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Real Issues : Real Solutions

SEP/OCT 2010

Deaconess Health System Hardwiring Change

HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.hcemag.com


Real Issues : Real Solutions

CONTENTS

04 Deaconess Health System

IN-FOCUS STORIES 08

Kno-Wal-Lin Home Care & Hospice

12

Baylor Arlington Orthopedic & Spine Hospital

16

Healthcare Management Systems, INC.

19

Childress Regional Medical Center

22

Eastern Health

26

East Cooper Medical Center

28

Interim LSU Public Hospital

32

PrimaCare Medical Centers

36

Gracie Square Hospital

38

McGill University Health Centre

42

Pacific Dental Services

45 Plaza Medical Center of Forth Worth

HCE EXCHANGE

SEP/OCT

2010

48

Spindletop MHMR Services

50

R.J.A Medicentres Canada

53

Northpoint Surgery & Laser Center

56

Respiratory Health Services

58

Larksfield Place

60

Longview Regional Medical Center

62

Mount Kisco Medical Group

66

Phoenix Childrens Hospital

68

Peconic Bay Medical Center

71

Sky Ridge Medical Center

74

Twin Cities Orthopedics, P.A

78

The Menninger Clinic


Deaconess Health System There are six acute care hospitals associated with Deaconess Health System, the provider of healthcare to approximately one million people in southwest Indiana, southern Illinois and western Kentucky. The heart of the system, Deaconess Hospital, dates to the 1890s when the Protestant Deaconess Association began providing private medical care to patients in Evansville. Now a 365-bed not-for-profit hospital, Deaconess Hospital is joined in the system by Deaconess Gateway Hospital, The Women’s Hospital, The Heart Hospital at Deaconess Gateway, Deaconess Cross Pointe (behavioral health hospital), and HealthSouth Deaconess Rehabilitation Hospital.


FIRST Culture

Strategically Focused

“Our culture is such that when we put people, quality

White describes the Deaconess leadership style as

and growth together with a superior service, the re-

very open and supportive. She credits a strong board

sult is a top financial performer, but it’s always about

of directors that is strategically focused on making

putting people first,” says Linda White, chief executive

sure the operations support the strategy. “It’s multi-

officer of Deaconess Health System. White has been

disciplinary and very team oriented,” she says. “As any

with Deaconess for more than 20 years and has led

organization with more than 5,000 employees knows,

the organization since 2002.

you can’t over-communicate. That’s a real challenge.”

The FIRST culture—which stands for Fantastic

Recent capital improvements at Deaconess

people, Increasing quality, Resulting in growth, Supe-

include renovations to the main campus to convert

rior service, Top financial performer—was introduced

semi-private rooms into private rooms. Deaconess

in 1999. Quality and safety along with managing costs

Gateway Hospital’s Tower II is under construction and

while putting people first continues to be the highest

is due to open in November. It is a 110-bed, six story

priority for the organization. The system is well-en-

tower that will open with 56 beds and the remainder

trenched in Six Sigma methods and has been applying

being shell space.

them effectively for years. “We’ve done our own internal training on black

In response to the realization that many patients in the community were going elsewhere for services,

belt. We even have a green belt and yellow belt

Deaconess has invested in equipment such as the da

designation to support Six Sigma processes,” says

Vinci robot that is shared between two of its hospi-

White. “We put people through an educational process

tals – The Women’s Hospital and Deaconess Gateway

and then assign them projects that are sanctioned by

Hospital. “We have OB-GYNs as well as urologists

Administration. We now have a fairly rigorous process

focusing on this technology,” says White.

for evaluating what workflows and processes to work on.” According to White, positive results have been

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Deaconess is active with local schools to promote healthy lifestyles for children in the community. The health system also serves as a clinical site for

sustainable. “We do see monetary savings and pro-

multiple health education programs—two universities

cess improvement going hand in hand,” she says. “I

and one community college in Evansville alone. “We

should put process improvement first because you

have a very well-known residency program for phar-

have to hard wire process changes for sustainability.”

macists. We also have a family medicine residency

As an international healthcare planning and design firm

program and are able to attract top graduates from

specializing in creative, efficient solutions for clients, we

medical schools across the country,” says White.

are honored to recognize exceptional leaders like Linda White. We support her and the efforts of her entire team in realizing their vision for Deaconess Health System. TEG is privileged to collaborate with and to pay tribute to such an extraordinary individual.

Safest, Greatest Integrated Health System “We are staying true to our vision,” says White. “The vision that we have is to become the safest, greatest integrated heath system for the people that we serve. We have approximately one million people in our service area depending on our hospitals. We’re not serving just a small city – we are really offering services for the entire surrounding community. We are prepared to provide our community a quality health care service with a compassionate and caring spirit.” The primary concern, of course, is to continually balance quality concerns and improvements with cost

“it’s always about putting people first.”

management. “How do we juggle all three of those?” asks White. “How do we make sure that we stay mission focused, but still meet our five year financial plan that means dollars coming back into the organization? We call it a balancing act, one that we’ve done well, but one the takes constant focus.” By T.M. Simmons

HCE EXCHANGE MAGAZINE

9


02 | Kno-Wal-Lin Home Care and Hospice

Changing Needs in Home Care DeBlois has been in home care for twenty-eight years. “The type of patients we care for now are significantly sicker now,” she says. “The average length of stay in a hospital is about three to four days, so they come home very unstable with multiple needs.” The primary population served is elderly, with an average age of 72. DeBlois says the pediatric population has grown significantly in recent years, however.

“We have a very strong pediatric team here,” she says. “We have developed a really nice relationship with the emergency department because a lot of the kids we take care of are very sick and their primary physicians may be located closer to a tertiary hospital which is an hour and a half drive from us.” The role of homecare, however, is not to be with a patient long-term. They work to teach the patient to be independent, make sure they have the knowledge necessary to take care of their own needs, and then move on to the next patient. “We’ve done very well with this. Our patient satisfaction scores and quality of care outcomes exceed national benchmarks,” says

Cerner BeyondNow

DeBlois. KWL has been a member of the Homecare

The Cerner BeyondNow suite of homecare solu-

Elite for the past four years. The Homecare Elite is

tions ensures caregivers provide the highest-quality

comprised of the top 25% of all Medicare certified

service while managing costs and building a better

homecare agencies in the country. Drivers for this

process in the homecare environment. Kno-Wal-Lin

distinction are financial outcomes, quality outcomes

Home Care and Hospice (KWL) selected Cerner as

and patient care outcomes. “We also have a very low

their HIT vendor last year. Through this partnership,

level of personal care services because we use a lot

KWL is improving quality and efficiency across all

of occupational care services to get patients back to

venues of care with a single, consolidated electronic

where they need to be.”

medical record.

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Kno-Wal-Lin Home Care and Hospice An affiliate of Pen Bay Healthcare in Rockland, Maine, Kno-Wal-Lin Home Care and Hospice (KWL) is a 44 year old organization that cares for 300 home care patients, 50-60 hospice patients, and more than 200 private duty patients on a daily basis. KWL is Medicare certified for home care and hospice and also state licensed as a private duty provider. The organization has about 150 employees. Donna DeBlois is the Executive Director of KWL and Vice President of Community Health for all of Pen Bay Healthcare. She has been with the organization for ten years. Donna also represents the New England states on the Board of Directors for the National Association for Homecare and Hospice.

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we’re embracing,” she says. “We are the very first

continue to grow as we move to reduce healthcare

healthcare system to implement POLST in the state

costs. Patients can be managed at home rather than

of Maine.”

incur the cost of an acute admission for exacerbations

POLST is Physician Orders for Life-Sustaining

of certain chronic diseases, such as, congestive heart

Treatment. It is a national movement, designed to im-

failure, and diabetes. Grass roots political advocacy

prove the quality of care people receive at the end of

on the part of all providers promoting the voice of

life. More common in nursing homes, it is now moving

homecare and hospice is necessary to guarantee that

into the acute care realm of healthcare.

we our industry is included in decisions regarding

“We’re really excited about it,” says DeBlois.

health care reform. I would encourage all provider

“There are some huge opportunities here. The other

agencies to join their state homecare and hospice

opportunity I see for home care within the realm of

associations, as well as their national associations for

healthcare is really about chronic care management.

guidance in this process to insure we all speaking w/

Hospitals and systems are looking at accountable care

one voice,” says DeBlois.

organizations, the role home care will be in keeping patients at home and reducing hospitalization. First,

by T.M. Simmons

they want to reduce admissions, and second, keep patients from ever going to the hospital to begin with. Home care has a huge role in that.”

Political advocacy “As the lowest cost provider within the healthcare continuum, the role of homecare and hospice will

Growing Use of Telehealth and Technology

the use of technology to reduce cost and gain efficiency. For example, their clinical record is paperless and Polycom is used to reduce travel to meetings.

KWL’s home care program is designed to be shortterm assistance for those recovering from acute illnesses. They currently have seventy-five telehealth

Facility Expansion

units and are working on expanding the program.

A new, 7-bed hospice house is being planned by KWL.

The compact, portable devices can be installed in a

The house, built on the model of a New England

patient’s home using existing phone lines. This allows

farmstead, is intended for those with perhaps a 7-10

doctors to analyze vital signs – including weight, blood

day life expectancy. “It will look like, act like, and feel

pressure, pulse, and oxygen saturation – without trav-

like a home, but the guts of it will be a nursing home,

elling to a patient’s home. If there are signs of trouble,

which is a requirement for an efficient hospice facil-

a nurse can visit the patient in their home to check

ity,” says. DeBlois. “This will certainly broaden the

on their condition. The telehealth units allow patients

scope of what we already have.”

to recover in the comfort of their own homes while keeping in touch with health professionals who can

Other Growth

monitor and educate them about their conditions.

Another aspect of the services provided by KWL that DeBlois sees expanding is taking care of patients with

The devices allow them to reach more patients, more efficiently. “We have the pleasure of serving four

palliative care. “Those who have a terminal, life-

island communities,” says DeBlois. “We either get to

threatening illness and are still receiving treatment,

them by ferry or US postal mail plane.” Because KWL

or have a life expectancy of a year or more—patients

is a rural agency serving the coast of Maine, home of

who are still receiving chemo or still fighting with end

many peninsulas and harbors, they have embraced

stage heart disease—that palliative care is something

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

13


03 | Baylor Arlington Orthopedic & Spine Hospital

Partners in Care “Not only do we have a partnership with our physi-

wanted everyone to feel comfortable in the hospital

cians, Baylor and USPI, but we also have a cultural

from patients to the staff members who spend many

partnership with our staff throughout the whole facil-

hours here. So they spent a lot of time with aesthetics

ity.” says Beck. “We are all partners in bringing that

as much as the flow process of inpatient to outpatient

care to the patient and I think that culture has caught

movement,” says Beck.

on really well. We are always saying that we are all

A lot of thought went into the technology of the

customers to each other. The patient is the number

facility, as well. Every operating room is equipped

one customer, but we also embrace the concept of

with a global device management system from Sky-

the physician being a customer to us as well as the patient’s family and our staff, we are customers to each other.” Beck believes in celebrating all the employees, and emphasizes that he prefers not to isolate just one subset such as nurses or technicians. “We actually have a “Partners in Care’ week; our facilities have incorporated that. We have a full week that we celebrate everyone who makes it happen.”

mind for the design; efficiency and aesthetics. “They

“Baylor and USPI have embraced partnering with physicians,” says Allan Beck, CEO. “This is one of the many ventures in place throughout the Dallas/Ft. Worth metroplex, and it has proven to be an excellent model for high-quality patient care yielding excellent outcomes, patient satisfaction in a very efficient setting.”

environmentally responsible, and reliable. We were the first company to introduce true HD autoclavable camera heads. Our Mpower suitable for multiple specialties and is washer-

Architects for the hospital had two key elements in

Arlington Orthopedic Associates, Baylor Health Care System and United Surgical Partners International have developed a brand new, 57,000 square feet, orthopedic and spine hospital in Arlington, Texas. Baylor Orthopedic and Spine Hospital at Arlington includes 24 inpatient beds, six operating rooms, one procedure room, imaging services and a two-bed emergency department.

that are multi-functional, easy to use,

2 system offers three battery options, is

Facility Design

Baylor Arlington Orthopedic & Spine Hospital

ConMed Linvatec designs and builds products

sanitizer safe! Our products are designed with the surgeons, OR staff and the patients in mind.

“WE CHOOSE TO PARTNER WITH CONMED LINVATEC BECAUSE OF THEIR GREAT SERVICE TO THE PHYSICIANS AND FACILITY” – Allan Beck, Chief Executive Officer, Baylor Orthopedic and Spine Hospital at Arlington

ConMed Linvatec is a global leader in the fields of arthroscopy, multi-specialty endoscopic video systems, and powered surgical instruments–with a reputation for outstanding service. “We were very pleased with ConMed Linvatec’s service during the opening transition of the hospital and look forward to a strong partnership moving forward, “ Allan Beck. Visit www.linvatec.com/betterpatientoutcomes for more information onn how we help improve patient outcomes and contain customer costs. 11311 Concept Boulevard • Largo, Florida 33773-49088 (727) 392-6464 • Customer Service (800) 237-01699 USA Fax (727) 399-5256 • International Fax (727) 397-4540 • www.linvatec.com m ©2010 Linvatec Corporation, a Subsidiary of ConMed Corporation HAD 90011

Real Issues : Real Solutions


RELIABILITY HAS A NEW NAME.

ence room and the people in the operating room will be able to hear and view the people in the conference room. They can go back and forth and ask questions of each other as the surgery progresses. This system also gives the hospital secure For years you’ve known us as BremnerDuke, one of the leading healthcare real estate companies in the United States. Today we enter a new era as Duke Realty. You can still rely on us to bring the expertise, flexibility and long-range vision you are looking for in a healthcare real estate partner. We’ll simply do it now with a new name. Learn more at www.dukerealty.com/healthcare

streaming capabilities. In one of their first sessions, colleagues in Mexico City, Sweden, and three different locations in the U.S. were able to participate in a surgical case presentation. Beck is choosing to focus on making sure information technology capabilities are fully enhanced with the global device manager and electronic white boards. “Making sure all systems are integrated.

RELIABLE. ANSWERS.

That’s our big push,” he says.

Challenges The hospital was built with the idea of easy expansion in mind, but the current legislative environment has imposed limitations. Getting the hospital up and running, of course, was a huge effort. Now that they’ve crossed that hurdle, they are left facing the same tron medical equipment company. Silver plates are

challenges as most hospitals. Decreasing reimburse-

installed in each wall that are compatible with every

ment; increasing costs. Beck says he refuses to turn

piece of equipment in the hospital. This creates a kind

the issue of pricing into a battle with the vendors.

of interactive theater experience for the hospital. Any

“Very early on we actually sat down to partner with

piece of equipment that is plugged in can be dis-

our vendors,” he says. “I think also engaging our

played on larger monitors in the OR room. Everything

physicians 100%, having truly engaged physicians who

is hardwired into the education network. They can

are very active in the organization has helped us get to

hold an education conference in the education room

where we are now.”

and have 2-way video capabilities from the operating room. Doctors can view the surgery from the confer-

He sees the hospital partnership with physicians as a plus. “They view this as their hospital and want to

“It’s going to be better for the hospital, the patient, and for everyone” participate in a positive way, and want to make sure that everything is done as efficiently and effective as possible.” The physicians and the hospital are working for the same interest, not competing with one another. “Others may have 70 doctors from 15 different

focus on making sure information technology capabilities are fully enhanced

groups,” Beck says. “There are different interests. This, on the other hand, is one physician group. We’ve had even more success with that because obviously any hospital that has highly engaged physicians is more successful. It’s going to be better for the hospital, the patient, and for everyone.” by T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

17


04 | Healthcare management systems.inc.

New Product Highlights

HMS PARTNER

The company is focused on products that are in keeping with the meaningful use criteria, specifically its CPOE product, which Stephenson said has seen increased interest from clients over the past 12 months. In addition, HMS recently introduced an interoperability product called HMS ConnexSM that allows customers to meet the meaningful use requirements of interoperability by enabling the exchange of clinical data between third-party systems, health information exchanges, and public registries. Two other new offerings that have garnered interest from clients are the ambulatory EHR and emergency department products, Stephenson said. “They help us round-out our product suite and hit some areas that we did not have solutions for prior to this year, giving us a more complete product set,” he said. Changes in government regulations can play a major role in driving new product development. “Listening to customers also plays a role, Stephenson said. They want to become more efficient, as well as incorporate new technology, such as the iPad, into their everyday operations. Another factor, he said, is considering what it will take for the hospital to communicate better outside its four walls.”

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Healthcare Management Systems, Inc. Companies in the business of providing IT products and services to the medical community are acutely aware of the oncoming rush to have their offerings certified for “Meaningful Use” under the American Recovery and Reinvestment Act of 2009 (ARRA), which includes billions of dollars in Medicare and Medicaid incentive payments to providers and hospitals for the meaningful use of certified health IT products. Healthcare Management Systems (HMS), Inc. is among the mix of IT companies racing to deal with this new twist in the ever-changing federal funding spectrum. The company, headquartered in Nashville, Tenn., provides integrated information systems to hospitals and healthcare systems. The HMS product line includes about 45 different applications for the community and specialty hospital space – everything from revenue cycle and patient access to computerized physician order enter (CPOE) and ambulatory EHR for physician practices. According to company president and CEO Thomas M. Stephenson, meaningful use is a “main driver” throughout the industry. While HMS has gone through the development process with

its products to make sure they meet the requirements, many in the industry are struggling to come up with the capital necessary to invest in the technology. “It’s a double-edged issue,” he said. “They know what they need to do but finding resources, both financial and human, to make that happen is a challenge in the market.” HMS currently has about 650 customers throughout the US and Puerto Rico, acquired primarily through direct marketing efforts implemented during the company’s 26-year history. With meaningful use, and the stimulus associated with it, clients are looking to the company for guidance on how they can implement new systems, particularly around CPOE. This is creating a challenge for a lot of organizations, Stephenson said. “We’re working with our customers to plan for that, begin the implementation process and ultimately drive adoption,” he said. “This is what’s driving our business right now.”


05 | Childress Regional Medical Center

“We need to look at how they can ‘talk’ to other enti-

“You have someone who, from an IT perspective, can

ties and service providers,” he said.

work with the physicians and the nursing staff through-

While not a new service, Stephenson noted that

out the implementation and understand it from a clinical

HMS subsidiary Sentry Healthcare Services has been providing professional services such as revenue cycle

perspective, not just an IT perspective,” he said.

management and accounts receivable for the past 10

Challenges

years. However, it was just last year that the com-

Capital for IT initiatives continues to be a challenge

pany spun off this addition to its business’ offerings.

for hospitals, which then becomes a challenge in the

Community hospitals in particular utilize this service,

sales process for HMS. The company brings in financing

allowing them to conserve limited resources while

partners and works with customers to define a payment

meeting demand.

stream to make purchases manageable. Stephenson also noted a slight increase in its ASP business, which is a

Differentiators in the Marketplace

little easier on the up-front costs and the on-going staffing required to manage much more complex systems.

Stephenson said they stay attuned to what the com-

“We’re actually seeing some of our long-time cus-

petition is doing and remain competitive with their

tomers who typically purchase a turnkey system now

products. He said HMS measures-up well against its

moving to our hosted solution,” he said. “It enables hos-

competition in terms of product functionality, particu-

pitals to implement the technology and functionality with

larly when it comes to clinical applications.

a lower up-front cost, spreading out the cost over time.”

The CEO also cites the company’s experience

The second challenge Stephenson identified is the

helping community hospitals with the adoption and

lack of clarity and definition around the meaningful

use of the technology, as well as its track record in the

use criteria.

corporate, for-profit marketplace, as differentiators

“There’s still a great unknown out there as to what

for HMS.

meaningful use is going to mean to people,” he said.

“Our ability to continually meet the needs of the

“But, we can’t wait until the last minute and pull the trig-

customers, as their needs and requirements change,

ger, with everybody trying to get through the door at the

has been a big plus for us,” he said.

same time.”

Successful Implementations

Finding Clinical Resources

While completing product implementations is not

Another area of the business impacted by the meaningful

“rocket science,” Stephenson said there are keys to

use criteria is human resources. Overall, HMS employs

making the process successful. For example, when

about 400 employees, most of which are located in Nash-

the hospital’s senior management is engaged in the

ville, but Stephenson said, “it has become challenging to

process, driving the process and explaining the value

locate clinical resources. As other medical entities gear

of the technology to the organization and its commu-

up for the impending implementation of new criteria,

nity, that enthusiasm goes a long way toward driving

employees with this type of experience are becoming

the success of the project. When senior management

more in demand.”

is disengaged, not involved and delegates manage-

While healthcare IT has challenges that remain con-

ment of the project to others, it becomes challenging

stant, it is variables such as ever-changing government

to work through the process when problems arise.

regulations that keep companies like HMS evolving and

The second tip, particularly related to the implementation of clinical solutions such as CPOE and EHR, is to include a clinical resource in the project, whether

growing to meet business objectives and clients’ needs. By Kathy Knaub-Hardy

that is a clinical informatics person or someone from the clinical staff who has an IT background. With that person on board, the implementation typically goes much smoother, he said.

Real Issues : Real Solutions

Childress Regional Medical Center

In the southwest corner of the Texas panhandle is a town called Childress, population 7,000. Childress Regional Medical Center is the 39 bed, rural hospital that serves that population, as well as another 23,000 or so rural Texans in the region. Eight family practice physicians practice in the hospital-based, rural health clinic. Also based from the hospital is an ambulance service, home health and hospice services and dialysis services. The hospital generates about $40 million per year in gross revenue. Approximately 80% of those charges are a result of outpatient services. Childress Regional has grown to about 240 full time employees. “The culture of this medical community is great,” says John Henderson, CEO since 2001. “We have broad-based support from the community. We have a strong governing board and a great local medical staff that’s been here for a few years. There’s a sense of pride in Childress Regional that I appreciate. We value things like honesty and compassion—teamwork. All things considered, I think we do a pretty good job for the communities we serve.”


CHARTING THE FUTURE OF HEALTHCARE® SINCE 1996

Capital Construction “Not only do we have a partnership with our physicians, Baylor and USPI, but we also have a cultural partnership with our staff throughout the whole facil In the last two years, Childress Regional completed a construction project that expanded the physical therapy services. They added a therapeutic pool and brought MRI services in-house. Prior to that, they were doing mobile MRI a couple of days a week. “We actually purchased that equipment and started providing that service on a full time basis. Last year we ended up with an electronic

fast, efficient & affordable.

medical record and went paperless in our clinic,” says Henderson. The hospital selected a Texas company, e-MDs, for their electronic medical records system. The company focuses solely on programs for clinics and ambulatory care. “EMR implementation—there’s no getting around it—it’s going to be painful at times,” Henderson says. “It’s not just about the technology, it’s as much about the change. Our physicians were all supportive and had a good attitude about it and are doing relatively well, but

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the way a 65-year-old physician handles automation is different than the way a 29-year-old physician who has grown up with a computer handles it. Those are difficult

from the Texas Medical Foundation. They’ve also been

issues. There are things we’ve still got to work through

named an employer of excellence by the Texas Work-

related to the interface, but all things considered we’ve As well as improving quality measures for the hos-

had a relatively good experience.”

Emphasis on Quality Care and Patient Safety

pital, this investment in personnel has helped them provide answers to recruiting in a rural area. “Rather than recruit someone from a metropolitan area to

“When you do a good job of quality and safety, there are

come to rural Texas—that’s a culture shock and we

savings,” Henderson says. “A poor or sloppy job costs

find they don’t tend to stay or stick—it works very well

not only the payers, but the hospital.” He reports that

to foster area students who value a rural quality of life

the hospital has been working harder at focusing on

and help them get the education or training they need

patient safety performance measures than in the past.

in return for service when they are through. That is a

“We’ve implemented a patient ID program where we’ve

real good recruiting program for us.”

standardized arm bands across all departments of the hospital,” Henderson says. The hospital has installed

Recognized as a Top Hospital

medication dispensing units on the floor to reduce

In spite of its small size and relative isolation,

medication errors. Bedside reporting is another recent

Childress Regional ranks top among hospitals na-

change they’ve made. “We’ve also invested a lot in nurse

tion wide. They were listed as a Top 100 Hospital by

training and education, which I think is good for the short

Solucient and Modern Healthcare in 2005. In 2007 the

term, and the long term, as well.”

hospital received the Governor’s Award for Quality

force Commission. Childress Regional seeks input to add services based on the needs of its community. “Patients will tell us, ‘I wish I didn’t have to travel to an urban area to get this service.’ Then we validate that through discussions with our local medical staff. We’ll say, ‘Yeah, that’s legitimate,’ or ‘No, that’s probably a little bit more than we should be doing.’ Once we have both

“We have an obligation to the people we serve. We want to do a good job for them and we take that very seriously.”

of those audiences supportive, then it’s just a matter of finding the right people to provide the service.” “What we do as a rural healthcare provider is important and it affects everybody. We try to work together and I think when we do that, we accomplish a lot. We have an obligation to the people we serve. We want to do a good job for them and we take that very seriously,” says Henderson. by T.M. Simmons

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HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

23


06 | Eastern Health

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Confidence in dynamic times

Eastern Health

Just over five years ago, in May of 2005, Eastern Health was born of a merger. Fourteen healthcare organizations and boards in Newfoundland and Labrador became four regional health authorities, of which Eastern Health is the largest. This relatively new, integrated health system, which is still evolving, serves a population of nearly 300,000 with over 13,000 employees. “We’ve got lots of work to do … We’ve had some pretty rocky times,” says Vicki Kaminski, President and CEO since June of 2009. Just after Eastern Health was formed, there was an issue with breast cancer testing. In short, the health authority found problems with the hormone receptor tests of 1,088 patients. These testing errors resulted in some women receiving treatment they should not have received and others lacking treatment they should have received. “The organization as a whole was very focused on trying to resolve those issues, deal with the patients, their specific test results, retesting and their treatment, and begin to restore the public’s confidence,” says Kaminski.

GE Healthcare is a global healthcare IT leader with

What Eastern Health Brings to Communities

advanced clinical expertise in workflows, emerging industry standards and demonstrated implementa-

Repairing the public’s perception of Eastern Health

tion methodology. The GE Healthcare’s Centricity™

was only part of the battle. Many people, employees

portfolio brings powerful tools that integrate across

included, felt that they had given up some of their

platforms to manage patient information and enable

autonomy in the merger. They worried that the

knowledge-based patient care. Our goal is to help

closeness they felt to their hospitals or long-term

you do more with less and improve quality, cost and access. Healthcare IT Re-imagined.

care facilities was being lost to the larger entity. “We had to demonstrate to them that we could, as Eastern Health, bring to them services that were going to make it better. We had to talk to them about their needs and how we were going to meet them,” says Kaminski.

facilities, which is no small job. “It is important they

The 12-member executive team is located

see us taking an active role in decision making at

throughout the whole Eastern Health region, both

those sites and letting people see that the bigger

rural and urban. They make a point of being vis-

organization isn’t going to destroy the aspects of

ible throughout Eastern Health’s 80 facilities, which

the smaller organization that they knew and loved,”

include hospitals, health centres and long term care

says Kaminski.

HCE EXCHANGE MAGAZINE

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By working to standardize their information technologies, they are able to bring services to their rural populations that would have been more difficult when each site was functioning as a separate entity. There have been many developments in tele-medicine, for instance, and they are currently working with the University Health Network in Ontario to pilot a comprehensive tele-pathology program. “We’re also looking at our information systems internally and how we can make better use of some of our technical networking that has to take place,” Kaminski says. “Beyond our patient platforms for medical technology, how can we integrate and standardize some of the communication vehicles we have, such as email and social networking opportunities. We’ve got a lot of work to do in that area because we have a number of communities in Eastern Health that haven’t

always had good access to even something as simple as the internet. The province has spent a lot of money

“Eastern Health, as an organization, really does care about what we do and how we do it,”

putting in broadband networks, and we are looking at how we can use those for some of our facilities and still maintain the security that we need to maintain for privacy of information.”

Building Confidence

Technology and Modernization As a large organization, they’ve been able to invest $76.7 million in new technology and equipment in the

“Eastern Health, as an organization, really does care

“I get comments from people that talk about the

about what we do and how we do it,” says Kaminski.

good care they’ve received here and they talk about

“We are very interested in having good outcomes for

it with a bit of surprise in their voice. They’ve come

our patients and our clients. We are interested in hav-

to expect that it should be terrible because of our

ing staff who feel respected and well treated by the

reputation. We are struggling and working very hard

organization, and we really need public trust

to change that.”

and confidence. “We really do need to be a part of the community

past couple of years. They have also spent more than

that we are serving – that means we have to partici-

$100 million on redevelopment that includes new

pate as equal partners. For the staff, we have to start

facilities and renovations across the region. “From an

celebrating the goodness of what we do. When I’ve

infrastructure perspective, a lot of our facilities are

talked to the staff, I say, ‘How many of you get the

really old,” says Kaminski. “Newfoundland and Lab-

reaction that when you talk to somebody and they ask

rador has traditionally not had a lot of money to spend

where you work, they roll their eyes and say, Oh you

on capital investments. It’s only been in recent years,

poor thing?’ We have to change that. That’s not who

with some of our discoveries of oil off-shore and our

we are.

ability to capitalize on that kind of marketplace, that

by T.M. Simmons

INDUSTRY PARTNERS CompassGroup Canada www.compass-canada.com

“We have very good success stories if you look at

we’ve been able to see an increase in our budget and

our patient encounters. By and large, 99% of them go

an increase in our ability to spend money where we

very well. If you only listen to the public recounting of

need it.”

Eastern Health, you would think that wasn’t so. You’d think that more often than not, things went wrong.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

27


07 | East Cooper Medical Center

New and Improved

to work with all of those different backgrounds. It is

Upon entering, the new East Cooper facility has more

one of the challenges of the job, as well, but it’s very

of a Ritz-Carlton aesthetic appeal than a traditional

rewarding,” he says.

hospital. The gems of the hospital, however, are within the surgical suites. The hospital is one of only a handful, for instance,

and one that is focusing on Medicare. “We are always

LiveData gathers critical information from diverse

looking at ways to become more efficient,” says Ray,

systems and displays it on screens in the operating

“not only with our supply chain, but also with our labor

room. Combining that with technology from Karl Storz

force. That’s an ongoing initiative at the hospital.”

technology, the surgical team will have a complete

Quality is the Bottom Line

picture of what is going on in the operating room as it is

“It all boils down to quality, really,” says Ray. “We’re

happening.

constantly working across departments to improve

Another change is the new electronic medical

departments to improve the satisfaction of our

room September 1, which is definitely going to improve

physicians, our patients, and our employees. If you can

the efficiency and quality of care for our ER patients,”

accomplish those three things, the financial results will

saysRay. “We have spent a significant amount of dollars

be a nice byproduct.”

the new hospital project.” Since they are located right next to the Atlantic Ocean, the building was also designed to withstand hurricane force winds. The hospital’s power plant is located on the second floor rather than the first to minimize problems if flooding occurs. “Really, the design was made with natural weather disaster in mind. It is very well thought out and we are the safety net for the community if there’s a hurricane that hits the coast of Charleston.”

A Community of Partners There was a time when the operations officer of a

All services from the old hospital were transferred directly to the new. As well, two new service lines were added; interventional radiology as well as a level II neonatal intensive care unit. “From a key service line perspective, we are very much surgically oriented,” says Evan Ray, Chief Operations Officer who joined East Cooper in August of 2009. “We have a well recognized and renowned spine program. We also have an emphasis in colorectal surgery, as well as plastic surgery. We like to consider ourselves a women’s hospital. We do a tremendous amount of breast reconstruction surgery, obstetrical care, and gynecological care..”

our core measures. We’re constantly working across

record. “It will be implemented into our emergency

on technology for the community and that was all part of

In April of 2010, a new hospital was opened in Mt. Pleasant, South Carolina. The facility replaces the original East Cooper Hospital which opened its doors in 1986. The process of moving took the hospital from a two-story, 125,000 square foot building to a five-story, 250,000 square foot building. Located in a suburb of Charleston, East Cooper serves a population of approximately 100,000.

Tenet, including a performance management initiative

that use the LiveData program in the operating rooms.

Endoscopy, a leader in minimally invasive endoscopic

East Cooper Medical Center

East Cooper’s corporate parent is Tenet Healthcare. They follow several initiatives that come via

hospital might have solely been focused on engineering and support. “I think now you see the COO really getting involved in business development; looking at how you can grow market share and increase the number of patients served,” says Ray. Evan thinks of himself as partnering with the different audiences that make up a hospital. There is the board of directors, a community board of directors, both employed and independent medical staff members, and employees of the hospital with different skill sets. “I think first and foremost–to be successful with this role or any other role–is to work with people and understand that their experience and expertise outweighs yours in many instances. One of the fun aspects of the job is

by T.M. Simmons


08 | Interim LSU Public Hospital

Recovery from the Storm Since November 2008, when Ali joined the hospital team, he has focused on the recovery work begun by his predecessors in further streamlining of the operational function of the hospital from the clinical perspective. “Multiple clinical programs have been restarted, and improved processes that enhance patient care, emphasize patient satisfaction, facilitate access to care, ensure continuity of care and improve throughput have been established. We have now reached the stage where we are a little bit more settled, and look forward to the future, ” says Ali. Prior to taking up the position of medical director, Ali was a full-time Professor of Medicine and a clinical educator at the LSU HSC School of Medicine in the section of Pulmonary /Critical Care Medicine. He continues this role in a limited fashion at ILH. “When I took up this position, I asked myself, ‘Why?’” he says. “The answer involves moving this institution to a new academic medical center, which we hope to build by 2014. In this transition period, while we build a new brick and mortar building, we need to get ready for

Interim LSU Public Hospital

The second oldest public hospital in the United States is in New Orleans, Louisiana. In the first 100 colorful years of its history, Charity Hospital existed in five different locations and was battered over the years by storms and fire. The sixth facility was built in 1939 and housed the hospital until it became a victim of Hurricane Katrina in August 2005. Charity Hospital and University Hospital were part of the Medical Center of Louisiana at New Orleans. Because of severe storm damage, Charity Hospital will not reopen. At that time, the Medical Center of Louisiana at New Orleans was part of the LSU Health Care Services Division. In November of 2006, University Hospital reopened as the Interim LSU Public Hospital (ILH) to provide comprehensive healthcare services.

Real Issues : Real Solutions

ILH has a tertiary care, multi-disciplinary, Level 1 “Spirit of Charity” trauma center with a very busy Emergency Department. ILH is affiliated with two medical schools (one is at the LSU Health Sciences Center; the other is at Tulane University). The 300-bed hospital runs an occupancy rate of about 80 percent. Its ambulatory clinics, which cater to the needs of the community with 16000 patient visits per month, are located in nearby buildings, and the hospital also has a well connected network of community clinics. The two medical schools provide approximately 800 medical staff . There are also community physicians on staff with limited privileges who assist those to refer patients to the hospital system and ensure community care follow up. “We have about 300 house officers from both schools who rotate through this institution and as part of their graduate medical program. Their training ranges from primary care to specialty and sub-specialty medical and surgical fields,” says Dr. Juzar Ali, Medical Director of ILH . Ali’s role is to be the liaison and coordinator for the faculty and house staff in organizing and operating clinical services at the hospital. He is also a member of the administrative council that runs the day to day operations of the hospital.


that new facility by enhancing our culture of patient

of strengths of the institution. “We are not limited to

care and streamlining our infrastructure.”

business as a safety net hospital alone, but we attract

Ali also looks to transform the years old vision of Charity Hospital to one of a modern and true academic medical center. “The clinical excellence of our medi-

patients from all over the community and our sister hospitals in the state network,” he says. It is the physical structure itself that is a weakness

cal staff is world class,” he says. “The professional

for ILH at the moment. The working facility is old, and

expertise and the cutting-edge research at the core

it has space limitations. “It doesn’t mean that we are

and translational levels are top notch. I want to bring

not improving on things, but we are focusing more on

the active engagement of the faculty and house staff

maintaining what we have and on concentrating on

into the working of the hospital and to truly take it, not

improving the processes of delivery of care rather

only from bench to bedside, but also from “gown to

than only capital outlay improvement,” says Ali.

town.” That is what my vision is. Further, no matter

Budgetary constraints have forced them to cut

what academic medical center we have, this cannot

staff in the past 16 to18 months, mainly in the realm of

work in isolation. We have to involve the community

operational and supply costs and by reducing the full-

with its participation and service to its needs.”

time-employee to bed ratio. “If not today, maybe in the

Strengths and Limitations of the Institution

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coming years we will be able to look at the possibility

For more information please contact our company at 504-468-6100.

of expansion of certain programs,” says Ali. Through the difficulties, Ali holds two areas above

The emergency room department, level one trauma

compromise. “We have tried not to compromise on

center, specialty surgery and disease management

how the medical and nursing staff provides services

programs, and intensive care units are all on Ali’s list

that relate to patient care and achieving national stan-

dards. It’s a balancing act, in this day and age of fiscal constraints,” Ali says. “The template we are working with is a very unique one, from the point of view of being a dual focus. In this system, at one end we have the challenges of amalgamating the teaching, training and academic mission of the medical schools and merging it with the mission of patient care and healthcare delivery to a community. This poses business challenges

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with operational budgetary constraints. It’s also providing , what you can see historically, as a change of focus, from where it was previously considered only a safety net public hospital to a more expanded focus of value-oriented care,” says Ali. “We are not where we should be, but the new academic medical center is what we look forward to becoming in the next five years, and our journey has begun.” Ali concludes. by T.M. Simmons

HCE EXCHANGE MAGAZINE

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09 | PrimaCare Medical Centers

The PrimaCare Medical Center has worked with

PrimaCare Medical Centers

hundreds of thousands of residents in the Dallas, Texas metroplex with its range of family, occupational, sports and lab services. Several years ago, PrimaCare decided to adopt MedInformatix’s Enterprise Practice Management system. “We knew

PrimaCare opened its first center in the Dallas area in 1979. The urgent care network grew and was acquired by a hospital system in the late 1980s to serve as a referral source. In 2000, the same system chose to divest itself of the clinics and the entity was purchased by a group of PrimaCare physicians. PrimaCare Medical Centers is now one of the largest urgent care networks in the Dallas metropolitan area with a primary focus on acute illness and injuries that are not life or limb threatening. All eleven centers are open seven days a week and no appointments are necessary.

that an EPM application would not only streamline our scheduling and billing, but also allow us to better analyze our overall performance,” said Jennifer Stephenson, PrimaCare’s executive director. Before long, PrimaCare started adding the MedInformatix Electronic Medical Record application, as well. Physicians were trained to enter patient data using tablet PCs, which made finding information significantly easier. While clinical and administrative efficiency was the main reason PrimaCare sought out an integrated EPM and EMR solution, today they enjoy an equally valuable plus: a gain in revenue with about a 3% improvement.

Serving Patients with Courtesy, Convenience and Compassion “Our mission is to provide quality healthcare to the patients in the communities we serve with courtesy, convenience and compassion,” says Dr. Don Dillahunty who has served as CEO/president of the company for the past ten years. He has been involved with PrimaCare for twenty years as both a practicing physician and in an administrative capacity. He also serves as president of the Urgent Care Association of America, an industry trade group which represents over three thousand urgent care professionals throughout the United States. Patients can be treated at a PrimaCare center more quickly and at a lower cost than at a typical

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

35


emergency department. Staff includes board certified physicians in family practice or internal medicine. They also have certified Physician Assistants and Nurse Practitioners. Including full and part time staff, PrimaCare Medical Centers have about 250 employees who work extended evening hours and weekends. Personnel are cross trained so that staff has multiple skills they can utilize in the operations of the centers. Last summer, the centers were accredited through the Joint Commission. Much of their capital expenditures of late has focused on enhancing quality including an upgrade of

“We try to remind people that we do need to understand what our mission is, as well as our vision—to be the premier urgent care network in the North Texas region” diagnostic equipment. “Last year, if you had the abil-

techs and patient representatives.” We have quar-

ity to purchase, it was a very good time to buy since

terly discipline meetings so that all employees are

equipment vendors, due to the economic recession,

informed as to what is going on with the company and

were eager to cut deals,” says Dr. Dillahunty. They

their specific job.

added computer radiography to all eleven centers. They also bought new hematology analyzers.

Managing Multi-Site Locations

Also, among the efforts to keep the lines of communication clear and open, they have a newsletter. The newsletter focuses on the employees and makes sure they are up-to-date on all developments. “We try to remind people that we do need to understand what

lean, reduce our overhead, and fulfill our mission by incorporating these good ideas into our day-today operations.” Retention of employees has also been less of a problem with the economic downturn. In addition, PrimaCare has taken a lot of steps to make sure they get the right hire initially. They have put a lot of time and effort into determining the background for the people they already have who are successful

“Everyone has a role to play and people have good ideas that they can share with us as an organization.”

with the company. Then they try to match those traits in new hires. “Do these people have the particular background knowledge, experience, and values that will make them successful?” says Stephenson. “No matter where we are hiring—from clinical personnel to people in our central billing office—we try to really look at who is most successful and then match up hires with those kind of profiles.”

The Future of Urgent Care

“If you are dealing with a multi-site group, one of

our mission is, as well as our vision – to be the pre-

the issues you have to focus on is communication.

mier urgent care network in the North Texas region,”

“With the emphasis on primary care in the federal

You have a corporate hub that has to reach out to

says Dr. Dillahunty.

health care reform legislation, I think both urgent

the various sites,” says Jennifer Stephenson, Prima-

Dr. Dillahunty emphasizes integrity and respect

care and the patients we serve stand to benefit,”

Care’s Executive Director. “We have center medical

for both relations with patients and relations between

says Dr. Dillahunty. “We in the urgent care industry

director at each location who works with all of the

employees. “Everyone has a role to play and people

provide quality, cost-effective and convenient care

providers scheduled at that location. Then we have a

have good ideas that they can share with us as an

to thousands of patients on a daily basis across the

center manager who works with the employees. We

organization,” he says. “We can improve our collective

United States and we believe our future is bright”.

have three disciplines at our centers, clinical which

intelligence, learn to do things better, provide better

includes nurses and medical assistants, lab/x-ray

customer and patient service, make operations more

by T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

37


10 | Gracie Square Hospital

Gracie Square Hospital

The hospital has increased staffing and has purchased more user and patient friendly equipment. They’ve introduced a better wheelchair, for instance, for

Since 1959, Gracie Square Hospital has been caring for the mental health of New York City’s greater metropolitan area. A member of the New York Presbyterian Healthcare Network, Gracie Square is a 157-bed psychiatric facility that accepts mentally ill patients ages 16 and older. Inpatient psychiatric and geriatric programs are primarily oriented toward the treatment of acute psychiatric conditions that require a relatively short period of hospitalization. Gracie Square offers a dual focus treatment program for those who are suffering from both significant psychiatric disorders and chemical dependency. They also offer services specifically tailored to the Asian population with bicultural and bilingual psychiatric services.

their geriatric population. Bathrooms at the hospital have been renovated and redesigned with safety requirements in mind, but also, they’ve put significant emphasis on constantly improving staff education and training programs. “Management wise, especially with my senior team, we always work hand in hand, side by side. Communication is always a focus, but also strategic planning. What kind of team do we need to put in place? I am always coaching my team to utilize an “us” and “we” mentality when confronted with obstacles where they need my assistance.” Kuo also has high praise for Gracie Square’s board. “Our board members play a very important role

improves the chances of successful outcomes for the patient and involves the family as active members of the treatment program. Gracie Square Hospital is also well known for its substance abuse programs. Too often, according to says Johnny Kuo, Chief Operating Officer at the hospital since 2000, deal with the issue of chemical dependency and treatment alone, without regard to the fact that many chemically dependent patients also suffer from a significant mental health issue such as depression or anxiety. Gracie has become a leader in successful treatment of these patients. The Gracie Square Hospital also has a unit for patients age 65 and older. This area most commonly deals with Dementia and Alzheimer-type symptoms and conditions. Gracie Square’s services include stabilizing the acute condition and then working with family to assess a patient’s needs and find appropriate after-care accommodations and services.

The Asian Program and Other Multi Areas of Emphasis

Patient Safety Initiatives

Offering culturally sensitive services to the Chinese,

major patient safety improvement program. “We iden-

Japanese and Korean populations of New York City is

tified a high number of falls, especially in the geriatric

one of the primary programs for which Gracie Square

patient population,” says Johnny Kuo, Chief Operating

Hospital is known. Since cultural influences strongly

Officer at the hospital since 2000. “What we found is a

affect the way patients view the causes and treatment

need for patient safety education and staff education.

of mental illness, this approach allows patients and

Throughout this project we have spent over a million

their families to work within their own cultural refer-

dollars to reduce patient falls while yielding extremely

ences when dealing with mental health issues. This

positive results.”

Real Issues : Real Solutions

Gracie Square is currently a couple of years in to a

Patient Care is our #1 Priority

in our organization. They are very valuable and also give very good feedback to bring about what’s best for Gracie Square Hospital.”

Challenges in Psychiatric Care Kuo says caring for Medicare and Medicaid patients, and the increasing number of uninsured patients is one of his greatest challenges. “We take our role in the community seriously,” says Kuo. “Our hospital teams up with other networks looking for the best answer for this uninsured population. It’s very difficult to overcome, but we continue to look for ways to branch out and meet the needs of those who are not prepared to pay for their health issues when they come.” The other challenge Kuo sees is keeping up with healthcare technology. Not only is it incredibly expensive, he’s working in a building that is more than fifty years old, so upgrading often requires actual renovation of the building structure which increases the price tag. “This is the type of a project we are facing now and in the future,” he says. “The reality is that pretty much throughout the building, we need redesign. It’s very hard to do, but we will find a way to do it the best that we can. That’s what is best for the organization.” by T.M. Simmons

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11 | McGill University Health Centre

IThe Heart of the Hospital

Quebec company well-known for developing major in-

“The Centre for Innovative Medicine is at the heart of

frastructure projects worldwide, and Innisfree Ltd. out

the hospital, both physically as well as spiritually,”

of the United Kingdom was selected. “You will see the

says Porter. “This is where our scientists will interact

design is very innovative and exciting,” adds Porter.

with our clinicians and research will be developed right at the bedside. While we treat patients using the

Mining the Digital Dividend

latest technologies and knowledge, part of our aca-

“One of the things we have not been particularly good

demic mission is to develop the new knowledge and

at as an industry is developing an electronic environ-

technologies that improve the quality of care.”

ment that gives us true value,” notes Porter. “It must

This is a fundamental change from the old-school model where the hospital is in one building and research in another. At the MUHC, the two are being

make an institution more efficient, more effective and more fiscally responsive.” Toward this end, the MUHC has shifted its busi-

fully integrated so that clinicians and researchers

ness model so that processes are better supported

work hand in hand, explaining issues and asking ques-

by information technology. Adjustments have been

tions of each other.

made in staff requirements as a result. New hospitals

The other change that will come about through

will benefit from wireless environments and two new

the redevelopment is an emphasis on elements that

platforms that Porter feels will make a big differ-

create a healing environment. Every new room is

ence. First is the electronic medical records platform

for a single patient and has a private bathroom, for

so that physicians may easily access the information

instance. “You don’t come to the hospital to make

they need. Porter expects the use and enhancements

friends; you come to the hospital to get well,”

of this tool to grow over time. Second is the person-

says Porter.

alized electronic health record. “You or me and any

The MUHC Redevelopment Project attracted inter-

person who we’ve designated can add information

est from around the world, with bids from very large

and share it with the doctors or other professionals

and multinational engineering, architecture and con-

we’ve chosen. It’s almost like your healthcare log

struction groups. A consortium led by SNC-Lavalin, a

book,” says Porter. “I truly believe that we need to be

McGill University Health Centre The origins of the McGill University Health Centre (MUHC) may be traced back to 1822 when Dr. William Robertson performed the first operation at the Montreal General Hospital, one of the five teaching hospitals affiliated with McGill University’s Faculty of Medicine that merged voluntarily in 1997 to become the MUHC. In 2008, a sixth hospital joined the MUHC. Combined with the Research Institute of the MUHC, the MUHC is one of Canada’s most notable academic health centres. “One of the things we have done since the merger of all our hospitals is to create a focus on developing a new platform for health care,” says the Honourable Arthur T. Porter, Director General and CEO. “That platform is both in terms of technology—how we deliver health care—and also in terms of construction of facilities. In April of this year we broke ground on the

Glen Campus, part of Canada’s largest healthcare redevelopment. It’s a $1.35-billion public-private partnership (PPP). It is the largest PPP in health care in Canada, and I believe in the world, at the present time.” In total, three campuses will be redeveloped. “This changes the institution from being one that not only provides the best quality health care, but also to one that has the infrastructure to be able to deliver it in the newest and most advanced ways,” says Porter. The 112-inpatient bed facility was projected to lose more than a million dollars the year Bolouki arrived. “The first year I was here, we turned it around and the hospital had a positive operating margin of $2.8 Million. We are now focusing on the expansion project.”


DESIGNING AND BUILDING FOR SAFETY, QUALITY AND SUSTAINABILITY

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more empowered as individuals to be part of our own healthcare processes.”

Challenges Such a monumental redevelopment project does present challenges. “You have to manage a complex transition process,” says Porter. “Our current hospitals have to provide excellent care until the very day that they shut down. Until then, you can’t reduce their functionality. The result is the need for two lines of thinking: How are you treating your patients today and how are you developing your plan of treatment for tomorrow?”

Building a Team “I have 14,000 colleagues who work with me,” says Porter. “Whilst one tends to build consensus, one needs to lead from the front. There is nothing I would ask somebody to do that I wouldn’t do myself.” Porter adds, “I try to build a team; everyone wants this but it’s not enough if it’s only in the abstract sense. I want our people to really feel they are part of a family, that they are insiders and that we will protect them. If you look after your people, they are also likely to look after you. That’s my style. There is not much room for airs and graces. While there is always a place for discussion, there comes a time when you have to deliver and that means acting.” by T.M. Simmons

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HCE EXCHANGE MAGAZINE Holder of a licence issued under the Building Act RBQ 2988-9037-02

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12 | Pacific Dental Services

Leading Modern Dentistry “The majority of dentists today—private dentists— Quality Systems, Inc.

haven’t changed they way they practice dentistry

(QSI) has been a leading provider of information tech-

in 20 years,” says Tinseth. “A lot of them still use

nology solutions for the healthcare industry for over

actual X-Ray equipment. They use paper charts.”

35 years.

PDS creates the infrastructure for a paperless office. From digital radiography to digital charting,

Since its first installation in 1976, the Company has

they are the first major dental-related group that

successfully installed and supported its technol-

has a complete electronic record for dental needs,

ogy solutions at dental and medical group practices,

including billing.

management service organizations, community health

other type restorations, for instance, are completed

hensive technology solutions assist Pacific Dental

in office. “No more temporaries or sending out to the

Service practices in the achievement of their informa-

lab. The offices create the final restoration, same

tion technology goals including the operation

day,” says Tinseth.

of “paperless” dental offices and Internet based patient interaction. www.qsii.com – 18111 Von Karman Ave., Ste. 600 . Irvine, CA 92612 . 800.888.7955

Pacific Dental Services Since 1994, Pacific Dental Services (PDS) has been partnering with dental offices. To date, they are putting smiles on faces through 200 dental offices in five states: California, Nevada, Arizona, Texas and Colorado. There are 2,800 employees associated with PDS and about 500 affiliated dentists. “We’re the experts at basically coordinating all the business processes that happen in any of our affiliate dental offices,” says Gary Tinseth, Chief Administrative Officer. “The office and practices are owned by the dentists. They employ all the hygienists and associate dentists. We manage the administrative aspects of the office for them, anything that needs to be done as far as business—the billing, the office processes, marketing the practice, all of their IT infrastructure and support. Basically, we take care of anything they need to do besides actually working on the patient.”

There are other advances, as well. Crown or

centers, and educational institutions. QSI’s compre-

More Value to the Patient “Everything we do is geared toward being more valuable to the patient and their time. We try to be very efficient in regards to time. We allow patients to do


13 | Plaza Medical Center of Fort Worth

all their pre-registration on the web. Appointments can be made on the web,” says Tinseth. PDS is plotting course based on demands from the patients. The insurance companies may be lagging, but the patients are opting for convenience, as well as quality. The company recently completed work with a number of patient focus groups from different regions. “We asked them, what do they see and what do they want from their dentist,” says Tinseth. The information collected from the focus groups was then followed up with an electronic email survey to more than 150,000 patients. “Our objective, of course, is that holy grail of getting those patients for life. In order to accomplish that, you have to find out what patients want. That was why we did this big focus group and survey. Now we’re taking that data and we’re going to put that into our best practices and all our training processes to get a better experience for the patient,” says Tinseth. “We know people don’t like to go to the dentist. What we try to do is make that process very efficient and as pleasant as possible for our patients.”

resources into each individual office,” says Tinseth.

The Future of Dental Practice Management

of electronic data is the ability to set best practices

Tinseth says that practice management groups still

company wide of which each office benefits. One

Another benefit to the linking of offices in terms as an industry. “We have a lot of initiatives going

account for a very small portion of the total dental

initiative we are working on now is our quality initia-

industry. They are beginning to see more growth, however, as independent dentists opt to join the more structured environments of management groups. The appeal is solid. As part of a system that takes care of the day-to-day business, dentists can focus all their PDS has plans to open new markets at the rate of one every other year or so, with a goal of adding 30-35 that’s totally realistic,” says Tinseth. “We’re not getting any resistance on the need for our services.” They work to support locally branded offices. “We’ve come up with a referral brand called ‘The Smile Generation’ where we will be doing more regional and national type marketing and funnel those

tive,” says Tinseth. “The dental industry hasn’t really had any measurements for quality or outcome of care. We think the way we are all tied in electronically with common systems, that we can now get into looking at quality initiatives, quality issues, and

attention on the care of their patients.

new offices per year in existing markets. “We think

Plaza Medical Center of Fort Worth

be able to maintain consistency overall.” “I think the key thing we’re looking for is to give the patients what they need in the future,” says Tinseth. “Basically, patients have a lot of choices. What we want to do with our modern dentistry theme, our quality initiatives and our patient engagement initiatives are to be that provider of choice in all the

Plaza Medical Center of Fort Worth has been in operation since 1974. For the past ten years the 320-bed hospital has been in the process of reinventing itself based on five major service lines related to cardiovascular, neuroscience, orthopedics, oncology, and specialty surgeries. Plaza has been recognized twice as a “top 100” heart hospital in the nation. It is the only hospital in the southwestern United States to have a hip and knee replacement programs certified by the Joint Commission. “We have a relatively small emergency department—about 16,000 visits a year—although 42% of our ED visits end up needing an admission,” says Chief Operating Officer, Greg Haralson.

markets we serve.” by T.M. Simmons

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

47


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End of Renovation and Continued Initiatives

operating rooms and from the cath labs to our beds.

designation or not. Just heading down that path

There is a lot of demand for beds here at Plaza. That’s

transformed our organization. It was a very tangible

my biggest challenge this year, to really improve the

element, gave us a sense of empowerment. The best

organization was in the middle of a $100 million renova-

through-put and flow of our emergency department.”

hospitals have the best nurses and this really be-

tion project. That project was completed last year, and

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included six additional operating rooms, as well as the complete renovation of all the existing rooms. “We did all this while maintaining existing operations in all those areas, as well as the entire hospital while we renovated each floor and moved patients to different to areas. As

RELAY MEDICAL INC.

well, we expanded the lobby and completely renovated cafeteria. All of that happened while continuing operations. From day-to-day, maintaining the flow of everything proved to be quite a challenge,” says Haralson. Now, among other things, Haralson is turning his focus to emergency department initiatives. “I think

It is easier to find critical care nurses because the

Alongside the structural renovations, the hospital has

climate and the culture are conducive to nurses

been investing in technology upgrades. An electronic

wanting to be here.”

medical record is in place, though it is not yet being

If staffing continues to be a challenge, Haralson

used for physician order entry. “We have a seasoned

says the difficulty lies in finding the right balance.

medical staff and they’ve been a little bit slow to adapt

“How many folks do we need in the organization at

to technology as far as signing off on records,” says

any given time?” he says. “When you look at 40 to

Haralson. “But they are working very well through the

45% of your overall dollar being spent in staffing

patient care aspects of it. That has been a positive

costs, you have to make sure you always have your

for us.”

eye on that ball.”

New generator and the switch-gear necessary to

“My philosophy has always been that if I’m serv-

go with that have been added. They modernized the el-

ing those who serve the patients, then we are going

evators, as well. “You don’t see a lot of return on those

to be in the right frame of mind. We’re going to have

types of things, but you are certainly glad you work for

the right things we need, the supplies we need, the

a company that is willing to make those investments.

staff we need, the physicians we need,” says Haral-

the system quickly and getting back to their homes and

It keeps us moving, keeps things flowing.”

son. “If I’m actively listening to what their needs are,

families as soon as possible,” he says.

An Employee Sense of Ownership

many of the folks you talk to have the same situation in terms of patient flow and making sure patients aren’t in holding too long in our emergency department and that those who don’t need admittance are moving through

Plaza has set a goal of 130 minutes turn around time

RELAY MEDICAL INC. 909 8th Ave Suite C Fort Worth, Texas 76104 817-332-9505

came an easier hospital for which to recruit nurses.

for each patient who enters the emergency department. “We’ve had quite a bit of success, but at Plaza we have a significant hill to climb,” says Haralson, “because of the number of patients who get admitted and those specialty services that drive a lot of admissions from the

then we are going to meet those needs.” by T.M. Simmons

The path to becoming a Magnet Hospital has proven extremely positive. “The nurses began to take pride of ownership in their jobs,” says Haralson. “That was going to happen whether we achieved the magnet

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

49


14 | Spindletop MHMR Services

Spindletop MHMR Services

which replaces some of the personnel we may have needed there,� said Harris. “Other centers have chosen to expand together and use a single medical director, or to share key staff. We are constantly

More than 100 years ago, the American oil industry literally burst onto the scene when a drilling derrick named Spindletop struck the black gold in Texas, proving to be the nation’s first major oil discovery. In the year 2000, another Spindletop began shaping a new industry, as Spindletop MHMR Services began the transformation of mental health and mental retardation centers in Texas.

looking at ways to expand or to get beyond our business. Hopefully we have positioned ourselves with this network to deal with budget cuts by working all as one.

Making an investment Upgrading the quality you provide generally means an improvement in the facilities that you have available, and Spindletop MHMR is no different. With capital funding running low because of a multibillion dollar state deficit, community centers like

services in inpatient, outpatient, crisis prevention, day programs, and work programs.� Becoming one of 39 community mental health and mental retardation centers in Texas meant taking a community approach to client care. The goal was no longer to just treat patients for whatever ailed them; there was now an added purpose of helping them to live and work successfully within the community in which they live. Spindletop MHMR Services also uses the community approach to consolidate many things in its operation, leading to better overall efficiency and some reduced costs by working with all of the other centers as a whole rather than individually. They, along with several other centers, share their own mail-order pharmacy, which saves money by

A community approach

allowing them the lowest prices on medications

Spindletop MHMR Services was created in Septem-

because they operate the pharmacy themselves. It

ber of 2000 after the Beaumont State Center and Life

also allows profits to be put back into projects and

Resources were combined, offering services in four

programs at the various centers.

counties in Southeast Texas.

There is also a wide area network used by all of

“We’re about a $32 million organization, with

the centers, with teleconference and tele-medicine

approximately 500 staff positions at any one time. We

capability throughout. Having one network for all of

serve four counties in Southeast Texas, with a popula-

the centers is cheaper than running individual ones

tion in the 470,000 range. We generally serve 8,500 to

and increases efficiency.

9,000 people a year,� said Dr. N Charles Harris, CEO of

“The network has allowed us to consolidate

Spindletop MHMR Services. “We’re a comprehensive,

some of our efforts. All of the centers in Texas have

community mental health, mental retardation center.

the same requirements when it comes to things that

We serve folks with mental illness and those with

need to be reported and with different audits and so

intellectual and developmental disabilities. We provide

forth. So we can do these things at the network level,

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Spindletop are forced to make tough decisions on how they spend their money. “One of the things we have done here over the last 3-4 years, is we’ve made a huge investment in ourselves, renovating almost every property we have. We have made a conscious effort to upgrade

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facilities and they are on par and exceed most of the things you’d see in the private sector,� said Harris. “These community centers are near the bottom when it comes to capital funding. That means we have to be more creative and look for

Throw in the fact that Spindletop serves a community

other revenue services, or if we can’t find them, we

with a median yearly income on the lower side of the

are limited to provide services to the most severely

scale, and it would be easy to see a dip in the quality of

impaired people, so that’s a challenge.�

services provided. But according to Harris, that is exactly the opposite at Spindletop. “We have a philosophy that regardless of your ability to pay, you should be treated in an environment that is functionally appropriate and as aesthetically pleasing as possible. We believe that is essential for our staff. They feel better about themselves and the organization,� he said. “So we spent about $4 million on improvements in our facilities, major investments in IT and other types of equipment. We believe our system is among the best in the state of Texas.� by Matt Bretzius

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

51


15 | R.J.A Medicentres Canada

Managing Physician Operations “We do set strategic directions for the organization, but we want to make sure each individual physician can have their particular needs met,” says Bhimji. “We’ve been able to provide them with flexibility so that they can enjoy their lifestyles while having the freedom to practice medicine. We don’t dictate how physicians practice. We have a variety of practitioners and they are able to fit into the organization.” Physician tenure with Medicentres is long. Bhimji estimates that at least half of the doctors have been with the company for more than 15 years. Other

At Canada Medical we are honored to partner with the Medicentres providing their surgical and medical supplies.

employees tend to remain long-term, as well. With the recent financial situation, retention has strengthened, which has saved the company costs that would normally be spend on recruiting and new hiring. An example of strategic direction would be moving all Medicentres to an electronic health record. New

R.J.A Medicentres Canada

centers are opening up with full electronic records in place. Existing centers are being wired, and a measured implementation means taking the time to introduce and teach physicians about the new systems. “The physicians will have a period of time to adjust,

Medicentres is a private physician practice management company that has been operating in Alberta, Canada for more than 30 years now. The founders opened the first Medicentre modeling what they had seen in their home country of England. The noted that physicians were in accessible and they wanted to ensure that patients could access care quickly and conveniently, but maintain the concept of family practice and continuing cared. The Medicentres model of nonappointment family practice has been thriving ever since. Today, Medicentres has over 180 physicians under management and approximately 500 employees. They provide a full scope of health care services out of 26 clinics in Alberta, with fifteen clinics in Edmonton, and nine in Calgary. They also operate 2 clinics in London, Ontario. “We tend to work at the fairly large, multi-site group practices and we service a variety of different disciplines including family practice, internal medicine, surgery, obstetrics and gynecology, and pediatrics,” says Dr. Arif Bhimji, President of Medicentres. The company provides all of the administrative services from patient booking, registration, and billing to management of medical records. They give a physician the ability to join a practice and start focusing on developing their practice rather than having to worry about administration, facilities maintenance and human resource management.

to find out what they need to know about the system before we begin the new reality of electronic medical records,” says Bhimji. “We need to insure that we are providing a superior service to the operations of the

all hours of the day, night and weekend to their

company because the operations of the company have

patients. “Physicians are choosing a lifestyle over a

to be consistent with what the doctors’ personal needs

career of service to their practice,” says Bhimji.

are and what the needs of the group are.”

Areas of Focus: Physician Recruitment and Site Location

Good for physicians, but more difficult for the neighborhood clinic to keep operating at preferred hours for patients. “That is a major issue for us and we have now even gone to looking at recruiting overseas and developing training programs for

“There is a shortage of physicians here in Canada,”

foreign physicians so they can quality for licenses

says Bhimji. That shortage is both relative and absolute.

here. So we are spending money and making the

There are more positions for physicians than there are

investments in physician recruitment locally,

individuals to fill those positions. As well, there is the

regionally, and internationally now.”

reality that physicians no longer want to work 60 hours

Another area of focus for the organization is in

a week. They tend not to work full days or be available

relocating to sites that are more accessible. They are

HCE EXCHANGE MAGAZINE

53


16 | Northpoint Surgery & Laser Center

partnering with various other health services such

more efficient within the healthcare system,” says

as pharmacy, physical therapy, and dentistry to form

Bhimji. “We have to take into account the external

health centers that become destinations rather than

environment much more than we did in the past

single service clinics. They are currently opening sites

because of changes that are happening that are

at a rate of about one per year.

fundamental to the way healthcare is moving and

“These are all very capital intensive and have to be done carefully,” says Bhimji. “We can’t lose sight of

being funded and delivered in Alberta.” Medicentres has been operating for 30 years in a

the fact that we are an operational company and that it

way that is beneficial to patients, physicians and the

is the operation that matters.”

owners. We expect to continue operating in this way

Internal and External Modification

for the next 30 years. by T.M. Simmons

The company, though private, is subject to all requirements of Canadian regulatory colleges. Physicians have the requirement of participating in ongoing continuing medical education, for instance, so Medicentres hosts a couple of events a year to give their physicians a convenient way to meet that requirement.

Northpoint Surgery & Laser Center

“There are changes that occur within an organization that, of course, have to be accommodated, but more and more we are seeing changes in the external environment which we are not able to control,” he says. Licensing changes have occurred in Alberta that now make it more difficult to recruit foreign medical graduates, for instance, and changes are taking place in the way physicians are being reimbursed. “We have been effectively left alone within the environment in the past, but all of that is changing because of integration, because of the need to become

INDUSTRY PARTNERS

Small companies have the capability to offer their clients customized, oneon-one care, but might have problems when it comes to capital expenses and large-scale projects. That’s where Northpoint Surgery & Laser Center in West Palm Beach, Fla. found a way to incorporate hometown care with nationwide support. According to administrator Connie Casey, Northpoint was physician-owned when it opened in 1996. However, in 2003, National Surgical Care became an equity owner, an addition that continues to be beneficial to the organization. National Surgical Care provides Northpoint’s management services and handles all financials, insurance and human resources. The partner also helps with billing, transcription and electronic recordkeeping. “National Surgical Care sets up all the services that we need,” she said. “This makes running the facility much easier for us than when we were operating by ourselves.”

Dell Canada www.dell.ca

Casey, who is the organization’s original administrator, noted that National Surgical Care also provides Northpoint with any back-up assistance that may be needed. For example, they have a nursing clinical liaison that comes to Northpoint and assists with policies or updating skills for the 80 staff members and/or 58 medical personnel. They also provide leadership development for the facility’s administrators. In addition to services, National Surgical Care installed one IT system throughout the company that gives administrators access to vital information. “That’s been a huge benefit,” she said. “Any time corporate needs me to provide them with information about the center I can look that up, even from home.” Real Issues : Real Solutions


Capital Expenditures Keeping up with the latest equipment is a big part of the business, Casey said. Northpoint just updated its arthroscopy equipment, which is typically updated about every three years, as the manufactures update features of the equipment. She said they also just purchased a new laser, updated their operating room tables and are trialing new ENT microscopes. In addition, to meet new infection control requirements, the organization just purchased a new washer disinfector, in line with new infection control guidelines. “It’s a constant battle when it comes to new equipment,” she said. “Doctors want to be the best that they can be, so as equipment is updated they receive training on the new equipment and we need to update.” On the software side, Northpoint is also instituting a virtual medical records system. This will assist in meeting Medicare regulations requiring surgical facilities to keep patients medical records for 10 years. “This creates a huge storage problem and a huge expense for most facilities, particularly ones

Challenges

like ours that have been in operation for more than

Having additional support also helps Northpoint deal

10 years,” Casey said. “You’re going to have to find

with a number of financial challenges, many of which

a place to store the patient charts.”

are due to financial cuts by either Medicare or insur-

This will also help Northpoint provide continuing

ance companies. Employees are stretched thin, as the

care to patients who return to the facility for regu-

center works to provide the same level of care with

lar treatment. Staff members and physicians will

fewer staff members.

Getting those employees to put in the extra time has also become a challenge, Casey said, as she finds younger staff members bringing a diminished work ethic. (to their.) They want the least number of hours possible and once on the job they don’t want to work as much as their older counterparts. “I think this is a matter of Baby Boomers were brought up to work as hard as you can, for as long as

and allowing physicians to revisit the patient’s previous medical history.

Quality and Patient Safety Initiatives Quality and patient safety are big topics in the surgical arena today, a fact Casey attributes to new Medicare guidelines that emphasize infection control. At Northpoint, the infection rate is 0.0003%, she said, and any infections are followed through until the compliThe organization has quality assurance performance

yet we’re still trying to provide the same level of care ing on a lot more jobs than before.”

making things like patient registration more efficient

cation is resolved and the patient is in good condition.

“We aren’t making as much money as we used to to our patients,” Casey said. “Our employees are tak-

be able to access patients’ records quickly and easily,

improvement and safety committees as well as an

Northpoint provide continuing care to patients who return to the facility for regular treatment

you can,” she said. “People just don’t want to work

infection control committee, each of which deal with various patient safety initiatives. Information on these matters is shared on a daily basis and monthly training sessions are held to train employees in something related to safety, infection control or quality assurance/improvement. In addition, all nurses are required to be trained in Advanced Cardiac Life Support and every nurse in the pre-op and PACU areas are required to be trained in Pediatric Advanced Life Support.

The Future of Healthcare Casey and her peers are closely watching the healthcare arena, as they being to feel the effects of insurance companies reducing coverage and adding hurdles to the pre-authorization process. Many of these changes leave facilities like Northpoint struggling to remain profitable. “They’re trying to decrease the payments they’re making to doctors, so doctors are selling their practices to hospitals or other facilities because they just can’t make it anymore on their own,” she said. “We’re moving toward a socialized medicine. That’s the last thing we in the healthcare arena want. You don’t know if you’re getting the best doctor to treat your medical condition. You have no choices.” Operating a profitable healthcare facility while keeping abreast of new regulations, and most importantly, providing quality patient care, are the challenges Casey and her Northpoint staff continue to handle on a daily basis. These are challenges, however, that this ASC administrator has confidence her organization will continue to take head on and deal with on a daily basis. By Kathy Knaub-Hardy

like that anymore.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

57


17 | Respiratory Health Services

Respiratory Health Services By tracking clinical outcomes, RHS is also prepared to help nursing homes face a pay-for-performance

Respiratory Health Services (RHS) is a national leader in clinical outcomes for respiratory therapy services provided to pulmonary patients in skilled nursing facilities. Founded in 1991, RHS was a co-creator of the original model of respiratory care in the long-term care industry. The company now employs more than 400 respiratory therapists and services more than 600 locations across the United States.

environment. “We are in a position to help nursing homes understand their costs and survive in that environment as well.”

Staying strong through staff development Attracting and developing staff is one key to remaining a leader in clinical outcomes. Investments in staff and

RHS is committed to improving outcomes for patients who need more complex care in nursing home environments. Through technology, staff and training, the company works hard to help nursing homes provide an optimal level of care to patients. “We are a partner with skilled nursing facilities,” said Dan Hirschfeld, president of RHS. “We help nursing homes care for medically complex patients, we give them the reimbursement necessary for those patients, and we provide good clinical outcomes.”

training have helped RHS recruit and retain qualified therapists. “Trying to find enough staff is a challenge. There is always a shortage of clinicians.” RHS addresses this challenge by partnering with schools to help provide clinical affiliations in nursing homes for respiratory therapy students. Hirschfeld hopes that through positive clinical affiliation experiences, these students will consider a career in long-term care.

prepared to handle complex patients, and that’s

“After we hire staff, the next component is making

where RHS comes in.

sure that we have the most highly trained team

“The vast majority of patients coming in for

available, and we do this by investing in our people,”

rehabilitation and then going home have some

Hirschfeld said. RHS has made significant investments

pulmonary distress,” he said. “Nurses need support

in technology and other resources, including

from respiratory therapists.” With RHS’s expertise and trained staff, “patients get the treatment they

Hirschfeld. “We are an industry leader on outcomes,

laptops, handheld devices, clinical programming and

need and experience the best outcomes possible.”

and we receive strong recommendations from hospitals

continuing education. “We teach staff and managers

because they consider us a preferred place for

how to use these resources to interact with customers

discharge based on our clinical outcomes.”

to get the outcomes we’re looking for,” he said. “We

Hirschfeld said the higher acuity of patients can be an opportunity for nursing homes when handled well. RHS offers two products to nursing homes:

have received a lot of great recognition for our training

ventilator programs. The ventilator programs are a

Helping nursing homes face reimbursement challenges

growing area for the company, which has been making

In today’s market, reimbursement is always a challenge

significant investments in technology.

for healthcare organizations, and RHS addresses those

numerous locations, we work to create a family

needs with customers.

environment. We provide ‘large company’ resources

respiratory therapy for pulmonary patients, and

“We are investing in the ventilator units, using

and education videos, and we’ve been recognized as a best place to work in key markets.” “Although we’re a large organization with

Assisting nursing home staff with quality outcomes

the latest technology to make sure that they’re smaller, quieter and better for patients,” Hirschfeld

the federal and the state level,” Hirschfeld said. “We

‘small company’ atmosphere because our staff feel

“The greatest evolution I have seen in this industry relates

said. “Through the ventilator programs, we are able

want to work with customers by partnering with them

connected to the company and to each other. This

to the acuity of patients,” Hirschfeld said. “Patients are

to increase census for nursing homes by offering a

to try to survive during this period of low

leads to our ability to attract and retain therapists.”

getting sicker and sicker. In addition, reimbursement

specialty program that allows them to attract more

reimbursement pressure.”

is, in part, driving the displacement of these patients

patients and establish themselves as a clinical leader

from hospitals, long-term care and acute care facilities, relocating them into nursing homes. This is good in some

in the marketplace.” Part of helping these facilities gain a positive

“Long-term care is under pressure overall at both

Nursing homes that provide services through

with reimbursement changes that make it easier for nursing homes to offer respiratory programs,

patient, anywhere from $11 per day to $300 per day,

Hirschfeld anticipates continued growth for RHS in the coming years.

ways, because they are in a lower cost environment, which

reputation comes from RHS’s detailed tracking of

benefits healthcare overall. But we want to make sure that

quality measures.

RUGs IV, will change the way nursing homes receive

In skilled nursing facilities, nurses are not always

“We track all outcomes of patients, whether in our respiratory or our ventilator programs,” said

With the company’s stellar reputation combined

RHS are able to receive a higher reimbursement per according to Hirschfeld. In addition, current legislation,

the staff is comfortable in caring for these patients.”

to therapists and patients, but have an intimate,

reimbursement, and may possibly create higher

By Patricia Chaney

reimbursement for complex pulmonary patients.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

59


18 | Larksfield Place

A Community of Family From the residents living independently in villas to those needing more hands-on, specialized care services, Larksfield thinks in terms of enriching lives and creating community. “We are here to serve our residents, number one, and we are also here to serve our staff. They are the backbone of our organization. When we conduct surveys, they show that the residents care more than anything about the staff, because the staff is like family. Some of them see the staff here more frequently than they do their own children. We operate in such a way that people feel valued and respected, regardless of the position that they are in. We don’t treat people who work in the laundry any differently than the administrators,” says McGhee. At the same time, the level of expertise for staff members is rising. First, people are coming out of hospitals needing more care than in past decades. The goal is to move them back into their homes to heal and recover rather than pay for long and lengthy hospital stays. Therefore, Larksfield has to maintain a nursing staff capable of caring for more serious

healthcare needs. As well, there is a greater focus on

“There is no sense competing with someone wanting

wellness today in retirement communities. “We have

to stay at home because we want people to stay at

people who are 100 years old who actually exercise

home. We want them to move to us when they really

three and four times a week. We have a lot more peo-

need us and not before they do,” says McGhee.

ple who exercise on a regular basis and they are living longer and they are living healthier,” says McGhee.

Challenges in Retirement Living Services

“We all better be ready for the next generation of older adults,” says McGhee. “We’ve all known that we are going to have this graying tsunami and we really will in the next 25-30 years. I think the opportunity for innovation is huge in the next 10 years when it comes

“There are always challenges in funding,” says Mc-

to older adults. What baby boomers will want when

Ghee. “We’re mission based. We’re not-for-profit. We

they triple the population of older adults is vastly dif-

still take care of people even when they’ve outlived

ferent than what the World War II generation wanted.

their resources.”

I think it’s important that all of us in health care stay

Another concern for McGhee is recruiting and

ahead of the game. We need to listen to our constitu-

maintaining qualified staff. “Fewer and fewer people

ents when it comes to older adults, to listen to some

are getting into this field,” she says. “Hiring nurses is

of the changes, and be able to deliver programs and

very challenging because they can usually make

services for that population.”

more money in the boutique hospitals than in long term care.”

by T.M. Simmons

“Even in my role as CEO, there aren’t as many people getting into the field because there are so many regulatory issues. We’re more highly regulated than a nuclear power plant. A lot of people are looking at the regulatory side of running retirement communities, because of the nursing home, and saying, ‘I’m not getting into this.’ There is not enough leadership, not as many administrators. We’re often challenged

Larksfield Place The average age of a resident of Larksfield Place, in Wichita, Kansas, is currently 82. The not-for-profit organization is a continuing care retirement community in the heart of the Central Plains. The community has about 300 residents living in 22 free-standing villa homes, 170 independent living apartment homes, and 90 licensed beds in an on-campus nursing home. They are in the process of constructing 40 additional assisted living units and 32 memory care units, with the help of GLMV Architects, a local firm that specializes in the field of aging with their building designs and construction. Larksfield Place enjoys the benefits of nationwide connection through membership in the American Association of Homes and Services for the Aging (AAHSA), an organization that advocates for older adults and keeps tabs on legislative movements that will affect them. “Things have changed dramatically in the whole industry of retirement living,” says Valerie McGhee, CEO since 2004. “AAHSA are the people who keep their finger on the pulse for us.”

with staffing.”

Future Services for Independent Seniors The organization looks for ways to enhance the lives of those living independently and assist them with those goals for as long as possible. “Maybe it’s a husband and wife and one of them is showing some sign of illness or dementia. We’re working on home-based technology programs where we can help people stay in their homes longer. It would be another financial stream for us,” says McGhee Another consideration is technology that monitors medication dispensation. As well, they are looking at programs that study movement patterns in a home and sound an alert for assistance when, for instance, a stove is left on too long or a person’s movements are really out of kilter with what is to be expected.

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19 | Longview Regional Medical Center

Longview Regional Medical Center lab, which is really a combination or hybrid model

In the two-hospital town of Longview in East Texas sits one of Modern Healthcare Magazine’s recent top 100 best places to work. Longview Regional Medical Center was ranked 35th in 2009, in fact, and the 30year old hospital is proud of that fact.

of a cath lab, radiology and intervention room. So it

Longview Regional is the smaller of the two hospitals in town with 131 beds, almost 700 employees and over 200 active physicians. They expect about 24,000 emergency room patients per year and will perform close to 12,000 surgeries in 2010. “We’re a very busy facility with an extremely diverse service line for our bed capacity,” says Jill Bayless Berney, Chief Operating Officer.

and it has been so immediately effective that we real-

is utilized not only by our cardiologists, but also our radiologists. This is a model you don’t usually see. We for both our radiologists and our cardiologists to use ized the need for an additional one.” A second hybrid is underway and is expected to become operational in the mid 4th quarter, 2010. As well, the hospital has just added a vein center screenings. They will be opening two more operating rooms in the ambulatory surgery center. Eventually,

someone from housekeeping, someone from nursing, someone from infection control and someone from the quality department. In short, they are making rounds to different departments within the hospital on a weekly basis and rotating between clinical and non-clinical departments. “We go into those areas and look at all the standards and how they are being applied. We try to have a fresh pair of eyes look at those areas. Is there a problem here? Is there something being done here that might benefit one area at the detriment of another?”

Good for the Patient Equals Good for the Employee Berney summarizes Longview’s culture as created by

The group is always asking questions. “Did you feel safe when you walked outside at night?” or “How quickly was your call light answered?” “We’re a team of eyes going around and looking

people wanting to do the right thing. “We have very

at patient and safety initiatives. We’ve found it to be

good physician satisfaction here. We measure that

quite effective in preparing for surveys, but also to

yearly,” she says. “We want to provide a good environ-

heighten awareness for people. We’ve been doing that

ment for our staff and we want to provide safe and ex-

for over four years now and have really found it to be

cellent care for our patients. I think all of those things

so effective that we use it in teaching administrative

together make for a great place to work.”

specialists here. We’ll take them around so it height-

One process that has worked for Longview is tak-

ens their awareness of those things as well. It’s been

ing not only mandated safety standards that come via

good for all of us. We think we’ve seen an improve-

joint commission or other regulatory bodies, but keep-

ment in patient safety, but in employee safety as well.”

ing an eye to events within the hospital and focusing on safety from a multi-disciplinary point of view. “We

Expansion Projects

have safety rounds led by our administration weekly,”

Longview is currently expanding its cardiology depart-

she says. “It always includes someone from the

ment, again! “Last year we added our second cath

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they will have four operating rooms and four gastrointestinal procedure rooms. “Those are some of the ways our capital dollars are being spent right now,” says Berney.

Challenges “I think one of the things that keeps me awake at night is the changing face and availability of staff,”

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says Berney. “For instance, we are fully staffed in our pharmacy right now, but it’s always difficult to get new pharmacists. What if someone leaves? How will we replace that person? We don’t have a pharmacy school here in Longview, so that’s one of my huge worries.” Berney thinks about quality of staff, as well. “I

always make good decisions. First is to always keep

want them to be able to come in and feel like what

the patients’ benefits in mind. Following that, to make

they are doing is making a difference and that their

it a good environment for staff and physicians to work

input is valued, because when employees feel valued,

in. When you have a good culture where those things

they give their best, and that’s when your organization

interact well, and you’re keeping patient safety and

gets better.”

good outcomes at the forefront, you just can’t lose.”

Then, of course, there is the constantly changing

“Having said that, do it in a dynamic environment

reimbursement models and regulatory issues. But

where you make it a little bit fun. If you look at doing

change, for Berney, isn’t always worrisome.

things in a different way, it makes for a good work

“Weekly we have doctors in the administrative

environment and a really good place for patients.”

area saying, ‘Gosh, I’d really like to see us get this,’ or ‘If we had this we could look at this other kind of care

by T.M. Simmons

delivery or we could start doing this new procedure.’ That’s the fun part – to talk about something in theory and then make a plan for it and put it into operation. That’s why I’m still doing what I’m doing.” “Healthcare is never static, but if we keep our three constituents always at the forefront, we will

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20 | Mount Kisco Medical Group

Shifting Focus “We were founded 64 years ago and had been focused on physician quality throughout that time. In later years, we focused on the quality of our technology, but now in even later years, we focus on patient service and patient satisfaction in a patientcentric environment,” said Dr. Abe Levy, Medical Director at MKMG. The shift of attention to patient satisfaction has led to sweeping success, as well as a sense of continuity, as physicians are joining MKMG and staying for the long hall. “In 2009, with over 200 physicians in the group, we had only one leave and that was due to retirement after a 33-year career. That is half of a percent

“Most of our quality assurances initiatives are really centered around the technology we use”

leaving. Basically our physicians stay here for their entire careers. They enjoy working here,” said Levy.

Projects and Initiatives Like most organizations these days, MKMG is

The physician-owned, multi-specialty group is headquartered in Mount Kisco, New York, with more than 20 other offices located in the surrounding area. Started in the mid-1940’s, MKMG continues to build upon the standards on which they were founded, while adapting to fit the needs of patients in the modern day.

the process of updating that technology now. Keeping its central operating system running smoothly is imperative to patient care, due to the broad range of

improving their processes will lead to improved

information it holds. “We’re selecting a new EMR because the one

attempted to improve their quality of care through

we’ve been using for eight years that we’re pleased

technology is by attempting to go paperless, using

with will not meet meaningful use, so we have to

data management systems and electronic record

have a new one in place by next year,” said Levy. “We

keeping to eliminate human error that comes with

have every single note on every patient for the last 12

handwritten notes and reports.

years in our EMR system, and every single lab test

“We see an opportunity where the electronics

from every patient for the last eight years as well.

makes for better quality and lower risk. Most of our

We will also use it to send over 400,000 electronic

quality assurances initiatives are really centered

prescriptions this year.”

around the technology we use,” said Levy.

With the increased amount of ailments and illnesses seen in healthcare today, it is most ideal for a medical center to have the ability to treat any type of patient in a safe and efficient manner. With more than 200 physicians, including experts in 30 specialties, Mount Kisco Medical Group may be the model of where the future of healthcare is headed.

first EMR a little more than a decade ago, MKMG is in

trying to keep up with technology in the hopes that patient care and satisfaction. One way MKMG has

Mount Kisco Medical Group

manila folder in a filing cabinet. Having selected their

A prime example is in the way specimens are

Other high-tech improvement projects currently underway at MKMG include a new pathology lab,

collected at MKMG medical sites. Rather than

and a patient portal. Already able to access their

having handwritten labels that can be lost or

prescription renewal and appointment requests

misinterpreted, all specimens are barcoded to

online, patients will be able to email physician staff

be completely trackable. The specimens are then

through an encrypted website for a secure connection.

scannable when sent out to various reference labs, where the data is instantly available, eliminating human error. MKMG also utilizes an Electronic Medical

Quality through partnerships When dealing with technological partners in the

Records (EMR) system, where a patient’s official

health care industry, there is a necessary trust needed

medical record is filed electronically, rather than in a

in order to form a successful bond. Rather than

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65


shopping around extensively to find the best financial deal, MKMG has found success by first finding the vendor that works most for them, and worrying about How can ROI be considered more than a financial consideration? When the initial investment also produces

cost later. “We have achieved efficiency by having

qualitative “soft” benefits that contribute to overall im-

relationships with as few vendors as possible, and

provements in performance. For St. Jude Medical Center

being as large a customer as possible for them” said

in Southern California, an investment in laboratory auto-

Levy. “The other thing we’ve always done is to select

mation generated measurable upticks in physician and

the best vendor in the industry and then negotiate the

employee satisfaction and patient outcomes. To learn

price, rather than using the price as a way of picking

more about how St. Jude Medical Center collaborated

the vendor. We don’t pick the lowest bidder, we pick

with Beckman Coulter to achieve a sizable recurring an-

the best vendor. That’s one way we’ve gotten efficiency

nual savings as well as numerous “soft” benefits, go to:

without sacrificing quality. We also become a partner

www.beckmancoulter.com/more

and a demo site with every major vendor. We have a partnership with Beckman Coulter in our laboratory for their hematology and coagulation equipment. And the ability to maximize on both efficiency and quality is what has propelled MKMG to what it is today. “I think the obsession with quality physicians, quality technology and patient centricity is what we’re about,” Levy concluded. “I think that the balance in those three is important, and that is what we’re trying to accomplish.” by Matthew Bretzius

More ways to increase

return on investment.

“Now we think of ROI as more than just a financial ncial calculation. calculation Beckman Coulter gave us the confidence we could achieve a significant return on investment by automating our laboratory–resulting in a recurring savingsof $1.3 million, annually. Asit turned out,lab automation measurably improved our physician and employee satisfaction and helps ensure that patient care is timely, as well. Our decisionto partner with Beckman Coulter helped us attain far more than we anticipated from the initial investment.”–Lee Penrose, President and CEO, St. Jude Medical Center, Fullerton, CA Find out more about all the ways Beckman Coulter can help your hospital achieve a better ROI at www.beckmancoulter.com/more. Blood Banking Centrifugation Immunoassay Information Systems

Chemistry Flow Cytometry Hematology Hemostasis Lab Automation Molecular Diagnostics Rapid Diagnostics

2010 Beckman Coulter, Inc. Beckman Coulter and the stylized logo are registered trademarks of Beckman Coulter, Inc.

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21 | Phoenix Childrens Hospital

Creating Effective Growth Opportunities

strategic alliance with Catholic Healthcare West that will result in additional pediatric physicians, nurses,

With approximately 60% of its patients covered

and staff.

by Arizona’s Medicaid program for low-income

Highlights of Expansion

families, the hospital has absorbed $17.5 million in state budget cuts since early 2008. The pediatric population continues to grow. “This requires us to be very disciplined in how we plan and manage our daily operations, as well as for strategic planning so that we—in light of the economic challenges—can continue to grow,” says Kuzas. Clinical leadership has worked to reduce length of stay in order to grow admissions and reduce the number of children who are turned away. “We want to make sure that those children that have an acuity level that is best served by a children’s hospital are able to be admitted to a children’s hospital,” says Kuzas. In 2008, they turned away 1400 potential patients. They were able to reduce that number to 800 by the following year and are currently turning away very few children. “That’s been a real success for us because, again, it emphasizes our role of taking on the sickest kids in our community and caring for them close to home,” says Kuzas. The hospital has recently announced a

Kitchell T O G E T H E R , B U I L D I N G VA L U E E V E R Y D AY.

The new facility under construction will move the hospital from semi-private to private patient rooms,

K I T C H E L L I S P R O U D T O PA R T N E R W I T H P H O E N I X C H I L D R E N ’ S H O S P I TA L .

a move that Kuzas says will dramatically improve patient satisfaction. Rooms have been designed with families in mind, with ample space for parents and visitors. “We have focused heavily on sustainability,” says Kuzas. “All the way from our central energy plant through to the finishes in a clinic and in patient rooms … The look and feel will not be high end—we are looking to be an organization that is focused on the investments for the clinical programs and have a sustainable environment for them.” Many areas of technology will be dramatically

Construction Management, Program Management, Site Development, Environmental Services

increased, as well. Imaging, for instance will move to the new portion of the hospital and MRI capacity substantially increased. Twelve additional operating rooms will be included in the new building. As a cost saving measure, approximately $100 million of

www.kitchell.com

the expansion project has been put into what Kuzas refers to as “shell mode.” The structure will be completed, but the interior finishing of some portions of the building will be put on hold until economic

Phoenix Childrens Hospital

improvements make completion feasible. “That has allowed us to take substantial dollars and put them in a holding pattern. We looked at other areas where there was an intensity of dollars through construction as well as medical equipment. Rather than reduce

The $588 million expansion project will make Phoenix Children’s Hospital one of the largest freestanding children’s hospitals in the nation. The project will more than double the size of the current hospital, resulting in 1.2 million square feet of space with which to treat and care for the most critically ill children of the southwest. At 344 beds currently, the hospital will have 626 beds by 2012. “The centerpiece of our expansion is an 11-story tower that allows us to move, as well as grow, our high intensity services including imaging, operating rooms, cath labs, intensive care and our hemophilia program. It’s been a substantial undertaking for the organization,” says Betsy Kuzas, Interim COO and VP Support Operations. Phoenix Children’s Hospital employs approximately 200 physicians in their medical group. With a Medical Staff of nearly 1,000 physicians, the hospital offers services in more than 40 pediatric sub-specialties, many of which are unique to Phoenix Children’s in the region. “We’re not just managing bricks and mortar in terms of our growth,” says Kuzas. “We have dramatically increased our medical group over the last three years, which improves access to care.”

the scope of the project, we put that portion in a shell mode or holding pattern,” she says. Pre-construction services by an area general contractor, Kitchell, have helped to tightly manage those dollars. “We have continued to refine the design and we have continued to cost it, so we’ve always known where we are relative to budget,” says Kuzas.

“Change is all around and the discipline with which we’ve been able to approach that change strategically is important, but also from a day-to-day operations standpoint it has been critical. We focus on information… We look for quality indicators to continually measure ourselves against… We also look to benchmarking data to make sure we are able to take advantage of all those efficiencies in technology and/or process,” Kuzas says. “We flex on a day-to-day basis. Persons coming into our organization are amazed at the amount of

Changing into the Premier Regional Pediatric Center of the Southwest

tools that we have in place to allow us to understand

“Part of our culture is to keep that vision out front

by T.M. Simmons

our overall staffing as well as to project going forward. That has been critical in managing change.”

so that we continue to progress,” says Kuzas. The management teams functions on the idea of embracing change and continually moving forward.

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22 | Peconic Bay Medical Center

Peconic Bay Medical Center

From community avoidance to community construction “When I came here in 2001, the institution was finan-

“Peconic Bay Medical Center is committed to improving the health of our communities by providing quality, comprehensive and compassionate care.” Not an uncommon mission statement. Many hospitals promote the same values and compassion to the communities they serve. But for Peconic Bay Medical Center, unwavering adherence to this mission statement has sustained the facility and completely turned its fortunes around. Located in Riverhead, NY -- the gateway to the East End of Long Island, the hospital’s primary service area has roughly 1.4 million people. During the past 10 years, under the direction of President and CEO Andrew Mitchell, FACHE, the hospital has experienced a total transformation, in looks, quality and service.

nize that even though we were financially challenged, we had incredibly rich resources,” he said. From that stimulus, the hospital continued its

cially troubled and had a high avoidance rate in the

growth, staying committed to the community that

community,” Mitchell said. “We needed to transform

inspired the beginning of this transformation. With an

that, and the first step was empowering everyone at

increasing population, especially of individuals over

all levels of the organization to be part of the change.”

age 65, the hospital needed to expand to become a ma-

“The Emergency Center, which was “falling apart,” needed hundreds of thousands of dollars of work to be considered a reasonable clinical facility,” Mitchell

jor medical center to properly serve the community’s evolving needs. In 2005, Peconic Bay established a foundation to

said. Funds that the hospital did not have. Rather than

handle the philanthropic and fund-raising aspects of

be defeated, the hospital staff and community at large

the hospital’s mission. The foundation raised enough

took it upon themselves to rebuild the Emergency

funds to finance a $35 million renovation and expan-

Center – a sort of Habitat for Humanity project. The

sion project. Within three years, the facility has become

local school system, fire department, Coast Guard,

one of the most honored hospitals on Long Island.

police and other community members participated in Center. The project was done completely with volun-

Continued transformation and expansion

teer labor and mostly donated materials.

In the Spring of 2009, Peconic Bay opened the Kanas

a four-day gutting and rebuilding of the Emergency

“This project was the biggest and most important change for us because it allowed everyone to recog-

Center for Advanced Surgery — a state-of-the-art surgical pavilion featuring the latest in patient safety

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23 | Sky Ridge Medical Center

Congratulations to Peconic Bay Medical Center technological advances, and providing more skilled nursing, rehabilitation, and home health services. The Emergency Center expansion was planned for in the original design of the project. Peconic Bay already has a skilled nursing and rehabilitation facility as well as a home health agency. With the growing senior community, expanding residential services to include assisted living, senior housing with a medical model component and possibly a life-care community is necessary to continue meeting the residents’ needs. “Residential services with a medical service component is needed in our community and consistent with the mission of the medical center,” Mitchell said. He said some components of the hospital’s long-term plan can begin next year, while the life-care community is about two years away.

Sky Ridge Medical Center

Leading the transformation ...on your beautiful new state-of-the-art surgical pavillion!

Peconic Bay Medical Center has doubled in size over the last three years and employs more than 1,200 people, making it one of the largest non-municipal employers in the region. The hospital has doubled its revenue base and doubled its admission base in the past 10 years since Mitchell has been President

technology. Six months later, the hospital was given a 5-star rating — the highest available — in general surgery by HealthGrades, the leading independent healthcare ratings organization in the nation. And just one year later — in the Spring of 2010 — Peconic Bay acquired the da Vinci Surgical System, a breakthrough surgical technology offering an advanced category of minimally invasive surgery. A member of the East End Health Alliance, which also includes Eastern Long Island Hospital and Southampton Hospital, Peconic Bay is also affiliated with Stony Brook University Hospital and Stony Brook University School of Medicine. . In 2010, Peconic Bay began its first family practice residency and hopes to expand to a surgical residency program, partnering with the New York College of Osteopathic Medicine. This is the beginning of an evolution toward becoming a teaching hospital as well.

and CEO. Mitchell describes his style as “participatory management.” He attributes the facility’s success to looking at the needs of the community and involving all stakeholders. “The bottom line is with everyone working together, organizations can grow quickly. My role is to make sure stakeholders are involved and help everyone stay focused on the true vision of the organization,” Mitchell said. The leadership needs to recognize that he or she has invaluable resources at the board level, physician level, staff level and the community at large. “Everything we have done here has been based upon community and executed properly, and we’ve been

ganized around three initiatives: upgrading the Emer-

“In addition to full range of surgical procedures and births, we also have a three imaging centers strategically located in the community,” says Susan Hicks, Chief Operating Officer (COO). “Our largest service line is our Spine & Total Joint program. We’re on track to do about 1,500 spine surgeries this year and 1,000 total joint replacements. In fact, Sky Ridge performs more spine surgeries than any other hospital in Colorado.”

very successful in going through a total institution transformation. It’s amazing what an institution can accomplish under very difficult circumstances.” By Patricia Chaney

Looking ahead, Mitchell says the future will be or-

Poised on a 57-acre campus mid-way between Colorado’s two largest cities—Denver and Colorado Springs—Sky Ridge Medical Center was the first hospital to open in Douglas County, which had been one of the fastest growing counties in the country for more than a decade. Open just seven short years, Sky Ridge is a 186-bed full-service facility with 1000 employees and 1200 credentialed physicians representing nearly every specialty. Keeping pace with demand in the community, Sky Ridge will see more than 36,000 people through its Emergency Department and admit more than 12,000 in 2010.

As COO, Hicks is in charge of all program development and key hospital growth initiatives. Working with physicians and helping grow programs is her passion. “Our imaging centers, surgical services, cardiovascular services and the spine and total joint programs are all under my span of control,” she says. “In addition, I am working on very exciting new project – the expansion of our comprehensive breast cancer program.”

gency Center to a Level 2 trauma center, continuing

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Meeting the Growing Needs of the Community Thanks to community support and physician enthusiasm for the Sky Ridge facility and its customer focused philosophy, the hospital has been expanding each year since it opened. “Early on, we expanded our Intensive Care Unit, followed by build outs on our third and fourth floors to create dedicated cardiovascular and orthopedics units, respectively,” notes Hicks. “Our largest project to date was the opening of our 60,000 square foot Spine & Total Joint Center, which added seven new operating rooms, a PACU and family/visitor center with its own private entrance.” In addition, Sky Ridge launched an open-heart surgery program, opened a second cardiac cath lab, started a cardiac rehabilitation program and will soon be launching pulmonary rehab and congestive heart failure clinics to augment the cardiac care program.

offers a more precise and consistent result for partial knee resurfacing. “MAKOplasty allows us to treat patients with knee osteoarthritis at earlier stages and with greater

Looking to the Future Sky Ridge, like many other hospitals, is in a very competitive environment therefore the team must stay ahead of the curve in terms of technology, customer service and healthcare advancements. “We continually assess the needs in our community and create a business case for how we will meet those needs,” Hicks says. “We’ve been very fortunate because our team is incredible, the physicians are highly regarded and the community has embraced the hospital. This has enabled us to continue to grow and expand. We are very much looking forward to the next seven years!” by T.M. Simmons

precision. Because it is less invasive and more of the patient’s actual knee remains, it offers a more natural knee motion post-operatively,” notes Hicks.

Performance Initiatives As a joint venture of HealthONE in Denver and the Hospital Corporation of America (HCA), Sky Ridge greatly benefits from HCA purchasing power. “Our company has a fabulous track record of purchasing on a large scale and contracting prices,” says Hicks. “I am a member of the committee that reviews all new product requests. We evaluate if the product is on contract and if it makes sense from a patient, physician and hospital perspective. Our company has a great infrastructure that allows us to maximize our buying power thus reducing costs.”

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24 | Twin Cities Orthopedics, P.A

Twin Cities Orthopedics, P.A Being the second-largest single specialty orthopedic group in the country gives an organization like Twin Cities Orthopedics, PA (TCO) advantages and opportunities equal in size. Facilities of that caliber have the ability to recruit good doctors, pool resources to provide total quality care and give back to the community. TCO handles about 27,000 patient visits per month with 500 employees at 31 practice locations throughout the Minneapolis area. The organization’s medical staff includes 79 physicians, 74 of which are orthopedic surgeons. “Because of our size, and good reputation in the community we’ve been able to recruit excellent doctors,” said Dr. David Holte, president of Twin Cities. “Through word-ofmouth, people come to us looking for employment opportunities,” he said.

With numbers like these, TCO is able to keep its support services in house, yet doesn’t become overwhelmed by the administrative aspects of running such a large organization. “One of the things we try to do is keep support services within the organization that we think we can do as well or better than others,” he said. “We try to do things ourselves rather than hire consultants. For example, we have our own human resources department, our own billing and collection department, and our own IT department. When we look at what other organizations are paying for those services, we find we are able to do it cheaper and better if we do it ourselves.” Dr. Holte, who has been president of Twin Cities Orthopedics since 2002, said the organization is extremely efficient with its billings and collections, accounts payable and accounts receivable. “Our AR days are very low as compared to the national average,” he said.

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Technology Advancements

2007. Next on the agenda is an outcomes study for

There are also some challenges with malpractice

Imaging is a vital part of any orthopedics practice.

total hip replacement and one on carpal tunnel syn-

liability reform that physicians there are looking at

In 2008, the organization took a step toward improv-

drome will follow that.

that closely.

ing that aspect of the practice by switching to digital

industry in general the quality of our physicians,”

a lot of tests that we order and some of the ways we

of its films, as well as the speed with which they are

Holte said.

practice are directly related to defensive medicine

other and decreases storage issues.

from customer satisfaction surveys. Looking at where

where the organization will be in five years, Holte

patients are most satisfied with the care they

concluded. However, he anticipates growth, in-

ing to a complete electronic medical record-keeping

receive, employees attend monthly training sessions

corporating new technologies such as electronic

system. Holte said he is hoping to have a system in

where they complete written exercises with the goal

medical records and thinks that the organization will

house and running by 2011.

of developing a service center culture within

continue to develop ancillary care, such as physical

the organization.

therapy, some imaging and other things are part of

TCO has added to its space with a number of new

Work Environment

buildings, as well as recently completed remodeling

One strategy TCO uses to recruit and maintain physi-

projects at existing clinics.

cians is to reduce the “buy-in” process for them to

“Altogether we have three new clinics being built in different locations around Minneapolis and three or four remodeling projects,” he said. One additional project includes the consolidation of three or four different clinic locations into one.

become partners.

The practice is managed by a board of directors. staff members feel equally represented. In addition,

physical therapy and hand therapy. The new consoli-

everyone is up front with information regarding what’s

dated location will also include a surgery center.

going on within the group. “We have a philosophy within the organization

of care for the patients,” Holte said. “They can come

of transparency,” he said. “Everybody can see what

to one location and their records will all be in one

everybody is doing and there’s a lot of sharing of

place. They can meet with the doctor and the physi-

information between regional groups so that people

cal therapist at the same time, develop a treatment

can see what the successes of one region is compared

plan and then move forward with that.”

to another. They can incorporate those successes into their business strategy. There is healthy competition between regions.”

Stephen H. Brown CCIM

Other initiatives in which Twin Cities Orthopedics has

Healthcare Reform

SENIOR VICE PRESIDENT/MANAGING DIRECTOR NORTHMARQ HEALTHCARE ADVISORY GROUP 952.837.8517 | steve.brown@northmarq.com

its patients in mind involve quality outcome stud-

With the advent of healthcare reform, Dr. Holte be-

ies. “We’ve been able to pool resources so that we

lieves that it’s going to be a challenge for medical pro-

can perform outcome studies and provide continuity

fessionals to understand all the aspects of that and

of care to our patients from the initial diagnosis to

how it might affect reimbursement. He anticipates

the end of treatment. We can efficiently take care of

some potential cuts from Medicare, which recently

patients and still provide quality care.”

presented a 21% cut in reimbursement to physicians.

knee replacement study that has been ongoing since

with a watchful eye to federal initiatives and their affects on the organization’s bottom line. By Kathy Knaub-Hardy

obstacle for some people,” Holte said.

digital radiography, as well as ancillary services for

The organization is currently conducting a total

the practice. Growth will continue at Twin Cities, but

process for becoming a partner, which became an

This facility will include imaging with MRI scans and

Quality and Patient Safety Initiatives

With healthcare reform, it’s difficult to predict

“It used to be, in days past, there was an onerous

All of the 11 members of the board are physicians, so

“This will help provide a little better continuity

Commercial Real Estate Services

and trying to avoid liability,” Holte added.

better access to patients’ films from one clinic to the

Structural Additions

Advised by:

In regard to patient satisfaction, TCO is developing a service center culture, looking at the results

Digital imaging is just one step toward convert-

NorthMarq warmly thanks Dr. David Holte for leading the strategic real estate efforts for TCO’s spectacular new Edina facility.

“We are supportive of that because we feel that

radiography. This allowed TCO to improve the quality taken. Maintaining images digitally also allows for

TWIN CITIES ORTHOPEDICS

“These studies demonstrate to insurers and the

Growth will continue at Twin Cities, but with a watchful eye to federal initiatives and their affects on the organization’s bottom line

“Currently that is on hold but if that goes through we’ll have to try to adapt to that,” he said.

northmarq.com

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

79


25 | The Menninger Clinic “We made the decision that the organization should find a strategic partner, preferably a major medical

Overcoming challenges Aside from the stigma surrounding mental illness,

school,” said Aitken, who has been with Menninger

funding issues create significant challenges for

since 1996. “That decision was based on our view

Menninger. “I don’t think there is a clear agreement

that research would lead the field into the future,

between provider and payer communities as to what

particularly neuropsychiatric research.”

constitutes effective care,” Aitken said. “We all agree

The organization searched for schools and in 2003 relocated to Houston to partner with Baylor College of Medicine and its partner at the time, Methodist

we’d like to deliver value to patients, but how we assign value is always a point of contention.” Most payers will cover a short stay at an acute

Hospital System. The Clinic now has 135 beds, about

care facility, but may not always pay for the longer,

350 staff members and still attracts patients from

intensive care provided at Menninger. Providing

all over the country (40 percent from Texas and 60

longitudinal data of the effectiveness of treatment

percent from remaining states and foreign countries).

plays a large role in changing the payer perspective.

The Clinic specializes in treating patients with

Menninger has begun taking steps to track outcomes

complex diagnoses and accompanying disorders. “Many patients who have not responded well

in patients. “As patients leave Menninger, many go to

to treatment in their local community come to

other treatment providers to continue honing the

Menninger for intensive treatment,” Aitken said.

management of their illness. Although they only stay

“Patients usually stay between six and eight weeks,

at Menninger six to eight weeks, we need to know two

which is significantly different from most psychiatric

Begun in 1925, Menninger has undergone major

years down the road that the investment they made

hospitals in the country. Those have an average stay of

changes to continue its position as a national leader,

produces long-lasting results,” he said. “We are in the

about six days.”

third year of an outcome project we’ve created here to

Becoming an international treatment destination position it has maintained since the early 1960s in

The Clinic engages patients in specialty, intensive

do just that.

mental health treatment. The Clinic was located

psychotherapeutic and psychobiologic treatment.

in Kansas for decades, but in 2000 Aitken says the

“This is not a typical model of psychiatric hospitals in

leadership began planning for the future and felt The

that affect a patient’s ability to sustain recovery.

the United States, but it’s a model we’re familiar with

Clinic needed a partner.

It is a difficult set of variables to manage to track

and have been practicing for the last 85 years.”

effectiveness over time. And then to convince others

There are a variety of environmental issues

who have an interest in that.”

The Menninger Clinic According to the World Health Organization, depression and other neuropsychiatric disorders are the leading cause of disability worldwide and affect around 450 million people. In the United States, about 95 Americans die by suicide every day. However, despite the prevalence of mental illness, it still remains one of the most stigmatized diseases. The Menninger Clinic, located in Houston, TX, hopes to eliminate this stigma by bringing mental health treatment into the mainstream, approaching diagnosis and treatment as you would any other disease such as heart disease. Ian Aitken, president and chief executive officer of Menninger, views research as the way to accomplish this mission. “We now have the tools and technology that allow us to understand the brain,” he said. “A lot of stigma around the disease has been that people haven’t understood its biological origins. They thought it had something to do with their character or family. People do not appreciate it as a malfunction of an organ in the body.”

Continuing the mission While tracking outcomes, Menninger has begun

the quality of care to people locally. “We are taking

implementing big plans for the future. Aitken says

a leadership role in the community and working with

Menninger has purchased land and is planning

those individuals who are serving in it every day. We

to create a “mental health epicenter,” making

need to measure ourselves in how we are able to help

the Houston facility a national destination for

the community’s most disabled members,” he said.

research, treatment and education. Aitken describes

Aitken is looking forward to the future and seeing

three elements to this plan: attracting the finest

some hope in improving the understanding of mental

researchers and students, collaborating for more

illness through research and technological advances.

effective research, treatment and prevention,

“I think people are starting to view mental illness as

and capitalizing on mental health and medical

a treatable disease,” he said. “A lot of patients are

professionals working side by side.

starting to understand they can recover. I believe the

“We would like to try to create public/private

future is very bright.”

collaborations with mental health organizations in Houston and Texas so that we can turn the public

By Patricia Chaney

system of care into something more effective than it presently is,” he said. Over the past few years, Menninger has initiated some community-based programs to help improve HCE EXCHANGE MAGAZINE

81


SEP/OCT

2010

Real Issues : Real Solutions

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