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Real Issues : Real Solutions

Cancer Treatment Centers of America Leading the Way in Cancer Care


NOV/DEC 2013

Real Issues : Real Solutions


06 Cancer Treatment Centers of America

Gerard van Grinsven, President and Chief Executive Officer


IN-FOCUS STORIES 12 Florida Hospital Altamonte 14 Castle Family Health Centers, Inc. 18 Association of Air Medical Services 22 Kentucky Lions Eye Center 25 St. Joseph’s Home Care 28 Fairfield Memorial Hospital 32 Functional Pathways, LLC 35 Manos Home Care 38 St. Luke’s University Health Network 42 Beauregard Memorial Hospital 44 Cleveland Clinic Center for Connected Care 46 Family Health Centers of Baltimore 48 Kaiser Permanente Hawaii



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CANCER TREATMENT CENTERS OF AMERICA The Cancer Treatment Centers of America (CTCA) is a leader in innovative, groundbreaking cancer care and is setting the stage for what patients can expect from a cancer center. With the health-care industry moving toward pay-for-performance and a greater focus on patient satisfaction, Gerard van Grinsven, the newly appointed president and chief executive officer of CTCA, has been charged with moving the organization into the next generation of holistic cancer care.

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health care, van Grinsven spent 25 years in the luxuryhotel industry. He worked in Asia to help open some of the foremost hotels in the world. From there, van Grinsven made the move to health care and served as president and CEO of Henry Ford West Bloomfield Hospital in West Bloomfield, Mich., from June 2006 to 2013. Now, he is bringing his experiences and expertise to patient care. “Having a background in hospitality taught me what


true service is about,” he said. “You are not just deliver-

Since its founding in 1988, CTCA has followed what

customers. They want to come back to you because you

is called the Mother Standard®, which asks, “If your

genuinely care for them.”

mother had cancer, how would you want her to be treated?” Treatment teams are expected to apply this principle to all patients in all aspects of their care. CTCA has five hospitals throughout the country and

ing a product, you are also emotionally connecting with

When he was approached about joining CTCA, van Grinsven had recently lost his father to cancer, giving him a personal mission to want to transform the way care is provided. “I feel that health care has moved too much to sick

treats more than 125 cancer types. The organization

care,” he said. “If you come to a hospital or clinic, you

overall has a 91 percent patient-satisfaction/loyalty

need more care and comfort than any six-star deluxe


hotel. At CTCA, with an extraordinary team of clinicians,

In July 2013, CTCA brought on van Grinsven as president and CEO. Before his career turned toward

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The organization mostly focuses on translational research, which generally refers to science that moves quickly from “bench to bedside.” “We are early adopters of research,” van Grinsven said. “Once we see positive results and have information from studies, we want to quickly bring those treatment options to patients. We seek opportunities to break the silos that are all too common in health care for the benefit of our patients.” Making sure care is accessible to patients is another element of providing quality care. Earlier in 2013, a CTCA hospital partnered with Blue Cross Blue Shield in the state of Illinois to become an in-network hospital, allowing many more patients access to its care. Van Grinsven said the organiza-

also emotionally connects with patients, caregivers, and loved ones. We address their worries, fears, insecurities, answer their questions about what this means for their personal life or professional life.” At the outset, van Grinsven visited all five hospital sites, talking with physicians, staff, and patients to understand their needs. His initial goals include finding ways to create more access for patients, advancing the clinical mission of being the cancercare provider of choice, and furthering the patient care experience. The patient experience is not the only area van Grinsven is planning to focus his efforts; he is also dedicated to making sure the physician and employee experience is exceptional. “You can only take an organization to the next level of excellence if you truly embrace and respect your workforce,” he said. “You have to create a culture where you treat people with trust, respect, and dignity and involve them in decision-making. If you surprise and delight your employees and stakeholders, they will do the same for our patients and their loved ones.”


tion welcomes more partnerships like this. Van Grinsven’s ideas and the CTCA structure are in line with where health care is going. With reform, van Grinsven thinks the organization is creating an environment where patients are more educated, with more information available to them about where they can receive the highest quality care and patient satisfaction. “We are proud to share our patient-satisfaction scores and quality indicators with patients,” he said. “I hope that all organizations are willing to be inspired by each other and learn from each other to create an extraordinary experience for everyone who comes through their doors.” Health-care reform is also heading in a direction that demands the provision of greater wellness care, and van Grinsven said another goal is to find additional ways in which the organization can help the communities it serves. “We need to be more involved in teaching people how they can change their lifestyles and live healthier,” he said. “We should not be just treatment centers, but also prevention centers. We are all motivated to find a cure for cancer, but we should also help our communities learn ways to minimize their risk.” BY PATRICIA CHANEY

CTCA sites participate in and help fund cancer research and partner with other organizations to obtain the latest treatments for its patients.




Florida Hospital Altamonte, a 340-bed community hospital, is the leading health-care provider for Seminole County, located in central Florida near Orlando. This market is dominated by three health-care systems, each of which has a hospital in the county: Florida Hospital, a not-for-profit organization; Orlando Health, another not-forprofit organization; and HCA, a for-profit health system.

Robert Fulbright, Senior Vice President and Administrator

Florida Hospital now owns about 50 percent of the market share, but it has had to fight its way to the top of the pack after a slump in the early 2000s.

Real Issues : Real Solutions


CONTINUING THE HEALING MINISTRY OF CHRIST. RETURNING THE HOSPITAL TO ITS MISSION Florida Hospital Altamonte opened in 1973 as the first satellite hospital to the system’s main campus. It experienced tremendous growth from 1973 until 2000, becoming known as the “country club” hospital in its community. But after 2000, the hospital began to see key operational metrics flatten or decline. “This hospital was viewed as the legacy facility,


so the system invested $120 million into facility renovations,” said Robert Fulbright, senior vice

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president and administrator of the hospital. “We began construction on a new emergency department, operating rooms, and inpatient rooms.”

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In 2006, Florida Hospital Altamonte unveiled a 866.232.1222

beautiful new emergency department, with private rooms and bathrooms. The new facility was gorgeous, pulling in the latest patient- and familycentered care elements and using evidence-based design. During the first three months after the new ED was opened, however, numbers were less than the same three months the previous year. “Seeing the numbers decline after opening was a kick in the gut to my team and me,” Fulbright said. “We realized that our community wants more than bricks and mortar. They want a different experience. So we returned to our mission statement and began to rebuild our operations.” Florida Hospital Altamonte is a faith-based organization whose mission is to “extend the healing ministry of Christ.” Fulbright said that focusing on the hospital’s mission creates a different way of looking at the patient experience. Rather than being concerned about regulations, databases, and percentages, staff are focused on making sure patients

are receiving the highest quality care to meet their needs. “When we put that mission statement on the wall, I think that’s all the pressure we need,” Fulbright said. “It doesn’t matter what anyone else tells us we should be doing. There’s no room for mediocrity in a faith-based organization.” Fulbright and his team chose to reform the newly renovated ED first. They discovered that what patients really wanted was door-to-doctor times under one hour. At the time, Fulbright said, nowhere in Central Florida could you find wait times under three hours. In February of 2007, Fulbright told the staff that on May 1 the hospital would run ads and billboards promising door-to-doctor times under one hour.



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Caution: Federal law restricts this device to sale by, or on the order of, a physician. Indications for Use: The CONSTELLATION® Vision System is an ophthalmic microsurgical system that is indicated for both anterior segment (i.e., phacoemulsification and removal of cataracts) and posterior segment (i.e., vitreoretinal) ophthalmic surgery. The ULTRAVIT® Vitrectomy Probe is indicated for vitreous cutting and aspiration, membrane cutting and aspiration, dissection of tissue and lens removal. The valved entry system is indicated for scleral incision, cannulae for posterior instrument access and venting of valved cannulae. The infusion cannula is indicated for posterior segment infusion of liquid or gas. Warnings and Precautions: The infusion cannula is contraindicated for use of oil infusion. The disposables used in conjunction with ALCON® instrument products constitute a complete surgical system. Use of disposables and handpieces other than those manufactured by Alcon may affect system performance and create potential hazards. Attach only ALCON® supplied consumables to console and cassette luer fittings. Do not connect consumables to the patient’s intravenous connections. Mismatch of consumable components and use of settings not specifically adjusted for a particular combination of consumable components may create a patient hazard. Vitreous traction has been known to create retinal tears and retinal detachments. The closed loop system of the CONSTELLATION® Vision System that adjusts IOP cannot replace the standard of care in judging IOP intraoperatively. If the surgeon believes that the IOP is not responding to the system settings and is dangerously high or low, this may represent a system failure. Note: To ensure proper IOP Compensation calibration, place infusion tubing and infusion cannula on a sterile draped tray at mid-cassette level during the priming cycle. Leaking sclerotomy may lead to post operative hypotony. Attention: Please refer to the CONSTELLATION® Vision System Operators Manual for a complete listing of indications, warnings, and precautions.

Florida Hospital Altamonte

Game Changer

“The staff asked me how we are going to do that,

been in the past,” he said. “We haven’t been good

and I said, ‘Don’t know,’” he recalled. “‘But you live

at policing ourselves; we haven’t owned up to our

this every day. You know what needs to be done.


My job is to break down barriers that prevent you from delivering great care.’” On May 1 the hospital hit its numbers and ran

But all of that is changing throughout the industry. Florida Hospital’s strategic plan for the coming years has three main components: determining the

the ads. Growth was in double digits, and the hos-

health disparities in the community and alleviating

pital experienced double-digit growth for the ensu-

or meeting those needs; promoting health and well-

ing three years. The hospital continued to trans-

ness; and aligning with physicians and health plans.

form the culture, moving into the operating rooms, employee engagement, and patient satisfaction. Key operating metrics for surgery are now in

Fulbright said in the future, he thinks hospitals will be more like health campuses with a hospital component. The current system doesn’t reimburse

the top quartile nationally, employee engagement

hospitals to keep people healthy, but “our mission

is in the top 15 percent nationally according to the

calls us to do that.” In addition, he said improving

Gallup database, and HCAHPS are in the top quar-

alignment with physicians and improving relation-

tile nationally and on the rise.

ships is key to providing better care for patients and


the community as a whole. “We have to take ownership of our industry and our work,” Fulbright said. “We should have the best

The hospital continues to see tremendous growth,

health care in the world, and it should be cost ef-

and Fulbright said the challenge in the future will

fective. We can create cultures in our hospitals that

be determining how to spend capital dollars as the

develop high-performing teams that will allow us to

organization learns what the Affordable Care Act

bend the cost curve and deliver high-quality care.”

will mean for them locally. Florida Hospital Altamonte is at capacity in the ED, OR, and inpatient


beds. “We are having to spend money to expand, while we stand at the threshold of reform, which I am not sure is going to provide the same volume,” he said. “As a tax-exempt organization, the dollars we make get reinvested back into the community through our facility. It truly is the community’s dollars, and we have to make sure we are being good stewards of the resources we are given.” Although there is uncertainty with reform, Fulbright is looking forward to changes in the healthcare system and feels they are necessary. “The regulations and the fact that we have politicians now telling us how to deliver health care are a reflection on our industry and what we’ve




Edward H. Lujano had spent a career tallying figures and crunching numbers, mainly as chief financial officer for various community health centers. At some point, however, he realized his career was stagnating and he needed to do something more with his skills. So, Lujano returned to school, obtaining his master’s and doctoral degrees in business administration. His goal was to be in frontline health-care management.

Edward H. Lujano, Chief Executive Officer

The first call he received after he finished his doctoral studies was from the multi-site, nonprofit Castle Family Health Centers. His first impression upon visiting CFHC’s facilities in Atwater, Calif., was potential. He felt CFHC had so much more potential than it was realizing at the time. Lujano accepted the role of chief executive officer on a year’s contract. Eight productive years later, he continues to pursue CFHC’s potential.

Real Issues : Real Solutions



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During Lujano’s time with CFHC, the organization attained a designation similar to ones held by Federal Qualified Health Centers. Its three locations have gone from seeing approximately 45,000 patients to seeing over 111,000 patients in 2012. Its operating budget has doubled, an impressive feat considering that CFHC receives no federal funding or grants and is driven exclusively by patient revenue. With a predominantly Medicaid population, CFHC has addressed its need to expand into a number of specialties, including dermatology, nephrology, and pulmonology. In many ways, Lujano said, CFHC has become a model for other health centers in the community since its clinics offer specialty care that its competition does not.

Established in 1996, Alpha Viana designs, manufactures, and supplies retailers with the latest trends in eye wear. We carry various lines suited for families with young children to those who are well into their 50s and 60s. Our wide range of frame selections meets the needs of our different customers. With our international presence, Alpha Viana is a company in its growth stage, with well-established markets in South America and Asia. Our products are made from the materials of the highest quality. We use memory titanium, stainless steel, and handmade acetate. Our unparalleled sales team will help your company stock the latest trends for your clients. At Alpha Viana, we provide our customers with the best in price, value, and quality on a global scale. We strive to continue to be innovative and lead with up to the minute designs. In addition, we foster growth and development with our suppliers, employees, and customers. At the same time, we pride ourselves in unique product development. With over 20 years of experience, our President designs the eyewear herself. With headquarters in North America, manufacturing in China, and a sales team around the United States and South America, Alpha Viana is building a strong domestic and international presence.

This is no small achievement, he added, given that most specialists are reluctant to see patient populations whose payer source is unclear, nonexistent, or unreliable.

THE IMPORTANCE OF PARTNERSHIPS As a former CFO, Lujano said he is always examining CFHC’s newest initiatives from a business perspective. He views partnerships as being vital to the organization’s continued success, which is one reason he has strengthened ties with Bloss Memorial Healthcare District and initiated a relationship with UC Berkeley’s School of Optometry. “I got UC Berkeley to partner with us, and we became their first rotation site in a community health center, giving the students truly an eye-

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opener of an opportunity to see patients with glaucoma, who are diabetics, from children to elderly,” he said.



percent, with the adult population coming in at 51 Eye Pro Lab, Inc.

percent. Approximately 36 percent of the children in the area under 18 are below federal poverty guidelines. About 80 to 83 percent of individuals speak a lan-

CFHC has become the school’s flagship over the

guage other than English in their homes. Approxi-

last few years, as students request time at the

mately 65 percent are Hispanic, 22 percent Cauca-

clinics so they can receive hands-on experience

sian, 7 percent Asian, 4 percent African American,

with a diverse demographic of patients.

and 2 percent Indian.

The UC Berkeley relationship also opened

It’s important, therefore, that care providers are

doors to financial opportunities for CFHC. By the

not only multilingual, Lujano said, but that they are

second year of the program, the optometry de-

also culturally sensitive.

partment was bringing in revenue of $200,000. “If we’re going to get into something, it has to

For example, some patients come to CFHC with their home remedies in tow. Some will only see a

make a business sense,” Lujano said. “As much

provider of the same gender, while Hispanic pa-

as it is providing care, it has to make a business

tients will bring their entire families with them.

sense. Otherwise, we’re not going to be able to provide anything.”

Also, the payer sources for CFHC’s patient population aren’t always clear, and many are unin-


sured, although Lujano is hopeful that the Affordable Care Act will remedy this. In spite of the odds, though, he said recruitment

With 175 employees, CFHC is centered in a large

is rarely a problem. CFHC is often able to conduct it

agricultural region. About 60 percent of the

without hiring any agencies.

population comprises the younger demograph-

“People enjoy coming to work here,” Lujano said.

ics, while the senior population is only about 8

“We have probably a 3-percent turnover rate in em-

Real Issues : Real Solutions

ployment, so we hold on to our employees or they stay with us.” CFHC’s oldest employee has been with them for 25 years, he added. While the pay is competitive, CFHC has also mastered a positive environment. “I am a believer in empowerment, making people feel not only that they belong, but that they add value to the organization,” Lujano said. The clinics close down twice a year so CFHC can hold organizational meetings that emphasize


communication with its employees. This emphasis has netted positive returns for CFHC. While most

“Be willing to change, be willing to learn, and be

organizations are cutting back, Lujano said he is in-

willing to teach. We have to change in order to

creasing wages and still holding Christmas parties,

stay ahead of the game, we have to learn about the

picnics, and recognizing employees for their efforts.

change and change the way we see and do things,

“It’s because of them that I’m able to keep mov-

and we have to teach and give back our knowledge

ing the organization forward. It really becomes what

to others, so others can be ready to help and lead

we call a family.”

when their time comes.”



In many respects, CFHC is not your average community health clinic. With a comprehensive lab program, CFHC conducts 85 percent of its labs in-house. It offers radiology, mammography, ultrasound, and urgent care, plus it has one of the only child-adolescent psychiatrists in the county on its staff, along with a team of licensed clinical social workers. Its adult daybreak health-care program sees approximately 25 individuals on an ongoing basis, and its pediatric center employs two of only four pediatricians in the county. Lujano attributes CFHC’s continued success to a simple three-pronged philosophy he applies not just to his leadership, but to every endeavor the organization undertakes.




Providing access to quality health care for all Americans is one of the guiding principles of the United States’ health care industry, and the air medical transport and critical-care ground transport system is a vital part of this industry, providing timely access to appropriate levels of care. Approximately 45 million Americans live more than an hour by ground transport from a Level 1 Trauma Center. For those individuals, an integrated local air medical transport system is a lifesaver.

Rick Sherlock, President and Chief Executive Officer

Real Issues : Real Solutions



and saw the faith our service members had in the military medevac system.” That belief carries over into his decisions for

represents organizations that serve as part of air

future AAMS strategic plans and his full support of

medical and ground critical-care transport systems

what the membership does for the communities they

in the United States and around the world, primarily

serve. He also understands the operational perspec-

through advocacy and education.

tive of members, the nuances of fixed-wing and

AAMS straddles two of the most heavily regulated industries -- aviation and health care. The

rotary-wing programs, their challenges, and varying mission profiles.

association examines regulations on both sides

During his time as head of the organization,

to gauge the effects for its members and provide

Sherlock said he has learned a great deal about the

a voice within those regulating bodies for these

operational side of the industry as a whole -- how


the clinical side and medical side come together at

President and Chief Executive Officer Rick Sherlock said AAMS does a great deal of work repre-

the federal and state levels to provide care.

Administration, the National Highway Traffic Safety


Administration, the Department of Transportation,

AAMS also includes a charitable arm, the MedE-

and the Department of Health and Human Services,

vac Foundation International, that funds research,

among others.

education, and outreach efforts for the medical

senting members to Congress, the Federal Aviation

“Part of our goal is to be the organization that

transport industry. Medical transport profession-

is contacted when an issue comes up, so we can be

als already provide the best quality care to stabilize

there to represent our members to the regulating

patients on their way to a medical facility, saving

bodies,” he said.

lives and greatly improving outcomes, but exciting

Sherlock came on board with the organization about two years ago and has worked to increase visibility among members and improve efficiency

research is being done to enhance the level of care provided en route to the hospital. One ongoing study Sherlock mentioned involves

within AAMS itself. He brings valuable experi-

using ultrasound technology to diagnose a stroke

ence and a deep appreciation for the role of each

and possibly begin treatment before the patient even

individual who makes up AAMS’ membership. He

enters the emergency room.

served 33 years in the Army as a helicopter pilot

“The provision of critical care and high-level pre-

and instructor, commanded aviation units, and was

hospital care makes a difference in outcomes,” he

involved in strategic planning.

said. “Numerous patients have told me that without

“I saw the benefits of the medical transport sys-

helicopter transport, they would not have survived.

tem in the military in peacetime and in wartime in

Knowing that more benefits are coming in the near

Iraq,” he said. “I am a firm believer in that process

future and the number of lives that can be saved



THE RIGHT CALL. As a leading air ambulance provider, PHI Air Medical is dedicated to going beyond the call for our customers and patients in communities across the country and internationally. As a partner to many of the leading healthcare institutions across the country, we safely transport more than 30,000 patients each year, operating out of more than 65 bases across the United States. At each base, we maintain a dedicated crew of pilots, nurses and communications specialists – all exceptionally trained and ready to respond.

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by high-quality care en route to the hospital is an exciting thing to be a part of.”

PHI Air Medical’s mission is to maintain the highest level of safety while delivering measurable benefits to our customers, our employees, our investors and communities we serve. Our values and integrity in providing the best possible care to our patients and customers is at the heart of every decision we make. PHI Air Medical’s employees are faced with critical and often life-saving decisions and that is why we employ a team of professionals unmatched in the air medical industry and who come to PHI to perform at a higher level. Going on Beyond the Call, in all that we do.

In addition to ongoing research endeavors, the Foundation publishes a variety of resource documents designed to help AAMS members improve operations, as well as materials that members can share with the communities they serve to help the public understand AAMS’ role in the healthcare continuum. The Foundation also provides much-needed financial assistance to support the families of AAMS members that have been injured or killed while on duty.

REINFORCING THE CARE CONTINUUM Air medical transport and ground critical-care transport continue to grow and be a vital part of the health-care community. Sherlock said many hospitals realize the value of these programs, as outcomes improve and length of stay is shorter for patients who receive care quickly. As many small community hospitals face challenges and close their doors, access to care in rural areas is a struggle. Having a strong medical transport system that offers patients quality care in the air and fast access to larger facilities with appropriate levels of care is a life-saving necessity. “When you have a time-sensitive injury or critical illness, the ability for Americans in rural areas to access an appropriate level of care is dependent on an air medical program,” Sherlock said. “AAMS is dedicated to supporting all aspects of the programs that save lives and allowing the industry to continue providing safe, effective transportation and care.” BY PATRICIA CHANEY




The Kentucky Lions Eye Center is home to the University of Louisville’s Department of Ophthalmology & Visual Sciences, which is a member of the School of Medicine’s multispecialty practice, the University of Louisville Physicians (ULP).

Henry J. Kaplan, M.D., FACS, William H. and Blondina Evans Chair of Ophthalmology & Visual Sciences and Director of the Kentucky Lions Eye Center

Founded in 1967, the Kentucky Lions Eye Center is also home to the charitable nonprofit Kentucky Lions Eye Foundation; the University of Louisville Lions Eye Bank; the University of Louisville Physicians - Eye Specialists, the private practice of the Department of Ophthalmology & Visual Sciences; and the University of Louisville Eye Clinic, which comprises its indigent eye-care clinics.

FIGHTING THE GOOD FIGHT. According to Dr. Henry J. Kaplan, director of the

divisions that have the potential to endanger their

Kentucky Lions Eye Center and chair of the Depart-

overall success and progress in the future.

ment of Ophthalmology & Visual Sciences at the University of Louisville, there are two divisions to


the department’s work: research and clinical.

Although the Congressional budgetary sequester’s

Historically, he said, the department has a

impact was not immediately apparent, the conse-

tradition of excellence in basic-science research

quences it has wrought have become all-too-clear,

related to eye disease and vision. Most of the

including dramatically reducing the funding from

15 faculty members in the research division are

the National Institutes of Health (NIH) and the

Ph.D.s, while some are M.D.s and others are M.D.-

National Eye Institute. “This will create many significant problems,

Ph.D.s. Likewise, the clinical division has an equal

not only through the immediate termination of

number of faculty who are mostly M.D.s, with some

staff that assist our scientists, but eventually the

O.D.s. They provide clinical care in each of ophthal-

release of the scientists themselves,” Kaplan said.

mology’s subspecialties, including the Low Vision

“This act of Congress is going to dramatically

Center, which provides the region’s most compre-

hamper the future of basic-science research in the

hensive low vision care.

United States in ophthalmology and other disci-

Kaplan was clear: although the infrastructure

plines.” Most of the students who are planning careers

they have in place with the University is solid, he and the staff of Kentucky Lions Eye Center are

in research are discouraged from entering the field

facing challenges both in the research and clinical

when only one out of every 10 research proposals

Real Issues : Real Solutions


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Kaplan said the discouragement and frustra-

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tion this is having on bright, young people who have much to offer the field should not be underestimated in its long-term impact. Furthermore, less than two decades ago the clinical side of academic medicine would crosssubsidize with the research programs of an orga-

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nization. But, Kaplan said, there is less and less clinical revenue so cross-subsidization of research is no longer possible. “The result is that the loss of financial support for research will impede the ability of scientists and clinicians to innovate and to explore novel

panding the Kentucky Lions Eye Center’s ability to

treatments for patients,” he said. “Being in an

deliver eye care, the organization is at a significant

academic medical center, we are frequently at a

financial disadvantage compared to community

disadvantage when competing with private prac-

practices, since over 50 percent of its patients are

tices for participation in clinical trials sponsored by

receiving charity care with little or no reimburse-

the pharmaceutical industry.”


In order to stay afloat, the doctors of the beyond the campus and become competitive within


the community, at sites throughout metropolitan

Kaplan is pursuing several initiatives designed to

Louisville and the regions of western Kentucky and

maintain the Center’s contributions to the Com-

southern Indiana.

monwealth of Kentucky.

And even though these satellite offices are ex-

The first initiative is the aforementioned satellite

Kentucky Lions Eye Center have had to branch out



offices throughout the community. The second is participation in the University of Louisville’s

ship position.” Overall, he thinks both American medicine and

700-member multispecialty physician group

science are in a fragile state, and this fragility is

--ULP--which is providing a fully integrated sys-

the result of congressional priorities. He believes

tem of health care.

the decreased funding for education and research

Third, in order for the Center to provide suffi-

at both the federal and state levels are harming

cient care for indigent patients, insurance payment

the competitiveness of the United States in medi-

for these services must be identified. Therefore,

cine and science.

the University has staked its hopes on the success of the Affordable Care Act. “It is hoped that this will provide a revenue

“I say this because our most important resource, bright young men and women, are being discouraged from committing themselves to these

stream that will allow us to be able to provide care

fields by the nation’s leaders,” Kaplan said. “It’s

for these people and pursue our other missions,”

difficult to attract intelligent, dedicated, motivated

Kaplan said.

individuals to a field which is being constantly

The University is also looking to establish a Center for Neurosciences that would include clinical specialties like ophthalmology, neurology,

hampered by the crippling politicization of issues.” BY PETE FERNBAUGH

neurosurgery, and psychiatry and basic sciences such as biochemistry, neurobiology, and molecular genetics. This Center would function much like the University’s cancer and cardiovascular centers. The goal is to bring together a core of talented people who can collaborate and conduct clinical translational studies that would allow the University to compete in these specific areas.

A FIELD THAT HAS OUTSOURCED INNOVATION Kaplan pointed out that major innovations are being made in ophthalmology in Europe and Asia, but not in the United States, which at one time was the undisputed leader in ophthalmological innovation. Now, United States eye doctors can’t afford the newest surgical and diagnostic equipment that many of their foreign counterparts can. “We can’t afford it because the hospital systems don’t see us as a necessary component of their financial sustainability,” Kaplan said. “I think that’s a major issue in the decline of our leader-

Real Issues : Real Solutions




With a steadily increasing number of seniors entering retirement and seeking long-term care, the home-care industry is a rapidly growing sector of health care, not only in the United States but also in Canada. St. Joseph’s Home Care is independently incorporated, but falls under the umbrella of St. Joseph’s Health System, which spans the continuum of care from hospitals to home care to long-term care.

Kim Ciavarella, President

As St. Joseph’s Home Care in Ontario builds its niche within the marketplace, the organization is developing creative ways to meet patient needs in a cost-efficient manner.



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FOCUSING MORE ON WHAT PATIENTS WANT Like the United States, Canada is also seeing baby boomers enter their retirement years. As a result, there is an increased demand for senior-oriented services. St. Joseph’s Home Care President Kim Ciavarella said her organization has been studying the care models employed by Great Britain and Scandinavian countries, both of which have had large elderly

worker. Furthermore, the client was much happier

populations for many years.

because she was able to maintain her independence

“The literature available repeatedly states that home care is the most cost-effective way of providing care, as long as there is access to primary care,” she said. “Most patients would prefer to be cared

at home. “We assume what patients want in many cases, but we need to start listening,” Ciavarella said. Additionally, falls are one of the key factors that

for in their own homes rather than in an institutional

result in loss of independence for seniors, and St.


Joseph’s began a falls prevention initiative that in-

Evidence related to client outcomes in the

cluded education for care teams and patients, along

home-care sector is limited, but what is available

with conducting home assessments and removing

has demonstrated that people recover better when

slipping and tripping hazards.

they are content and in a comfortable environment.

Ciavarella said they have seen declining fall

Ciavarella said one of the most frequently over-

rates since implementation, and the rate of falls for

looked aspects of providing quality home care is

St. Joseph’s Home Care clients is below the provin-

listening to patients.

cial norm.

She gave an example of one 82-year-old patient a home assessment that determined she needed


personal care and assistance with bathing; such as-

Although health care in Canada is funded by the

sistance could be provided at great cost three times

government, individual organizations are not seeing

per week by a personal support worker.

budget increases and are facing many of the same

who was referred to St. Joseph’s. She had received

However, when the St. Joseph’s care coordinator came out to see her, it was concluded that this

fiscal constraints as their American counterparts. Being part of a larger system allows the home-

woman was more than capable of bathing herself

care division to build a close relationship with the

if a grab bar was installed. The grab bar would

hospital, which is both a necessity and an advantage

cost a total of $30, a solution that saved money

in reducing costs across the entire health-care

and eliminated the need for the personal support


Real Issues : Real Solutions

Ciavarella said the board of directors and executive

perspective, looking at what patients value in the

team for the three St. Joseph’s organizations in the

health-care experience. The map, which included all

city of Hamilton--which include an acute-care and

steps from the pre-op visit at the hospital to being

research hospital and divisions for long-term care

discharged from home-care services in the commu-

and home care--is under the same governance

nity, was 50 feet in length and had 92 steps.

and management structure. Last year, all three organizations adopted a

“With 92 steps, it’s no wonder why patients’ information was getting lost and the follow-up could

joint five-year strategic plan that will transform

take days ,” she said. “We were able to cut that

how they work together by breaking down barriers,

process by a third initially and continue to refine

using research to inform and innovate the path of

the process today with feedback we receive from

clinical excellence, and engaging their people, both

patients and staff involved with the program.”

staff and patients, within the process.

For the pilot program, the system focused

“We are uniquely positioned to offer the

on patient-population groups, such as short-stay

continuum of care and advocate at a higher level

surgery and chronic diseases. Each patient who

than just home care,” Ciavarella said. “We want to

presents to a St. Joseph’s hospital with one of these

break down traditional barriers in healthcare.”

conditions is assigned a coordinator for their entire

One major initiative is a pilot program that spans the entire health system. The Change

episode of care. Ciavarella said the system saw a reduction

Foundation released a paper in June 2009 about

in hospital length of stays and readmissions and

people’s experiences receiving home care after

home-care visit times were cut in half. She added

being hospitalized.

that the program has worked best for the short-stay

The report found 37 areas of improvement and noted that “I Don’t Know,” which is the title of the report, was the most commonly heard phrase from

surgery population, and patient satisfaction has been extremely high. St. Joseph’s Home Care will continue to look for

patients when asked what was happening next in

ways to collaborate with the hospital and develop

their care journey.

new models of care oriented around meeting the

Ciavarella said St. Joseph’s took that report and mapped a new model of care from the patient

needs of the new group of seniors who will be seeking home-care services. “We have to break down the silos in health care,” Ciavarella said. “We have one patient, and when we focus on the patient and quality, we will get better outcomes and better efficiency.” BY PATRICIA CHANEY





In spite of the many federal and state pressures being placed on rural health-care facilities, Fairfield Memorial Hospital, a 25-bed criticalaccess hospital located in Winnsboro, S.C., has not wavered in its devotion to providing quality health care to its patients in the best way possible. Even though Fairfield is facing many daunting challenges, it continues to hold its own, expanding and fine-tuning its services to meet the expectations of its patient population.

Michael L. Williams, Chief Executive Officer

For example, the hospital started a new program called Senior Connection, designed to reach out to Fairfield’s primary demographic, seniors. As part of this program, the hospital hosts two Senior Connection Days each year, one in April and one in October, with the first event having been held in April 2012.

Real Issues : Real Solutions


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to educate the seniors and their caregivers on the


various departments and services available at Fair-

Compounding Fairfield’s challenges is a recent

field. A newsletter is also distributed at the event,

decision by the state of South Carolina to reject the

and vendors who specialize in senior services are

Affordable Care Act’s Medicaid expansion, which

on hand.

will rob providers of $11 million over the next six

Although there is plenty of fun to be had at this event, with Bingo and door prizes, its purpose is

Fairfield has also put together a Screen Team


that attends around 25 health fairs each year,

The majority of Fairfield’s patients who visit

screening for cholesterol and blood pressure.

its Emergency Department have no insurance, nor

The ultimate goal of these programs is the

do they qualify for Medicaid, under the current re-

prevention of readmissions through education.

quirements. In fact, one out of every four patients

“With the Affordable Care Act, they are looking

at Fairfield does not have a physician. If the state

at how you’re going to deal with senior readmis-

had accepted the expansion, these patients would

sions,” Michael L. Williams, chief executive officer,

have insurance and Fairfield could be reimbursed,

said. “We’re looking at transitional care, where you

at least in part, for these patients’ visits.

work with the patient when they go home.”

This is no small matter, for patient volume

This level of dedication is nothing new for Fair-

within the ED has increased approximately 100 vis-

field, however. In spite of enormous odds, Williams

its per month. As Williams pointed out, this means

and his team are determined to keep faith and

more bad debt and charity care.

keep pressing forward.



On the positive side, Fairfield’s rural health clinic is

as its $1.8-million EMR that went live in September

in its second year and doing exceptionally well.

and its newly opened dermatology and orthopedic

The Fairfield Life Improvement Program (F.L.I.P.), whose purpose is to work with patients

clinics, would draw many people back. “One of our biggest challenges is just replacing

suffering from chronic diseases, diabetes, heart

capital equipment,” he said. “We got state-of-the-art

disease, and COPD, received a grant of $2 million

equipment now. We’re in the process of installing

three years ago from The Duke Endowment.

a digital-mammography unit. We do have an MRI

Williams said the hospital was more than

system, which a lot of small critical-care hospitals

grateful since F.L.I.P. represents a great need

don’t have.”

in its community. Fairfield County is among the

This ambition to be as up-to-date as possible, he

highest regions in the state with deaths related to

said, enables Fairfield to stand out from the other

chronic illnesses.

five critical-access hospitals in the state.


and CEO for five. During his tenure, the hospital has

With many localized issues to tackle, Williams said

seen increased revenue over the last five years, go-

he was looking to improve the hospital’s marketing

ing up 25 percent.

to areas far outside the county. He said the hospital

Williams has been with Fairfield for 30 years

“We are increasing our volumes, and we are try-

was planning to advertise in local magazines and

ing to decrease the out-migration of patients leaving

put up signs in an effort to attract new patients to

the county,” he said. “We’ve come a long way, and I


think we’re doing exceptionally well.”

He believes the hospital’s improved services, such

However, Williams said he is anticipating the ensu-

Real Issues : Real Solutions


ing years will be difficult. Even so, in the next three to five years, Williams said he would like to begin collaborating and affiliating with another facility. “The reason why you want to do that is because of the resources that the tertiary hospitals have. The buy-in power is there and you can work with staffing or sending specialists here.” Fairfield also wants to reopen surgery, Williams said, adding, “Hopefully, one day we’ll be building a new facility.”


“With the new health-care reform, we’re changing the way we’re practicing,” Williams said. “We’re not just flipping a patient when they come into the hospital. Now, we’re trying to track these patients when they go home.” BY PETE FERNBAUGH

Williams is well aware of the implications of running a hospital in a smaller community. “Working in a small community is a different ballgame than working in a large one,” he said. “You got to focus on your patients. In a large hospital, a lot of times a patient is just a number. In a small hospital, everybody knows everybody.” The imperative to provide quality care is even higher. After all, health-care professionals see their patients at church, school, the grocery store, the hardware store, etc. Therefore, to keep the hospital on-course with patient satisfaction and safety, Fairfield recently signed a contract with Press Ganey to do its inpatient survey.




In many ways, Dan Knorr, president and co-founder of Functional Pathways, LLC, is an example of good, old-fashioned American entrepreneurship. Knorr started his career as a physical therapist, graduating from the University of Pittsburgh and moving to Knoxville, Tenn., in the mid-1980s, where he worked in what he describes as “a really intense rehab environment” at Patricia Neal Rehab Hospital.

Dan Knorr, President

He then took a job that was considerably more rural than Knoxville, in Scott County, Tenn., where he was the only physical therapist in the county. His services were, therefore, in high demand, leading him to start his own company.

However, he soon found himself unable to juggle the numerous requests coming in from home-health agencies and nursing homes and decided to hire other therapists. Eventually, he sold the company in the early 1990s, figuring his career in physical therapy was effectively retired. But the connections he made, especially in longterm care, continued to request his services, and by 1995, he had co-founded Functional Pathways, LLC, whose mission is to bring rehabilitation services to long-term care facilities. In its nearly two decades of existence, Functional Pathways has grown to include more than 130 facilities across 16 states with 2,500 therapists in its employ. Functional Pathways provides its services exclusively to long-term care facilities, such as nursing homes and Continuing Care Retirement Communities (CCRC), that outsource their rehabilitation departments to it.

MAKING ITS CLIENTS THE BEST REHAB PROVIDERS “Most organizations,” Knorr said, “are focused on attaining solid clinical and financial outcomes. However, running a rehab department is usually a headache.”

Real Issues : Real Solutions


EASING THE BURDEN OF REHAB. By outsourcing the department to Functional Pathways, long-term care facilities find a partner that provides all the rehab services they need. “A manager is incorporated into each facility and handles all of the documentation, the billing software, program development, compliance, and support marketing of the department,” Knorr said. The long-term care facility still handles the billing of patients and its payer sources, while Functional Pathways is reimbursed based on the volume of work it does. “I think one of the strengths that we had initially was that our growth was based on relationships,” he said. “I would go in and talk to customers and find out what their needs were, making sure that they were comfortable. From that, a relationship was developed. We really grew kind of as a family company.” Functional Pathways has had to change its growth strategy over the years, he continued, and now, its growth is based on the services the company offers customers, simply because long-term rehab is a competitive niche. “Our main competitors are some of the very large nursing-home companies that have their own rehab company,” Knorr said.

Second, it takes its promise to its customers seri-


the organization promises to provide excellence in

Knorr believes Functional Pathways differs from its competitors in three ways. First, its values are taken seriously by the company’s leadership. “Every employee must know them,” Knorr said, “and each department must demonstrate on a weekly basis how they’re incorporating those values into the care they’re providing.” These core values are: Relationships, Responsibility, Self-Improvement, Innovation, Commitment, and Passion.

ously. Referred to as the Partnership Promise, rehab achieved by “Elite People who give Elite Care and produce Elite Results.” Through this promise, Functional Pathways ensures that excellence in rehabilitation will be achieved throughout the organization. Finally, Functional Pathways provides valueadded services that distinguish it within the rehab industry. For example, it recently released a new secure web-based product, RightTrack, to its customers. RightTrack allows family members to track the patient’s progress.



ago the nursing-home industry became the No. 1 most-regulated industry even surpassing nuclear power for regulations. That’s more of an issue.” It’s difficult keeping track of 2,500 therapists, he added. “We spend hundreds of hours making sure our therapists understand the rules and regulations and are adhering to those standards.” Regardless of these challenges, Functional Pathways continues to grow at a rate of 15 to 20 percent annually. Knorr wants to continue on that growth track, saying his goal is to become the No. 1 rehab provider in the industry for rehab services. “That’s our ultimate goal. That’s what we are moving towards,” he said. “Excellence in rehab is what we do. We’re not like the larger nursing-home Whenever a family member admits someone into

companies that own their own rehab company. Our

one of the facilities for rehab, their email address

complete focus is partnering with our clients to

is requested, through which they receive automatic

become the best rehab provider in the area. That’s

email updates on the patient on a regular basis.

our goal.”

They can also log into a portal and see a graph of all the different outcomes that are being tracked


for the resident and see how the resident is progressing. RightTrack can be accessed by the facilities and the referring physician, and it can run multiple outcome reports based on differing criteria. It can also run outcomes for specific patients and doctors and compare outcomes from the referring hospitals. “Not only does the family have these updates available,” Knorr said, “but facilities can use that information to market their services and show specifically the outcomes that they’re getting for the patients that have been receiving rehab in the facility.” “No one has anything even similar in the industry,” he added.

BATTLING COMPLIANCE STANDARDS “Health-care reform hasn’t really had a huge impact on Functional Pathways,” Knorr said. “It’s compliance that challenges our mission. The compliance side of it is huge for us. A couple of years

Real Issues : Real Solutions




Located in the East Bay of Northern California, the nonprofit organization, Manos Home Care, has been providing services to people needing care within their homes, both those who can afford this care and those who cannot, since 1989. Manos Home Care has been operating ahead of the curve in health care since its founding, using technology and cost-effective solutions to serve its customers’ needs, with a special emphasis on providing culturally sensitive care.

Kevin Rath, Founder and Executive Director



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trators from the various cultures we serve, not just individuals who have learned the language.” A primary way in which Manos achieves multi-

Manos Home Care offers respite care, child care,

cultural service is through cross-cultural training.

and home care for children, adults, and seniors

The goal of this training is to give its team a better

in Alameda and Contra Costa counties, one of

understanding of each other and reduce cultural

the most culturally diverse regions in the United

clashes within the administration. It can be chal-

States. The organization has 1,300 clients, speak-

lenging, but Rath said it is necessary in order to

ing seven different languages: English, Spanish,

provide the best care for clients.

Cantonese, Mandarin, Tagalog, Vietnamese, and Farsi. The diverse cultures represented in Manos’

“To be multicultural, you have to start with the board of directors and continue with the staff and administration,” he said. “You have to let go of your

service area present a unique challenge to those

fear. Most people hire within their culture because

providing health care. But Manos has embraced

it’s comfortable. Sometimes we make mistakes,

the diversity and created an environment within

miss cultural cues, but it is part of our vision and

the organization that mirrors this diversity from

we stick with it.”

the top down. sents four cultures; our administrative staff speaks


seven languages, which are represented by our

Manos is in the midst of upgrading its technology

clients,” said Kevin Rath, founder and executive

to better serve clients’ needs, in part because of

director. “We have staff, executives, and adminis-

the geographically dispersed nature of the service.

“The management team from Manos repre-

Real Issues : Real Solutions

With 1,300 clients in a home-care environment,

some have chosen to go into nursing homes, conva-

this amounts to 1,300 work sites spread over a

lescent hospitals, or assisted-living facilities rather

1,500 square-mile radius.

than staying at home.

Rath understands the importance of using

In order to address the rising costs of home

technology to lower costs and has created a web-

care, Manos plans to create a web-based service for

based software application that will serve as the

home care that would reduce costs by 30 percent,

platform for rolling out Internet-based services

allowing more people to take advantage of its ser-

designed to enhance the home-care experience

vices. This would also allow care to be provided any-

while reducing its cost.

where, as employees can clock in virtually, be paid

Manos’ new software will include a mobilephone app component, allowing parents, case managers, and workers to log into the website and view its activity. For many of the parents who access home-

virtually, with client, family, and worker interaction based on a web portal. Manos plans to continue pushing technology to improve access to care at a lower cost. Rath will work to expand the organization to other areas in

care services for children with disabilities, benefits

California and seek partners on the web-based

are provided through the government with a

home-care service.

limited number of hours available for them to use

“We have an incredible affordability crisis in

those services. The new app would allow parents

health care,” he said. “We cannot continue to spend

to log in and see how many hours they’ve used and

this much of our GDP on health care with the re-

also see the status of their requests from Manos.

turns we are getting. And we can’t create systems

Rath said Manos is also working on translat-

that exclude people from receiving health care. We

ing the website into several languages. All patient

have to figure out how to use technology to reduce

forms have already been translated into Spanish


and many into Chinese.


As the United States becomes more diverse and health-care reform seeks system integration on a national scale, Rath said he hopes to see more

Before founding Manos, Rath was organizing day

diversity reflected in health-care organizations and

laborers and house cleaners with limited English

more coordination with services such as Manos.

skills into collectives. The James Irvine Founda-

“We are a non-medical social service that is tied

tion was offering grants to community-based

into the health-care system,” he said. “Hospitals

businesses that could provide jobs to low-income

need to work as closely with attending care agen-

women. Rath received a planning grant and wrote

cies and workers as they do with skilled-nursing

the business plan for Manos Home Care, which

facilities and post-acute care organizations. Without

was awarded a $400,000 grant.

that coordination, they will see an adverse financial

Rath chose home care because it was a rising

impact. For example, if someone breaks a hip three

need in the area and offered the potential to create

times because they don’t have home care, the hospi-

many jobs.

tal has to pay for that surgery and the client suffers

Manos eventually added respite care and home care for children with disabilities in 1992. This area has now become a major focus of the organization. The group has faced challenges with the reces-

needlessly. We need to figure out how to integrate and work together across all areas of health care.” BY PATRICIA CHANEY

sion, but has remained open while many standalone home-care centers in the area have closed. Seniors have had trouble affording home care, and




Across the health-care spectrum, physicians are increasingly taking on administrative roles, in addition to running a medical practice, as they evaluate whether to remain in an independent private practice or join up with a larger medical system. Christopher S. Alia, M.D., FCCP, is one example of this new-century physician, as he serves many roles for St. Luke’s University Health Network.

Christopher S. Alia, M.D., FCCP, Vice President of Medical Affairs and Medical Director of St. Luke’s Allentown Campus ICU

Real Issues : Real Solutions


EMBRACING THE FUTURE OF PATIENT CARE. PROVIDING PATIENT CARE AND ADMINISTRATIVE LEADERSHIP St. Luke’s is a fairly large network serving seven counties in eastern Pennsylvania and into Warren

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County, N.J. The network has six hospitals, more than 80 owned physician-practice sites, more than

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125 employed primary-care and specialist physician sites, outpatient services, and home-health and hospice services. Dr. Alia serves as vice president of medical affairs and medical director of ICU at the network’s Allentown campus. The Allentown campus is a 149-bed community hospital.

Because Sysmex understands urgent patient care decisions.

He is also a partner at St. Luke’s Pulmonary & Critical Care Associates. He has two outpatient

offices in the area and provides inpatient pulmonary and critical care at the St. Luke’s Allentown, Bethlehem, and Anderson campuses. He has been with the organization for seven years, joining right out of fellowship. At the time, Alia said the network was expanding and providing impressive professional opportunities. “It is important to me to have input into the

“We work together to make sure processes are optimal for physicians and patients,” he said. “We are aiding in health-care decision-making that will

health-care policies of our network,” he said.

advance the organization in a way that is best for

“Having physicians in administrative roles provides


a bridge between competing financial goals and patient-care goals. Practicing clinicians respond better to other clinicians who are subject to the same rules and regulations and would be more likely to comply with some changes, knowing an administrative colleague also has to comply.” As vice president of medical affairs, Alia has the opportunity to work with vice presidents at other locations in the St Luke’s network and the chiefs of clinical sections in moving care forward for the network as a whole.

MAKING A DIFFERENCE IN PATIENT CARE As medical director of the intensive-care unit at Allentown, Alia began making changes to care delivery. Previously, the ICU, which had been expanded in 2008, operated as an open concept where internists and surgeons have primary service and pulmonary or other specialists were consultative. He enclosed the unit so that all patients were managed on the critical-care service. The critical-



care physician would then be primarily responsible

hospital network is working toward leveraging in-

for directing the ICU care of the patient and involv-

formation technology to provide better patient care,

ing the necessary consulting physicians.

communicate effectively with patients, and receive

Alia also helped institute a nurse practitionerled rapid-response team that not only works

the proper reimbursement for the services provided.

patients, but also responds to medical emergencies


outside the ICU, ideally treating the patient before

St. Luke’s Allentown Campus has a stroke center,

he or she needs to be transferred to an ICU level of

chest-pain center, a center of excellence for bar-


iatrics and minimally invasive gynecology surgery,

directly with critical-care physicians caring for ICU

“Patients in the ICU or on the floor needing urgent-care interventions are getting them through these rapid-response teams,” he said. “We have

as well as service-line focuses for neurology and neurosurgery. The hospital is outfitting a new operating room

reduced code rates for patients having acute com-

and has added a parking deck to improve patient

promise or cardiac arrests, reduced ICU transfer

access. The Allentown Campus is also a site for

rates, and improved quality measures.”

advancing medical education, with rotating nurse-

As St. Luke’s expands, Alia looks forward to

practitioner students from Drexel University and

future changes and challenges. The hospital is pre-

Jefferson University. The campus supports an

paring for a pay-for-performance fee structure and

osteopathic internship and has several residency

participating in a Medicare demonstration project


for value-based purchasing. All primary-care and

Another exciting addition is the St. Luke’s

specialty sites are attesting for Meaningful Use

West End Medical Center, which recently opened

for electronic medical records utilization, and the

a new adult urgent-care center and sports and

Real Issues : Real Solutions

human-performance center for employees and

less transition of care for patients from hospital to

the community and includes a separate pediatric

community and into outpatient care.

urgent-care site through a partnership with St. Christopher’s Hospital for Children. OB/GYN, pain management, lab, and X-ray services are on-site with plenty of room for future

The campus also wants to expand communityhealth initiatives by providing increased services through its mobile-medical and dental-health vans. “Health care is constantly changing,” Alia said.

growth that is currently in the planning stages, Alia

“Coming out of medical school, I never thought


I’d be doing what I do today. Our organization has

St. Luke’s University Hospital - Bethlehem

shown that it is versatile and responsive to the

rolled out a hybrid operating room with state-of-

needs of the community. We do an excellent job of

the-art imaging, allowing patients to remain in the

working as a group to solve the challenges we face

OR for complex vascular procedures, last Novem-

in health care today, and we are confident we will


stay strong into the future.”

The hybrid OR and the imaging technology in the network is part of a GE International Show Site.


Additionally, the hospital partnered with Temple University to create a medical-school campus with the first class of nearly 30 students graduating in 2015. In 10 years, St. Luke’s expects to graduate upwards of 300 physicians. In the coming years, the Allentown hospital plans to expand perinatal services and the neonatal intensive-care services, as well as increase surgical and critical-care volumes. Alia said his goal is to work more closely with the network’s physician group to provide a seam-



BEAUREGARD MEMORIAL HOSPITAL Beauregard Memorial Hospital is a 60-bed, acute-care hospital located in DeRidder, La. As a sole community provider, Beauregard Memorial has served the entire parish of Beauregard, as well as Vernon Parish and surrounding areas, for over 60 years. The hospital has survived many heady waters, mainly because no matter what changes have come its way, Beauregard has remained anchored to one guiding principle: the Golden Rule.

When a loved one is sick and needs medical attention, the most comforting aspect to patients and family members is to know that someone genuinely cares about them. Beauregard believes this is rural medicine at its best. Treating patients like they’re part of the family also guides rural organizations like Beauregard through the constantly stormy seas of today’s health-care industry.

OVERCOMING OBSTACLES WITH COMMON SENSE “Rural health care often has no choice but to focus on the patient,” Darrell Kingham, CPA, chief financial officer and part of the Beauregard Memo-


rial family for 24 years, said. “After all, there are numerous other obstacles to overcome, primarily the difficulty in acquiring capital resources and attracting talent.” Although Beauregard Memorial faces the same

“The foundation of Beauregard Memorial’s mis-

challenges many rural hospitals throughout the

sion is treating every patient and every employee

country face and continue to struggle with, such as

like they are part of the hospital’s family,” Anita

the rising cost of health care and decreased reim-

Thibodeaux, chief nursing officer, R.N., APRN, MSN,

bursements, the hospital has made tremendous

and FNP-BC, said. “I have been part of the Beau-

improvements and has experienced a $5 million-

regard family for 33 years, and there is no greater

dollar turnaround in the last year.

place to work. You get to know the people that you’re

The organization credits hard work, dedication,

taking care of and have a positive impact on their

good people, physician recruitment, new service


lines, increased volume, and an emphasis on the

One aspect of rural health care often taken for granted is the close relationship that exists between

patient experience as contributing to this impressive success.

the medical professional and their patients. Often-

“Over the past year, our focus has been on two

times, focusing on people instead of policies, is an

main areas: recruitment and volume,” Kingham

essential ingredient of rural care.

said. “We have signed four primary-care physicians

Real Issues : Real Solutions

11 | BEAUREGARD MEMORIAL HOSPITAL in an effort to shore up our primary-care base and opened an urgent-care clinic to take some of the burden off the emergency room.” The hospital also recently opened a rural health clinic in the southern part of the parish, started a sleep-study program, started a hospitalist program, started an athletic training program, purchased a 128-slice CT machine, and opened a new ICU wing. The turnaround at Beauregard has not been “rocket science,” however. The hospital has simply focused on building relationships with physicians, employees, and the community.

A REASON TO USE AND TRUST THE HOSPITAL The medical staff at Beauregard had one goal in mind as the hospital regained its footing: giving patients and their families a great experience when they had to use the hospital’s services. “The initiative we have pioneered in order to enhance the quality and safety in our care for patients is to put ourselves in their shoes,” Randa Smith, BSN, R.N., director of inpatient services and part of the Beauregard Memorial family for eight years,

fluence and affect the health care of the community in a positive way. Rural communities deserve first class health care and that is what patients receive at Beauregard Memorial Hospital.” Many thanks to Kelli C. Broocks, director of public relations, human resources, and physician recruitment at Beauregard Memorial Hospital, for her assistance on this article. BY PETE FERNBAUGH

said. “We put patients first at Beauregard Memorial; the quality and care we offer to patients does not differ from one to another. Over the last six months, our patient satisfaction scores, as well as our quality scores have skyrocketed, which I believe has been a major influence in our recent growth and success. We’ve gotten back to the model of where we’re honored to take care of people, and it’s a privilege for us to do that.” This model of honor, where the privilege isn’t for the patients but for the ones providing care, will guide Beauregard through health-care reform’s already-rocky roll-out and into the future. “As we move into the future, Beauregard Memorial Hospital will continue to provide and promote new services,” Thibodeaux said. “Rural hospitals bring so much to local communities and provide an invaluable service. “Beauregard Memorial Hospital impacts our local community in tremendous ways. We are one of the largest employers in DeRidder and have a tremendous opportunity, even an obligation, to in-




The world-renowned and highly respected Cleveland Clinic has made platform integration the number-one priority of its IT department. Recently, it created a new center with the express purpose of integrating home, transitional, and post-acute care into its overall continuum of connectivity. Falling under the purview of Musood Pirzada, director of information technology, the Center for Connected Care is expressly concerned with patients suffering from chronic diseases who are often readmitted to the hospital.

Musood Pirzada, Director of Information Technology

The Center for Connected Care’s mission is to be a resource and partner to Cleveland Clinic’s transitional-care programs and its institutes and hospitals, as well as actively building relationships with national and local providers.

The Center’s focus on home-care services includes physician house calls, Cleveland Clinic’s home-health agency, its home-infusion pharmacy,

ELIMINATING DISCONNECT AMONG PROVIDERS Pirzada and his team are especially concerned

respiratory-therapy program, and its hospice and

with eliminating the disconnect that seems to exist

palliative-care programs.

between providers inside and outside the Clinic,

The Center for Connected Care is also work-

making integration an ongoing mission for Pirzada.

ing to integrate Cleveland Clinic’s in-patient rehab

He wants physicians to be able to see where their

facilities and telemonitoring programs as a way of

patients stand in the post-acute setting after

reducing readmission rates.

they’ve been discharged simply by looking them up

These programs include Heart Care at Home,

on the Clinic’s EMR.

a multidisciplinary transitional program for heart-

“Otherwise, it seems to be a total disconnect,”

care and cardiac patients, and the Post-Acute

he said. “More of a silo mentality. You have to

Knowledge and Solution Center, which is helping

be able to coordinate care, measure quality, and

to expand Cleveland Clinic’s reprioritization around

report outcomes, and include patient experience.

outpatient care.

Basically, that’s the mantra that has been set for

Pirzada said EMR integration, distance health,

us by our CEO.”

outcomes, and research all play into these programs.

In addition to the Center for Connected Care, Pirzada has been working on integrating wireless

“It’s all about changing healthcare to value-

technology. Some of the Clinic’s physicians already

based rather than a la carte. It’s all based on value.

connect to the EMR using their iPhones or their

The bottom line is the program aims to reduce 30-


day readmission rates. Basically, we are doing what we set out to do years ago.”

But, Pirzada said, Cleveland Clinic’s IT infrastructure must be so sophisticated that a physician

Real Issues : Real Solutions



Beckman Coulter, Inc.

should be able to connect to the system at any time in any place. “The goal here is whatever documentation is being done, it has to be pushed out to the EMR so the clinicians can see all of the documentation in one place, even though they could be doing documentation in different systems.”

A GROWING NEED FOR EFFECTIVE POST-ACUTE CARE An amazing number of patients, at least 33 to 34 percent, are in need of post-acute care upon being discharged from Cleveland Clinic, Pirzada said. He expects those numbers to go up with the baby boomers retiring in droves. Cleveland Clinic already discharges over 160,000 patients each year across its nine hospitals. “That’s why this continuum of care, this transition becomes an important aspect of the future of health care,” he said. He believes this need for connectivity will require mobile devices and cloud-based systems to play more of a function in day-to-day health care, especially with technology becoming cheaper and more portable. With more tools and greater functionality being available to physicians, Pirzada said there will be a greater commitment to outcomes reporting, espe-

ing towards, having an enterprise-wide data mart where we are able to have access to data easily,” he said. “The changing dynamics of health care, of reimbursement, we have to be able to connect dots a lot more now, to be able to generate the outcomes for the patient in order to get reimbursed and being able to provide the tools for the physicians to be able to document better and take care of the patients better.” Cleveland Clinic receives patients from all over the world. Therefore, it needs to be able to find providers from any state in the country. The discharge planners, he noted, touch every aspect of a patient’s stay in the hospital and their transition to a post-acute care setting. “We have to change with the changing environment,” Pirzada said. “We have to be able to provide better technology that is portable, fully integrated, and maybe cloud-based technology, where it provides better tools for all caregivers to manage patients across all care settings while improving outcomes – an overall shift towards more proactive care and greater quality of life at less cost to the system.” BY PETE FERNBAUGH

cially as data visualization and dashboards become increasingly user-friendly. “That is also going to be a big part of health care because you’re going to get paid based on the performance, and you have to be able to show that performance,” he said. As the future leans on him with greater speed, Pirzada and his team feel the urgency to get the Cleveland Clinic on to one integrated system, instead of the numerous platforms from which it’s drawing right now. “That’s one of the things that we are work-




Family Health Centers of Baltimore is a Federally Qualified Health Center, providing affordable, quality care to uninsured and low-income individuals. The center provides general pediatric and adult primary care, prenatal care, infantmortality prevention, dental services, substance-abuse and mental-health services, as well as transportation, translation, case-management services, and patient education to help improve access to care.

Paula McLellan, Chief Executive Officer

Paula McLellan recently celebrated her 20th anniversary as chief executive officer of the facility, which is practically a lifetime for health-care leadership.

“With our mission and challenges of health-care

patient load who were uninsured and would need

access, especially for low-income and underserved

to be signed up for a health plan.

communities, people like me tend to stay,” she said.

Maryland was ahead of many other states in preparing for reform with navigators ready to help

She has seen the many changes in health

educate people about the health plans and their

care over the years and is driven by the belief that

options. With the roll-out, the Family Health Cen-

health care should be viewed as a right rather than

ters works with patients and members of the com-

a privilege.

munity to educate them about health-insurance

“There has been a point in our history where

options and eligibility guidelines.

the quality of care was dependent upon an indi-

“For people who are not citizens, they will

vidual’s ability to pay for it,” she said. “If you had

remain uninsured, but reform is good for our pa-

no money or no job, you had no access.”

tients,” McLellan said. “We will continue to serve

Centers like hers help to lower that disparity, as does the newly instituted Affordable Care Act. She looks forward to health-care reform providing more people with access not just to doctors,

patients regardless of coverage or citizenship, and we look forward to being able to help and educate people who are hesitant to sign up for a health plan.”

but also to labs, diagnostic services, and specialty referrals.

Unfortunately, problems with the Maryland Health Connection and the federal government’s


ACA websites are inhibiting health-care enrollment at Family Health Centers. Between 20 and 25

Family Health Centers of Baltimore began doing

people are seen each week who need help with en-

outreach before the Oct. 1, 2013, opening of online

rollment, she said. These people are encouraged

health-insurance exchange markets in order to

to complete paper applications because of website

identify people in the community and within their

problems, and paper is hard to track.

Real Issues : Real Solutions




Another element of reform McLellan thinks will be a move in the right direction is the establishment of a true health-care system. “What we have is not a system but a hodge-

“It is hard to find doctors who come out of medi-

podge,” she said. “You have primary care over here,

cal school interested in working with underserved

pharmacy over there, labs somewhere else. Reform

populations,” she said. “There are a few, and paying

is going to give us more of a system of care, and

them a good salary is a challenge. But they are

that’s what we’re really looking forward to.”

committed to the population, and we want to keep

As the country moves toward a more cohesive system, McLellan said Family Health Centers is trying to provide more one-stop shopping facilities. The main facility is adding a mental-health pro-

them.” Another challenge is meeting what she calls “unfunded mandates,” such as electronic health records. Going paperless requires a large investment

gram to complement the substance-abuse services

in software and consultants with little to no funds

already available. And the group is renovating a

available for the start-up costs.

warehouse in the Brooklyn neighborhood that will

McLellan said the center is working to help

include physicians services, dental, and behavioral

patients receive the maximum benefits they are

health under one roof.

entitled to and to sign up for health insurance when


eligible. “Our care is not free, but it is affordable,” she emphasized. “We see our patient encounters as a

The Family Health Centers of Baltimore is accred-

starting point. We treat people, and as their means

ited by the Joint Commission and strives to provide

improve, we hope they will see the value we provide

the highest quality care to patients. As a Federally

and continue to come here after they acquire health

Qualified Health Center, the facility receives gov-


ernment grants, reimbursement of Medicare and Medicaid, and other benefits. Patients are charged according to a sliding scale based on income and family size. About 60 to 70 percent of patients seen at the center receive coverage from Medicaid. One of the biggest challenges financially is

McLellan maintains her dedication to the center and the patients she serves, stressing the importance of public health and the work that her staff does. “Health care has always been perceived as a commodity, but it should not be an exclusive club,” she said. “When you have an element of the com-

recruiting and maintaining medical professionals,

munity that is unhealthy, the rest of the community

McLellan said. Nurses, medical assistants, and

will be affected by it. We live together, we breathe

physicians are not always paid market-based sala-

the same air. Without access to treatment in the

ries, and many are lured away to larger hospitals or

past, tuberculosis would have spread much worse,

health centers once trained.

HIV would have spread much worse.”

She said a large focus of the group’s strategic plan is to find ways to offer more competitive sala-


ries in order to retain physicians and staff.




Kaiser Permanente has been leading the way with innovative, integrated models of care delivery for 50 years, operating as an Accountable Care Organization long before the term became an everyday buzzword. The organization is one of the nation’s largest not-for-profit health plans and includes Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, Inc., and The Permanente Medical Groups. It is spread throughout six geographic regions in the United States.

Janet Liang, President

In Hawaii, Kaiser Permanente is blazing a trail with top-ranked health plans and an array of wellness programs. In addition to the health-plan arm, Kaiser Permanente Hawaii includes one hospital, located on Oahu, and 20 medical offices and clinics throughout the islands. The group cares for about 20 percent of Hawaii residents.

PROVIDING TOTAL CARE FOR PATIENTS EVERY DAY. CULTIVATING AND DELIVERING TOTAL HEALTH By being a part of a patient’s health from insurance coverage through treatment, Kaiser Permanente emphasizes total health, with numerous wellness programs and outreach efforts. “We put our members at the center of everything we do and strive to provide the safest, highest-quality care in our everyday medical program,” Janet Liang, president of Kaiser Permanente Hawaii, said. “We provide direct patient care for nearly all members in the state.” The organization has been recognized for its efforts, garnering many awards for the Moanalua Medical Center, a 235-bed acute-care facility. The hospital has received an A safety rating from The Leapfrog Group and is the only Baby-Friendly designated hospital in Hawaii. The hospital, and Kaiser Permanente as a whole, has a robust safety program, working with

the Institute for Healthcare Improvement and other patient-safety groups across the country. “We consistently look at safety measures to ensure we are one of the leading organizations in the United States,” Liang said. “What really pushes us from good to great is when we deploy a reliable process to the frontline staff who are invested in and understand our obligation and mission to patients.” As part of the commitment to treating the whole individual and focusing on wellness, Kaiser Permanente Hawaii has received Level 3 PatientCentered Medical Home recognition at all 16 primary-care clinics. Liang said the organization is continuing to innovate and set the standard for coordinated care, especially in light of health-care reform. “When you have all the pieces from doctors to hospitals, pharmacy, lab, therapists, and the right financial incentives, you get the ideal environment to do the right thing, rather than trying to work within rules that disincentivize you to put the individual at the center,” she said. “The total health agenda is becoming more prevalent as hospitals

Real Issues : Real Solutions


become more like an ACO. The industry is moving toward the model we have.” Liang also said Kaiser Permanente does a lot of outreach in the community, conducting health

Office Max Workplace

education and bringing care to individuals to help prevent illness or chronic diseases. The organization has a presence at workplaces, schools, and community centers. The KP Walk program is designed to improve employee health by encouraging employees at all locations to walk 30 minutes a day, five days a week. By logging their minutes, employees earn rewards. Everybody Walk is an extension of the program, without the rewards, open to anyone. All one has to do is sign on and make a pledge to walk more and improve their health. For years, the organization has been involved in efforts to curb obesity through its Community Health Initiatives for Healthy Eating Active Living, which supports obesity prevention collaboratives in communities, non-profit organizations, and government agencies. In addition, Kaiser Permanente was a partner with HBO for a series on the obesity epidemic in the United States, titled “Weight of the Nation.”

organization’s disease-prevention mission. Liang said the organization just worked with hospitals in Hawaii to open medical records to viewing for physicians across the islands so that they can see patients who end up in the emergency room anywhere in the state. Furthermore, the nephrology group is now able to identify patients early on with the potential for chronic kidney disease and reach out to those individuals with preventive efforts. Health-care reform is encouraging changes as it puts more emphasis on technology and wellness, and Liang said reform is bringing exciting opportunities to Kaiser Permanente as the group gains a better understanding of exchange markets and how consumers will now shop for insurance. “Reform means changing the way we think, market, sell, and introduce ourselves to a community,” she said. “We are planning on growth. More people covered by insurance is a good thing for the health-care industry as a whole.” From the provider side, reimbursement chang-


es will continue to be a challenge. Hawaii is one of

Kaiser Permanente has made significant invest-

reimbursements, so efficiency has always been a

ments in health information technology with efforts to connect every hospital and care provider across all of the islands for the exchange of basic information. The organization has an integrated electronic health record and received HIMSS (Health Information and Management Systems Society) Stage 7 ranking for medical technology. Providers in Hawaii use Internet-based tools to meet with patients, having roughly 1.2 million visits online annually. Patients are also able to view their medical test results through an online health record. With the electronic medical record in place, Kaiser Permanente Hawaii is reaching out to other health-care sites to improve connectivity across the state and to collect information to further the

the lowest markets for premiums and government goal for health-care organizations in the state. “By following 20 percent of the marketplace, we can demonstrate over time what happens to the population,” Liang said. “We are excited to showcase that. We have a lot of members that we have taken care of since birth and are beginning to be able to show some lifetime results.” Looking toward the future, she believes collaboration will be the key to being successful in this changing market. “We are seeing more people converse together,” she said. “It’s hard to go it alone, whether you’re a hospital, health plan, or office. It’s time for us all to collaborate within our communities.” BY PATRICIA CHANEY





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


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