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EXCHANGE

HCE

Real Issues : Real Solutions

MAR/APR 2013

University of Kansas Medical Center Growing Research Opportunities And Facilities HEALTHCARE EXECUTIVE EXCHANGE MAGAZINE | www.healthcareix.com


Real Issues : Real Solutions

CONTENTS

04 The University of Kansas Cancer Center IN-FOCUS STORIES 08 The Ohio State University Wexner Medical Center 12 Stroud Properties 16 Hocking Valley Community Hospital 18 Avera Marshall Regional Medical Center 22 Kadlec Regional Medical Center 25 New Hampshire Hospital 28 Tucson Medical Center 31 Wayne County Hospital 34 Carolinas HealthCare System

Dr. Roy Jensen, Director

36 Desert Valley Hospital 39 Murray County Medical Center

HCE EXCHANGE

MAR/APR

2013


Perceptive Software

The University of Kansas Cancer Center It’s an exciting time to be involved in cancer care and research, and the University of Kansas Cancer Center is positioning itself to be a leader in research and treatment. After a nearly decade-long effort, the Cancer Center became a National Cancer Institute (NCI)-designated center in July 2012. The designation signifies a commitment to excellence and an emphasis on research. It also opens the Center up to more clinical-trial and funding opportunities.

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Growing research opportunities and facilities According to cancer.gov, for an institution to become an NCI-designated cancer center, it must “demonstrate scientific leadership, resources, and capabilities in laboratory, clinical, or population science, or some combination of these three components. It must also demonstrate reasonable depth and breadth of research in the scientific areas it chooses and transdisciplinary research across these areas.” The University of Kansas Cancer Center invested about $330 million to upgrade facilities, programs, and services to meet the criteria for designation. The community actively supported the Center’s initiative by giving more than $100 million

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the facility can support about 350 to 400 patients on

genome, the future is going to be revolutionary,” he

trial every year.

said. “It’s an amazing time to be a researcher. You can do experiments and answer questions that we

Dr. Jensen said in addition to funding and meet-

could only dream about ten years ago.”

ing the requirements for designation, getting staff

He cautions, however, that budgetary cuts to

and community organizations involved and part of

the NCI and National Institutes of Health are stifling

the process was a challenge. “When we started the designation process,

to research and discouraging to new researchers.

only three faculty members had ever worked at an

Years ago, he said, a young investigator could have

NCI-designated center,” he said. “We had a number

their first-funded work in their early 30s, but now

of issues around education and getting folks to understand what it means, what it entails, why we have to start doing things differently.” The Cancer Center helped form the Midwest Cancer Alliance, a group of 20 healthcare research organizations scattered across Kansas and western Missouri, to bring everyone onto the same page and understand the benefit to the region of having an NCI-designated center.

Continuing to improve care and quality

“We are very proud of the community support we’ve received.”

the average age is in the 40s. “The constraint of resources is holding back what many of us feel could be tremendous progress. We are really changing the paradigm of how we grow and develop our researchers,” he said. “I’m afraid the new world order is not going to be in their best interest or in society’s.” However, he does see some positive changes coming out of Washington with respect to reform. “The chance of survival of an uninsured person with cancer is about 50 percent that of someone with insurance,” Dr. Jensen said. “Last year,

The Cancer Center is continuing to expand service

600,000 Americans died of cancer. I think any ef-

offerings and stay focused on improving quality of

forts to expand the number of covered individuals

care. It has plans to continue forward and achieve

should be applauded. You cannot get comprehen-

NCI designation as a comprehensive cancer center,

sive and well-coordinated cancer care in emer-

which requires further efforts for outreach, public-

gency rooms.”

health initiatives, and community involvement. Looking toward quality, the Cancer Center parin philanthropic contributions and by voting for a

ticipates in the American Society of Clinical Oncolo-

ballot initiative to increase the sales tax in support

gy’s Quality Oncology Practice Initiative Certification

of a new cancer research center.

Program. The initiative promotes self-examination,

“We are very proud of the community support

and certification recognizes a practice’s commit-

we’ve received,” said Dr. Roy Jensen, the Cancer

ment to quality related to patients, payers, and the

Center’s director. “The sales-tax initiative came

medical community. In recognition of its efforts, the University of

at a time when Lehman Brothers had just gone south, and there was a lot of uncertainty about the

Kansas Cancer Center was recently ranked No.

economy. We weren’t sure whether voters would

37 in the U.S. News & World Report’s Top 50 Best

support taxing themselves.”

Hospitals.

Through the money raised, the Center reno50,000 square feet of research space for early-

Looking toward an exciting future in research

phase clinical trials. The Center has a beautiful

Dr. Jensen is enthusiastic about the future of

82,000-square-foot facility devoted to Phase I clini-

clinical care and cancer research and the Cancer

cal trials. It has a bioanalytical lab, clinical space,

Center’s role in delivering that care.

vated 170,000 square feet of research space and

“With the technology available and knowledge

exam areas, and space for all infrastructures needed to conduct trials. Once fully operational,

by Patricia Chaney

coming out of efforts to sequence the human

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02 | The Ohio State University Wexner Medical Center

The Ohio State University Wexner Medical Center Phyllis Teater has been with The Ohio State University Wexner Medical Center, central Ohio’s sole academic medical center, for more than two decades and currently serves as its chief information officer and associate vice president for health sciences.

Phyllis Teater, MBA, Chief Information Officer and Associate Vice President for Health Sciences

Teater brings to the table a practical eye, uncanny focus and savvy, and common-sense insight on the issues and trends confronting CIOs on a daily basis. Her talents and leadership have contributed to Ohio State’s Wexner Medical Center achieving the highest stage of HIMSS Analytics’ Stage 7. In fact, bringing Ohio State’s Wexner Medical Center to the point of being completely paperless is one of her and her team’s greatest accomplishments. In October 2011, over the course of three to six weeks, Teater and her team trained 14,000 people on the Epic Enterprise Intelligence platform. In one day, Ohio State’s Wexner Medical Center was able to “go live” with every major and many minor revenue-cycle applications that a critical-care facility could have. Her perspective and wisdom offers valuable insight for CIOs and IT personnel who are struggling with the perplexities of the U.S. healthcare system.

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The first dimension is technology-based. A CIO must be active in researching and presenting solutions that will advance the strategic vision of the medical center. These solutions must be broad enough to cover everything from the help desk to a $100-million investment in electronic medical records. The second dimension is relationship-based. A CIO must work with all of the operational departments at the organization so they can gain the broad perspective needed to bring solutions to the table. A CIO needs to listen to each department head, because most of them have been in health-

Relating to the executive and clinical teams When it comes to the board room and contributing to the organization’s decision-making process, Teater considers a CIO’s role to have two dimensions.

care long enough to have overseen or experienced the automation of some aspect of their department. “I have been here 22 years and I am very fortunate to have a rich history of understanding a lot about all of the departments, because in 22 years all of them have undergone at least one system

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government, and vendors. It can be hard to deter-

from your organizational leaders who can help

mine where strategic priorities should be placed.

you champion the right things to do, you will fail,

Now that the Wexner Medical Center has

because you will try to do them all, you’ll do none

achieved EMR integration, Teater is focusing much

of them well, you’ll have everybody struggling to

of her attention on mobility and the social tools that

understand why you’re not doing their individual

accompany it.

thing.”

“It’s that whole side of the world that is pro-

She concluded, “You better have a tight pro-

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gressing so fast that we are challenged even to

cess for thinking about how you deploy your lim-

Everything you need to Maximize the Power of Dragon Medical

keep up, let alone to try to get ahead and really plan

ited resources on the very best things, especially

out our own strategy to leverage and support it,”

when they’re all great ideas.”

she said. of the incoming caregivers who are young enough

Communicating ideas in unique ways

to be as attached to their phones as teenagers are.

In the future, CIOs will be guided by this ability to

Their acclimation to smartphone technology is re-

lead, to motivate and empower staff, to build peer

ally changing the game, she said.

relationships, and to rally organizations around

She sees a tremendous opportunity with many

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“We need to be able to provide solutions that enhance their productivity in the way that mobile

steeped in their technology abilities are gone,”

ally and professionally,” she added.

she explained. “I think that there are CIOs who have good technical backgrounds who can be good

themselves, their team, and the executive suite that

leaders, but the characteristics of a strategic CIO

will help them gain this leverage?

who is really contributing to the organization move

Teater listed several.

away from the technical skills and more to the soft

First, how do you take advantage of techno-

skills.”

logical advances? How do you incorporate RFID

A CIO’s job description in the future will be

into healthcare? How do you strategize building

about getting people to understand why they’re

automation?

implementing a certain technology and what that

How can you develop the more infrastructurebased advances that have the ability to make

technology brings to the table, she predicted. “Without a good foundation in how you com-

patients’ lives more convenient, make an organiza-

municate ideas in unique ways to get people’s

tion’s care more accessible, and make the patient’s

attention in the deluge of information that appears

journey through a system feel planned and less

in every device and mailbox, an organization will

reactive?

flounder,” she warned. “It won’t understand what

How do you engage your organization in planning and implementing this trailblazing amount of change? Finally, how do you manage the resource crunch that has come with the explosion of automaPhysician Technology Partners

“I think that the days of a CIO that is more

phones enhance all of our productivity both personWhich questions, then, should CIOs be asking of

overhaul, if not four,” Teater observed.

ideas, Teater said.

you’re doing. “Communication is a huge piece of managing change.” By Pete Fernbaugh

tion and information technology in healthcare? “The demand is overwhelming to the point where

Because she is a key member of the executive discussions, she is able to address departmental issues that may not have been initially considered.

Asking the right questions When it comes to identifying IT trends, CIOs are routinely deluged with information from media, the

Physician Technology Partners worked hand in hand with the OSU Wexner’s Emergency Department to integrate Dragon Medical with their Epic EHR implementation. The project was a great success and they have achieved nearly 100% adoption. The transcription savings and increased productivity has been tremendous!

the bad ideas nobody even talks about, and you can’t get to all the good ideas,” Teater said. “As they’re preparing for this future, all organizations need to spend a lot of time on their decision-making process around priorities. If you don’t have a strong process here, where you have involvement

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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03 | Stroud Properties Inc.

A son remembers his father Back in the eighties, Jim’s father, a resident of the Texas panhandle, suffered his second stroke and was told that he had to enter into supportive care. “The only care that was available in the panhan-

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said. Nevertheless, he and his brother consented, only making one request of the supportive-nursing community. They asked that their father not receive tray service in his room. To do so would lead to iso-

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lation, and they feared that their father could lose his spirit of living.

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“Sure enough, six months later, he was getting tray service,� Jim recalled. “One year later, he wasn’t doing anything physically.� Eventually, Jim’s father lost the ability to com-

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municate and soon passed away. “I thought if I could ever do something different and create something that was more consumer friendly, that really matched the level of care with the level of need, I would do it,� Jim stated.

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A focus on resident choice In 1990, Jim joined with others who shared his

Stroud Properties Inc.

vision for senior living to form a trade association that is known today as ALFA or the Assisted Living Federation of America. The group would develop a senior-living model

Stroud Properties, Inc., was founded in 1982 as a real-estate acquisition and land-development company. Eventually, Stroud’s primary focus would be on the development and operation of senior-living communities. However, Jim Stroud, president, will tell you that the road to assisted living was a long one, and it began with a very personal experience.

largely based on one that had been present in Hol-

the first—consumer choice. The third pillar was oriented around providing

land for decades and introduced to them by Paul

senior-friendly programs that would combine the

Klaassen.

benefits of home with supportive care, avoiding “one

From the beginning, the group knew that senior living had to change its focus to resident choice, which Jim sums up in the following way: “The resi-

care fits all,� and instead matching the level of need with the level of care. The fourth and final pillar was centered on hir-

dent has the ability to choose their living environ-

ing people who had the right heart and were pas-

ment. The resident and their family have to be able

sionate about serving seniors.

to choose what type of care program they want. It shouldn’t be something that is mandated.�

Jim Stroud, President, and Will Stroud, Director

care reimbursements. The second pillar followed

By 2009, this company, Capital Senior Living (NYSE: CSU), was seeing record growth with over

This was reflected in the four pillars of the

2,000 employees and 65 properties nationwide. Jim

organization. First, the group determined that they

resigned from CSL in 2009 and returned to the hold-

would remain private pay so they could avoid the

ing company, Stroud Properties. That’s where his

limits imposed by state and federal law on Medi-

son, Will, who had been working in senior living at

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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Even today, most market analysis is basic—start with a simple analysis of census data and look at the number of seniors in a market; determine the number of units already in that market; and determine if there is a demand by comparing the two in a ratio. However, Will was able to apply new technology,

“Every day should have a purpose.”

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such as state-of-the-art mapping software, satellite

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technology, and census-tracking data to the process of land acquisition and building development.

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Through these tailor-made tools, Will and the team also developed a grid of 15 different variables that would indicate key markets and the viability of

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a project in each one. By forming a land-acquisition network of people who could inform Stroud of the specific traits of that market, they were able to figure out the areas in which Stroud should develop senior-living facilities, down to the most attractive census tract, zip code, or even block. “You see a lot of product that has to be turned around due to low occupancy,” Will observed. “Seventy-five percent of the time, they probably built it in the wrong location. The other 25 percent of communities have ineffective management in place. We feel that through our systematic approach to development and our attention to the daily needs of seniors, we have created a successful business

various levels since he was 14, entered the picture,

strategy.”

bringing his youth and expertise with technology and love of business to the table.

A typical development process involves Stroud

Sonoma House Assisted Living is their new prototype that has broken ground in Carrollton, Texas, with an even greater focus on resident-centered living. They use smaller buildings with higher staff-to-resident ratios to give the resident a truly homelike environment. Through this development, Stroud has the ability to tailor each resident’s daily living experience uniquely to them, just as if they had live-in care, but without the enormous expense that comes along with it. “What we’re doing is creating purpose,” Jim said. “Yes, they’re aged. Yes, they may have physical and mental impairments. But they still have a day. Every day should have a purpose.” By Pete Fernbaugh

looking at 20 to 30 Primary Market Areas of four

Making Stroud Properties more senior-focused The questions before Jim, Will, and their team

miles each before deciding which ones to be in. Once those PMAs are identified, this system allows them to collect and process huge amounts of information almost instantaneously.

were, What type of product, what type of design,

Currently, Stroud has two different product

and what type of building method would be able

types under development. Orchard Park is the

to launch Stroud Properties into the senior-living

brand name of their 75-unit Assisted Living and

market for the next 20 years?

Alzheimer’s community that is under development

“We realized there was a better way to do things

with the McFarlin Group throughout Texas, the first

as far as the way we approached markets, the way

of which will open to the public in late February

we approached land acquisitions, the financial

2013 between Midland and Odessa, Texas.

modeling, the actual product itself, and the actual customer we were appealing to,” Will said.

Five more of these communities are under construction and will open in the next 14-18 months.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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04 | Hocking Valley Community Hospital LeeAnn Lucas-Helber has been president and CEO

“We get some fabulous comments from families,”

for five years; however, her career with the hospital

she said. “People will bring a family member and

stretches back 18 years. She has previously served

say, ‘You got mom back into life’…and helped them

as chief financial officer and network administrator.

to be functional and understand what’s going on

In fact, it was her IT background that brought her

with them.”

into healthcare where she discovered an outlet for

She added, “It’s just a wonderful thing to see

her passion to make a difference in other people’s

folks that are just really not engaged and dis-

lives.

connected with family and life in general to get

She finds that the connection she shares with the community serves to motivate this passion, observing, “When you go home at night, you’re

reconnected through some activities and therapy sessions. It’s just a wonderful thing.” Hocking Valley is also proud of its HCAHPS

seeing those people in your grocery store, they go

patient-satisfaction scores. As a critical-access

to your church, your children go to school with their

hospital, they’re not required to participate in the

children, so you’re caring for your friends and your

HCAHPS survey, but she explained that the lead-

neighbors.”

ership team felt it was important to see how the

Reaching beyond critical-access care Although a critical-access hospital by definition, Hocking Valley has expanded its services be-

hospital was doing compared with other area organizations. She said they routinely score in the 90th percentile or higher, often surpassing the numerous hospitals in nearby counties. “In a small hospital you can’t be all things to

yond what is expected of them. For example, the

all people, but you can certainly compete from the

organization runs an urgent-care center inside the

aspect of service,” Lucas-Helber stated. “Patients,

hospital, and it has a 10-bed geriatric psych unit in

there’s no question that when they come to a

addition to its 25 patient beds.

healthcare facility, they’re expecting you to provide

“That’s definitely a need that we have,” Lucas-

quality care and do everything right, but it’s how

Helber said. “We pull from a large referral area. It’s

you make that patient feel while they’re here, and

kind of a unique unit. Obviously not a lot of places

not only the patient, but their family. You’re caring

have that.”

for everyone and keeping them informed, and just

In fact, since the service was added in 1997, the

creating the best experience that you possibly can.”

psych unit has attracted people from as far away as

Modeling a positive culture Several years ago, the organization became involved with the StuderGroup. Lucas-Helber recalled “An organization will never achieve full potential until the ED is leading the way in patient satisfaction and physician leadership.”

that at the time, it was a new, but common-sense approach to changing the health of the hospital’s culture.

— LeeAnn Lucas-Helber, CEO

“When you’re honest with your folks and have a healthy culture, when you have to face some difficult decisions, your culture’s more accepting,” she said, adding that the culture has drastically changed since she first arrived at Hocking Valley in 1995. For one thing, the executive team places a higher priority on regularly communicating with the staff.

Premier Physician Services recognizes Hocking Valley Community Hospital and their efforts to provide quality care through appropriate use of resources, community education and new technologies. Premier is proud of Hocking Valley’s success and our partnership in Emergency and Hospitalist Medicine.

As CEO, she holds frequent employee forums where she sets aside time over a three-day period to update all of the employees and staff on organizational issues, such as patient satisfaction, quality metrics, finances, new services, and other changes the hospital is making. It’s important, she said, to connect every employee with the hospital’s mission and goals. “We’ve worked really hard to make sure when you ask someone what they do, they don’t say, ‘Well, I’m just a housekeeper.’ No, you’re in charge of making sure that our infection rate is low,” Lucas-Helber explained. “Making that connection gives them ownership in that role, and that, ‘You are a key piece to our success.’ It takes all of us working together, growing in the same direction

South Columbus.

to make all of the moving parts of healthcare flow smoothly.”

Hocking Valley Community Hospital

Advocating for rural healthcare

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Lucas-Helber firmly believes that small rural hospitals are critically important to the healthcare

Like most rural hospitals, Hocking Valley Community Hospital plays an integral role in its community, for Hocking Valley is the only hospital in its county. In many ways, Avera Marshall was content to be a local hospital, mainly concerned with the needs of those confined to the city limits. A critical-access facility located in Logan, Ohio, Hocking Valley struggles to meet the needs of an economically challenged community. The hospital serves a 55 to 60-percent aging payer mix of Medicaid, Medicare, and underinsured patients. Furthermore, Hocking Valley is an economic engine within its community, being the second-largest employer in the county.

system in the United States. “Sometimes I don’t think communities realize what a valuable asset that that community hospital is,” she stated. “Again, we can’t do all the grand things that you may be able to do in a large urban setting or a teaching setting, but there are things that can be initiated and started in your community hospital.” Even if the patient has to go to a larger facility

community hospital for rehab or other post-acute needs. That alone, she said, “keeps healthcare costs down.” It also helps the families. “If you’re here in your hometown at your local hospital, it’s less strenuous for families than to travel an hour, hour and a half, two hours to a larger city to help in that recovery process.” by Pete Fernbaugh

for more complex care, they will often return to the

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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05 | Avera Marshall Regional Medical Center

Among its service offerings is OB, which is unusual for a critical-access hospital. However, with 460 babies born at Avera Marshall each year, the service is justified, as is its emergency department that hosts 7,600 emergency-medicine visits per year. Its physicians’ group, Avera Medical Group, has rapidly expanded and now comprises a large part of its business.

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Symbolic of its rapid growth, Avera Marshall added 22,500 sq. ft. to the main campus of its medical center in 2012. This is comprised mostly of a new physiciansâ&#x20AC;&#x2122; office building for the medical group. The organization prides itself on having solid

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lence and growth, Avera is now a designated Level 3 trauma center. â&#x20AC;&#x153;Weâ&#x20AC;&#x2122;re poised for really good growth,â&#x20AC;? Mary Maertens, president and chief executive officer, said. â&#x20AC;&#x153;And we think our primary-care group will drive additional clinical-care business for us. The Level 3 does differentiate us from really every other

Avera Marshall Regional Medical Center

hospital in our immediate footprint here. We feel

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30

very strongly about the steady improvement that the emergency medicine has taken.â&#x20AC;?

As recently as October 2008, Avera Marshall Regional Medical Center in Marshall, Minn., did not have a medical group or own any clinics. It was largely concentrated in its own relatively small footprint. In many ways, Avera Marshall was content to be a local hospital, mainly concerned with the needs of those confined to the city limits.

Mary Maertens, President and Chief Executive Officer

Fast forward to 2013 and Avera Marshall is growing rapidly and proving to be a competitor in a highly competitive region. A member of the Avera network of hospitals, it is now a $90-million business with 26 hospital-based and mid-level providers, spanning a service area of roughly 123,000 people across several counties. It is state-licensed for 49 beds and operates 25 of those as a critical-access hospital.

Trying to be more Looking back, Maertens is candid about Avera Marshallâ&#x20AC;&#x2122;s past. Having been a city-owned organization for nearly 60 years, she recalls that the hospital had undercurrents of a public-entitlement attitude. As a result, she said, â&#x20AC;&#x153;we were sort of asleep.â&#x20AC;? The hospital board, however, began to reexamine the hospitalâ&#x20AC;&#x2122;s potential, and various board members felt the organization didnâ&#x20AC;&#x2122;t have to limit itself to one service site. They believed Avera Marshall had the potential to be a regional referral center.

â&#x20AC;&#x153;Everyone on our board thought we needed to aspire to something bigger and greater, so thatâ&#x20AC;&#x2122;s been our focus for the last eight years,â&#x20AC;? Maertens said. To achieve this would mean awakening the lethargic culture that had gripped the hospital for years. It meant that its tenured staff--every manager, every leader, every staff member--would have to adapt and grow. Expectations would no longer be rooted in the status quo. Avera Marshall engaged the StuderGroupâ&#x20AC;&#x2122;s services, working with them to create a culture of alignment, accountability, and action.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

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in the community. It’s important that they fill gaps in care by partnering with the community in innovative and creative ways. As part of the Avera network, co-sponsored by

“I feel very strongly about really putting the patient in the center of our decision making.”

the Benedictine and Presentation Sisters, faith and ministry are key to Avera Marshall’s operations. Being a member of that system has motivated Avera Marshall to widen its footprint and increase its dedication to keeping care close to home. Maertens has been with Avera Marshall for 25 years. However, she has been president and CEO for the last six years, one of its most transformative times. Through these ongoing challenges, her personal values of compassion, hospitality, and stewardship have been reaffirmed. As a registered nurse, she knows firsthand how important it is to be dedicated to the patient. “I feel very strongly about really putting the patient in the center of our decision making,” she said. By Pete Fernbaugh

As part of this culture change, Maertens said it

that’s fast enough to do these sorts of things, and

has now centered its quest for growth on aligning

being able to manage and mitigate enough risk to

itself with physicians and providers through both

have enough money to make payroll,” Maertens

employment and acquisitions. The hospital also has

said.

a number of service teams who are engaging the

It’s much more difficult to find capital to pay for

direct-care staff, partnering with them to renew fo-

new expenditures than it was five years ago, she

cus on the patient, resident, and client experience.

added. Fortunately, for the last five years, Avera

They’ve also started operating from a value-based

Marshall has had good operational performance

purchasing standpoint.

thanks to the solid governance of its board and its

“Our vision is really based on growth, commitment to market differentiation through technology,

CFO’s efforts to position them for the difficult times. “We’re all as healthcare executives challenged

and maintaining financial performance so that we

to change our own leadership style to be more

can plow it back into growth,” Maertens explained.

results-oriented and be more responsive to our

Working with less Given its rural location, Avera Marshall’s goals are ambitious, but in the current healthcare environ-

communities and patients in a very, very competitive, rapidly changing environment,” Maertens observed. Because of these difficult times, it would be

ment, its goals are also daring, especially with

easy for Avera Marshall to slip back into sleep

less and less money coming into the system from

mode, but as its leader, Maertens is determined to

reimbursements and insurance.

continue on the path of growth in spite of the odds.

“In our world, we’re trying to deal with all of

It’s important that healthcare executives

that and reposition ourselves under a value-based

maintain their sense of mission to the community

purchasing, accountable-care environment, wrap-

around them, she said. It’s important that they be-

ping our head around it, having the decision support

come increasingly mindful of the healthcare needs

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

21


06 | Kadlec Regional Medical Center

40,000+procedures 38 radiologists 9 locations

Budgetary concerns for implementing an EMR Vice President of Information Services and Chief Information Officer David Roach said budgetary concerns are often the biggest hurdle in receiving buy-in from the executive suite on a major system.

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existing applications that Epic would replace. “One unified system will save you money in the long run,” Roach said. “It’s a large investment in the front end, but when we looked 10 years out, the

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mittee and CEO on the unified system, Roach found the need for many more budget items that may

Kadlec Regional Medical Center All healthcare facilities are interested in or moving toward electronic health records, both as a federal requirement and for improved efficiency and safety within organizations. Implementing these systems across a health system or even within one hospital is often a headache and requires many moving parts coming together.

David Roach, Vice President of Information Services and CIO

Kadlec Regional Medical Center implemented the Epic suite of products a little over a year ago with much success. The hospital did a “big-bang” go-live, bringing up all service lines in the hospital simultaneously, and replaced more than 30 smaller applications with one large, integrated medical record. As a 280-bed acute-care community hospital, Kadlec is one of the smaller clients with whom Epic has engaged. Kadlec’s services include open-heart surgery, interventional cardiology, a neonatal intensive-care unit, among many others, as well as physician practices and primaryand specialty-care clinics, for a total of about 15 sites.

sometimes get overlooked or not included in the initial phase of planning. He suggests hiring legal counsel for contract negotiations, mainly because

Roach said the consultants were onsite for about

the investment is likely to be a 10 to 20-year part-

14 months, which was no small investment, but it

nership.

was necessary.

“When contracting for a product that would

At the go-live, Roach also had about 100

outlive me, I hired a couple of lawyers to assist with

consultants onsite for two weeks providing floor

contract negotiations,” he said. “It is helpful to get

support to clinical staff.

some expertise on your side. Contracting is key to a successful partnership.” Staffing was another large budget item. The hospital had a shortage of IT staff at the time, so

“The cost of consultants was not insignificant, but it was the right thing to do to support the clinical people making the conversion,” he said.

work and maintain the existing clinical applications,

Getting the clinical staff on board with an EMR

while the full-time IT staff focused on learning the

Getting physicians, nurses, and other clinical

new applications, receiving certifications, meet-

staff on board with a new electronic system can

ing with physicians and medical staff to configure

be a major challenge. Roach said his team opted

the system to meet their needs, and other training.

to go live with all hospital departments at once

Roach hired consultants to fill in the day-to-day

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

23


07 | New Hampshire Hospital

because it minimized the clinical risk. However, the off-site clinics came online a few months before the hospital. Training and communication with medical staff are also key to a successful implementation. Roach decreed that no optimization changes would be made to the system within the first three months. The IT team’s focus would be on fixing things that didn’t work, but all other requests would be put on hold. IT worked closely with the clinical team to prioritize the fixes and then later, worked with them to prioritize the optimization changes. “Once we had an ongoing dialogue with the clinical team, they were happy and on board with the process,” Roach said. “We had meetings to prioritize, then would report at the beginning of every meeting what we had completed from the last meeting. The clinical team realized that IT was trying to meet their needs.”

Next steps to mine data Now that the system is in place, Roach said his next efforts are to focus on how to use the data coming from Epic. One area is to arm the hospital’s business staff with patient-care and quality data that they can bring to the table in negotiations with

nity-connect model and selling the Epic system to local physicians and possibly some critical-access hospitals. The data and connectivity provided by the system also place Kadlec in a good position to lead an accountable-care organization in the region should the market trend that way. BY Patricia Chaney

insurance companies. Focusing on meeting Meaningful Use require-

New Hampshire Hospital

ments is also a large part of Roach’s responsibility. He said the funds available add up to about $8 mil-

Current trends in healthcare all seem to revolve around the mantra of “do more with less.” For most facilities this involves re-evaluating processes and finding ways to become more efficient. As a public psychiatric inpatient hospital, New Hampshire Hospital has had to retool its care plans to adjust to a changing landscape during the past two decades.

lion over five years. So far, the hospital has received about $3.5 million. “Someone has to oversee the use of the system and hold doctors accountable,” he said. “The government does pay you, but it’s not without a lot of effort.” The next steps for Kadlec are to increase connectivity across the region by developing a commu-

Robert MacLeod, Chief Executive Officer

In the 1990s, New Hampshire Hospital had 220 beds and about 800 annual admissions. Today, the hospital has 152 beds and about 2,500 annual admissions, with many more complex cases. The average length of stay has dropped to seven days, whereas in the past, patients may stay weeks at a time.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

25


Trust your energy needs to a specialist.

ated and treated within that span. New patients

had to reduce its staff by 200 employees. Although

are assigned a treatment team consisting of a

challenging, MacLeod said the organization was

psychiatrist, a registered nurse, a social worker, a

able to downsize without disrupting services and

mental-health worker, a recreational therapist or

without damaging staff morale.

an occupational therapist, and a medical doctor if needed. A growing trend in providing psychiatric care is incorporating substance-abuse treatment. MacLeod said about 50 percent of the population

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and reimbursement, and the civil-commitment pro-

the hospital has kept the two problems separate,

cess, which is defined as people who are danger-

but now treatment must incorporate substance-

ous to themselves and others. The hospital is also

abuse treatment into the care plan.

working on ways to improve public safety such as

involving metabolic diseases and their influence on mental health. As with all organizations, patient safety and quality are extremely important at New Hampshire Hospital. Ensuring the proper identification of patients before administering medications or any other treatment is paramount. At a psychiatric hospital, patients come in distraught, disoriented, confused, or sometimes angry and are not always able to articulate who they are or their medical history, including current medications. Infection control, suicide prevention, and falls

“Mental-health care is going to look different as we

prevention are major safety initiatives going on at

know more about mental-health diseases and how

New Hampshire Hospital.

to treat them,” said Chief Executive Officer Robert

The hospital has succeeded in providing

MacLeod. “We have to place more focus on shorter

safe, quality care to patients and maintains Joint

hospital stays and a care plan that gets people back

Commission Accreditation. Using the Global As-

into the community. We need an internal view and

sessment Functioning score to measure patient

an external view, working with community health

improvement, MacLeod said that most patients

centers and other community providers.”

come in with a score of about 30 and leave with a

Most patients are admitted to New Hampshire

score around 70.

have a right to a hearing within three days of ar-

Finding ways to do more with less

riving. If a petition is granted, they can be kept at

Budget cuts are increasingly common among gov-

the hospital for 10 days. Patients must be evalu-

ernment-funded services, and in 2012, the hospital

of legal work to be done by the hospital, as patients

Currently, the hospital has Lean initiatives go-

addition to their mental-health issues. Historically,

health, and the hospital has had initiatives going on

Hospital involuntarily. This requires a large amount

annually by consolidating warehouse services.

comes in with substance use or abuse problems in

sideration to how medical issues affect mental

Changing the delivery of mental-health care

For example, the hospital saved about $1 million

ing on in the admissions/discharge process, billing

MacLeod said providers also give more con-

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New Hampshire has been implementing Lean Six Sigma principles as well to improve efficiency.

notifications of discharges.

Developing strategic partnerships In the 1980s, New Hampshire Hospital faced a crisis point in its ability to provide care, and out of that was born a partnership with the Geisel Medical School at Dartmouth College. All psychiatrists at the hospital are also faculty at the medical school, and every resident of the medical school spends two months working at the hospital. A number of medical students also perform their third-year psychiatry rotation at the hospital as well. With some uncertainty as to what the future holds, MacLeod emphasizes the importance of providing quality mental-health care. “Mental health affects other parts of health and is as important as anything else we do in healthcare,” he said. “Mental illness hits almost every family in one way or another. Our goal is to take away the stigma. We want to get people who need help admitted, get them healthy, and get them back out in the community.” by Patricia Chaney

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

27


08 | Tucson Medical Center

Delivering quickly and staying on budget

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Prevallet said his primary challenge on this project has been time. Once he had approval from the Board for the project, he needed to start delivering. “It’s really how fast can you get going and how fast can you get the place opened up so you start generating income,” he observed. Initially, Prevallet was concerned that various commodity prices, such as steel, were going to skyrocket. He immediately went out and struck longterm deals with manufacturers that locked the prices at their then-current levels. Another decision Prevallet had to make early on regarded LEED certification. He ultimately decided

Tucson Medical Center

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that TMC didn’t have the money to spend on the certification process. However, this didn’t deter him from modeling the project after LEED standards, and he

Several years ago, Tucson Medical Center in Tucson, Ariz., determined that it simply wasn’t feasible to build a complete replacement hospital. “We certainly have the space for it on our campus because we have a lot of acreage, but the cost of construction to build a replacement hospital was too high,” Richard Prevallet, vice president of facilities and construction, said. “What we did recognize was that the existing hospital really had good bones in the sense that we could do major core renovations within the hospital and make some additions and improvements and really modernize the hospital for the next 25 years.”

Richard Prevallet, Vice President of Facilities and Construction

figured that he could achieve 80 to 85 percent of LEED

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benefits just through good design. “For me, that’s a nonnegotiable that we are designing to a LEED standard even though we would not go through the formal certification process,” Prevallet explained. “Certainly as a design requirement, when it comes to energy, the facility will be designed and built so it earns an EPA Energy Star rating.” A solid energy-efficient design also makes for a

Confronting infrastructure challenges One of the most challenging areas in the project so far

better environment within the building, he added. Not

has been the low-voltage systems. With a complex IT

only does the facility have better thermal control and

infrastructure supporting 24 operating rooms on two

comfort for the people that are in the building, but the

floors, the cabling infrastructure is extensive. It was

building also has better indoor air quality and a safer

vital that the design team had a clear understand-

TMC has already completed expansion on its pediatric and maternity units and will soon complete construction on its new operating rooms, entrances, parking garage, four-story surgical and bed tower, and physician medical offices.

environment for patients.

ing of low-voltage systems, because managing the

Much of the planning for this $125-million expansion and renovation project took place throughout 2010. By June 2011, TMC had successfully expanded its pediatric and mother-baby units along with much of the roadway and infrastructure work on the east side of the campus.

mitment of the facilities team year in and year out to

This decision by the TMC Board of Trustees and it chief executive officer, Judy Rich, set in motion a campus redevelopment plan that has transformed the 115-acre campus and its 629bed, 750,000-sq.-ft. hospital, the largest single-story hospital in the country.

That was the first of two phases and cost the organization roughly $20 million in construction and improvements. TMC is currently in the middle of the project’s second phase.

“What it ultimately comes down to in my mind is the commitment of the organization and the com-

installment of those systems was vital to the project’s success. Also, it was important to first understand the

maintain the building and environmental systems for

front-end costs and benefits of distributed chilled-

the hospital in a way that drives the best operational

water systems versus a stand-alone system before

costs and the lowest energy costs,” Prevallet stated.

making a decision as to what was best for TMC. Initial

“If you don’t have that commitment, it doesn’t matter

costs for stand-alone systems tend to be lower, but

whether you’re LEED certified or not.”

the life-cycle costs are higher.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

29


09 | Wayne County Hospital

“Understanding the costs-benefits analysis for in-

cess, he said. Six months after it is in the space,

frastructures is critical and then being able to show

TMC hopes to see improvements in efficiency and

the benefit over the life of the building is important

increased surgical volumes while maintaining the

as you move forward with planning and budgeting

highest standards for patient safety.

for a project,” Prevallet said.

Third, he asks, what are the patients saying

Transitioning personnel from one stage of a

about their experience in the hospital? Patient input

project to the next was something else that needed

was also an important element of the project plan-

to be taken into account. Currently, Prevallet is

ning. What did former patients think TMC needed to

figuring out how to move an entire surgery depart-

do differently in pediatrics? Much of the design for

ment into the new wing and still keep operations

patient rooms came from their feedback.

flowing for both the surgical services and the sterile-processing department. “It will be really tricky to figure out how we

“It comes down to really high-quality care, which will drive to great outcomes and the best possible patient experience,” Prevallet said. “If we

piece-by-piece room-by-room leave the exist-

can hit those three things on the project, then we’ve

ing location and then move into the new building

done well.”

while maintaining our high standards for patient safety and minimally impacting surgical volumes,”

by Pete Fernbaugh

Wayne County Hospital

he said, adding that multi-disciplinary teams have spent many months developing the transition plan.

Making a project successful

Rural hospitals across the country are working to become more efficient, meet their financial obligations, and evaluate service lines to ensure they are providing the most necessary care to their patients.

Prevallet has three barometers by which he will measure the success of his redevelopment plan. First, have they built the safest environment

Uncertainty about the effects of reform still looms, as details of changes to critical-access status or other reimbursement issues are not yet clear. But most rural hospitals are fighting to stay open and reminding Washington that, although small, they are vital members of the communities they serve.

possible for their patients, visitors, and staff? Second, have they built an efficient and effective environment for their staff and physicians? Receiving input from the physicians and staff has been critical in the planning and design pro-

Daren L. Relph, PS/CCP, Chief Executive Officer HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

31


in PTAs, city council, school boards, and other civic or service organizations. This spirit “draws tight connections between our facility and other entities in the community,” Relph said.

Providing the best care needed to patients As with any small hospital, Wayne County is constantly evaluating the services it provides to ensure they are the most useful to the community. The hospital operates four family-practice clinics that are spread throughout each corner of the county. These clinics are extremely successful for the hospital, with the largest one receiving more visits per month than there are residents in the town. In addition, the hospital provides obstetrics for a five-county area and has a strong orthopedic program, performing hip and knee replacements. Wayne County leverages technology to provide quality care to patients as well. The hospital recently upgraded its electronic medical record and added a patient portal for the clinic system that allows patients to schedule appointments, pre-register for appointments, and pay bills online. In partnership with Saint Luke’s Hospital in

Caring for friends and neighbors

Kansas City, Mo., Wayne County Hospital provides eICU care for critically ill patients. The service has remote-monitoring capability for patients requiring

In one of the most sparsely populated counties in

a higher level of care than a normal acute admis-

Iowa sits Wayne County Hospital. The 25-bed criti-

sion.

cal-access hospital serves a county of about 6,600

“The eICU program allows us to keep higher-

people with a total catchment area of approximately

acuity patients near their families and give them

18,000. It is the largest employer in the county, and

the care they need,” Relph said. “It also gives our

as a result, Wayne County has a close connection to

medical staff and nurses the back-up they need to

the residents.

feel comfortable with that level of care. We were

“In a community of our size, our staff always has some connection with our patients,” said Chief Executive Officer Daren L. Relph, PS-CCP. “We see

one of the first critical-access hospitals in the state to have an eICU.” Wayne County continues to look for services to

them in the grocery store, at ball games. Our staff

add as it strives to determine what is most needed

is constantly aware of the people we are serving

for the community.

and our commitment to providing healthcare for

“We regularly vet proposals for service lines to see what is most productive financially and what

our populace.” In addition, employees of the hospital are closely tied to the community, actively participating

will meet the needs of the community,” Relph said. “We would like to expand services and create job

opportunities to increase our economic impact as well.”

Preparing for financial changes

Dedicated to quality and patient satisfaction

Wayne County Hospital has a management agree-

When providing care to family, friends, and neigh-

Network of Healthcare Services. But with changes

bors, patient satisfaction is extremely important to Relph and the hospital staff. Wayne County has received two awards from Press Ganey for consistently achieving high patient-satisfaction scores. “We remain focused on the importance of our patients’ perception of care and continue to carefully monitor the results,” Relph said. “We currently survey our Ambulatory Surgery Department, Emergency Department, Inpatient Service, and Outpatient Service areas, and beginning January 2013, we will survey our Medical Practice Clinics, as well.” He added, “I think our rural setting and friendliness of staff lends itself to higher quality and patient-satisfaction scores.” The hospital has a robust quality program and has a partnership with the Studer Group. Relph said the hospital has been able to identify areas for quality improvement, but now has a better ability to mine data and track progress and has developed a process for submitting areas of improvement to drive change.

ment with Mercy Medical Center of Des Moines and is part of the center’s statewide collaborative, to the critical-access program, the hospital is unsure of what reimbursement will look like in the coming year. The hospital sees a large number of elderly patients and has a payer mix of about 60 percent Medicare and Medicaid. Relph said the focus now is on efficiency and process improvement. To receive a more favorable reimbursement, the hospital and clinic system obtained official Rural Health Clinic designation for all locations. As with everyone in healthcare, Wayne County is looking for ways to do more with fewer dollars and shelter itself against legislative uncertainty where possible. “I think that the pressure is on the C-suite in every organization to be as innovative as possible,” Relph said. “As the healthcare dollars from reimbursement get smaller and smaller, we will have to be smarter about how we operate.” by Patricia Chaney

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

33


10 | Carolinas HealthCare System

“We recognize that the entire industry is on an eco-

hospital networks for treatment of stroke and heart

ally. Uncompensated care and community benefit

nomically unsustainable path, and we have to look

attack. Certified neurologists are connected with

runs about $1.16 billion annually, which is nearly 20

at what changes allow us to provide more value

hospitals to aid in diagnostics remotely.

percent of the system’s operating budget.

over time, while still recognizing that healthcare

In addition, the Levine Cancer Institute is a first-

Premier facilities in the system include Levine

is a large part of the economy in the communities

of-its-kind approach to cancer care. The Institute

Cancer Institute, Levine Children’s Hospital, and

we serve,” he said. “The opportunities that exist

distributes expertise and resources strategically

Sanger Heart & Vascular Institute. By covering a

are substantial and gratifying. This is some of the

throughout the region. It has 30 oncologists and

large geographic area, the system sees a diverse

most fulfilling professional work that goes on in

12 charter-member institutions. In January 2014,

range of patients from all ages, backgrounds, and

our country, and I am grateful to have a voice in an

the Institute is expanding to offer a hematologic-

income levels.

organization such as Carolinas HealthCare System

malignancies unit to treat patients who need bone-

to help guide the transformation of healthcare go-

marrow transplants.

ing forward.”

CHS is also one of 26 large organizations “fully

Bringing innovative solutions for care delivery

engaged” as a Hospital Engagement Network (HEN)

“We understand our communities and put functions and assets in place to meet their individual needs,” Ray said. He added that CHS has a system-wide initiative

through a federal initiative to improve quality and

to improve health literacy in order to help patients

safety and enable hospitals to work collaboratively.

receive the information necessary to guide their

“Fully engaged” means the system is regularly

own healthcare. CHS recognizes the difficulties

With such a large geographic area and limited spe-

reporting data on all 10 measures. HEN hospitals

in transitioning between care sites and levels and

cialists, CHS has developed innovative care models

receive federal funds to reduce 10 types of harmful

how imperative it is for patients to understand and

to deliver quality care across the region to a diverse

events by 40 percent and reduce readmissions by

adhere to treatment plans.

set of patients.

20 percent in two years.

The system has about 100 critical-care beds

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Another common need in most communities is quality mental-health care. In North and South

“We are focused on continually improving not only

Carolina, as in many other areas across the coun-

quality of care, but also coordination of care,” Ray

try, behavioral health is in a crisis situation. CHS is

said. “We want to use our scale and turn it into

are a limited resource. So CHS has established

Being a strong force in the community

remote ICU monitoring to provide assistance to

As a large organization, CHS has an influential

building a $36-million behavioral-health hospital to

synergy that’s meaningful for patients and commu-

patients throughout the region. The system also

economic impact on the communities it serves. The

meet this need and provide high-quality inpatient

nities. We plan to grow integration, alignment, and

has some of the nation’s largest accredited multi-

system has nearly $8 billion in net revenue annu-

care.

connectivity.”

across two states, but board-certified intensivists

“We are devoted to increasing capability to address this currently unmet need,” Ray said. “In our

by Patricia Chaney

current environment, this isn’t a business line that

Carolinas HealthCare System

is going to be profitable, but it is needed to benefit our community.”

Increasing connectivity As the healthcare industry faces major changes and restructuring, large healthcare systems are at the forefront of leading and influencing those changes. In Charlotte, N.C., Carolinas HealthCare System (CHS) serves the Charlotte metropolitan area and surrounding areas in North and South Carolina. The system is a driving force in the region with 38 hospitals, nearly 800 care locations, and more than 60,000 employees. With patient encounters at around 10.5 million annually, being chief medical officer for a system this size can be a daunting challenge. But Executive Vice President and CMO Roger Ray, M.D., says it’s exciting to be part of such a large organization during this critical time in healthcare.

In the coming years, CHS is focused on increasing connectivity and collaboration through its hospitals and care site. The system has an electronic medical record deployed in all ambulatory, acute-care, and post acute-care sites. Six hospitals have achieved Healthcare Information and Management Systems Society (HIMSS) Stage 6 for implementation.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

35


11 | Desert Valley Hospital

“We have had a huge market of underinsured and uninsured individuals,” said Chief Executive Officer Margaret Peterson, Ph.D. “These patients are coming in with chronic issues they’ve been living with for some time. They are very sick individuals, and we have to learn to work with them to meet their acute needs and ongoing needs once discharged.” Desert Valley Hospital is evaluating how to link

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with the community in order to improve health status so that patients are not arriving at the hospital in dire need without any prior healthcare. Peterson said the hospital has always been active in the community with health promotion and wellness activities and is looking to add more activities to

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ensure patients have continuing care once they are discharged from the hospital. Peterson added that she has been impressed with how the staff is handling the change in the type of patients accessing the hospital for care. “Our physicians, nurses, and staff deliver care to everyone equally,” she said. “I think that speaks highly of our staff. They are willing to do what’s right for the patient every time.”

Adjusting to expansive growth In addition to handling changes in the patient mix, physicians and staff at Desert Valley Hospital are also adjusting to the challenges involved in becom-

Desert Valley Hospital

ing a tertiary care center after years of being classified as a community hospital. In early 2012, the hospital expanded from 83 beds to 148 beds and added an open-heart surgery

With the election past, healthcare organizations are adjusting to the effects of reform. Most organizations agree that having more individuals with insurance improves the health status of communities as a whole, but handling the influx of new patients can be a challenge.

Margaret R. Peterson, Ph.D., Chief Executive Officer

One hospital in the High Desert in California has seen a market shift as reform allows more patients in its market to receive health insurance. The High Desert has a high unemployment rate -- about 15 to 18 percent -- and many patients previously had no insurance and were not part of the local healthcare system. Now, Desert Valley Hospital is having to reevaluate how it provides care and coordinates with the community to meet the needs of these patients who previously were unknown unless they were in a major crisis.

program. “The growth has changed the way our staff functions on a day-to-day basis,” Peterson said. “The staff has to have a higher level of responsiveness to handle patients that are very critical.” This is a large change in the hospital’s relatively short history. Desert Valley Hospital was founded in 1994 by Prem Reddy, M.D. In 2001, the then-failing hospital was bought by Prime Healthcare Services, which was also founded by Dr. Reddy, and turned back into a highly successful organization. Peterson said the physicians and staff have been handling the shift well, and her goal is to

grow the heart-surgery program in the coming year. Peterson also said being an organization that can adapt and change is critical for success in a changing healthcare arena. “In healthcare today, there is a lot of talk about being a dynamic organization, but healthcare is often the most non-dynamic environment,” she said. “It is hard for us to change the way we do things. We have to be forced before we will make the changes necessary. Today, we are in an environment that is constantly changing and we need to be quick to adapt.”

Measuring up in quality and safety Desert Valley Hospital has exceptional quality and safety scores, with surgical-site infections, centralline infections, and urinary-catheter infections far below the national average. Furthermore, the hospital has the highest outcomes in its market. After an

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37


12 | Murray County Medical Center

initiative to reduce ventilator-associated pneumonia (VAP) cases, the hospital has gone two years without a VAP infection. The hospital is looking to reduce other infections to zero as well. There has been a national campaign led by the March of Dimes to reduce elective deliveries prior to 39 weeks for non-medical reasons. The hospital has been working collaboratively with obstetricians, nursing staff, and the Hospital Association of Southern California Patient Safety Collaborative to reduce this rate. Desert Valley Hospital just finished 2012 with zero elective deliveries prior to 39 weeks. In 2013, Desert Valley Hospital was once again rewarded for its efforts by being named one of the nation’s Top 100 Hospitals by Truven Analytics (formerly the healthcare business of Thomson Reuters), now recognizing the hospital as a seven-time winner of this distinguished award. The American Osteopathic Association gave Desert Valley Hospital a score of 99.4 percent of achievable standards for its quality patient care. The organization is a four-time winner of the HealthGrades Patient Safety Excellence Award. It has also been ranked in the Top 10% Hospital Quality Index by PacificCare. These distinctions encourage Peterson and the

Murray County Medical Center

medical staff to continue striving for excellence in all areas of care. In the coming years, Desert Valley Hospital looks to streamline procedures, improve care in the community, and further automate the hospital. Closely connected with the hospital and also owned by Prime Healthcare is the Desert Valley Medical Group, the largest multi-specialty group in the region. The hospital is working with the group to help provide seamless care for patients. Integrating electronic health records between the hospital and group is also a priority for the coming year.

Rural critical-access hospitals are facing uncertain futures as policymakers examine ways to cut costs. With increasing focus on high-quality, patientcentered care, rural hospitals are often setting the bar higher than major medical facilities.

disease and promote health among those that are our patients and those that are residents of our community. It is a further reflection of the care we deliver on a day-to-day basis, which is only going to

But this shouldn’t come as a surprise. In close-knit communities, small hospitals have always been focused on the patient--who is often a friend, neighbor, or family member--long before patient-centered care was a popular buzzword.

get better with the new services we offer.” by Patricia Chaney

“Integration of the hospital and group opera-

Mel Snow, Chief Executive Officer

tions with the community at large is a big part of our strategic plan,” Peterson said. “We need to

In Murray County, Minn., one critical-access hospital is excelling in high-quality, patientcentered care. Murray County Medical Center is a 25-bed facility serving a rural population comprised mainly of farming area and a predominantly older population. It provides mostly generalized healthcare, some trauma, and orthopedic surgery and also has one community clinic and one on-site clinic for primary and specialty care.

make sure we do everything we can to prevent

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39


INDUSTRY PARTNERS Delta Medical Systems, Inc. www.deltamedicalsystems.com

a primarily elderly population, the majority of its

and focusing on what our patients need, the bottom line has taken care of itself.”

revenue comes from Medicare.

Expanding Community Care

through quality initiatives and a focus on reduc-

However, the hospital has remained strong ing medical waste. Throughout the recession, the

Since the bottom line has taken care of itself, the

Focus on Quality over Quantity impressive quality metrics. In the past few years,

many hospitals struggle with physician recruitment. Snow said the work environment at the hospital

In 2012, the surgery department had no sentinel

is what has attracted most of the physicians. For

events and only one surgical infection, and the

example, the medical staff and leadership all work

hospital had only one incident of hospital-acquired

together in decision making and reviewing finan-

infection.

cials. Through this shared-leadership process, Snow

of 35 Gold Standard Performers by Larson Allen,

said all hospital employees and physicians have

which reviews the financial sustainability of critical-

developed an obligation to the facility. The hospital

access hospitals. Hospitals that have achieved this

also has a strong nursing staff with an area pool of

status generally adhered to the following guidelines

nurses who want to work for the organization.

for success: pricing that provides for financial suc-

The new building project will add six more of-

cess; greater revenues from non-Medicare payers;

fices with exam rooms to the clinic to accommodate

superior cost performance; strong procedural

the new physicians. But, Snow said, the building

and ancillary services; outstanding physicians and

project is really centered on patients. The building

excellent relationships with medical staff and the

will have a new patient area with all-private rooms

community; and initiatives to aggressively grow

and a nutritional area in the room for families; and

revenues and manage costs.

all inpatients will receive free massage therapy.

The hospital was also named as one of the top

Other upgrades include an expanded imaging

32 hospitals in rural health by the University of

area to house increased capabilities from a 64-slice

North Carolina at Chapel Hill in 2011.

CT scanner, digital mammography and bone-den-

To assist with excellence and safety initiatives, Murray County Medical Center has a management agreement with Sanford Health out of Sioux Falls,

sity equipment, ultrasound equipment, and a new MRI machine. “Our new imaging equipment has really helped

S.D. However, the hospital still maintains autonomy

us continue to increase the level of healthcare we

and is responsible for its own financial success,

provide here,” Snow said.

which Chief Executive Officer Mel Snow says has come by focusing solely on what’s best for patients. “We are a county hospital, so we’re more

for two years to help with the $12.5-million building

years since Snow has taken charge, the hospital has recruited six new physicians--no small feat as

In 2009-2010, the hospital was named as one

give raises. Employees even agreed to forego raises

to double the size of the facility. In the past seven

Although small, Murray County Medical Center has the hospital has received three safety awards.

hospital did not lay off employees and continued to

medical center is now undergoing a building project

“Everybody deserves healthcare, and we need to find affordable, accessible ways for everyone to get it.”

project. The nurses are part of a union in Minnesota, and this creates some challenges in communicating to the union the quality of the work environment provided at the medical center. “We have one of the best nurse-to-patient ratios in the state at 2.7,” Snow said. “We struggle to have the union recognize that at times.” As reimbursement changes are issued, the medical center is focused on reducing readmissions by improving wellness and primary care. The hospital has a bus that travels the county to provide wellness screenings. It also has a team instituting a healthcare home. Through its efforts, Murray County has done exceptionally well in remaining financially viable and looks forward to a strong future. Because of its success, Snow is able to emphasize the need for rural hospitals. “Rural healthcare is good healthcare and is often cheaper for everyone while still achieving national quality standards,” he said. “Everybody deserves healthcare, and we need to find affordable, accessible ways for everyone to get it.” by Patricia Chaney

Overcoming financial challenges

patient-centered and more healthcare-centered,”

As with all rural facilities, there is little “extra”

he said. “We don’t worry as much about the bottom

capital coming in and looming cuts to reimburse-

line, and by creating a positive work environment

ment. Since Murray County Medical Center sees

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions

41


MAR/APR

2013

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