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Real Issues : Real Solutions

Lifelabs Dealing With Different Markets

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Real Issues : Real Solutions

CONTENTS

04 LifeLabs

IN-FOCUS STORIES 10 Trellis Mental Health and Developmental Services of Canada 14 Athens Regional Medical Center 18 Campbell Clinic 22 KSB Hospital 26 Memorial Hospital of Martinsville & Henry County 29 Rosebud Health Care Center 32 OSF Healthcare System 34 Senior Whole Health 37 eHealth Data Solutions

Doug Tkachuk, M.D., Chief Medical and Quality Officer

40 Harrison Memorial Hospital 43 Memorial Hospital of Carbon County 46 Beacon Pointe Memory Care 48 Matrix Medical Network

HCE EXCHANGE

MAY/JUN

2013


LifeLabs LifeLabs Medical Laboratory Services (LifeLabs) is Canada’s largest community-based medical diagnostics lab. Its presence is most predominately felt in the country’s two largest provinces, Ontario and British Columbia. LifeLabs processes over 50 million laboratory tests for more than 10 million patients and 20,000 physicians across the provinces of Canada annually. LifeLabs (formerly known as MDS) has been around for over 50 years, and it continues to grow. Recently, LifeLabs purchased its largest competitor in British Columbia, BC Biomedical Laboratories. Intrinsic to its mission is a drive for quality, service, and efficiency. These are goals that LifeLabs’ owner, Borealis Infrastructure, the sole investment arm of OMERS, has tasked Doug Tkachuk, M.D., chief medical and quality officer, with accomplishing.


Sysmex Canada, Inc. in Ontario serves as the Canadian headquarters for Sysmex Corporation Kobe, Japan. Sysmex Canada sells and supports Sysmex hematology and urinalysis automated analyzers, reagents, and information technology products and services to healthcare facilities within the country’s 10 provinces and three territories. Sysmex is the global leader for Hematology and Hemostasis. Whether your lab handles 10 or 10,000 samples every day, Sysmex has comprehensive analytical instruments and integrated information systems to generate the most accurate information and enable your organization to provide the best clinical decisions. All systems are FDA and Health Canada cleared before they are introduced to the market. Sysmex Canada has grown to a market share of 34% as a result of service agreements with some of the country’s largest healthcare providers including the Eastern Ontario Regional Laboratory Association of the Champlain Local Health Integration Network (LHIN), comprised of 16 hospitals, Diagnostic Services Manitoba which is comprised of 67 sites throughout urban and rural Manitoba and commercial labs such as Life Labs who has re-signed with Sysmex in 2011. Other Canadian healthcare providers currently benefiting from Sysmex’s portfolio of product and services include blood centres, cancer centres, and the Canadian National Defense. As a result of our growth, Sysmex Canada continues to be a viable employer, doubling our work force in five years.

market share is allocated to three large labs, with all three taking on volume risk. In other words, they are paid the same regardless of the number of patients walking through their patient centers. “As a result, we’re a fairly cost-effective solution for increasingly fiscally restrained governments in the provinces,” Tkachuk said. Five percent of Canadian healthcare is spent on labs. Because of Ontario’s capped system, labs are one aspect of the healthcare system that has become disproportionately smaller to the cost of other healthcare providers. British Columbia, on the other hand, is still based on the fee-for-service model, although it has soft caps for volumes, meaning LifeLabs needs to operate efficiently in B.C. as well.

Sysmex Canada, Inc.

Tkachuk explained that under Ontario’s system,

www.sysmex.ca 5045 Orbitor Drive, Building 9, Suite 401, Mississauga, ON L4W 4Y4 905-366-7900 | 1-888-4SYSMEX (1-888-479-7639)

LifeLabs has become a partner with the ministry in controlling appropriate lab utilization. When the fee-for-service model, where the providers take on the volume risk, is replaced, he said, the lab is obligated to order tests appropriately, administering only the ones that are absolutely needed. The capped system has been in place in Ontario for a number of years, and Tkachuk emphasized the

Dealing with different markets

importance of service-level agreements that spell out the items important to the patients and the regulators, such as patient access and wait times.

Because most of Canada’s healthcare delivery

“The caveat for cap systems to work and work

system is based on the single-payer model, the first

well is if both the government and the lab providers

step to providing laboratory services in a province,

agree on those basic lab services and performance

Tkachuk said, is to form a contractual agreement

expectations, such as turnaround times, patient ac-

with the provincial ministry.

cess, and quality,” he added.

“Those contracts give us licenses and those

As someone who has worked and trained in the

licenses allow us to carry out medical diagnosis,”

United States, Tkachuk is familiar with both sys-

he explained.

tems. He readily admits that Canada still benefits

It’s challenging providing lab services in Canada

enormously from being situated beside the U.S.

since provinces differ in the method behind their

Sometimes, it’s more cost-effective to take a one-

delivery system. For example, Ontario runs under

off lab test for extraordinarily rare conditions and

a capped regulated system, so the percentage of

run the results in the States, he said.

An unsustainable marketplace In trying to keep pace with the demands on healthcare, the Ontario government continues to struggle with the needs of its population. It’s predicted that half of all money spent by the government in the coming years will be on healthcare. “That dot is unsustainable,” Tkachuk said. “It also squeezes all of the other non-healthcarerelated expenditures for the government, like education and taking care of the poor and the elderly. As a result, we face enormous pressure from our funders (the government) to be more and more efficient.” Furthermore, the single-payer system struggles to be adaptable. For instance, the test menu has not been able to keep pace, Tkachuk observed, and has not kept up with modernization, meaning the most sophisticated tests remain off the public menus and on the private side. In an effort to tackle expenditures and enhance efficiency while improving quality, LifeLabs has taken on a number of initiatives. As mentioned above, LifeLabs is working with the government and physicians to control “utilization.” For example, not every healthy male at the age of 40 needs a full annual physical exam. In fact, some tests should only be given when clear medi-

and turnaround times. We are emphasizing more quality around the pre-analytical side.” LifeLabs has also pursued other initiatives to improve efficiency and quality. One of LifeLabs’ goals has been to improve tube-spin times or how quickly it transfers tubes into the lab and obtains a turnaround on the results. It has also begun monitoring on a real-time basis how long patients wait at their service centers, and it has begun to allow patients to book their blood testing in advance online. LifeLabs is also looking to improve the way it conducts colon and cervical-cancer screenings. “Colon cancer and cervical cancer are cancers that can be prevented by appropriate population screening,” he said. “Labs have a big part to play in preventing colon and cervical cancer.” LifeLabs has been working with Cancer Care Ontario to validate new kits and ways of confronting cervical cancer. Instead of doing multiple tests on women 25 and older, for instance, it has been using Pap Smears as the primary HPV triage tool. “More testing isn’t necessarily better,” Tkachuk concluded. “More testing can lead to unwanted work-ups and complications for patients, so appropriate lab-test utilization is good for patients and it’s good for payers.” by Pete Fernbaugh

cal guidelines are met. These tests shouldn’t be ordered just so physicians can check off every box on a lab test, Tkachuk contends. “We work hard to be a trusted partner with the government,” he said. “We try to merge cost effectiveness and delivering quality. We try to never compromise quality, while staying a trusted partner to our single-payer systems. What that essentially means is that we strike fair compensation agreements for lab services and we adhere to servicelevel agreements around patient access, quality,

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02 | Trellis Mental Health and Developmental Services of Canada

of the secondary effects that come with mental illness, such as not working or living in poverty. We are starting to see different outcomes for people with this early intervention program, which places a tremendous emphasis on collaboration, integration, and education.” In addition to community partners, Trellis felt the need to search for corporate partners to make the organization more financially sound. Wagner said Ontario has a significant deficit, and healthcare organizations were told that they would not receive any revenue increases over the next two years. “We have to look down the road at strategic partnerships to practice our mission more efficiently and effectively,” Wagner said. “We need to partner up to adequately address complex prob-

Developing partnerships to create a better system

Trellis Mental Health and Developmental Services of Canada During a time of shrinking budgets, rising costs, and increased pressure to perform to quality standards, strategic partnerships are becoming an integral part of most healthcare organizations’ future plans. Even in Canada, where funding comes mostly from government sources, budgets struggle to keep pace with the increased need for services.

Fred Wagner, Executive Director

He said the provincial government has looked for ways to deliver services more efficiently and has

Trellis provides a full range of services for all ages,

decided to move additional dollars into community-

from children to seniors, with mental-health issues

based healthcare and away from hospital care, an

or developmental challenges in three counties in

initiative that is indicative of healthcare’s overall

Ontario. The organization has about 179 employees

future.

from disciplines including psychiatry, social work,

In April, Trellis’ Board of Directors merged with

youth workers, nurses, and others. Trellis offers

the Grand River Branch of the Canadian Mental

case management, community outreach to the

Health Association. By combining resources, the

homeless, court support, and family services, along

two organizations are now able to provide more

with traditional office visits.

seamless care across the region, offering residents

Part of Trellis’ goal, especially with young people, is to begin providing care at the first episode of psychosis to improve functioning and

better access to care and the ability to maintain a higher standard of care. “We are pleased with the progress we have

help prevent detrimental effects into adulthood.

made in bringing the two organizations together

This involves partnering with schools and having

and look forward to delivering the promised ben-

behavioral-health workers at the schools to better

efits to residents,” Wagner said.

serve students and their families. “Healthcare organizations can no longer look only at their own needs and strategic future; they have an obligation to develop a system that provides better healthcare,” said Fred Wagner, executive director of Trellis Mental Health and Developmental Services of Canada. “The field has changed in terms of accountability, with more focus on outcomes and the value achieved from each specific dollar.”

lems such as mental health.”

is exciting because it helps change the trajectory

Leveraging technology to contain costs

of disease,” Wagner said. “For example, if you get

With more emphasis on community care and a

involved early with someone who has a diagnosis of

recovery model rather than treatment, Trellis has

schizophrenia, ensure they’re getting support, get

focused on using technology for an increasingly

the family involved, you can stall or reduce some

holistic view of mental-health care. Trellis has an

“Having teams for early psychosis intervention

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electronic health record and is looking at ways to integrate its system with other organizations to share information more easily.

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Robert Ryl 647-505-8542

Trellis has also begun using a common as-

Healthcare Environments

sessment tool for mental health that can easily be shared with other organizations. A patient can fill out the assessment at a walk-in appointment at Trellis, but if they go to another health organization, they can have access to that assessment to help coordinate care. A major challenge for Trellis has been to recruit and retain qualified mental-health professionals. Ontario has a shortage of psychiatrists, and with budget cuts or freezes, it’s difficult to offer competitive salaries. To help combat this problem, Trellis has been a heavy user of Ontario’s telemedicine system, one of the most sophisticated in the world. Staff at Trellis are able to consult with psychiatrists or providers hundreds of miles away to assess and diagnose patients, saving the organization money and making up for shortfalls in recruitment. Trellis is also evaluating the use of tablets so that providers have access to patient information at

“It has a tremendous impact on how we do busi-

the point of care.

ness,” he said.

Properly managing time is vital to becoming

The forming of strategic partners is also a pen-

more efficient and in cutting costs, so Trellis has

dulum swing. No longer can an organization operate

looked at a few options for increasing productivity

in a silo; it must make tough decisions in the best

and meeting patient needs. One way is by offering

interests of the system and in providing holistic care

more walk-in clinics. Setting up appointments cre-

to patients, Wagner explained.

ates a lag from when a person calls and when they

“The process of bringing two organizations

can be seen that has the potential to be detrimental

together is not without significant challenges, but

for patients with mental illness.

taking bold steps to improve healthcare service

“When people are motivated and saying they

delivery is required if we wish to improve healthcare

have an issue that needs to be addressed, we

outcomes for residents and provide better value for

should cut down on the time it takes to assist

the healthcare system as a whole.”

them,” Wagner said. “We are trying to get away from the notion of pre-arranged appointment

by Patricia Chaney

times.” Wagner said technology is one of the biggest changes he has seen in his 25 years of working in mental health.

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03 | Athens Regional Medical Center

Infor Healthcare

Athens Regional Medical Center Athens Regional Medical Center (ARMC), a member of Athens Regional Health System (ARHS), is a 365-bed full-service institution located in Athens, Ga. Considered the backbone of ARHS, ARMC serves a diverse patient population that is spread across 17 counties, consisting of rural, semi-rural, and urban communities and uninsured, underinsured, Medicare/Medicaid, and third-party payers. Athens itself is home to the University of Georgia, bringing even more diversity to ARMC’s patient base.

With legislation driving changes to existing business models, healthcare organizations like Athens Regional Medical Center rely on our 25 years of experience—as well as our industry-leading, healthcare-specific, Infor Lawson business management and Infor Cloverleaf integration solutions—to standardize, centralize, and automate business processes across their entire enterprise.

Embracing and nurturing change James G. Thaw, president and chief executive officer of Athens Regional Health System, feels its part of his job to create a culture that is excited and enthusiastic about the impending changes in the healthcare industry. “We try to bring a sense that change can be exciting and exhilarating here and not to harp on the unknowns,” he said. “And I think we’re doing that by engaging our partners and our employees and trying to integrate our medical staffs together with process improvement, care improvement, and evidence-based medicine.”

James G. Thaw, President and Chief Executive Officer

Thaw added, “At the same time, we’re reaching out to our community partners to try to further strengthen partnerships with them about how we

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

15


kicked off with an initiative in one of the nursing Softchoice

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As a result, Thaw feels the organization is estab-

Integrating and recruiting physicians

lishing a fairly solid IT foundation on the clinical in-

No matter how much waste a hospital eliminates

formation and hospital levels, even as it attempts to

or how much technology it institutes, high-quality

integrate ambulatory EMR into the package. ARMC

patient care is more dependent on the executive

is committed to fulfilling Meaningful Use and so far,

leadership engaging and working together with the

has invested upwards of 50 percent of its capital

medical staff, Thaw said, fully admitting that this

budget in information technology and EMR.

is a simple principle, but one that depends on the

“We want to achieve a totally integrated group of systems, since we’re not using one system, so

hospital culture to achieve. “We want the medical staff to work collabora-

that we can manage the patient population more

tively with the leadership and board, and we’re

seamlessly from all access points throughout the

trying to further reach out with credibility to the

hospital,” Thaw said.

Focusing on waste If anything keeps Thaw on edge, it’s the unknowns

“We’re very grateful to them for sharing the vision about why we need to start educating physicians to stay here in Georgia. You can have

voluntary medical staff, showing them that we need

all the medical students you want, butif they have to

to work together for the betterment of our commu-

leave a state to do their residency, it’s not uncom-

nity and our patient population,” he stated.

mon that that’s wherethey stay to do their private

Thaw believes Athens Regional has made

practice.” Thaw is hoping that this program, along with

can be more proactive in taking care of the more

surrounding the multitude of reimbursement cuts

significant headway with integrating physicians into

chronic needs of our patient population.”

that seem to be increasing every quarter.

the hospital culture, especially since bringing on

ARMC’s other initiatives will position thehospital for

Mark Ellison as president of the medical staff. El-

the uncertainty of the next few years.

“We’re an independent system so we do as well

He said the majority of Georgia’s population suffers from obesity. Currently, ARMC is partner-

as we do through the treatment of our patients,”

lison shares Thaw’s vision of a united front.

“We can’t avoid this change,” he said. “If we can get ahead of it, I think we can helpshape healthcare

ing with the University of Georgia to confront the

he explained, “so hearing some of the experts talk

obesity epidemic and the related issues that come

about 10 to 30 percent reductions is pretty daunt-

system, he hopes that it will be the easier to recruit

delivery during this revolutionary time, and I’d like

with it, such as diabetes.

ing. Whatever healthcare reform holds for us, we’ll

new talent for ARMC. Right now, the hospital is

to be part of thatand I’d like the hospital industry to

have to see how it impacts us from an economic

working to establish five residencies—internal

be part of that.”

standpoint.”

medicine, family medicine, general surgery, OB/

Bringing platforms together

Georgia’s governor, Nathan Deal, opted out

As more physicians are integrated into the

GYN, and the transitional year. When the program

Beyond the obesity epidemic, ARMC, like other

of a state-managed health-insurance exchange

reaches full maturity, over 105 residents will be

hospitals, is striving to meet the federal Meaningful

(HIE), which ARMC sees as unfortunate. Given the

brought to ARMC.

Use standards.

diversity of its payer mix, an HIE would have been

“We have a primary-care need not only here in the

positive for the organization economically.

Athens community, but in Georgia,” Thaw said. “I

Thaw said bringing in a CIO from Washington D.C. has been ARMC’s best strategic move yet. This

Instead, ARMC has shifted its attention to

CIO is guiding the organization through the process

eliminating waste from the hospital. Recently, the

population. The governor has done something won-

of Meaningful Use and helping it to achieve these

organization established a program that seeks to

derful and appropriated money through the Georgia

standards as quickly as possible.

eliminate $25 million in waste over five years. It was

Board of Regents to help new programs get started.

by Pete Fernbaugh

think Georgia ranks 44th in physicians per 1,000

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04 | Campbell Clinic

Meeting the demands of its marketplace Chief Operating Officer Sarah Maurice was hired just prior to receiving the Certificate of Need, and she sees it, as well as the hiring of two new physicians and a physician assistant, as representative of

Mid-South Digital, Inc. congratulates Campbell Clinic and is proud to be their Technology Partner for office equipment for over 10 years.

the way Campbell is looking to meet the demands of its marketplace. “We’re expanding the number of providers so that we can open up access to patients,” she said. “The demand is always there. That never wanes. If we can increase supply, then that only helps the community that we serve.” She added that Campbell Clinic’s surgery center has backlogs, especially as the baby-boomer population continues to grow. Baby boomers want to stay active later on in life and as a result, are opting to have elective surgeries, such as knee or hip replacements, earlier in life. “They want to benefit from the value it brings, and the implants last much longer than they did in

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the past, so the technology is there to really be able to do that,” Maurice observed. Last year, the clinic upgraded all of its X-Ray equipment at its main location in Germantown, Tenn., to a DR system that improves image qual-

Campbell Clinic

ity, throughput, and operational efficiency. It also exposes patients to less radiation. The organization plans to roll this out to satellite locations before the

The world-famous Campbell Clinic has built its reputation on the superior orthopaedic care it provides. Campbell Clinic physicians are internationally recognized for their technique and innovation in orthopaedic surgery. They recently published the 12th edition of the “Campbell’s Operative Orthopaedics” textbook that has been translated into seven different languages.

Sarah Maurice, Chief Operating Officer

Located in Memphis, Tenn., Campbell Clinic’s operations include four clinic offices and four physical therapy and rehab centers. Its ambulatory surgery center recently received a Certificate of Need that would allow it to expand from 12,000 sq. ft. to 32,000 sq. ft. This would make it one of the Mid-South’s largest ambulatory surgical centers.

end of 2013.

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Forming personal relationships with the front line Additionally, Maurice herself has become more involved with Campbell Clinic’s hands-on, in-thetrenches work. Once a month at one of their locations, she works alongside the staff, learning each position and role as best she can. “Being in the clinic environment on the front lines, not dressed in the office suit, gives me a

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Furthermore, Campbell Clinic has been gradually

access for patients. Finally, it is focusing on devel-

converting from a fee-for-service environment to a

oping quality metrics that are more suitable for the

value-based environment. CMS’ reporting met-

bundled-payment era of healthcare.

rics, however, have become more demanding, and Maurice said adapting to these changes has been

in operative orthopaedics,” she stated. “We also

challenging, especially as the clinic tries to adjust

want to be the best when it comes to operational

seamlessly, without any interruptions to their daily

efficiency.”

operations or patient experience.

Beefing up supply

forward.

don’t really understand how we operate.” Maurice previously worked with Methodist Healthcare as a physician-alignment specialist. Forming relationships was key in this role, she said, and it’s this primary leadership value that she brings to Campbell Clinic. “I was a point of reference for any and every question when it came to plugging newly acquired practices into corporate operations, ranging the gamut from HR to payroll to IT to finance,” she recalled. “I had to form relationships not only with the physicians of these practices that had aligned with Methodist Healthcare, but also with their frontline staff because these are the ones who are in there doing it day to day. “

Maurice observed, “As healthcare continues to evolve as an industry, tighter regulations demand transparency in cost, improved quality, and in-

that improve operational efficiency with its current

creased access so that we’re nimble enough as an

staff and internal resources. Second, it is looking

organization that even with a 104-year history we

to grow its market share by adding physicians and

can still adapt and move forward and progress.”

mid-level providers, so it can provide additional

my desk about improving operational efficiency if I

of past success. But eventually, this would cost the organization, since healthcare is always moving

First, Campbell Clinic is working on initiatives

said. “It’s difficult to make decisions from behind

of how Campbell Clinic could settle into the malaise

not waning, Maurice said. Therefore, the clinic is shore up its access for the consumer.

and also what it’s really like for our patients,” she

As a 104-year-old institution, she is well aware

The demand in Campbell Clinic’s marketplaces is focused on three different angles in which it can

firsthand look at what it’s really like for our staff

“We want to be the absolute best of the best

by Pete Fernbaugh

Confronting the healthcare shift Campbell Clinic achieved Stage 1 Meaningful Use last year. One of the goals related to Meaningful Use is to make the organization’s medication reconciliation more efficient and safe for the patient. Although acquiring this information is timeconsuming, Maurice said it’s necessary so that a physician prescribing medicine is aware of potential drug interaction. The clinic’s EMR is designed to flag potential drug interaction but only if the data is in there. “We’ve got to make sure we’re capturing that information from the patient and getting up-to-date medication lists from them, entering that into our EMR and reconciling that with what we’ve already got in the system to ensure that we’re not prescribing to the patient something that could harm them,” she stated. “And that’s a daily task, day in and day out. That’s one thing that we monitor very closely.”

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05 | Katherine Shaw Bethea Hospital

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“We are proud of our quality statistics, and we are highly transparent with those,” Schreiner said. “Our service gives people a reason to stay at home, rather than travel to Chicago suburbs. We want them to know that bigger isn’t always better.” To stay in touch with employees, Schreiner writes for his blog a few times a week, sharing patient stories, recognizing employees, and sharing awards or general information about the health of the organization. “My goal was everyone knowing where we stand from a patient satisfaction, quality, and financial perspective,” he said. “Our employees need to know what is going on and know that we are all in this together.”

Katherine Shaw Bethea Hospital Without the resources and connections that come with being a large, academic medical center or being affiliated with a regional healthcare delivery system, independent rural hospitals rely heavily on each employee to ensure success. In Dixon, Ill., a small town of about 15,000 city residents, Katherine Shaw Bethea (KSB) Hospital has maintained exceptional patient satisfaction scores mainly because of its care team. The hospital has received the HealthGrades Outstanding Patient Experience Award three years running.

David Schreiner, President and Chief Executive Officer

Building employee development and satisfaction

In addition to transparency with staff and clinicians, KSB has a young professionals group, the goal of which is to develop those employees who have the desire to enter into management

The 80-bed hospital is one of the largest employers

positions. KSB leadership received 25 employee

in the community and employs more than 70 physi-

applications for 16 slots in the program to attend

cians. Mindful of this fact, KSB Hospital has man-

an evening meeting, unpaid, once a month, where

aged to avoid layoffs during the country’s economic

healthcare and community leaders come in to talk

downturn by implementing Lean processes and

about professional development topics.

reducing staff through attrition. President and Chief Executive Officer David

The hospital’s board also has education opportunities during board meetings. Schreiner said

Schreiner also places a heavy emphasis on em-

bringing in speakers to board meetings has been

ployee development and communication, which in

more successful than off-campus retreats or other

turn leads to patient satisfaction and high quality.

training opportunities presented in the past.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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to enact its mission and to embrace patient-centered care models and develop a culture to build great systems and avoid individual blame. “We want employees to feel comfortable coming forward and saying that a mistake was made so that we can evaluate the system and fix shortcomings in our process,” Schreiner said.

Trying to stay independent Remaining independent is important to the hospital’s board, but Schreiner recognizes that partnerships may be a vital part of the future. “Our mission is to take care of the community, and we have to do that in the way that is the most viable,” he said. “Our future may be as a standalone, but we may need to partner with other organizations.” The demands on healthcare leaders and hospital operations are rapidly changing. Schreiner

“Our mission is to take care of the community, and we have to do that in the way that is the most viable.”

has been CEO of KSB Hospital for two years and is working with staff and leadership to carve a new path forward. “What was successful in the past may not necessarily be successful for us in the future,” he said. “We are always focused on patients, but we have to also focus on metrics to be viable. Community hospitals are important, and we want to be among the top 100 hospitals. The people in our commu-

KSB Hospital also has a family-medicine residency

structure. About two years ago, the hospital recruit-

in association with the University of Illinois. The

ed a chief nursing officer out of Iowa with experi-

country, and I think we can deliver that with the

hospital hosts two residents each year and is in the

ence in Lean processes who has taken the lead in

resources we have.”

11th year of the program, and some graduates are

implementing those programs.

beginning to stay in town.

Building a strategic plan

KSB is also working to improve its electronic

by Patricia Chaney

medical records system, moving from multiple separate systems to one integrated medical record.

KSB has a four-point strategic plan for growth and

The hospital is implementing a new EMR and rev-

sustainability over the next three to five years. In an

enue cycle management system by Siemens.

effort to continue avoiding layoffs, one of the orga-

nity deserve to receive the best healthcare in the

Patient and employee satisfaction and growth

nization’s main goals is achieving Lean sustainable

make up the remaining half of the hospital’s strate-

operations to take $1.2 million out of the expense

gic plan. KSB aims to build the best team possible

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

25


06 | Memorial Hospital of Martinsville & Henry County

Memorial Hospital of Martinsville & Henry County

Educating an entrenched lifestyle Smoking is one of the wellness issues Memorial is

Exuding optimism about healthcare and the future of one’s organization can be difficult for many hospital leaders, but Grady W. (Skip) Philips III, chief executive officer of Memorial Hospital of Martinsville & Henry County in Martinsville, VA, possesses optimism in spades.

Grady W. (Skip) Philips, Chief Executive Officer

Philips has been in healthcare for 25 years and is excited about the trends he sees developing within the industry. One of his primary goals with Memorial Hospital is to make it more of a presence in its community and catchment area of 85,000. To this end, the hospital has been forming partnerships with community-based physicians and health services, as well as other community agencies indirectly and directly involved with healthcare. Furthermore, Memorial has been partnering with its physicians to provide better outpatient services, reduce readmissions, and reduce primary admissions for a number of diagnoses with earlier access and treatment. Over the last 18 months, he has also been promoting community-wide initiatives around diabetes, congestive heart failure, and pneumonia. As a result, Memorial is moving in the right direction on its core measures and benchmarks, a game of catch-up that has been hindered by some of the health challenges within its catchment area. “We’ve got a number of health challenges in the community that we serve,” Philips said, “but most of them have to do with some of the lifestyle issues. We happen to have the challenge and the privilege of being in the tobacco belt and being beneficiaries of the Tobacco Fund in Virginia.”

facing in its community. Philips said the organization has taken a two-pronged approach to this issue. The first approach has focused on hospital employees and other employers in the region. “We went to a wellness focus in 2012,” he said.

Bassett Office Supply congratulates Skip Phillips on his honor and we thank Memorial Hospital for working with BOS to provide all of their document management needs.

“Our campus went tobacco-free, but in addition to the tobacco-free initiative in the middle of the Tobacco Belt, we also focused on diet and exercise with our employees.” Furthermore, Memorial created a regional

healthier lifestyles, really trying to reach kids in

business health coalition with a majority of local

elementary and middle school, not that we ignore

employers who are privately insured. Through that

the high school students, but we’re really trying to

cooperative, Memorial began discussing initiatives

help address them before they get to the stage of

employers could put in place that would positively

already trying a few things.”

impact the 25,000 people collectively employed by the coalition, along with their extended families. As a result, many of these employers established tobacco-free work sites and many of them instituted wellness initiatives that didn’t exist two

The response he said has been generally, if not universally, positive. “People have been cooperative,” he stated. “They’ve worked with us.”

The second prong is focused on kids.

Transitioning to patient-centered care

Philips explained, “There’s a significant

Philips is also optimistic about the patient-

years ago.

amount of energy in the community around the

centered focus that is transforming healthcare.

YMCA, outdoor activities, the Boys & Girls Clubs,

Memorial was able to successfully integrate hos-

and activities in the school system to promote

pitalists into its continuum of care, and from that,

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

27


07 | Rosebud Health Care Center

it was able to increase the primary care provided to

the quality of care we provide for the community we

its community.

serve.”

As the hospitalists were added, Memorial’s

With four other LifePoint hospitals in Virginia

physicians were able to see more people in their

and two more over the North Carolina line, it also

offices, and most of these practices have been able

provides many opportunities to network services.

to add new physicians and mid-level providers over the last 12 to 18 months. Furthermore, Memorial

Guided by the future

has been successful at recruiting physicians in OB-

Whatever success Memorial has achieved, Philips

GYN, Internal Medicine, Cardiology, Orthopaedics,

gives quick credit to his loyal team, a team that

and Pediatrics.

wears many different hats and fills many differ-

Philips credits this progress in no small way to its membership in LifePoint Hospitals. “We are very fortunate to be part of LifePoint

ent roles. This team is always ready to confront Memorial’s most daunting challenge: being creative in how it reaches people with access to preventa-

Hospitals,” he said, “and LifePoint has placed a fair

tive and screening services on the front end. Philips

amount of emphasis over the last couple of years

believes taking care of the patient is going to direct

on the relationships with our physicians both in the

healthcare organizations in the future. “The healthcare we provided for the last 40 to

hospital and in the community.” This emphasis has made Memorial more at-

50 years is not the healthcare we necessarily want

tractive to potential recruits who hear from the

to have as we age,” he observed. “As we look to

medical community that Memorial works to engage

healthcare both now and into the future, Memo-

its physicians, helping them to be successful both

rial Hospital wants to be an active partner with the

personally and professionally.

community we serve, and we want to be able to

Membership in LifePoint has also given Memo-

create those linkages that may mean fewer people

rial an edge when it comes to information technolo-

in the hospital, but will also mean a healthier com-

gy. LifePoint’s two-way interface platform, LifePoint

munity.”

Connect, has enabled Memorial to connect with 40 percent of its physicians’ private practices. EMR

Rosebud Health Care Center

by Pete Fernbaugh

integration is also coming along nicely, and the

There are many reasons to respect rural healthcare. Not only does it provide services within sparsely populated regions, but it also provides these services under increasingly tenuous regulatory conditions and depleted financial resources. Rural healthcare often survives because of the combined passion its providers hold for healthcare and community.

organization has qualified for Stage 1 Meaningful Use. By the second quarter of 2013, it’s expecting to have physician order entry integrated, and all communication is now electronic on the inpatient and non-physician side. “LifePoint provides a fair amount of resources,” Philips observed. “Many community hospitals, when they’re trying to go at it alone, don’t always have the level of support. Having that resource helps us not only improve patient safety, but also improve

Ryan Tooke, Chief Executive Officer

This is the kind of passion that has carried Rosebud Health Care Center of Forsyth, Mont., through some difficult times. An 11-bed critical-access hospital, Rosebud also has a rural health clinic and a 44-bed nursing home; it draws approximately 3,500 patients from its catchment area.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

29


2002, we converted to critical access,” he said.

Although satisfied with the direction of these proj-

“But this last year we’ve been able to get the

ects, Tooke continues to worry about the changing

financing and start construction on a new clinic as

CMS regulations for critical-access hospitals. With

well as get our EHR. We were also able to assure

many of the smaller PPS hospitals achieving this

the community that we’re here.”

designation, Tooke is concerned that CMS might

He explained that this last component is especially important. In smaller communities, residents are prone to assume that the hospital

require all critical-access hospitals to abide by the same rules, regardless of size. “We’re not big enough,” he stated. “If they say

may go away at any time. Tooke said it’s vital for

we have to have a hospitalist, we don’t have that

tion confront the two biggest issues in its region: a

an organization to show growth and optimism if

kind of coverage. If they say that we have to have 24-

growing elderly population and the mental-health

it’s going to secure the lasting support of its com-

hour ER with a provider on site at all times, I can’t

needs of its patient population.

munity.

do that, because I can’t hire enough people.”

Unfortunately, he explained, “we don’t have enough

Securing its role in the community

He added, “I guess my biggest fear is, how controlled are we going to be with our payer sources,

As the organization continues to innovate within

In December of 2011, one of Rosebud’s lead

be within the scope of practice of everything? With

its region, he urges providers around the country to

providers moved on, leaving a service-line hole

that comes cost. If you don’t get paid to stay current

advocate for rural health.

that needed to be filled. Tooke’s first instinct was

with everything, then you fall behind and then you

to panic and hire the first provider who became

mess up and get sued and it’s just a vicious circle.” To guard against this, Rosebud has joined the

cided they would take things more slowly, not just

Frontier Community Health Integration Demonstra-

hiring a provider for the sake of hiring one, but

tion Program or F-CHIP, a pilot project that seeks

Rosebud’s patient population is a growing mix of

going out of their way to find someone who would

to attain a new designation for extremely rural

aging retirees and younger payers who work on

be the right fit.

facilities, establishing a buffer zone between them

the Burlington Northern and Santa Fe Railway and

It took them until September of 2012 to secure a new hire, but taking their time was beneficial.

would also change the reimbursement system for

south of Rosebud.

The new provider is skilled and talented and

smaller critical-access hospitals.

brings a wealth of experience not always afforded to rural healthcare organizations.

know what our limitations are and we do very well at the services we provide.” by Pete Fernbaugh

“The quality and expectations would be all the same,” Tooke explained. “It’s just that we would be

self-pay, and nearly six percent are Medicaid. Being

Tooke also said the organization is delving

able to provide more home health and more extend-

located next to an Interstate, Rosebud also attracts

full-force into EHRs. Although Rosebud had previ-

ed care in the hospital. Right now, the nursing home

79 percent of the people who are traveling through.

ously had a platform, it wasn’t certified. On Dec.

is basically losing money, but if you can provide ad-

Ryan Tooke has been chief executive officer for

7, 2012, the organization converted all of its data

ditional beds, you can break even a little bit.”

two years, inheriting the position in the middle of a

into the new platform by Healthland. He said that

worsening financial crisis for the hospital.

Rosebud is fortunate to have two very young mid-

Top priorities for 2013

level providers who are computer savvy, along

In 2013, Tooke would like to see Rosebud complete

albatross, because in the late nineties, we found

with an older provider who is aggressive about

construction on its clinic and finalize integration of

ourselves in extreme financial strain, and then in

going forward with technology.

its EHR. Beyond that, he wants to see his organiza-

“For the last 10 years, it’s just been a financial

“We are very vibrant,” he said. “We’re competent people who choose to live in smaller areas. We

and the larger critical-access hospitals. The F-CHIP

in the generation plants and coal mines 25 miles While predominantly Medicare, roughly 30

health services.”

because you have to be competent and you have to

available. However, he and the organization de-

percent are commercial payers, 10 percent are

providers, but we have a lot of demand for mental-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

31


08 | OSF Healthcare System

OSF Healthcare System Healthcare is rapidly changing these days, and information technology is the fastest growing sector of healthcare delivery. What once was left in the capable hands of the “technical people” is now an integral part of delivering care at the bedside and in business decision making. Likewise, the role of chief information officer has evolved from a manager of different software and hardware systems to a leader involved in the organization’s strategic planning and in understanding the day-to-day needs of care providers.

Jim Mormann, Chief Information Officer

“Information technology now touches every aspect of a healthcare organization,” said Jim Mormann, chief information officer of OSF Healthcare System. “In healthcare, we are just beginning to scratch the surface of what business intelligence really means. CIOs now have to consider the personal interaction between patients and caregivers, operational issues, and strategic investments. You have to speak to the organizational side in a non-IT fashion and communicate organizational goals to IT staff.”

vestment gets replaced because it doesn’t do what everyone expected it to do.” One pitfall he sees happening often is when the software company sells an organization on the

Building the Future of Health Care

business strategy, only to find the product doesn’t fit within the company’s structure. It is more ideal for the organization to decide on its own strategy and search for a product that meets those needs. Mormann said OSF has been successful at letting the appropriate components of the organization drive the project, rather than IT leading. With the deployment of the Epic suite, the organization spent a lot of time upfront on process change and allowed the product to support those changes.

Future growth and accessibility For now, most organizations are making sure that

Growing IT connectivity and efficiency

produce better quality outcomes, making us more

they have a common electronic health record to

efficient in what we do,” Mormann said.

meet Meaningful Use standards.

He added that consolidation of IT systems is the

“We are seeing everyone jump on board with

Catholic-based integrated healthcare network con-

current trend, as everyone wants to share informa-

Meaningful Use,” he said. “The stimulus is a sig-

sisting of eight medical centers and two colleges of

tion and have quick access to records.

nificant aspect of that, but it’s really about using

OSF Healthcare System, based in Peoria, Ill., is a

nursing. The system also includes a home health

systems to produce data that are meaningful to the

primary-care and specialist physicians and nearly

Planning for IT implementation

300 advance-practice providers. To align more

With most healthcare organizations strapped for

to share those records across EHR systems and

closely its care-delivery system with physicians,

resources, technology investments must be made

through smartphones or tablets, allowing providers

OSF developed clinical service lines in cardiovascu-

on long-term planning and with the goal of efficien-

more access to patient information at the bedside.

lar services, neurosciences, and pediatrics.

cy in mind. Strategic planning within the IT depart-

Mormann said he is excited to see this future.

ment as well as on an executive level is key to suc-

Finding ways to work through the challenges pre-

hospital has been deploying a new electronic health

cessfully implementing any new electronic records

sented by such open access is a concern, however,

records system, moving toward an integrated

or other system. Mormann said ensuring that

especially when it comes to protecting patient

record across hospitals, primary-care settings,

the appropriate components of the organization,

privacy on secure networks.

specialty care, and home care using the Epic suite

including physicians and clinical staff, are on board

Another area that is rapidly expanding is

of products. Re-educating staff to use one consoli-

from the start is essential to keeping a project from

telemedicine, which has been floating around the

dated system as opposed to several systems for

becoming “just another IT-based project.”

market for about 15 years, but recently has become

network and OSF Medical Group with more than 600

Mormann said during the past three years the

“With the technology that’s available today, we

different service lines has been a major component of the deployment, along with handling the state’s

have to transform our services through process

815.332.8600 I Ringland.com

delivery side.” Most organizations are now looking at ways

more common. “Telemedicine is an area of great opportunity as

telecommunications services, which are behind

change for any IT project to be successful,” he said.

we have products that do what we need them to do,

those of many other communities.

“If the organization doesn’t invest time in process

and we are finding that consumers are no longer

“Having a common system platform allows us to

change, three or four years down the road that in-

afraid of them,” he said. “I think that will cause a

new look and feel toward our world, as we have been talking about telemedicine for some time.” All of this proves that healthcare must be more adaptable in today’s environment than it has typically been in the past. As Mormann said, “Unless government puts out a mandate, we are slow to change.” But increasing efficiency and consumer demand for more access are big drivers in today’s marketplace, and the role of CIO is steadily becoming more influential in major strategic planning for the longterm viability of an organization. by Patricia Chaney

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

33


09 | Senior Whole Health

Focusing on wellness to save money Senior Whole Health provides a healthcare plan for dual-eligibles, combining state Medicaid benefits and federal Medicare benefits in a way that improves individual health and saves money. The company has more than 9,500 subscribers in Massachusetts and New York.

Kendall Press Kendall Press, a commercial printer specializing in marketing collateral and business stationery, is proud of our long working relationship with Senior Whole Health by supporting their marketing communication projects with various printed materials and mailings.

Marketing Communications Materials Business Stationery & Corporate Identity Packages

With nurses, member-services employees, and

Posters & Banners

pharmacists on staff, Senior Whole Health focuses

Educational Materials & Legal Documents

on ensuring members receive the care they need to remain healthy and happy, from obtaining Meals on

Graphic Design

Wheels or moving into assisted living. But the focus

Direct Mail, Shipping & Mailing Services

is primarily on allowing low-income seniors to remain independent as long as possible, thus saving the system money overall. “We cover the lives of our patients,” said Chief Executive Officer Wayne Lowell. “We have more than 3,800 members who, if not for our services, would need to be in a nursing home, which is typically a Medicaid benefit. On average, it would cost $60,000 to $70,000 per year to institutionalize these patients.”

Instead, the state pays Senior Whole Health to combine the healthcare needs of seniors with the social needs of low-income circumstances. Nurse aides visit members two to four times a year to check up on them and note any changes in behavior that should be reported to a primary-care physician. This allows almost 4,000 people to remain in their homes instead of being in a nursing home. Senior Whole Health estimates that this saves Massachu-

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setts nearly $100 million per year. “Our nurses ask members not only about their health, but also about their social life and other aspects of living necessary for an older individual

Senior Whole Health

to thrive,” Lowell said. “I am always amazed at the strong relationships these nurses build with our members.” assistance services to ensure patients are seeing

Helping individuals navigate the system

their physicians on a regular basis and making

Navigating the healthcare system is a challenge

appointments when they have problems. In many

for well-educated Americans, but it can feel nearly

instances, low-income individuals will call an

impossible for people who are illiterate or don’t

ambulance when they have a problem because

speak English as their primary language. Many of

they have no other means of transportation, and an

Senior Whole Health’s subscribers are illiterate,

ambulance trip to the emergency room is covered

and subscribers speak 30 different languages, the

by Medicare. This creates thousands of dollars that

most common being Chinese.

Senior Whole Health also offers transportation-

Rising healthcare costs, particularly in light of an aging population, is a challenge for healthcare and government leaders in the United States. One company in Massachusetts, however, is working to provide total care for seniors receiving Medicare and Medicaid benefits.

can be minimized through social assistance and adherence to preventive-care measures.

Wayne Lowell, Chief Executive Officer

By integrating the benefits of Medicare, Medicaid, and Medicare Part D into one plan, members

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

35


10 | eHealth Data Solutions

“We work hard to make good promises, deliver what we promise.�

receive one membership card and one place to go to get questions answered. Members also have 24/7 phone access to a nurse care manager. Senior Whole Health is an approved Medicare Special Needs Plan and Medicare Part D Plan.

@V\Y,49,/9 :\WWVY[:WLJPHSPZ[Z

Expanding to more states SSenior Whole Health started in Massachusetts, a state that has been a leader in healthcare reform,

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and recently expanded into New York City. LowProviNET Solutions

ell said the company hopes to export its model to other states, but it is challenging because of

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ProviNET Solutions, born from a long-term care provider, is a full-service healthcare Information Technology consulting company that offers the healthcare industry, a full array of knowledge, products and services.

obtaining licenses for each state and the difficulties in convincing states to embrace a program that integrates both state and federal benefits. “We have about a dozen states east of the Mississippi River that are dedicated to integrating programs,� Lowell said. “We are poised to take what we’ve done in Massachusetts and export it to

*HSSc^^^7YV]P5,;JVT

other places. We’ve seen the impact we have on

pool to manage the total health of the population

members’ lives and the difference our nurses and

for which they are responsible.

pharmacists make.� Although Senior Whole Health is a for-profit

“ACOs involve assuming and managing risk, and there is more willingness of providers across

company, Lowell said 88 cents of every dollar

the country to share risk,� Lowell said. “I think this

received goes into healthcare. It’s not a business

trend is here to stay, and we are pushing hard to

where a person will make a lot of money, but, as

align incentives for prevention rather than diagnos-

with most healthcare work, offering a better qual-

ing and treating.�

ity of life to low-income seniors presents its own rewards.

ealthcareix_eHealthDataAdInsert_3.38x4.63_4c.indd 1

4/30/13 3:2

eHealth Data Solutions Data management and health information exchange are top priorities for most healthcare organizations. Once relegated to the realm of IT departments, these issues now keep chief executive officers up at night.

by Patricia Chaney

“We may not make a lot of money, but we are able to create a reasonable return for investors, save the government money, and provide incredible

In the midst of a competitive marketplace, one company is innovating in data management and information exchange. eHealth Data Solutions (eHDS) takes a customer-centered approach to providing information-technology tools to its niche market of long-term care providers.

care for the people we serve,� Lowell said. Senior Whole Health is a step toward a future with Accountable Care Organizations, where hospitals, physicians, and health insurers are all in a

John Sheridan, President and Co-Founder

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

37


Innovating in customer service President and co-founder John Sheridan said eHDS’ approach is primarily unique in the way it serves customers. Customers are encouraged to try a product before buying, and eHDS doesn’t charge for the product until users are trained and the customer feels the product expected has been delivered. “We work hard to make good promises, deliver what we promise, and not charge until our customers are satisfied that the promise has been fulfilled,” he said. With most IT investments consuming a significant portion of a healthcare facility’s budget, demonstrating return on investment is critical to attracting and retaining customers. Sheridan said proving return on investment for eHDS has been consistently possible because the company is “attentive and focused.” “We are focused on making a difference for our customers as opposed to getting a return for the organization or our report to stockholders,” he said. “Those things are taken care of when our customers are happy.”

Innovating for long-term care

CareWatch is designed to improve resident-assessment data accuracy and enhance care plans. The product uses the Centers for Medicare and Medicaid Services’ Minimum Data Set (MDS), a tool for the screening and assessment of nursing-home residents used as part of the Resident Assessment Instrument (RAI). CareWatch assists nursing staff with the assessment process to ensure consistency

mance and quality improvement: CareWatch®, RiskWatch®, and UBWatch®.

hospitals. Sheridan said his products can accept any approved Meaningful Use Stage 1 and Meaningful Use Stage 2 continuity-of-care documents. Innovating in this arena has been challenging for eHDS. With government regulations constantly reinvent its product at least three times, some as

RiskWatch is a web-based incident-reporting tool that allows for evidence-based risk manage-

many as five times, because of changing specifications.

ment and continuous improvement. It focuses on

Despite changes in the marketplace, however,

each occurrence through investigation, response,

eHDS always listens to the needs of its customers

and review. In addition to the long-term care indus-

and lets those needs drive the innovation.

try, eHDS has one client with 40,000 Department of

“We teach our team to be attentive and focused

Housing and Urban Development (HUD) units using

on the customer,” Sheridan said. “We remain agile

these tools for incident reporting.

and work diligently to respond to customer re-

UBWatch is designed to enhance the billing and claims process. It detects and reveals unintended patterns by reviewing each Universal Bills claim

quests.” by Patricia Chaney

before submission and alerts providers to inconsistencies or compliance issues. Together these tools allow long-term care providers to manage data according to the latest government specifications, ensure accuracy and consistency, and reduce costs associated with er-

Innovating around regulations

main products to enhance organizational perfor-

ing homes and physicians and nursing homes and

tain correct reimbursement and lowers costs.

data-management solutions for long-term care

retirement communities. The company offers three

systems that can share information between nurs-

changing, Sheridan said the company has had to

rors.

facilities, assisted living, and continuing-care

with others is still a challenge. eHDS is developing

and accuracy to the MDS, which helps a facility ob-

eHDS has carved out a niche market of providing providers, with clients that include skilled-nursing

“We remain agile and work diligently to respond to customer requests.”

eHDS continues to innovate, working on developments with information exchanges. While most organizations have electronic systems for their own care management, allowing these systems to talk

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

39


11 | Harrison Memorial Hospital

INDUSTRY PARTNERS Logan’s Healthcare Linen Systems www.loganslinens.com years, originally serving as a candy striper, then a nurse. Contrary to many larger healthcare facilities, Currans said Harrison Memorial does not ascribe to the hospitalist environment. She said physicians in town develop lifelong relationships with their patients and don’t want a hospitalist program. “We have a stronger partnership with medical staff that can be nurtured if we see them every day,” she said. “I see our physicians on my rounds in the morning as they visit patients before heading to the office. It makes for a better environment and a closer connection to the community.” In keeping close ties with medical staff, Harrison Memorial has condo suites for primary care and specialty clinics on campus that physicians can rent or own. Currans said a few physicians have purchased their office space, helping to retain physicians in an area where recruitment is challenging. Although the quality of life in a small town is good, not every physician is seeking the rural life or

Harrison Memorial Hospital

“Our patients are our family” As with many rural community hospitals, Harrison Memorial Hospital takes a personal approach to all

More than 100 years ago, the citizens of a small tobacco farming community in north central Kentucky built a hospital to serve emergency and acute-care needs. Today, that facility has expanded to include numerous specialties and services, while maintaining the hospital’s original personal and caring philosophy.

patients, with physicians caring for many patients from birth to midlife or later. “We run into the patients we care for at the grocery store, our kids play soccer together, we see them at church,” said hospital Chief Executive Officer Sheila Currans. “With each patient, we really feel as though we are caring for a family member.” This personal feeling creates a unique environment for staff, nurses, and physicians and influences the overall operations of the facility. Currans

Sheila Currans, Chief Executive Officer

herself has been part of the organization for 40

the close-knit community that Harrison has. Currans said recruitment, particularly in primary care, general surgery, and obstetrics is one of the main challenges for the hospital. Harrison is located centrally between Lexington and Cincinnati, giving residents big-city opportunities, but “only certain types of doctors are going to ascribe to rural living,” she added.

Keeping an active role in the community The hospital board and subcommittees of the board draw in community members to maintain a strong relationship. Harrison Memorial is dedicated to providing the services needed specifically for the

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

41


12 | Memorial Hospital of Carbon County

residents of Harrison County and surrounding areas. And the hospital offers a surprising array of services for a rural facility. “We understand that we don’t survive without the community and their loyalty,” Currans said. “We provide the care that’s needed close to home, and our market continues to come here even though we are only 35 miles from Lexington.” Although patients are referred to tertiary centers for high-level procedures, Harrison Memorial is able to offer specialty clinics for follow-up care within most specialties, including cardiology, pulmonology, neurology, and oncology. Specialists hold hours on a monthly or weekly basis, depending on the needs of the community. Maintaining the current facility is also part of Harrison Memorial’s commitment to the community. The building was constructed in 1968 on a hill on the outskirts of town and has been renovated and expanded upon over the years. Currans said the hospital has made a commitment to maintain a presence and not abandon a large building, leaving it to become an eyesore. Recently, the hospital expanded its rehabilitation services department with a 2,450-squarefoot addition. With the recruitment of a physician certified in orthopedics and sports medicine, the rehabilitation department has seen tremendous growth in volume. The addition allows for physical therapy, occupational therapy, speech therapy, massage therapy, and a wellness center open to the community. The department offers a SilverSneakers program and has begun offering a Vertigo and Balance Disorders Clinic. As the healthcare landscape changes, Currans said reaching out into the community and following patients after they leave the hospital is going to be a greater focus. “In the past, we cared for patients in the acute phase, then referred them to post-acute care pro-

laborative initiatives with local and regional nursing homes, hospice, and home care.” Harrison Memorial plans to maintain the personalized attention it has always had with patients and staff, no matter the changes to the healthcare environment. Performance improvement and patient-centered care have always been central to the hospital’s operations, and moving forward, Harrison will be developing additional informationtechnology initiatives and working on capturing data more efficiently. Both are always challenging for small facilities, where employees often have to wear multiple hats. Currans said the staff has been able to handle most IT and data mining in-house, as leadership supports training and development opportunities for staff. With further patient-safety and customerservice initiatives to meet federal requirements, Currans feels confident patients will only benefit

Memorial Hospital of Carbon County

from continuously improving care. “Patients benefit when our staff puts safety and quality of care first,” she said. “They live that every

Tucked away in a small corner of the United States is a hospital with a big mission: “to become the most exceptional healthcare facility in the country.”

day, and our patients benefit, which is reflected in our patient satisfaction and quality scores.”

Memorial Hospital of Carbon County (MHCC) is a 25-bed critical-care facility that has a catchment area of about 16,000 in south central Wyoming, along with five clinics and radiology and lab services.

by Patricia Chaney

viders or sent them home with good instructions, and things went well,” she said. “Now, we have to think outside those walls. We are involved in col-

Ned Hill, Chief Executive Officer

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

43


Healthcare Resouce Group Helping improve your Revenue Cycle, offering specialized products and services; we focus on your Patient Access, Health Information Management, Patient Accounting and Information Technology departments.

When Hill joined MHCC, he first focused on pulling together physicians, staff, and the community to reevaluate how resources were being used. His goal was to reduce overall costs. “With volume growth and cost containment, we have gone from an operating loss to a much stron-

So we are trying to educate the community

unique environment.”

about that.” Hill added that it is important for commu-

the key to achieving that. From the governing board

Providing a phenomenal patient experience

to physicians and staff, everyone has been commit-

With cost-containment measures working, Hill said

communities, and staff. Most small hospitals

ted and on board.”

MHCC is stepping up its focus on the care experi-

work to provide the best care at the lowest cost

ence patients have.

possible.

ger profit margin,” Hill said. “Teamwork has been

Charting a new financial course

educated, licensed individuals working for us. It is a

Setting a high standard for transparency

“We want to get to a place where the community

nity hospitals to share how they are being good partners for everyone -- physicians, patients,

“Hospitals are sometimes misunderstood

is proud of our hospital,” he said. “Where we are

as far as services provided and at what cost,”

As a publicly funded hospital, transparency has

providing care at the same quality level as any large

he said. “I encourage anyone who wants to, to

also been a major factor in the hospital’s financial

facility in the country.”

sit down and learn how hospitals run. Ad-

Chief Executive Officer Ned Hill came on board

success. Hill said the administration has made an

about a year ago to help turn the hospital around

effort to teach managers and staff how a hospital

sponsored and approved through a constituent

government leaders, and others of the ins and

financially, renewing the facility’s mission to pro-

works from a financial perspective. Of every $1

vote, the hospital was able to invest in an $8-million

outs of the industry.”

vide an exceptional experience for patients. MHCC

charged, staff is shown how much remains to-

renovation of its surgical suite, with two surgery

is vital to the community it serves, with no other

ward the bottom line after insurance is billed and

rooms, an endoscopy room, and a recovery room,

hospital located within 100 miles in all directions of

expenses are paid.

and a six-bed intensive care unit. Furthermore,

the county.

The community is also informed regularly of

Thanks to a bond the County Commissioners

by Patricia Chaney

MHCC recently moved into a new physician clinic

“We want to provide a phenomenal experi-

the hospital’s expenses and reasoning behind the

and purchased a new Toshiba MRI scanner to en-

ence from a care standpoint as well as availability

charges patients receive. At monthly board meet-

hance its imaging services.

and access,” Hill said. “Maintaining the ability for

ings, MHCC will give financial statements to the

patients to receive care locally is one of our initia-

newspaper. It will also share information with the

measures and other reported quality and safety

tives.”

public on investments, such as spending $1 million

measures, and it is encouraging the community

on a new MRI scanner and how long it will take be-

to receive regular screenings to improve overall

towns to see patients in Carbon County on a regular

fore the hospital can recoup that initial investment.

outcomes for patients.

basis. The hospital is also experiencing growth with

“I think people are usually surprised when they

MHCC works with specialists from neighboring

ministrators can educate staff, communities,

Hill said the hospital is following all core

“People who get annual screenings have far

increased volumes and good physician recruitment

see what it costs to run a hospital,” Hill said. “We

better outcomes in the long run,” he said. “We have

efforts.

run small profit margins, have highly trained, highly

the technology to detect illness early and save lives.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

45


13 | Beacon Pointe Memory Care

Beacon Pointe Memory Care Tucked away in upstate New York, just north of Albany, is a small 52-bed facility for residents with Alzheimer’s, dementia, or other memory impairments. Known as Beacon Pointe Memory Care, it’s a unique facility, with a strong community atmosphere that gives residents the feeling of being in a small village. The facility has two sides with 26 beds on each side and a town square in the middle, complete with a barber shop, office space, banking area, sweets shop, and murals to replicate an outdoor atmosphere. Beacon Pointe is operated by Peregrine Health Management Company, giving it access to the resources of a larger organization. Peregrine’s foundation, The Peregrine Way, provides services to Beacon Pointe’s residents, families, and staff.

event during the Summer Olympics, with balloon volleyball, trivia, and other games. Cardish said having Weston Paxxon onsite has been a huge benefit, because it is difficult to find outside providers to come in and offer therapy to residents with memory impairment.

Providers of on site Physical and Occupational Therapy Services Within Assisted, Independentand Memory Care Communities

All of this activity has reaped great rewards

Stimulating residents the Peregrine Way

A healthy environment of activity

The Peregrine Way is much like a three-legged

“In this environment, our activities program is just

stool, Administrator Donna Smith-Cardish said. It

as important as the medication residents receive,”

has programs designed for everyone involved in the

Cardish stated. “We try to push the envelope a little

Dedication from staff to ease transitions

residents’ care, including families and staff.

to challenge and stimulate our residents. We have

Caring for residents with memory impairments is

a master gardener program, an arts program, and

physically and emotionally draining and takes a

tional opportunities through the foundation to help

music.”

special kind of person. Cardish said the facility is

them understand and adjust to this new stage in a

The facility also has a music therapist who plays

lucky to have dedicated and loving staff who enjoy

quainted with the resident in his or her new home

loved one’s life. Families can be taught proper com-

piano, performs duets with residents who still have

coming to work and developing strong relation-

and help understand the limitations of a person

munication techniques, receive sensitivity training,

the ability to play an instrument, and even sings

ships with their residents.

suffering from dementia.

opera on more formal occasions.

“Our caregivers do a fantastic job,” she said.

Families of residents are offered many educa-

take family-support programs, and become involved in outlets for creative expression, such as art and

To help residents maintain abilities longer,

for the organization. As Beacon Pointe has added programs, retention rates have increased.

“They get attached to residents, and it feels like

For more information please call 631-467-3700

Maintaining solvency for the future

Beacon Pointe presents opportunities to work

losing a family member when residents have to

within the community. The facility will bake for a

move on to a higher level of care or pass away.

Pointe’s staff with the opportunity to receive

local church, offer filing or administrative services

But that’s how you know they have been success-

look for ways to offer the best care to residents. So

behavioral-management training, sensitivity train-

to local nonprofits needing help, and other small

ful and nurtured that resident.”

far, the facility has been able to sustain occupancy

creative-writing programs. The Peregrine Way also provides Beacon

ing, and other various and ongoing development

services.

Residents themselves are offered spiritual programs; classic radio days that feature music from the 30s through the 60s; Around the World, a monthly program that explores different cultures

and has adjusted some rooms to accommodate

environment of the facility helps to ease transi-

different living arrangements. With some larger

“Although they have memory impairment, each

tions, which are challenging for everyone. Before

units, Beacon Pointe can accommodate couples

one has a unique history. We try to tap into their

residents are admitted, Beacon Pointe has an

who would like to remain together, offering a

strengths and set them up for success.”

interview with residents, family members, and

discounted rate.

“Our residents have a lot to offer,” Cardish said.

opportunities.

The compassion from staff and the home-like

Beacon Pointe continues to expand programs and

Because of New York state licensing, all

through dining, dress, music, or learning a new lan-

residents of Beacon Pointe must be fully ambula-

guage; and Legacy Stories, which are written with

tory and able to feed themselves. When residents

caregivers to learn as much about the resident as possible to help them through the transition. “Some people have difficult transitions, but

Cardish also credits marketing efforts and Beacon Pointe’s reputation in the community for being able to maintain occupancy. But most of all,

become physically frail, Beacon Pointe offers physi-

after they leave for a holiday, some will tell their

Beacon Pointe and Peregrine are simply passion-

cal therapy through Weston Paxxon to help them

family that they are ready to go home, represent-

ate about keeping people active and healthy long

residents’ memory issues, while using their abili-

extend their stay.

ing that Beacon Pointe has become their home,”

after physical ailments have slowed them down.

ties to the fullest and ministering to their families’

Weston Paxxon rents space from the facility and in

Cardish said.

Cardish said, “We will continue to stay ahead of

the assistance of local high school students. This array of programs is designed to work with

Transitions are also difficult for family

needs and the needs of those who take care of them

turn, has added physical therapy to the activities

on a daily basis.

program. This resource has allowed the facility to

members, caregivers, and spouses who are left

offer some fun new programs, such as an Olympics

behind. Beacon Pointe tries to set up activities or

In fact, keeping residents active is the primary goal

an environment where the caregiver can get ac-

of Beacon Pointe.

the competition and push the envelope in terms of aesthetics and programming.” by Patricia Chaney

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

47


14 | Matrix Medical Network

Matrix Medical Network When it comes to the various strategies healthcare organizations are implementing to curb readmission rates and enhance the continuum of care, partnering with an in-home assessment company may not be at the forefront of consideration.

letin (PB) program, offered by Ascender Software, a Matrix company, combines analytics (including algorithms and data mining) and clinical-chart reviews to identify Hierarchical Condition Category (HCC) opportunities as well as HEDIS and Stars

However, Matrix Medical Network, the country’s largest prospective health assessment company in the Medicare Advantage market, has proven itself effective in confronting some of the core challenges facing healthcare leaders.

Randy Dobbs, Chief Executive Officer

quality gaps for MA plan patients. Electronically delivered to the physician at the point of care immediately prior to a plan members’ appointment,

Founded in 2001, Matrix’s mission is focused on one overarching goal: improving the health and lives of senior Americans through better management of their care. The company works on behalf of Medicare Advantage (MA) health plans throughout the United States and has seen its market presence escalate over the last three years, with a growth rate of 524 percent.

the concise, timely, and relevant information in the PB can be rapidly reviewed by the physician, helping to improve their diagnosis accuracy. The second product focuses on reducing today’s nearly 20-percent hospital readmission rate for Medicare patients by helping the patient

Building on rapid growth When Randy Dobbs was hired as Matrix’s chief executive officer a little over a year ago, he brought with him an impressive track record of turning around broken businesses. However, Matrix’s business wasn’t broken. In 2010, the company had conducted 60,000 health assessments; in 2011, it completed 115,000 assessments. Matrix’s staggering growth was transforming

chosen an MA plan) and a national focus on reduc-

also gives the NPs opportunities for continuing

ing costs while raising quality of care intensifying,

education.

Matrix expects prospective health assessments to be an important part of healthcare growth over the

marketplace, you like that view and you never want

next few years.

it to change,” Dobbs said. “So, we think about our

“We’re the largest provider in a growing mar-

cially if it was going to continue its growth trajectory and expand into new markets. “If a business is not hitting on all cylinders, it’s the result of not having the right people, the right processes, and the right technology,” Dobbs explained. “If you do those three things, they typically will lead you to having a better product, better productivity, and a stronger position in your market.” Once implemented, Dobbs’ three-pronged approach—people, processes, technology—brought about immediate results. In 2012, Matrix conducted 225,000 prospective health assessments and is on track to do more than 330,000 in 2013. With Medicare and Medicare Advantage plans also growing (currently over 14 million people have

treatment provided by Matrix NPs. Collaborating with the hospital and health plan, the NPs assess patient needs, develop indi-

ment.”

vidualized 60-day care plans, and administer care

Broadening services and offerings

Typical care plans can include prescription review

ceive you as delivering volume on a consistent basis,

Being unique in a crowded marketplace

In other words, Matrix needed scalability, espe-

that identify high-risk patients with diagnosis and

to maintain that is if your clients continue to per-

overwhelmed, unprepared to handle its new level

operational processes.

Transition of Care solution integrates analytics

benefits and continuing education and develop-

quality without flaws, and a competitive price point.”

stable, more efficient approach based on better

people and how we can support them with great

medical-facility care to self-care in the home. The

ket,” Dobbs stated. “The only way that you continue

the company quickly and dramatically, and it was of marketplace presence. The company needed a

“If you’re the lead dog in a growing, competitive

transition from round-the-clock hospital or other

Every month, seven to 10 percent of the people its NPs see are in a situation that demands immediate

Dobbs was clear that Matrix and its competitors are

referrals, whether to a primary-care physician or a

using many of the same strategies every day. How-

case worker. Sometimes, the situation demands im-

ever, there is one differentiator for Matrix.

mediate hospitalization. More often than not, a visit

The company fully employs over 400 nurse practitioners who are deployed in more than 30 states.

from a Matrix NP changes or saves a life. A typical in-home assessment, which is com-

The majority of its competition contracts out nurse

pletely covered by the member’s MA plan, takes

practitioners for in-home assessments.

over an hour. The NP provides not just clinical

In fact, Matrix’s network of nurse practitioners

services, but also education on how the member

nearly doubled in the last year, mainly because of

can improve and control their health situation in the

the demand for its assessments. To improve its

future.

processes, the company also went paperless and

The impact this has on their wellbeing is im-

completely digitized its operations. This allows it

mense. Independent studies have shown that those

to provide better day-to-day support for its NPs,

who are assessed in-home versus those who are

including scheduling and logistical routing.

not have a notable reduction in medical expenses,

Furthermore, because the NPs are fully employed, Matrix is able to provide them with benefits that show how highly valued their expertise is. It

personally or through the Matrix Care Center staff. and adjustments; coordination with physicians, medical equipment manufacturers, and community services; and education around the condition, medication, and nutrition. As Matrix continues to build its operational capacity and its clinical-support services and as Americans continue to sign up for Medicare Advantage plans, Dobbs said he expects the company to play an even greater role in helping both patients and organizations coordinate care. “At the end of the day,” he observed, “it’s going to be about understanding the condition and the risk of a number of people joining these medical plans who have been underinsured or uninsured in the past.” by Pete Fernbaugh

hospital admissions, and ER visits. Matrix is looking to build on this value by introducing two new product lines. First, a Physician Bul-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

49


MAY/JUN

2013

Real Issues : Real Solutions

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