevada Medical Center, a 108-bed acute-care hospital that sits on 23 hillside acres in Sparks, Nevada, for less than a year. In many ways, he was fortunate, he said, to walk into an organization that was already driven and committed to excellence. As its new chief executive officer, he was tasked with maintaining this excellence, including the center’s solid quality scores and patient-satisfaction ratings.

Alan Olive, Chief Executive Officer

Prior to his arrival, Olive said the organization had secured the Nevada Hospital Association’s Quality Improvement Award and was recognized by the Joint Commission for its core measures and by the NHA for its fall reductions. It was also awarded the 2013 Nevada Excellence Award by the Small Business Institute for Excellence in Commerce (SBIEC). “The culture is already strong for outcomes and so that’s easier to work off than to rebuild,” he said. In previous leadership roles, Olive has achieved leading-class quality results, and his goals for Northern Nevada Medical Center are to take it to the top fifth percentile in the nation for every category, including outcomes, falls, HCAHPS, and employee engagement.

Real Issues : Real Solutions

06 | NORTHERN NEVADA MEDICAL CENTER

CONTINUING THE IMPLEMENTATION OF EMR Northern Nevada Medical Center has completed Phase I of its EMR implementation, and CPOE is set for implementation in June of this year. Olive is well aware of the challenges that confront an organization as it gets deeper into the implementation process. He said successful implementation requires several factors to be in play: 1.) a culture of teamwork; 2.) physician and staff engagement; 3.) order sets and processes that are proven; 4.) education and training; 5.) a great EMR partner; and 6.) a commitment of resources and support from the administration. Olive added that he also relies on the vendors

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for the wisdom they have gleaned over the course of many integrations.

INVESTING IN TELEMEDICINE AND TELEMONITORING Currently, Olive is spearheading investments in shared services for the sake of consistent outcomes. This includes upgrading its facilities, since the current hospital is over 30 years old. Furthermore, Northern Nevada Medical Center is looking to invest in technology, not just in the hospital, but also with physician groups in rural communities to provide teleheath, telemedicine, and eHealth. “For example, we have a telestroke robot in multiple rural locations, and we’ve partnered with physicians to provide immediate stroke-consult solutions with video and audio as well as the ability

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to interchange PAC systems and images,” he said. Many of these facilities do not have such services, but thanks to telemedicine, one can be online within a minute or two, saving lives and brain function and determining whether or not TPA should be administered, Olive added. ©2013 St. Jude Medical. All Rights Reserved.

HCE EXCHANGE MAGAZINE

He said the organization is considering eVisits and

of care, a high-reliability organization, reducing our

eTechnology for cardiac monitoring in patients’

costs, and ensuring that our patients are extremely

homes. In addition, Northern Nevada Medical

satisfied so they have a warm welcome, amazing

Center is looking at predictive modeling for patients

experience, and a fond farewell.”

and disease states so it can address care in advance and lower readmissions and ER utilization.

REMEMBERING ACHIEVEMENT IS ROOTED IN LEADERSHIP

Because of these shared goals, Olive would like to extend this excellence to his competitors. “My thought is we need to be more collaborators than competitors because the cost of care, the need for collaboration and community is greater

When considering Northern Nevada Medical

today than it’s ever been. That’s part of my mantra.

Center’s success, Olive points to its engaged staff,

That’s why I’m looking at partnering and working

physicians, leadership, and board support.

with our local hospitals, regardless of their align-

“You have a board that’s very committed to

ment, as well as our physician groups, whether they

these outcomes, they’re very intelligent people,

be employed or nonemployed, and with the local

very engaging people,” he said. “They’re business

government, to ensure that we provide the right

leaders and community leaders who say, ‘This is

models of care.”

our hospital, and it must provide the best care.’” He added, “Healthcare today, we’re all working

BY PETE FERNBAUGH

towards the same end to provide the highest level

Real Issues : Real Solutions

07 | ADELANTE HEALTHCARE

ADELANTE HEALTHCARE

A Broad-Based Approach to Providing Care Adelante Healthcare is a not-for-profit federally qualified health center based in Maricopa County, Ariz. The organization operates seven health centers throughout the Phoenix metro area with plans for expansion into Peoria this fall.

Avein Saaty-Tafoya, Chief Executive Officer

Under healthcare reform, most care providers are seeking ways to keep patients healthy and transform the old paradigm of primarily offering sick care. Adelante Healthcare has forged its own path in this regard and is taking a wide-ranging integrative approach to care delivery.

HCE EXCHANGE MAGAZINE

“As a provider, it’s frustrating to sit in a room with a patient you’d like to help and the only tool you have is a prescription pad,” Saaty-Tafoya said.

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Adelante encourages conversations about lifestyle factors that contribute to the patient’s disease and the development of a game plan that may include medication as well as nutrition and self-management techniques. Saaty-Tafoya said patients are assessed to better understand their background, primary and

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preventive needs, risk factors, as well as personal elements of health they may not be aware of in an effort to provide an array of options. “In the past, we may have given someone with chronic pain narcotics, but now, we might offer acupuncture, physical therapy, or even nutrition,”

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Saaty-Tafoya said. This approach has generated improvements

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so far. Pain-management scores used to be low, mainly because it wasn’t a primary area of focus. The organization developed a multi-pronged approach to training and treatment, bringing in careteam members who may not typically be involved

EMBRACING A HOLISTIC VIEW OF TREATMENT

in pain management so that everyone was sharing observations. Saaty-Tafoya said it is important to test all mo-

As a recently accredited patient-centered medical

dalities and clinical guidelines with the same rigor,

home (PCMH), Adelante takes its mission to heart

including nutraceuticals, which are already popular

with a strong emphasis on providing personalized

in some of the top cancer treatment centers in the

care. Evidence-based design and sustainability are

world.

incorporated into the physical environments, along with added hospitality elements.

“We have a good handle on communicable disease,” she said. “Behavior and lifestyle, more than

“I joined the medical field because I really want-

anything else, are determinants of quality of life

ed to help people and leave the patients I serve bet-

and longevity. We made a mission change that has

ter than I found them,” said Chief Executive Officer

taken us back to our roots and that we hope will

Avein Saaty-Tafoya. “Adelante Healthcare facilities

improve the health of our community.”

are modeled after warm environments that people want to be in such as coffee shops or libraries.” Adelante’s broad-based approach brings

It has taken time for Adelante staff and stakeholders to adjust to this shift in practice, and the organization is still in the early stage of the PCMH

together medical care, dental, nutrition, integrated

model. But Saaty-Tafoya said she was able to get

behavioral health, and even naturopathic medicine.

staff engagement once they understood the ways

As a community health center, most of Adelante’s

they could change lives. Providers are involved in

patients deal with chronic diseases and diseases

developing and testing new approaches for quality

related to lifestyle, behavior, and stress.

improvement.

Real Issues : Real Solutions

Adelante has brought in a few partners and still has some ground to lay before the expansion project can be launched, but the center has already received positive responses. Saaty-Tafoya said the early adopters were open and ready for something new, and other partners are seeing the changes and opening up to new opportunities. “We had gotten to a point in the old paradigm where leaders had enough,” she said. “They were being confronted by boards and strategic teams to achieve new goals, particularly those related to payment reform. If you don’t have an answer with the current model, you have to start looking for a “Our providers are attracted to community health centers because they want to make a difference in

different approach.”

patients, and we really want to see them improve.

EDUCATING THE NEXT GENERATION

That mission is where we’ve gotten the care team

Adelante is also actively involved in training and

to embrace this practice change.”

educating up-and-coming practitioners. The Mesa

patients’ lives,” she said. “We care for underserved

INTEGRATING HEALTHCARE CENTERS INTO THE COMMUNITY Adelante is in the early stages of an expansion project that would develop a community healthcare

Health Center has become a workforce development incubator with multiple schools rotating students through the site, which is located on a joint vocational school campus. “Medical students are getting a glimpse of how

park involving partners from schools, business,

the patient experience needs to evolve,” Saaty-

and government. The center has a partnership

Tafoya said.

with a local hospital system and wants to develop

In all, Adelante has graduated about 50 stu-

a colocation with other community services “so

dents from its osteopathic medical program at A.T.

that when the community thinks about going to the

Still University in Mesa, Ariz.

doctor, they don’t think of it as detached from other aspects of their lives.” This model has been done in other areas of the country, and Saaty-Tafoya hopes to make Adel-

Adelante has an exciting future ahead, and Saaty-Tafoya said getting buy-in from frontline staff has been key to making everything work. “Changing the culture is a true investment in

ante’s unique. She said the idea is in part prompted

time and some risk,” she said. “But it provides

by the center’s membership in an accountable-care

sustained dividends and improvements in difficult-

organization, which has given the center for-profit

to-achieve health outcomes. Sometimes to push in-

and not-for-profit partners.

novation, you have to be on the edge of logic. Maybe

“We have to have a broad approach to provid-

it’s not what we’ve done in the past, maybe it’s not

ing care because reimbursement is changing,” she

proven, but we’re dealing with people, and we have

said. “We don’t just want to survive. We want to

to embrace the human condition. ”

thrive and have a measure of say in what the future of healthcare looks and feels like.”

BY PATRICIA CHANEY

HCE EXCHANGE MAGAZINE

INTERIM LSU HOSPITAL

Navigating Significant Changes While Providing Uninterrupted Care Over the course of five months in 2013, Interim LSU Hospital (ILH) in New Orleans, La., experienced significant changes in operations and ownership through a public-private partnership. During those five months, the organization went from being a state-managed hospital facing deep budget cuts and layoffs to being a privately managed, not-for-profit facility. This transformation occurred without any interruption in patient care.

Cindy Nuesslein, Chief Executive Officer

By the summer of 2015, the hospital will move two blocks from its current location into an all-new, state-of-the-art facility.

Real Issues : Real Solutions

08 | INTERIM LSU HOSPITAL

SWITCHING OWNERSHIP FROM STATE TO PRIVATE In Louisiana, the state ran a hospital system of 10 facilities, but in 2012, it realized the arrangement was no longer viable because of changes in state and federal funding. The state then began seeking private partners to take over operation and management of these facilities. ILH is a large academic medical center that is vitally important to the teaching missions of Louisiana State University New Orleans Schools of Medicine, Nursing, Dental Medicine and Allied Health Professions and Tulane University School of Medicine. ILH also has affiliations with Xavier and Dillard Universities, Delgado Community College, the University of New Orleans, and others. In June 2013, University Medical Center Management Corporation, of which LCMC Health is the sole member, took over operations of the facility and appointed Cindy Nuesslein, the longtime vice president of operations for Children’s Hospital in New Orleans, as chief executive officer of ILH. LCMC is currently a system of four hospitals, with additional hospitals to be added in the near future. Nuesslein said before the private partnership occurred, the state was going to cut the size of

services, and built up employee and medical-staff

the organization in half, which would have dealt

engagement.

a crushing blow to all of the schools that rely on these facilities for training. At ILH, the hospital and staff has made a

“This has been such a unique environment, and the staff is truly remarkable,” Nuesslein said. “Everyone is committed and energized, and I feel

remarkable transition in such a short time without

we are all driving toward a common goal, which is

patient care or employee morale suffering.

to run a world-class academic medical center.”

As the state was seeking private partners,

That camaraderie continues as the hospital

employees of the facilities were in limbo about the

looks to open a new facility in the summer of next

fate of their jobs. During the ILH transition, all 2,000

year.

employees were laid off and 1,800 were rehired other opportunities, thereby greatly minimizing the

TRANSITIONING TO A NEW FACILITY

economic impact to the local community.

ILH, formerly known as University Hospital, was

by ILH. Many of those not rehired retired or found

In addition to onboarding employees, in just nine

originally one of two teaching hospitals part of the

short months the hospital has opened more acute-

Medical Center of Louisiana at New Orleans. When

care and psychiatric beds, expanded emergency

the second hospital, Charity Hospital, closed fol-

HCE EXCHANGE MAGAZINE

lowing Hurricane Katrina, all of its operations were

What would be vital, she added, is ensuring the

moved to ILH.

staff will have everything they need to care for the

The hospital has active residency and fellowship programs for two local medical schools and one dental school. Education is a vital part of the hospital’s mission and service to the New Orleans community. The new hospital, currently under construction

patients, since maintaining a cooperative, patientcentric spirit will be key to the coming transition. Nuesslein feels confident in her people. “LCMC Health is a respected organization,” she said. “We are well-known for taking care of people in the right way, and we realize it is an honor

between Canal Street and Tulane Avenue, is a $1.3

and privilege to care for the people who cross our

billion investment.

doors. We are all working toward the common goal

Nuesslein said that ILH was resource-poor for a

of doing what’s right for the right reasons.”

long time, so the new University Medical Center will have all-new technology and medical equipment.

BY PATRICIA CHANEY

One of the biggest challenges for now is determining where to invest capital dollars during the transition period. “We are developing a short-term capital investment strategy to help grow without wasting resources,” Nuesslein said. “We are only spending where it is absolutely necessary, and we are making sure we can take any new equipment with us in 14 months.” One example of this strategy is the decision to purchase a da Vinci Surgical System with a teaching module. Residency programs require training on the system, and no facility in the region has the teaching module. Therefore, Nuesslein said ILH felt this was a necessary investment for patients and trainees. ILH is still in the early stages of reviewing information technology, which is another significant aspect of the transition planning. The hospital inherited many disparate systems and is assessing how to integrate those applications. One of the primary concerns of any transition is ensuring that employees and medical staff are prepared and that patients will not experience any interruption in care. If invoices or billing have to be delayed during the transition, Nuesslein said that would be acceptable.

Real Issues : Real Solutions

09 | PHYSICIANS CARE SURGICAL HOSPITAL IN ROYERSFORD

PHYSICIANS CARE SURGICAL HOSPITAL IN ROYERSFORD

Chris Doyle, Chief Executive Officer

Overcoming the Challenges of the Past for the Possibilities of the Future Chris Doyle joined Physicians Care Surgical Hospital in Royersford, Penn., on March 25, 2013, after the organization partnered with the internationally renowned Rothman Institute. Physicians Care Surgical Hospital was originally founded by community surgeons, including Drs. Larry Feiner and Fred Liss, who were seeking to advance specialty care in the area. The Rothman Institute itself is the largest orthopedics practice in the Philadelphia region and is highly regarded as the best in the world. Patients from every corner of the globe seek out the services of the Rothman Institute. After opening its doors in October 2010, the hospital’s first few years were a building period, but with new leadership, 2013 was Physicians Care Surgical Hospital’s most productive time to date, especially in the area of HCAHPS scores. “Traditional hospitals have other challenges, other focus areas, but we feel because we’re a surgical hospital, that our SCIP measures and our HCAHPS should really beat the top of the pack,” Doyle said. HCE EXCHANGE MAGAZINE

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the new office building, the case volume in 2014 will climb even higher. These changes have brought in new personnel and new positions, namely the development of a pre-admission testing department and the creation of a role for director of quality and accreditation. For this position, Doyle promoted from within the hospital after identifying an accomplished nurse leader, Lisa Gill. He also hired a new director of nursing, Tom McLaughlin, and a new director of perioperative services, Michele Mayes. The new leadership team joined Jennifer Ryan, business of-

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The hospital saw vast improvement with employee engagement throughout 2013, reaching among the top percentile in the nation. “The culture has shifted not just with myself and new leadership, but also as a result of the volume and new ownership,” Doyle said. “With

EXPANDING ITS APPROACH TO DELIVERING CARE

[2012’s] volume, there were a lot of inconsistencies with staff scheduling, staff expectations, and the staff feeling of productivity. With the volume we

Doyle said the organization has numerous proj-

have now and how we’re streamlining a lot of our

ects on its plate right now. For one, the Rothman

departments, we’re seeing an improvement in this

Institute just opened a new medical building that

area. We’re seeing staff that feel more satisfied,

features an urgent-care orthopedics center, a

feel more productive, and feel more accomplished

staff of newly hired physicians, and innovative and

by the end of the day.”

new approaches designed to complement the care already being provided. “The idea is that if a patient arrived at the

INCREASING VOLUME AND IMPROVING TECHNOLOGY

urgent-care center and needed care we would be

Doyle would like to accomplish several goals in the

able to provide surgery relatively quickly,” he said.

next year. For one, he wants to increase orthopedic

“If not the same day, we would provide it in the next

services by 45 to 50 percent of the current volume.

couple of days. So it would change our model just

He is also working to create more inpatient stays

slightly. Currently, as a specialty hospital, we’re

than outpatient.

very scheduled. So we’re able to know our surgical

He added that Physicians Surgical Care would like to bolster its existing EHR with improvements

cases in advance.” Second, Physicians Care is dealing with an

such as scanners for patient wristbands and an ad-

increase in volume. In 2013, it received 4,200 surgi-

vanced platform that would allow them to integrate

Real Issues : Real Solutions

with local physician practices. He is exploring the possibility of bringing on a general surgery practice

approach the accountable-care organization model. “I think the immediate political climate is prob-

located to the southwest of the facility and would

ably not going to permit those laws to change,”

like to offer vascular surgical services.

he said. “I think that long-term, pendulums tend

Overall, though, he believes his first year has

to swing, though. And when we look at the data,

been marked by the financial success the hospital

among the top five hospitals in the Philadelphia

has experienced. Last year, Physicians Surgical

market are physician-owned hospitals. Our coun-

Care was challenged financially and was desper-

terpart, Rothman Orthopaedic Specialty Hospital in

ately trying to be successful with outpatient cases.

Bensalem, is also affiliated with Rothman Institute

Coordinating with the Rothman Institute and the

and is among the top five. Also the Surgical Institute

founding surgeons, 2013 proved to be a transforma-

of Reading is physician-owned and near the top of

tive year for Physicians Care Surgical Hospital.

scores.

“There was a lot of change that occurred last year and change is difficult for most people,” Doyle

“So we’re hoping that at some point we as a society see the value in physician-owned hospitals.”

said. “The initial impact left some staff members wondering how the hospital would be impacted by

BY PETE FERNBAUGH

these changes. When I and my leadership team arrived, we embraced a lot of those changes and when the staff were able to recognize the excitement behind bringing on new surgeons and learning new techniques and having brand-new instrumentation and the commitment basically that not only the leadership team, but also the new orthopedic surgeons have for the hospital, the staff themselves were very excited by this.” Currently, physician-owned hospitals are not permitted to expand with additional operating rooms or in-patient beds. The problem here, he said, is legal with certain laws regulating the growth of physician-owned hospitals. More recent laws have favored other models in hopes of encouraging larger accountable-care organizations and preventing physicians from scheduling cases at hospitals that they own themselves. In response to the current environment, Physicians Care Surgical Hospital is now eyeing potential expansion through the creation of a surgical center. In addition, other health systems have asked to tour Physicians Care Surgical Hospital after recognizing that better patient outcomes and satisfaction can be achieved using the specialty service model. Doyle sees partnerships as an opportunity in the future to

HCE EXCHANGE MAGAZINE

ROSELAND COMMUNITY HOSPITAL

Regrouping and Refocusing through Teamwork and Leadership Tim Egan, president of Roseland Community Hospital, began his tenure on July 8, 2013. The organization was in financial upheaval. In fact, it was difficult for Roseland to meet payroll during the first half of 2013. As a result, much of Roseland’s staff had been let go, and what Egan inherited was a skeleton team. On top of that, his first task was preparing for redesignation as a perinatal level 2 unit.

Tim Egan, President

Presented with these challenges, Egan resisted the urge to panic and instead, focused on organizing a working group “to make sure that we were paying attention to all of the details needed to have a successful recertification.” This included recruitment of new staff. For example, the hospital was in need of a department manager to serve as director of perinatal services. Roseland was lucky, he said, to find Rachel Jones.

Real Issues : Real Solutions

10 | ROSELAND COMMUNITY HOSPITAL

DMS Pharmaceutical Group, Inc.

tWith this team in place, Egan began to prepare for

FULL LINE PHARMACEUTICAL

the Jan. 31, 2014, full-day survey to determine the hospital’s perinatal status. “We had weekly meetings, we did our mock surveys, and everything right up to the last minute worked out well,” he said. Then, two days before the survey, bad weather struck Chicago and one of the pipes burst over the OB unit. Once again, instead of panicking, Egan said his team came together and cleaned up the unit, fixed the broken pipe, and repaired the tiles in the roof. “It was just one of the best team efforts I’ve ever seen in a 20-year healthcare administrative position,” he said. And the effort was rewarded when the Illinois Department of Public Health (IDPH) surveyor team redesignated them as a level 2. “It was one of the greatest feelings in the world at the end of a very long day to have the survey team give us unanimous approval for redesignation,” Egan said. “Some of our peers have struggled with this perinatal redesignation in the last year, but we really put the effort in.”

FOCUSING ON 2014 Topping Egan’s list of projects is the revised 2014 Strategic Plan. He and his team established five pillars for 2014 that would help Roseland focus on the basics: Patients, Physicians, Employees, Community, and Collaboration. “For our physicians, we want to be able to provide them with the support and the facilities that they need so they can provide that quality of care,” Egan said. “I’ve always said the greatest assets you can have in a hospital are your employees. You can spend millions in marketing, but a smile from your environmental services team to your security to your nurses to your CNAs, that can do wonders.” He summed up his vision for the organization simply: “We work in healthcare because we want to

help people. So when you come here every day, we want you to pick up that vision of saying, ‘I’m here because someone is injured, sick, or ill, and we want to make their lives better.’” Beyond the strategic plan, Egan is also developing marketing strategies for Roseland’s Mammography Unit. Featuring the Philips MicroDose Mammography system, the unit is the most sophisticated in the city of Chicago and was made possible by a Philips grant. The program has been bolstered by a $200,000 grant from the Chicago Department of Public Health. By contracting local radio host Consuella Williams of V103 as spokeswoman for the unit, Egan said the hospital has seen an uptick in its mammography services. Roseland is also in the process of participating in all aspects of healthcare reform. The organiza-

HCE EXCHANGE MAGAZINE

tion wants to move away from the current standard where a majority of inpatients are direct admits from the emergency department. As Egan explained, this means they’re seeing people on the last leg of their healthcare journey. He wants to catch them on their first leg. Therefore, wherever the hospital can, it is providing more preventive medicine through its network of outpatient clinics. Currently, Roseland has a wound clinic and is in the process of reinstituting hyperbaric chambers that had previously been shut down during the financial crisis. Egan said Roseland also has great plans for a bricks-and-mortar asthma clinic, since 22 percent of inpatient stays at Roseland are due to chronic asthma conditions. Overall, Egan said, he thinks “that this is a challenged community that deserves high-quality healthcare and that’s our mission.”

A PASSION FOR PEOPLE AND COMMUNITY In spite of the many challenges that Egan has confronted in his first year at Roseland, he is passionate about the organization and the people of the community. The IDPH not only redesignated Roseland as a level 2 perinatal, but also commended it for its exceptional commitment to excellence and for its revitalized focus on HCAHPS scores. “One of the things that I think the surveyors really appreciated was the fact that myself or one of the senior administrators goes up and greets every

they are now masters of HCAHPS, Egan said, which is why he advises his executive colleagues, especially those at troubled organizations, to not panic when confronted with institutional crises. “The best advice I can give in a time of great crisis is to be patient and not make knee-jerk reactions. Outside of all these problems, there seems to be two sides to each issue, and I’ve found the truth is always somewhere in the middle, so you need to be able to weigh both sides and use that information to make an educated decision. In a time of great crisis, you have to be calm. You’ve got to avoid that temptation of reacting with emotion.” BY PETE FERNBAUGH

mom upon delivery and gives them a gift on behalf of the hospital, and they thought that was great,” he said. When he first arrived, there were many members of his staff who were unsure as to what HCAHPS scores were. Through intense education,

Real Issues : Real Solutions

11 | xG HEALTH SOLUTIONS, INC.

xG HEALTH SOLUTIONS, INC.

Bringing Years of Experience and Data to the Marketplace Dr. Earl Steinberg was hired by Geisinger Health System, one of the most prominent integrated healthcare delivery systems in the United States, after accumulating 30 years of experience in various healthcare organizations.

Earl Steinberg, M.D., MPP, Chief Executive Officer

Steinbergâ&#x20AC;&#x2122;s diverse background includes 12 years as a medical professor and researcher at Johns Hopkins University, during which time he developed several of the HEDIS measures and CMS quality-care measures for dialysis centers that are still in use today. He also founded Resolution Health Inc. (RHI), a company that performed sophisticated data analyses to identify actionable opportunities to improve quality and reduce costs and offered a number of high-tech, low-touch interventions to address those opportunities. Prior to being purchased by WellPoint, RHI analyzed data on approximately 30 million lives. After WellPoint purchased RHI, Steinberg became a senior vice president at WellPoint in charge of quality and clinical strategy, until he was recruited three years ago by Dr. Glenn D. Steele Jr., the world-famous CEO of Geisinger. Steele had spearheaded numerous innovations during his time with Geisinger and was interested in exporting the systemâ&#x20AC;&#x2122;s accomplishments to other healthcare delivery systems. He hired Steinberg to figure out which Geisinger innovations were exportable and scalable, how to go about exporting them, and ultimately to manage the service and product-delivery effort.

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ACCURATE ANALYTICS

FOR BETTER DECISIONS

“So, basically, xG Health has received a perpetual license, on an exclusive basis, to everything Geisinger has developed or develops over the next 10 years that, broadly construed, is related to healthcare performance improvement, including care management, data analytics, electronic medical records, and other HIT, contracting, compensation, and leadership,” Steinberg said. Along with this exclusivity is a non-compete agreement, which means that no part of Geisinger can compete with xG Health outside of Geisinger’s own delivery system.

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Since the Geisinger Health Plan had begun doing work with other healthcare delivery systems 18 months prior to xG Health’s rollout, the agreement between Geisinger and xG Health specified that the health plan would subcontract with xG Health to provide population health data analytics and caremanagement services outside of Pennsylvania. “We started with 11 customers as a result of the contributions from Geisinger, and we’re now up

BUILDING XG HEALTH SOLUTIONS FROM THE SYSTEM OUT Steinberg spent about eight months studying Geisinger Health System in order to understand the intricacies of its influence. After developing a business plan and partnering with JPMorgan Chase to raise $40 million, Steinberg unveiled xG Health Solutions Inc. on Feb. 1, 2013. Although xG Health is primarily owned by the Geisinger Health System Foundation and private equity firm Oak Investment Partners, it is an independent entity from Geisinger itself. In addition to contributing start-up funds to xG Health, Geisinger also licensed all of its healthcare performance improvement intellectual property that existed as of February 1, 2013, and that it develops until February 1, 2023, to the newly formed organization.

to 29 customers,” Steinberg said. “And we started with 11 employees and we’re now up to 100.”

PROVIDING HEALTHCARE ORGANIZATIONS WITH THREE SERVICES xG Health Solutions Inc. provides three types of services: advisory services focused on assessing a healthcare provider’s current state and developing a volume-to-value roadmap; care design and delivery; and population health data analytic services. For advisory services, xG Health assists “a healthcare delivery system in developing a road map or action plan for how to transform themselves and move from the typical fee-for service volume orientation to a value orientation without committing financial suicide,” Steinberg said. For care design and delivery services, xG Health helps clients redesign primary care and estab-

Real Issues : Real Solutions

lish advanced patient-centered medical homes; implement evidence-based protocols, which are known as ProvenCare™ modules; and coordinate care across the care continuum. xG also trains or embeds trained case managers in PCMHs to manage complex patients and in hospitals to facilitate transitions of care, provide case-management software, and help integrate workflow redesign into providers’ EMR systems. For population health, Steinberg said xG Health analyzes insurance-claims data, EMR data, lab results, and patient-reported data, such as healthrisk appraisals, to “produce insight into how to manage a population as opposed to managing one patient at a time.”

FINDING SUCCESS WITH ITS FIRST ENGAGEMENT “Our first engagement was with West Virginia United Health System, which is the largest system in West Virginia and an academic medical center,” Steinberg said. “It’s got about eight hospitals, 1300 beds, 900 physicians, and 12,000 employees overall.” Like most providers of its size, WVUHS was self-insured and interested in beginning its transformation from volume to value by focusing on its self-insured lives. Geisinger Health Plan became WVUHS’ third-party administrator (TPA), conducting claims processing and benefits design, as well as performing population health and data analytics and providing UM and DM services. “Because we have to allow adequate time for the claims run-out, we have data through 20 months of experience,” Steinberg said. “In the first year, we reduced admissions by 16 percent and

cost of care, and we markedly improved quality on a rather typical set of HEDIS-type measures.” He added, “The point is we got results within a year, the results have improved in the second year, and we haven’t even turned on everything that we can turn on.” xG Health’s influence has grown rapidly and its solutions are being used at facilities in eastern Maine, Delaware, Washington State, California, Georgia, and even Singapore. In Steinberg’s opinion, one major factor makes xG Health unique: it is not a company that is trying out new concepts and technology. “These are techniques, technologies, and protocols that have been refined over 15 years at Geisinger and have been proven to work there,” he said. “We have a playbook in each of the areas that we have been able to extract from Geisinger. We started out with something that had already been shown to be successful and what we’ve done is basically adapt them and package them in ways that can be implemented elsewhere.” BY PETE FERNBAUGH

readmissions by 16 percent. By 20 months, we had reduced admissions by 26 percent and readmissions by 37 percent. We also reduced ER visits, total

HCE EXCHANGE MAGAZINE

THE FLOATING HOSPITAL

Providing Care to New York City’s Homeless Population Federally Qualified Health Centers provide a valued service to underserved populations across the country. In New York City, one center offers dedicated service to the homeless population.

Shani N. Andre, M.D., Chief Medical Officer and Vice-President

About 80 percent of New York City’s homeless population is comprised of families, and many are victims of domestic violence. The Floating Hospital is the sole contracted healthcare provider at the point of entry into the city’s shelter system. The organization has two larger clinics in Long Island City and six smaller satellite clinics. The Floating Hospital is growing and adapting to meet changes in the industry, while satisfying the unique needs of its patients.

“It has been a challenge to make sure our smaller facilities can do everything they need to as a PCMH,” said Shani Andre, M.D., chief medical officer and vice president. Dr. Andre has been with the organization since completing her residency program and possesses a deep and abiding dedication to the clinic’s mission. The Floating Hospital is pursuing PCMH recognition through the National Committee for Quality Assurance. “The recognition is mostly about engaging patients to make sure all their care is comprehensive through our medical center,” Dr. Andre said. The clinic offers family medicine and wellness

PROVIDING PATIENT-CENTERED CARE

services, along with mental health and dental care, to all ages from children to seniors. The staff is made up of physicians, psychiatrists, nurse prac-

The Floating Hospital has undertaken an initia-

titioners, physician assistants, licensed psycholo-

tive to bring all clinics under the Patient-Centered

gists, social workers, substance abuse counselors,

Medical Home (PCMH) model. The larger clinics

and case workers. Because the clinic serves a transient popula-

have been operating under this model for about two years, and the organization is bringing on the

tion, it has to approach care a little differently than

smaller clinics.

other healthcare facilities. Dr. Andre said follow up

The satellite facilities have smaller volume and

is a challenge, and when patients are in, they try to

limited support staff, some as small as three or

run all services needed at that one visit because the

four people, including providers.

patient may not come back soon, if at all.

Real Issues : Real Solutions

12 | THE FLOATING HOSPITAL “We have to understand the limitations of our patients,” she said. “If our patients are moving throughout the shelter system, their support isn’t the same as a typical family, and their priorities

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aren’t the same. Addressing a chronic medical condition is not always a priority. We have to figure out how we can meet patients where they are.”

STAYING CONNECTED THROUGH TECHNOLOGY

Dr. Andre said some younger providers who are im-

In support of the clinic’s mission to meet patients

system struggled with typing, making documenta-

where they are and adhere to PCMH standards, The

tion slower at first. Older providers, who were a

Floating Hospital implemented an electronic health

little technology averse, needed some nudging and

record (EHR) in 2010 using eClinicalWorks.

training on the best way to use the system.

Dr. Andre said getting the EHR finalized in 2011

mersed in technology and could easily navigate the

Creating access for all providers was also a

was one of the biggest accomplishments since she

challenge. The clinic has one provider who is blind

has been on staff. The first step was getting the

and one who has a tremor, making typing difficult.

organization’s chief executive officer, an attorney by

Both have adapted by using voice dictation soft-

trade, on board with the system.

ware.

“With clinics in different boroughs, having one record we could all share was vital,” Dr. Andre said. “As we look toward PCMH initiatives and integra-

“We ensure everyone has access to the system despite their limitations,” Dr. Andre said. When it came time to roll out the system to the

tion of care, all providers need to be working on

individual sites, the clinic used a phased approach.

the same medical record. Two providers can have

They brought on the main Long Island City health

a conversation about managing a patient’s depres-

center location about eight months before bringing

sion and diabetes.”

on the satellite clinics.

With the CEO and other leadership on board,

“By bringing on a smaller subset first, we were

the next step was making sure the staff and provid-

able to see how it works in practice, how to modify

ers were accepting of and trained on the system.

work plans, without disrupting everyone at once,”

“Everybody was open to the EHR, so that made

Dr. Andre said.

it work,” Dr. Andre said. “We didn’t have anyone

The Floating Hospital has since continued

who put their foot down and refused to adopt it.”

working to ensure it is using the system to its full

UNITING THE STAFF AROUND EHR That doesn’t mean implementation wasn’t without challenges.

capacity. As the clinic’s technology needs have grown, Dr. Andre said the organization had outgrown its existing IT firm and recently began working with a new company. “Our IT company had longer turnaround times and was needing to subcontract out many of our requests, so we knew we had outgrown their capacity,” she said. This year, the organization will be looking at requirements for the later stages of Meaningful Use and the shift to ICD-10. BY PATRICIA CHANEY

HCE EXCHANGE MAGAZINE

DEPARTMENT OF VETERANS AFFAIRS Managing and Constructing Facilities that Provide Quality Care to Veterans The Department of Veterans Affairs is tasked with the responsibility of providing services for all U.S. veterans, especially when it comes to their healthcare.

Stella Fiotes, Executive Director, Office of Construction and Facilities Management

Managing existing facilities and building new care locations involves the efforts of multiple departments within the VA working together. The Office of Construction and Facilities Management, led by Executive Director Stella Fiotes, oversees all major construction projects estimated to cost $10 million or more. A registered architect with a master’s degree in architecture and urban design, Fiotes has worked for the federal government, primarily in agencies focused on science or healthcare, since the 1990s. Her current projects include a $600-million hospital in Orlando, Fla., an $800-million hospital in Denver, Colo., and a $900-million replacement hospital in New Orleans, La., as well as major renovations, improvements, and additions to existing facilities. Fiotes’ total construction portfolio consists of over 50 active major construction projects across the nation totaling about $13 billion.

SETTING PRIORITIES ON A GRAND SCALE With such a wide range of responsibilities, the department has a heavily data-driven process for determining which projects receive funding every year. Fiotes said the department looks at gaps and requirements about 10 years out and ranks projects according to priorities. Top-ranking projects are those related to safety and security, fixing existing structures, and right-sizing the inventory. From the hundreds of projects that make the list, the department develops a design program that will support construction funding requests. Once a project reaches 35 percent design, it is considered for construction funding and included in the department’s budget request. As medical needs are continually evolving, the evaluation of new projects is conducted each year. “We try to strike a balance between new or replacement facilities, additions, renovations, and

Real Issues : Real Solutions

13 | DEPARTMENT OF VETERANS AFFAIRS

ancillary and support facilities such as parking

ners right from the start. Fiotes said in the past,

garages, utility plants, and other infrastructure

medical-equipment planners would be brought

needs,” Fiotes said.

in around the commissioning or activation stage.

Once projects are assigned, the challenge of

Because healthcare is constantly changing both in

execution begins. Programs under $10 million are

care models and in technology and most projects

overseen by one of three administrations at the

start four to five years before the equipment is go-

local level. Individual hospitals also fund their own

ing to be moved into a space, those planners have

maintenance projects such as roof repairs, boiler

to be present early on in order to keep everyone

replacements, or other needs.

aligned with what is needed.

GOOD PLANNING MAKES GREAT PROJECTS

Sometimes, changes are unavoidable, as happened recently when the facilities transitioned to a patient-aligned care team (PACT) model of care.

Fiotes said the number-one key to having any suc-

In that case, Fiotes said the change was significant

cessful project is proper planning, and by proper

enough that some designs needed to be stopped

planning, she means an intensive process of prepa-

midstream and redesigned to support the new

ration and consultation.

model.

Her planning office includes planners, archi-

“Healthcare doesn’t stand still,” she said.

tects, and engineers who handle planning issues,

“Some changes are unavoidable, so we have to be

standards for hospital construction, and the Techni-

adaptable. But that comes at a cost.”

cal Information Library. Actual management of de-

Another key at the early planning stage is to

sign and construction is accomplished through her

ensure consistency throughout projects, including

operations staff, which is located across the nation.

having one project management software system

With so many stakeholders involved, coordination with all parties throughout the process is vital. “I have to coordinate with local offices and

that everyone uses and consistent processes for certain elements.

over their planned maintenance projects,” Fiotes

SUPPORTING THE MISSION IN A CHANGING ENVIRONMENT

said. “We start with the strategic capital investment

“Our mission speaks for itself,” Fiotes said. “Being

planning, then use the Veterans Integrated Service

part of an organization that provides healthcare

Networks to plan across multiple medical centers

facilities for veterans to receive the care and atten-

with the goal of ultimately developing physical mas-

tion they have earned and deserve is immensely

ter plans for each individual facility.”

satisfying.”

medical centers to make sure we are not stepping

Fiotes said it is important to go through all of

In the future, Fiotes said telehealth will become

the steps methodically, from identifying the right

more important to the VA in providing quality care.

requirements to implementing the right solution,

While the department distributes the healthcare

so the project is launched correctly the first time.

system as much as possible, such as through the

Many lessons, though, have been learned through

use of community-based clinics, the population is

trial and error.

so spread out, the VA sees a need to use technol-

“In the past we haven’t always had such a structured planning process,” she said. “We have had projects that would start as one thing and over

ogy and other means of delivery to provide greater access to care. “But bricks and mortar will not go away anytime

several years of implementation and additional

soon,” Fiotes said, “and we will continue to enhance

funding, requests would morph into something big-

and adapt our construction delivery methods to

ger and more expensive.”

meet the emerging facility needs.”

To help limit those changes in scope, the department brings in medical-equipment plan-

BY PATRICIA CHANEY

HCE EXCHANGE MAGAZINE

MAR/APR

2014

HCE Exchange Magazine EDITORIAL Editor: In-Focus Pete Fernbaugh Contributing Writers Teresa Pecoraro Jacqueline Rupp David Winterstein Meghan White Patricia Chaney Kathy Knaub-Hardy Editorial Associates Levent Nebi Deepa Bhatia Lori Ryan Anami Mittal ART DEPARTMENT Art Director Kiki Ikura Associate Art Director Devdutt PRODUCTION DEPARTMENT Production Director Russell Ford Production Associate Ivan Bogdanovich SALES DEPARTMENT Sales Associates Rahul Bhende

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