Healthcare Intelligence Exchange

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Real Issues : Real Solutions

Dignity Health-St. Rose Dominican Bringing Sustainable Care to the Las Vegas Valley


MAR/APR 2014

Real Issues : Real Solutions


06 Dignity Health St. Rose Dominican

Rod A. Davis, Senior Vice President of Operations, Dignity Health Nevada


IN-FOCUS STORIES 10 H. D. Smith 14 UPMC Presbyterian Shadyside Hospital 18 Presbyterian SeniorCare 22 The William W. Backus Hospital 25 Arise Austin Medical Center 28 Decatur County Memorial Hospital 32 GBMC HealthCare System in Baltimore 35 Scarsdale Medical Group 38 Nemours Children’s Hospital 40 Scotland County Hospital



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DIGNITY HEALTH-ST. ROSE DOMINICAN The Dignity Health system of hospitals has been making rapid gains in market share within the competitive Las Vegas Valley. Case in point, Dignity Health-St. Rose Dominican, located in Henderson, Nev., is the only not-for-profit, religiously affiliated health system in the area. Since 2000, St. Rose has expanded from one hospital to three acute-care facilities, along with other entities, to become a fully integrated delivery system. Rod A. Davis, senior vice president of operations for Dignity Health Nevada, has been with St. Rose for 22 years and has seen the system go from holding 5 percent of the market share in Clark County to 18 percent.

cardiovascular and thoracic surgery, and transplant. St. Rose has four full-time Stanford faculty on site and in private practice. Additionally, a Stanford clinic is located adjacent to the Siena Campus. Davis said the organization has been ap-

BUILDING INTEGRATED SYSTEMS AND EDUCATIONAL PARTNERSHIPS With this expansive growth over the past decade, St. Rose has been focused on a clinical integration initiative, working with physicians to integrate data systems, negotiate payer contracts, and develop a delivery model focused on patient population management. Davis said there are more than 600 physicians contributing to the initiative and working to capture patients before they are admitted to the hospital and manage them more efficiently while they are in the hospital. At discharge, the system facilitates transfers to sub-acute facilities or manages care in home to help prevent readmissions and improve quality of life. “We have developed partnerships with physicians,” Davis said. “There is a lot of anxiety among

proached by a number of medical schools to offer a residency program, and future plans are being made to develop a number of residency training programs. “Having graduate medical education here enhances our care delivery model for this community,” Davis said. “It will make a difference in the level of service we provide to residents of Las Vegas and Clark County.”

GETTING POSITIONED FOR A CHANGING ENVIRONMENT Davis said St. Rose and Dignity Health Nevada are preparing for the transformation in the healthcare industry, regardless of changes made to the Affordable Care Act. “A change is occurring in healthcare, and it has to,” Davis said. “The system we had before is unsustainable.”

physicians today with the transitions in healthcare. We want to establish positive relationships that support them. We think it’s the right thing to do to deliver better care at a lower cost with improved


outcomes.” The initiative is about a year old and has one managed care contract already. Davis expects over the next two years to have the systems and infrastructure in place to manage patients more effectively, generate value to physicians, and demonstrate performance to major employers and insurers. St. Rose is also looking to fill a need in the area for training programs and has established an academic relationship with Stanford University Medical Center. Las Vegas doesn’t have a major academic medical center, but with the relationship with Stanford, St. Rose has a linkage over several service areas, including neurosurgery, pediatric neurosurgery,



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strategy to work closely with physicians and maintain a strong presence in the community. Davis feels confident that Dignity Health-St. Rose Dominican is well positioned for the future. The organization has developed a strong reputation within the community as a well-managed, trustworthy system. “We have consistency with the workforce and medical staff over a long time, giving us a common focus, common objectives that we work together to achieve,” he said. In an industry where many organizations feel pressure to cut expenses and staff to achieve success, Davis said St. Rose will “innovate ourselves to success, rather than cut ourselves to success. Our employees and physicians are engaged and encour-

St. Rose is looking at ways to reduce costs across all service areas and integrate the three campuses to act as one organization. Davis said he is seeing economies of scale

aged to think outside the box to find better solutions. As an industry, we need to be flexible, willing to adapt and embrace change as we move forward.” BY PATRICIA CHANEY

through the integration. A new patient-centered care nursing model has been implemented across all three campuses that combines case management with a charge nurse and bedside caregiver as one team working with the physician. This program has led to improved clinical outcomes, more efficient care, and higher patient and physician satisfaction. Davis said the organization is also seeing a reduction in supply and medical-equipment costs through integrated purchasing systems. To prepare for a changing environment, St. Rose is looking at models with employed physicians. Nevada has typically not had a history of hospital systems hiring physicians. “We think it is important that we make an employment option available to physicians,” Davis said. Dignity Health Medical Group, a multispecialty physician practice, also strengthens the hospital’s




Growth through Efficiency and Effectiveness

Scott Wilson, Senior Vice President Drug Divisions

Within the field of drug distribution, an avalanche of branded drugs going off patent and the influx of multiple generic alternatives has materially changed market dynamics. National healthcare wholesaler and solutions provider H. D. Smith is taking advantage of the numerous savings that can be found within the drug market today by providing support to hospitals, pharmacies, and alternative-care facilities across the country. Senior Vice President Drug Divisions Scott Wilson said that by 2017, many of the historic blockbuster brand-name drugs will have lost their patent protection and market exclusivity. The increased availability and use of generic alternatives will continue as more Americans have access to prescription medicines as a result of the Affordable Care Act. In addition, dynamic growth in specialized medicines helps to fuel the uncertainty while suppliers, payers, and the insured are all working to understand the details.

Real Issues : Real Solutions

02 | H. D. SMITH

months. This was a huge feat, requiring a massive effort of planning, implementation, and training. “We had a great spirit of unity and determination to get this done,” Wilson said. “We brought together people who were skilled in their areas, merging business folks with technical people, and put them on the road for a year. I tried to stay out of their way and just make sure they had the resources they needed.” He said he is happy with the way things have gone so far. The still-new Six Sigma efforts are having an impact on the H. D. Smith culture. Through continued work, hiring, and training of different


belts, he feels confident the organization will see continued improvement. Another major investment for the company has

In an industry of thin margins, H. D. Smith has

been in SAP software over the past three years.

implemented a range of initiatives to promote

This investment has influenced all other projects,

efficiency. The company began a Lean Six Sigma

as the company re-engineers its business process-

project throughout all seven of its locations, which

es to maximize effectiveness.

are strategically positioned throughout the coun-

These efficiencies are a necessary part of the

try. H. D. Smith has hired several black belts and

future of H. D. Smith, as they are with most areas

trained a number of green belts who identify “pain

of healthcare. The industry is faced with the chal-

points” within the company and develop plans to

lenge of providing excellent service at the lowest

improve processes or define potential savings in

cost possible. With the shift to generics, Wilson said

those areas. Wilson said the company currently has

wholesale distribution is becoming more commod-

10 such projects going on.

itized, which increases the need for efficiency.

During the past several years, the company has

salers. This expansion has increased the need


for more cohesion and efficiency throughout the

The infrastructure efforts were implemented with


an end goal of bringing more value to H. D. Smith’s

expanded significantly, building five new facilities across the country and acquiring other whole-

In 2011, H. D. Smith invested in a new ware-

customer base. With that backbone in place, Wilson

house management system. This investment

said the organization’s next step is to begin apply-

transitioned eight warehouse facilities to paperless,

ing the benefits in ways that support H. D. Smith’s

seven of which had never had automated systems.

customer service and satisfaction.

Wilson said they were able to implement the system with no interruption for customers in only 13

H. D. Smith’s mission statement says it intends “to be the preferred, customer-focused, national



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supplier of healthcare products and business solutions improving the quality, safety and cost of patient care, while maintaining the highest level of honesty and integrity.” Wilson said he feels confident that current investments in software and infrastructure have met the goal of improving quality, safety, and cost. He also said honesty and integrity are key char-


acteristics the company looks for in potential new employees. “All of our approvals start with validating the

increases in efficiency, Wilson said the organization

integrity of candidates,” Wilson said. “In terms of

is poised to remain a leader in the industry and a

trust, we are above board with our customers and

preferred supplier.

suppliers.” He said that H. D. Smith will continue to focus

“We are the only wholesaler that is dedicated to independent pharmacy,” he said. “Our services are

on training and growing employees and adding tal-

geared to improve the gross profits of our custom-

ent to scale the company’s capabilities.

ers, and we feel that if we continue to focus on that,

“We have begun a town-by-town assessment

our profits will improve as well.”

with every individual in the organization to understand the talent we have,” Wilson said. “We plan to


identify our talent needs, educate and train existing employees, and acquire new talent over the next three to five years.” He said it is now time to take the lessons learned and focus outwardly on delivering excellent customer service. Through employee training and




Doing More with Less When John Krolicki accepted the position of vice president of facilities and support services at the University of Pittsburgh Medical Center’s Presbyterian Shadyside Hospital six years ago, he was tasked with one overarching goal: standardizing the hospital’s systems from both a maintenance and medical perspective. Originally from the Detroit area, Krolicki had previously worked with Beaumont Health System for 16 years as director of facilities development for design and construction. When he arrived at UPMC, he said the organization was “well along on some of their system standardization. We just took it to the next level.”

John Krolicki, Vice President of Facilities and Support Services

CREATING SPACE WHERE THERE IS NONE One of the earliest projects he had hoped to complete was a new patient tower, but the necessities of healthcare reform delayed this goal until January 2015. In the meantime, he and his team began pursuing other projects, such as constructing a new clinical labs building, relocating a helipad to the top of Presbyterian Shadyside, and preparing the radiology suite in the old children’s tower for relocation into Presbyterian. Beyond these projects, Krolicki is in the process of privatizing as many patient rooms as possible while making them compatible with current technology. “We struggle with that in our plan,” he said. “So our main goal is to really have the patient units be

what they need to be, while also improving them with technology.” He noted that each room will be considerably smaller from 10 years ago, when designers were creating elaborate, spacious atriums with multiple amenities. The focus is now on creating rooms with the appropriate amount of space that are more reliant on technology and less reliant on bricks and mortar. Presbyterian Shadyside has enlisted industrial engineers from the University of Pittsburgh for its last four design projects. These engineers are especially skilled in improving processes and flow, Krolicki said. They’re also able to provide insight on making operations leaner. For example, when his team was renovating the emergency department, they noticed that nurses were leaving patients 10 to 15 times during visits to

Real Issues : Real Solutions



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retrieve supplies that weren’t in the room. To solve this, Krolicki and his team purchased carts fitted for the quantity of supplies each nurse would need, enabling them to be prepared when they saw each patient. One of the greatest challenges Krolicki has confronted over the last six years is a lack of available space. Departments have had to move and adjacencies either created or found. And just because a temporary space is available doesn’t always mean it is right for patient flow. “Our hospitals are all 100 percent occupied, so any project we’d move forward on was requiring dominoes,” he said.



Building projects to a higher quality.

Ronald McDonald House Charities

Children’s Hospital of Pittsburgh of UPMC Lawrenceville, PA

ADVANCING THE PATIENT EXPERIENCE Krolicki recently oversaw the construction of a new center for blood diseases at Shadyside’s Hillman Cancer Center. Because these patients and their families make repeat visits, Krolicki and his team figured they would be the best source for finding out “what works and what didn’t work.” As a result of their input, the rooms were designed to be more flexible to the patients’ needs. Sometimes, for example, a cancer patient will feel fine and want to socialize with a roommate, but other times they want privacy. A movable partition in each room provides them with this option. Each treatment chair was given Internet and TV

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convenient. The waiting room was also eliminated. When patients arrive, they go to the treatment space where they are immediately seen by a clinician or physician.

HCE Exchange-1.indd 1

Additionally, the chairs were redesigned to be

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more comfortable for waiting family members and were chosen with the involvement of the patients. His team also created an outside area for the summer months where patients and their families could go to relax. A tracking system was installed so physicians could find where the patients were on


the floor with little confusion. He said the patients were impressed and amazed that the design team not only took the time to listen to their concerns and suggestions, but implemented them as well.

BECOMING LESS DEPENDENT ON BRICKS AND MORTAR As an experienced design professional, Krolicki is fascinated by the many healthcare construction

Real Issues : Real Solutions

“FOR HOW LARGE WE ARE, WE’RE VERY NIMBLE.” trends that are overtaking the industry. For one, he

Involving the end users from the beginning can

said the downsizing of space is becoming more of a

make all the difference in a project, he added,


since the end users can look at its scope and

“Before you do any bricks and mortars, you

tell you if it’s correct and if it’s realistic. Also,

have to ask, what can you do just from a flow per-

he advised including industrial engineers on the

spective?” he said. “Before you start spending dol-

design team, since they’re experts on process

lars, the question is, can you fix a problem without

flow and improvement.

capital?” Technology is also shaping design in unprec-

Finally, staying on track with technology is vital. He said UPMC Presbyterian Shadyside is

edented ways with robotics becoming an even

fortunate to have a progressive IT group that

greater tool. He recently installed a robotic system

ensures technology is not being duplicated

for delivering food and emptying trash since the

throughout the system.

employees “hated pushing the carts. They were heavy, and they didn’t like doing the work.” With the robotic system, the hospital now has fewer injuries. Furthermore, “it’s more efficient.

“For how large we are, we’re very nimble,” he said. BY PETE FERNBAUGH

They’re able to spend more time with the patients instead of that travel time up and down.” The hospital is even testing robotic UV systems for disinfecting patient rooms and operating rooms. “It doesn’t replace your normal cleaning process, but it’s an extra layer that tackles the 99.9 percent of all the other germs you don’t see,” he said. “There’s been research out there that says it reduces infection rates.” Above all, he said, they have to work smarter with fewer resources while asking, how can they make it a better environment for the patients? How can they work smarter? “It’s how can we integrate technology with workflow to make people more productive.”




Bringing Innovation and Collaboration to Senior Living Paul W. Winkler, chief executive officer of Presbyterian SeniorCare, first joined the organization in 1987, when his predecessor, Charles W. Pruitt, was leading the Board of Directors into areas previously untouched by senior care.

Paul W. Winkler, Chief Executive Officer

At the time, Presbyterian SeniorCare already had a reputation for being a pioneer in senior living and was breaking new ground with Woodside Place, a dementia-care facility, the prototype of which was then nonexistent in the United States. Recognized by the American Institutes of Architects in 2007 as one of 10 facilities that have made a difference in the field of aging, Woodside Place has been called “a paradigm-shifting way of looking at serving people who have special needs in a way that takes the caregiver into their world rather than trying to pull them into our world and make them adapt to our environment, system, and regimentation,” Winkler said. Woodside Place is only one example of the ways in which the Presbyterian SeniorCare leadership has consistently held themselves to the highest standards of care, accomplishing big undertakings by adhering to one of the tenets of the organization’s values: collaboration. “Innovation and collaboration really go hand in hand when you bring people with widely different perspectives together--out of the world of architecture and academia, the hospital world and long-term care and senior living--and really look at things differently,” Winkler said. Presbyterian SeniorCare has 56 senior-living and care communities located across 10 counties in one of the oldest regions in the country: western Pennsylvania. As a result, the organization feels a responsibility and an obligation to set an example for how quality senior care should be delivered within the United States.


INTEGRATING SERVICES FOR THE BENEFIT OF ITS PARTNERS As Presbyterian SeniorCare looks ahead to 2014, its goal is to become the foremost integrated post-acute/senior-living organization in western Pennsylvania. Accomplishing this goal involves being aware of the most pressing needs confronting its hospital partners and physicians, such as readmission rates. For several years, Presbyterian SeniorCare has worked with UPMC and other hospital partners to assist in reducing these rates, and it was the first post-acute provider to join western Pennsylvania’s original and largest health information exchange,

“We are proud to be part of your experienced team that helps our Seniors make the transition from Home to Longwood at Oakmont, a beautiful one, and wish you continued success. Thank you.”

ClinicalConnect. In order to serve the community with broader

7940 Saltsburg Rd. Pittsburgh, PA 15239

specialty geriatric medical services, Presbyterian

Tel: 412-793-6790 | Fax: 412-440-7498

SeniorCare is currently working with UPMC St.

Margaret in offering a geriatric assessment center on the Oakmont campus. Through a partnership with UPMC and the Jewish Association on Aging, it also sponsors a PACE program called Community Life. A decade ago, it introduced an innovative alternative to long-term care insurance that doesn’t just pay for care but also finds and manages it for its members. Longwood at Home is a Continuing Care at Home program licensed by the Pennsylvania Department of Insurance as a CCRC (Continuing Care Retirement Community).

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Similar to Community Life, the goal of the program is to keep seniors living at home for as long as possible. As the largest of its kind in the country, Longwood at Home has been very successful to the point that Presbyterian SeniorCare has freely

tinuum, with a particular emphasis on Woodside Place

shared information with other communities seeking

and The Woodside Model.

to launch similar programs. Finally, Winker said, a key component of

He said The Woodside Model has been replicated in nursing homes and personal-care/assisted-living

Presbyterian SeniorCare’s 2014 strategic plan is

facilities across the country, but Presbyterian Senior-

building out dementia-care services across its con-

Care would like to expand these services farther into



This begins with upgrading its nursing and personal-care facilities to meet the demands of new care models. According to Winkler, senior care is now “more person-centered or resident-centered, looking at everything through the lens of the resident or family member and how we can provide more choice and enhance quality of life.” the community, increasing access to dementiacare services not just for patients, but also for

In other words, Presbyterian SeniorCare’s facilities are moving from “hallways to households.”

caregivers and physicians.

Before renovating a facility, its facilities team

“That’s something we see as a huge need and

isn’t so interested in where the command and con-

we’re now looking at how we do that in a way that

trol stations will be, but in creating a comfortable

can also be a platform or framework to reach

atmosphere that brings the scale down to a more

people who today are really underserved, highly

humane level and decentralizes dedicated staff as-

stressed, and at risk,” he said. “Many times the


caregivers’ own health is really at risk because of the caregiver burden.”

Furthermore, the organization is making a point to distinguish short-stay rehab residents from long-


stay nursing-care residents, with two goals in mind: creating a hospitality environment for short-stay residents focused on a speedy recovery and return to home and providing person-centered care and

Beyond the expansion of services, Winkler is look-

programming in a home-like setting for long-stay

ing to reinvent the network Presbyterian Senior-

residents focused on quality of life.

Care has built. His team’s desire is to create positive and fulfilling experiences for people.

Thanks to a grant from The Harry and Jeanette Weinberg Foundation, Presbyterian SeniorCare is

Real Issues : Real Solutions


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also converting an entire floor into three specialized dementia-care households at its Oakmont nursingcare community. Above all, Winkler’s goal is to continue cultivating the spirit of innovation and collaboration that has been key to the success of Presbyterian SeniorCare since it was founded 85 years ago. He proudly notes the ongoing collaboration with other nonprofit senior-living organizations across southwestern Pennsylvania as a member of the Faith-Based Network Alliance. “I think this idea of innovation and collaboration together really became embedded in the organization, and it continues,” he said. “Our leadership team thinks that way, acts that way, and has been very stable and cohesive. We have been very blessed that most of our members of our leadership teams have been here 20-plus years, which is pretty unusual. That enables you to do bigger things than when you have a lot of turnover at the top.” BY PETE FERNBAUGH




Working with End Users to Develop CPOE Dr. Jennifer Bellino, chief medical information officer of The William W. Backus Hospital in Norwich, Conn., has been with the organization for 10 years. She previously trained in internal medicine and worked for a year as a full-time hospitalist before joining Backus Hospital.

Dr. Jennifer Bellino, Chief Medical Information Officer

She eventually was named chief of the hospitalists at Backus, then was asked to serve as the physician champion for its CPOE program. This eventually morphed into her current role as CMIO. Her focus as CMIO has been on the constant optimization of CPOE based on user feedback. As she explained, “User feedback can come in a variety of forms. Folks may submit a brand-new order set based on a new procedure that would impact our development. We work with the folks that manage our ambulatory functions to make sure our CPOE order sets are in constant compliance with core measures.” Bellino said the actual content of this feedback is usually sound, and the difference this level of engagement has made in the integration of CPOE into the hospital’s infrastructure has been pivotal in creating an optimal system. Furthermore, she added, when she and her team implement changes based on end-user suggestions, “they recognize that their voice is being heard and that the EHR isn’t just something the IT folks decided to turn on and leave. We realize it’s a tool and an essential tool in the way that we take care of our patients.” Each new system brings with it a unique level of inefficiency, Bellino said, and when the end users aren’t trained well, that inefficiency develops new levels of complexity. For this reason, she and her team have designed a system that is as user-friendly as possible.

SUPPORTING MEDICAL TRANSPORT SERVICES One of Bellino’s greatest successes with CPOE has

the patient, the chart, and the pharmacy. They then enter their findings into CPOE to create a well-organized list for the providers. “It saves the physicians a lot of time and ef-

been in Backus’ pharmacy. The pharmacy employs pharmacy technicians whose job is to personally

ficiency to not have them type in the original list of

interview all patients being admitted into the emer-

medications,” she said. In both Backus’ emergency department and its

gency department. From the interview, the technicians establish as complete a medication list as they can based on

freestanding ED, patients being discharged are provided with a version of this list that tells them exactly

Real Issues : Real Solutions


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which medications they are going on, which prior medications haven’t been changed, which new medications are being added, and which ones are being stopped. “The pharmacy team has certainly taken the brunt of doing a lot of the testing of the actual program,” Bellino said. “And they constantly are checking that the pharmacy IT works with the pharmacy ER.” Working to communicate with departments Backus Hospital has been named a Stage 6 hospital by HIMSS Analytics, and Bellino said she and her team are proud to be a Stage 6 organization. “The physicians have accepted CPOE and we have



seen the medication-error rate and the Pyxis-

patient care, it’s easy for Bellino’s colleagues to

override rate decline. The use of non-formulary

assume her involvement in IT has detracted from

medications is at the lowest it’s ever been.”

the impact she’s having on patients. She doesn’t

She added, “With the increasing acceptance of

see it that way, though.

the electronic medical record, we’ve expanded the

“I feel that I can actually affect more positive

emergency room functionality. Providers do their

change by helping a system be efficient and safe,”

documentation electronically and other physicians

Bellino said. “By developing safety steps for the pa-

are asking for it now, as are the ambulatory folks.

tient, I feel that I can use my medical background

It works with the inpatient side as well.”

in helping the IT team build a system that is really

According to Bellino, she and her team have

helping provide safe care.

achieved this level of success because they make

“With our current day and age there’s really

communication a priority. They also thoroughly

nowhere you’re going to go where you’re not go-

prepare and research current workflows and how

ing to take care of a patient without the use of a

future workflows need to be changed. And above

computer, so why not make the computer the most

all, they listen to the end user.

user-friendly, safe tool that it possibly can be and

“If they’re resistant, I usually believe it’s a resistance for a good reason, and if it’s not a good reason, it’s not usually that they’re being obstinate,

have it benefit our patients and staff.” BY PETE FERNBAUGH

it’s usually that they think the suggestions or the changes are apt to fail,” she said. “It’s very important to listen to their concerns and have them be the ones that can troubleshoot for you what’s going to work.”

WORKING FOR THE PATIENTS Bellino is proud of the patient-safety gains that have been made and the increased physician engagement with new technology. She is also pleased that her team has developed a solid relationship with those physicians. “I think it has helped the culture in the MIS area that the folks in MIS are such a talented group of individuals and they realize they are really doing a service in helping our nurses and doctors and all of our end users take care of the patients,” she said. “The patients are always the priority, even at


the MIS level.” As someone who used to be deeply involved in

Real Issues : Real Solutions



Providing Uncomplicated, Friendly Patient Care In July 2013, Arise Healthcare took on its first owned hospital venture with the purchase of Austin Surgical Hospital in Austin, Texas. Plagued with financial troubles since its opening in 1997, the hospital was on the verge of closure. Since Arise has taken over, however, the renamed Arise Austin Medical Center has seen a major turnaround in both services and finances.

Diana Zamora, Chief Executive Officer

DEMONSTRATING A NEW APPROACH TO CARE Arise Austin Medical Center (AAMC) is a 23-bed acute-care hospital located on the western edge of Austin. Austin is a fairly competitive healthcare market with a population of more than 800,000 and with 33 hospitals across its metropolitan area, some of which are run by large healthcare organizations. According to Chief Executive Officer Diana Zamora, however, AAMC is not focused on competing with the larger facilities, but rather in providing necessary services in patients’ neighborhoods. “We offer healthcare as it was intended -- uncomplicated, friendly,” Zamora said. “We will not build a tower and become a 12-story complex entity. We provide services in the communities where patients need the care delivered.” In addition to the hospital, the medical center has a wound-care facility and recently opened an outpatient imaging and women’s services facil-

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Not assuming the debt has been a key factor in

services are most needed. AAMC has also broken

AAMC’s financial success.

ground on another facility for imaging and women’s care in the Austin area.

AAMC is a physician-owned hospital and is unique among most because the facility was

Zamora said providing high-touch, high-quality

already Medicare-accredited, and the hospital

care is one way that AAMC has and will set itself

has been able to continue seeing Medicare

apart. Although Austin is a large metro area, AAMC

patients without having to screen them. The

is a community and physician-focused hospital,

Affordable Care Act limits what percentage of a

with an unwavering commitment to doing what’s

hospital physicians can own, but Arise worked

best on behalf of patients at all times. This includes

within those restrictions and resyndicated the

making investments in the latest technologies and

facility, offering partnerships to desired physi-

being aware and responsive to the tools and equip-


ment doctors need to remain on the forefront in their fields.

AAMC is Arise Healthcare’s first venture into owned hospitals, but it has had manage-

“We want to make sure that our patients un-

ment agreements with other hospitals and

derstand the care they are receiving and at the end

owns three freestanding surgery centers,

of the day, feel like we listened to them and helped

which are majority-owned by physicians, as

them through the process,” she said.

well as a compounding pharmacy and real-


estate company. Zamora said the hospital has a strong focus on building relationships with physicians who

Austin Surgical Hospital was built in 1997 by the

operate within the organization and those who

Renaissance Women’s Center, but closed in 2001

refer to the hospital. She also said with AAMC’s

because of financial troubles. OrthoNeuro Corp.

smaller size, it is able to respond faster to re-

purchased the hospital in 2002, and in 2009 Sym-

quests made by physicians. And, as proven with

bion Inc. bought a majority stake of the hospital.

many physician-owned healthcare facilities,

Arise Healthcare purchased the assets from Sym-

when the physicians are involved in decision-

bion without assuming its debt, allowing the new

making and hospital finances, costs usually

hospital to start with a clean slate.

decline even as quality continues to improve.

Real Issues : Real Solutions

Although the physician employment model is be-

Because many new services have been added, the

coming more common, “we think there is some-

hospital has limited data on the impact it’s hav-

thing to be said for independent physicians still

ing, but Zamora said patient response to the care

having control over how healthcare is delivered,”

they have received has been extremely positive.

Zamora said. “It should be easy for physicians to

She said patients feel welcomed and listened to

provide services for patients. We should partner

throughout the process.

with them and facilitate that.”


AAMC will be watching as healthcare reform solidifies and will respond to requirements and changes in the near term. In the coming years, it plans to grow based on the needs of the commu-

One of Zamora’s first jobs as CEO was to evalu-

nity, offering more services at the hospital or build-

ate the existing service lines and look for areas to

ing freestanding clinics in the communities where

improve based on the community’s needs. Surgical

healthcare is needed. Zamora said additional

services were a major focus, adding or expanding

services will be evaluated based on patient needs.

orthopedic and neurological spine, ENT, urology, gynecology, orthopedics, bariatric surgery,


podiatry, and pain-intervention services. Existing service lines were restructured and new services were added. Aside from knee and hip replacements, most surgical services now provided were not previously available. Furthermore, AAMC discontinued cosmetic plastic surgery, which made up about one-fifth of surgical procedures at the hospital. However, AAMC did begin to offer minimally invasive surgery with the da Vinci robot. As with all hospitals, managing costs is also part of the turnaround, but AAMC has had a positive revenue stream right out of the gate, which Zamora plans to continue. To maintain this, AAMC is evaluating cost-saving measures and valuebased purchasing, while focusing on quality.





Listening to the Community When Decatur County Memorial Hospital, a critical-care facility in Greensburg, Ind., was planning its mission goals for 2014, the hospital leadership decided to focus on culture, quality, service, and finance from both an internal and an external perspective. They also wanted to better define the plans for the hospital and work on branding it in a fresh, new way. Lynzee McDowell, Marketing and Communications Manager

But above all, Decatur County Memorial Hospital was concerned with one vital component of its operations: how it related to the community. “We are an organization that is in the county,” Lynzee McDowell, marketing and communications manager of Decatur County Memorial Hospital, said. “We are a small hospital. Really everything we do is for our community. We don’t want to just guess their needs and the services they want.” Real Issues : Real Solutions


integrated healthcare liability risk specialists

To effectively communicate with the community,

nity to come and making it the hospital they choose

Decatur County Memorial Hospital set up four

for their healthcare needs.”

focus groups. The leadership wanted answers to tients?” and “How can we provide safety for visitors


and their families?”

One of the pieces of feedback that motivated

such questions as, “How can we satisfy our pa-

As a result of the feedback received from these

Decatur County Memorial Hospital to build a new

focus groups, the hospital was prompted to build

surgical suite was dissatisfaction with the semi-

a new medical surgical unit, and its vendors were

private rooms in the old unit. The new unit now

prompted to enhance the security of the facility

has 22 private patient rooms with bathrooms and

to ensure that all parties would be accounted for

different amenities designed for both patients and

when on the hospital campus.

their visitors.

“Really there has been an overall cleaning up of the structure within,” she said. “We’re focused

Another improvement motived by the focus groups was an investment in new signage.

on making it a comfortable place for our commu-



“We know that a big part of patient satisfaction is

among employees and develops educational mate-

being able to find your way around a place that is

rial on staying healthy, along with weekly weigh-ins

unfamiliar,” McDowell said. “We’re going to work

and measurements.

on getting signs in place so that people know where

The wellness initiative has paid off in dividends,

they’re going.”

McDowell said. In August, Decatur County Memo-

Branding has also taken on a new meaning for De-

rial Hospital was named the healthiest workplace in

catur County Memorial Hospital. The organization is

Indiana for the 100 to 499 employee range.

aiming for its brand to be more than just color, font,

Then, in February of this year, the hospital was

and a logo. Its brand has to expand on the slogan,

named the No. 2 healthiest workplace in the na-

“The quality care you want close by.” The leadership

tion. The organization also received a Community

envisions the hospital brand as being an answer to

Engagement Award, largely for its Healthy Fair, the

the question, “What are we to this community?”

LiveWell wellness program, and the StayWell initia-

Therefore, the focus groups were only the

tive through which the hospital partnered with local

beginning of Decatur County Memorial Hospital’s

schools to provide screenings and other services by

outreach to the community.

way of a third-party payer.

“Everything we do we try to do local,” she said.

“The awards are certainly accomplishments,”

“Whether it’s partnering with another organization

she said, “but the programs we’ve put in place while

or it’s purchasing signage, we really want to give

winning those awards I think is more of an accom-

back to the community and make them feel that not

plishment to me and it says something about the

only are we here for you to come to us, but we want

hard work that the staff has really put into every-

to come to you and support you as well.”



The StayWell initiative relied heavily on Decatur County Memorial Hospital’s two physician offices, Tree City Medical Partners and Primary Care, to

Creating community wellness has become a major

help with the development of the program. Both

focus also. Because Decatur County Memorial Hos-

offices willingly extended their hours and accepted

pital sees itself as the primary healthcare repre-

greater patient volumes to accommodate the needs

sentative in town, the leadership firmly believes the

of additional patients.

hospital should be setting the standards and pace for wellness.

Furthermore, unlike other hospitals in the region, Decatur was able to offer free flu clinics,

Over the last few years, the hospital has focused on an employee wellness initiative and has hired

both standing and drive-thru, to the community and surrounding counties.

a wellness coordinator who works up different activities and competitions to promote good health

McDowell pointed out that the changing healthcare environment prevented many hospitals from

Real Issues : Real Solutions


offering this service for free and in many cases, it was eliminated altogether. This is another reason, she said, why “rural hospitals are not to be looked over.”

A SMALL HOSPITAL OF GREAT AMBITION Despite being in a small town, Decatur County Memorial Hospital doesn’t view itself as a smalltown hospital. Instead, it seeks to be as thorough and complete a healthcare resource as its big-city counterparts. For example, the hospital has the highest-grade CT scanner in the area, digital mammography units, bone-density scans, visiting cardiologists across several subspecialties, two hyperbaric chambers that require no physician referrals, a wound care center, pediatric therapy, and a speech clinic. McDowell said she reminds colleagues she encounters at conferences and professional events that rural hospitals are just as innovative and sophisticated as the sprawling health systems of the nation’s largest metropolitan areas. “Rural hospitals are really staying up with the times and showing that we can be just as great and very comparable,” she said. “We offer the same things that one might expect from a big-city health system.” BY PETE FERNBAUGH




Making Reform Work for Physicians and Patients One community healthcare system in Baltimore, Md., has taken a pioneering approach to reform, making it work long before the Affordable Care Act was passed into law. The GBMC HealthCare System, which includes Greater Baltimore Medical Center (GBMC), is run by Dr. John B. Chessare, a pediatrician by training who has been in healthcare for more than 30 years.

John B. Chessare, M.D., MPH, FACHE, President and Chief Executive Officer

Through his experience as a pediatrician who has moved into administrative roles, Chessare has an understanding of the many layers of the U.S. healthcare delivery system and the areas in which it is broken. He is passionate about reforming healthcare into a system that provides the best outcomes for patients at a lower cost and allows physicians to practice medicine as they were trained to practice it.

Real Issues : Real Solutions


MAKING THE TRANSITION FROM PRACTICE TO LEADERSHIP During his early years of training and work, Chessare had the chance to study under mentors who were ahead of their time in applying evidencebased care techniques and in implementing quality improvement. He eventually left regular practice to focus full-time on administration, working to redesign care at Albany Medical Center, then becoming chief medical officer at Boston Medical Center. “My time at Boston was great,” he said. “I was part of a small group of leaders who were committed to redesigning care and making care for poorer people just as high quality as for those of higher means.” In 2005, he became president of Caritas Christi Health Care System’s Caritas Norwood Hospital in Boston, Mass., and joined GBMC in June 2010. GBMC is a 300-bed acute-care not-for-profit hospital. The GBMC system also includes Greater Baltimore Health Alliance, a group of more than 200 multispecialty physicians in locations throughout the region, and Gilchrist Hospice Care.


This was when the Greater Baltimore Health Alliance was born. “We decided to make the hospital become a cost center and build a primary-care company that

When Chessare came to GBMC, the board was

could coordinate care and fight to keep people

nervous because many standalone hospitals were

out of the hospital, but still take advantage of our

folding or having to join with larger organizations.

wonderful hospital when needed,” he said. “We had

The current U.S. healthcare system doesn’t offer

no future as a standalone hospital, but we had a

much support for smaller hospitals to remain

phenomenal future if we could become a commu-

independent, and Chessare was not content with

nity-based health system.”

that future. “I started educating the board about the need

By system, Chessare refers more to the patient experiencing a system designed to keep him or her

for reform, not in terms of the Affordable Care Act,

healthy. He is frustrated with the country’s health-

but about the absurdity of the status quo,” he said.

care infrastructure being designed to provide many

“The board started embracing the need to redesign

services without reflecting on the coordination of

a better system, and we developed our vision state-

the patient’s care and trying to prevent hospitaliza-


tions. The lack of coordination may benefit inves-



tors, but it impedes physicians’ ability to get the

by reducing Medicare cost per beneficiary, while

best possible outcomes for patients.

providing better outcomes in health and service.

Those feelings have driven Chessare to rede-

Because of state regulations, GBMC gets paid

sign GBMC’s care delivery and implement many

less for the same services than larger academic

aspects of reform. He touts not only the benefits to

medical centers. This has previously been a nega-

patients and the uninsured, but also the benefits to

tive, but with the recent movement toward value-

American business through large cost savings with

based purchasing and price competition through

more efficient care.

the healthcare exchanges, payers are looking to


GBMC as a high-value facility. “We are fighting to keep patients out of our hospital by keeping them healthy, but we have peo-

GBMC follows the national Triple Aim of providing

ple knocking on our door to put patients in because

better care and a better experience at a lower cost,

we are such high value,” Chessare said.

but adds a fourth aim of more joy for those provid-

He encourages other healthcare organizations

ing the care. The organization’s four-paragraph

to take action on the Triple Aim by redesigning their

vision statement defines what drives every decision

delivery systems. GBMC has embraced the patient-

made by the board, administrators, providers, and

centered medical home model and believes it is key


to making this new delivery system work.

It begins with the need to change and contin-

“We need to redesign our primary-care system,

ues into a goal of providing patient-centered care

change the way it is organized, allow our primary-

that “manages the patient’s health effectively and

care physicians to do what they were trained to

efficiently while respecting the perspective and

do,” Chessare said. “The question should not be,

experience of the patient and the patient’s family.”

‘How many patients did you see?’ It should be, ‘Did

Chessare has been supportive of a fee-for-per-

you generate better health, better care, at a better

formance over fee-for-service structure for many


years and has been moving GBMC in that direction since 2010.


“The fee-for-service world is a problem,” he said. “We have to become fee-for-health. We are not waiting for the system to change. We take every penny we’ve been saving and reinvest it into our patient-centered company.” The third part of the vision statement talks about creating the infrastructure to support “evidence-based, patient-centered care” and being accountable for care delivered. The creation of the Greater Baltimore Health Alliance made GBMC the first hospital in Maryland to be associated with an accountable care organization operating within the Medicare Shared Savings Program. Through all the changes GBMC has made, Chessare said he expects when final data is available, his organization will have saved the country money

Real Issues : Real Solutions



Offering an Attractive Model of Care Scarsdale Medical Group is a medium-sized, multi-specialty physician practice with three locations in New York’s Westchester County and the Hudson Valley area. The practice offers a wide range of specialties including cardiology, endocrinology, pulmonary, infectious diseases, rheumatology, gastroenterology, nephrology, geriatrics, dermatology, neurology, gynecology, podiatry, nutrition, and mind-body medicine. Kenneth D. Croen, M.D., Managing Partner



patients get lost in the system after a hospital visit.

10 Slater Street, Port Chester, NY 10573 Tel: 914-937-0004 ● Fax: 914-937-0257 WWW.STRAUSSPAPER.COM


Scarsdale uses coordinators to help bridge that gap. The practice has three care coordinators currently and would like to add more, but it is a service that is tough to afford. One care coordinator acts as a hospital liaison who visits the patients on admission and during


their stay. She also reviews discharge plans and medications with patients. Additionally, the coordinator contacts the office and updates the outpatient record to allow for a more continuous care experience for patients. “The biggest hole in the healthcare system is the transition from one location to another,” Croen said. “When our data comes in, I anticipate it will show that our coordinator process has led to a decrease in readmissions.” To fill in gaps where there aren’t enough coordinators, the practice’s physicians often work long after their office hours have ended, making phone calls and answering messages on the patient portal. For this reason, Croen said he hopes to be able to hire more coordinators in the future.


GROWING THE PRACTICE AND SPECIALTIES Scarsdale began as a two-physician practice, but its recent growth has been impressive. Over the past 2

Scarsdale Medical Group has been well ahead of

years, the group went from 22 physicians to 34 and

the healthcare-reform curve, having used elec-

is still expanding.

tronic health records for 10 years. A patient portal

“We offer an attractive model for practice,”

allows physicians to generate reports for patients

Croen said. “Many physicians are realizing that it’s

and send data instantaneously. The group is also a

not profitable to stay autonomous and are hunting

Level 3 Patient-Centered Medical Home.

for a place to call their own.”

“We keep constant pressure on ourselves to

Scarsdale is selective about the physicians it

bring innovative ideas to our practice,” said Dr.

recruits, but the doctors have the opportunity to

Kenneth Croen, managing partner of the practice.

be involved in decision-making for the group. The

Using care coordinators is one strategy Croen believes is important to improving healthcare. Many

group is mostly overseen by a series of committees on quality improvement, personnel, marketing,

Real Issues : Real Solutions

Croen said Scarsdale has been offered opportunities to join various institutions, including local hospitals, but has chosen not to. “We like our independence,” he said. “I think we can do well on our own.” Croen is also resistant to Accountable Care Organizations, which, to be successful, need to keep patients within a network of providers. In addition, the providers are incentivized to maintain quality but at a lower cost. However, Westchester County is a fairly wealthy area, and many people recruiting, lab, and care coordination, as well as the

receive care wherever they choose, regardless of

Management Committee.


Giving new physicians more space to practice,

“Patients are not a part of savings in an ACO,

Scarsdale is opening an outpatient surgical suite

so there is no incentive for them to participate,”

for podiatry, gynecologic surgery, endoscopies and

he said. “Doctors should not look for ways to save

colonoscopies, and other outpatient procedures.

money on patient care without engaging the patient

Scarsdale is surrounded by several large medical practices, including some linked to New York City medical centers. But Croen is confident in the

in that conversation. Mistakes will be made, and we don’t want to go down that path.” Croen said a better path would include trans-

quality of care at Scarsdale, care that is provided at

parency of cost and quality, allowing patients to

lower fees than the larger medical practices.

find high-value healthcare. Patients with skin in

During a contract renegotiation, Scarsdale pre-

the game will have an incentive to be healthy. Most

sented data to three insurance companies related

patients are not aware of the large discrepancies

to managing patients with diabetes. Compared with

present in fees paid for the same procedures at

data from the New York Insurance Commission,

different facilities.

Scarsdale far outperformed both the state and

“When people are unaware and unconcerned

national averages, mainly because the group has

about costs of care, they go where they please,”

more than 2,000 patients with diabetes and has a

he said. “We can lower healthcare costs by letting

comprehensive program with four endocrinologists,

people have access to fees before they get care and

three nutritionists, one diabetes educator, and a

then be responsible for a portion of the cost of their

rigorous and effective weight-loss program.




The last several years have created an air of uncertainty around the healthcare industry, and Scarsdale is looking at the best ways to position itself in this changing environment.




A New Building, A Fresh Start Over six years ago, The Nemours Foundation dreamed of building a brandnew children’s hospital in Central Florida that would outpace and outclass any other form of healthcare in the region.

Nelson Roque, Director of Facilities and Construction

Preliminary planning for the project began in early 2007. At that time, Nemours hired Nelson Roque to manage the construction of this $400-million, 620,000 square-foot investment. Roque would eventually become director of facilities and construction for Nemours Children’s Hospital. Around 2008, Roque said, the details and design of the project began to take shape. “That’s when it really got fast and furious.” At issue was the location. Nemours had been looking for property closer to the center of town, but Florida is a certificate-of-need state, so proximity to other hospitals became an issue. Not only did Nemours need jurisdictional approval for a new location, but its competition was also objecting to the organization’s intended site. Then, Orlando city officials revealed plans for the land southeast of the airport. Their ambition was to create a medical city. Already in the works was a veterans hospital, the Central Florida School of Medicine, and the Sanford-Burnham Medical Research Institute. On top of this, the land was a greenfield site. It had originally been a cow pasture, and nothing had ever been built on the land. The Nemours Foundation executives agreed that being part of this medical city was ideal for their mission, and they immediately purchased 60 acres. “Thank God they did,” Roque said, “because it’s turned into something really great. It’s getting press all over the country.”




TThe benefit of being part of a large organization such as Nemours, Roque said, is its access to resources. The best architects were hired, the most


experienced consultants brought in, and the fore-

In spite of this, Nemours Children’s Hospital’s

most experts across a variety of fields were used.

first year of operation has been a rousing success,

Nemours also tapped into its in-house talent to de-

Roque said. “I think it’s been wonderful actually.”

termine the model of care the hospital would offer

The main issue that remains is parking. The

and the most effective design for the building. Flow

hospital needs more of it, he said. “It’s been painful

was of the highest priority.

at times hosting some large events that bring on

“We were able to sit down and put on paper some different throughputs and what departments we would like adjacent to other departments, trying

a large number of vehicles because of the lack of parking. “But all in all, I think the building has per-

to use evidence-based design from experience and

formed very well from a facilities standpoint. There

from what we could read or learn,” Roque said.

are a couple little tweaks to be made. Valves need

“We had a lot of visits to other hospitals all over the

to be more accessible, but the building’s per-

country that have really beautiful and innovative

formed very, very well.”

things. Not one is perfect, though, so we borrowed

He added, “I’m very surprised with the low en-

from them all to try to come up with the better

ergy consumption. Our utility bills are much lower


than I had anticipated.”

Another matter in discussion was how the hos-

Building a robust infrastructure for both IT and

pital was going to open with not just a new facility,

utilities, though, was a priority from day one, and

but also a new staff.

Roque said he was thankful The Nemours Founda-

“We were totally green as far as our end users were concerned, and by end users I mean the

tion allowed him to do everything he requested during construction.

administrators that were going to run this hospital,

To him, this project was an example of how

the doctors that were going to provide care for the

certain events over the last decade have enhanced

kids, the nurses, everybody even the maintenance

the importance of facilities directors nationwide.

folks,” he said. “Everybody was going to be new to the building and each other.” And because every end user was going to be

“We’ve learned a lot from different natural disasters,” Roque said. “Maybe we weren’t building these things as robust or strong or as invincible

a fresh hire, Roque’s team found it “very hard to

as we thought years ago. Now with the differ-

design or try to design this place always knowing

ent storms that we’ve had and the other Mother

in the back of my mind that these doctors and ad-

Nature-related incidents that we’ve had, we’ve

ministrators were going to come into play and want

learned a lot. I think that every facility guy out there

to do things differently than what we were going to

needs to spend a good portion of his day explaining

design for them originally.”

to senior members and making sure that they real-

He added, “It was just one of those things that

ize how important some of this stuff is.”

in theory everything works but in real life certain things have to be tweaked.”





Where Community Comes First Scotland County Hospital was first established in 1970 in Memphis, Mo., as a non-for-profit district critical-access hospital. Since the beginning, its focus has been on families, both the families of its employees and of its patients SCH was originally a 19,000 sq.-ft. campus that offered inpatient care, a surgery room, lab, and X-ray. Over time, these offerings were expanded to three hospital-based rural health clinics in Scotland, Clark, and Schuyler Counties; a state-of-the-art 24/7 surgery center; specialties ranging from orthopaedics to obstetrics & gynecology to ENT & podiatry to rheumatology; a women’s center staffed with five physicians; and an ER that offers round-the-clock physician care. As the only hospital within a five-county radius, the importance of offering premier care to its community cannot be underestimated. It’s also imperative that SCH is always looking to the future, embracing the latest ideas and projects and taking stock of what its communities’ needs really are.


professionals love rural areas and have a pas-

SCH continues to be successful thanks to an en-

and friends.

gaged leadership and employee base that believes

sion for providing the best care to their families

healthcare of our communities with services close


to home.”

Currently, SCH is working on a grant initia-

in the organization’s mission “to improve the

“Close to home” also means close to home for

tive called Med Club, a program that reaches

the leadership and employee base. Many of SCH’s

out to young people in the community for the

personnel are residents of the surrounding commu-

sake of educating them on the different career

nities who have grown up there and in many cases,

opportunities, especially in healthcare, that are

returned there to raise families following college.

available to them locally. Med Club also works

This employee base is extraordinarily stable,

to encourage students to seriously pursue math

with many having worked for SCH for three or more

and science and seeks to give young people per-

decades, and it’s this core of employees that pro-

spective on potential careers, mapping out what

vides the heart that is needed for a family-focused

their day-to-day lives would look like in such a

facility like SCH.

career, how many hours they would work, salary

Furthermore, SCH employs or has relationships

potential, etc.

with approximately 20 physicians who were born

The goal is to keep the youth in the area

and raised within 50 miles of the hospital. These

committed to settling locally and contributing to

Real Issues : Real Solutions


the future of these communities. Med Club opens students’ eyes to the many healthcare careers beyond becoming a doctor or a nurse, such as medical

MMS Medical

technicians, IT techs, coding experts, dieticians, and receptionists. Approximately 300 students across four counties are enrolled in Med Club. These students meet

This catch-22 has the potential of impeding the

monthly and also go on field trips to larger learning

hospital’s passion for providing the same level of

institutions throughout the year where they spend

care available at every other facility. The near-

the day with different specialties, whether it is in a

est hospital is 45 miles away. SCH isn’t close to a

cadaver lab or IT.

four-lane highway. There is no time and no space

The hospital then remains in touch with those

for the kind of wrangling currently going on with

students who decide to pursue a medical career

healthcare reform. Organizations like SCH need

over the course of their education. SCH wants them

to know what healthcare is going to become in the

to know the offer to practice with the hospital is

next several years.

open for them.


Whatever happens federally, however, community will come first at SCH. In the late 1990s, obstetrical care was vanishing from rural hospitals,

SCH is the very definition of a rural hospital.

but not at SCH. Instead of removing obstetrics, SCH

Located in the extreme northeast of Missouri, it

chose to build out these services and constructed

is a healthcare oasis in an area that has to travel

a women’s center and began developing a birthing

one-lane bridges and state highways to arrive at the


nearest cities. The elderly population is higher than the state and federal averages, and the payer mix is

This is only one example of the SCH philosophy, for at SCH, it’s always about community.

about 62 percent Medicare and between 11 and 12 percent Medicaid. Because SCH is in a farming community, local industry is centered largely on agriculture. As a result, SCH does not have the luxury of accessing the group insurance that is normally provided by other industries. Roughly 20 percent of its patient base is covered by insurance and five to seven percent is self-pay. SCH also offers an income-based slidingfee scale that allows people who do not have insurance to better manage their medical coverage. Right now, SCH is at the mercy of whatever the reimbursement system is going to become. It is also


at the mercy of rapidly evolving medical technology. The technology is expensive, but if the reimbursements are cut, SCH suddenly finds itself battling a catch-22.





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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Real Issues : Real Solutions

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