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Real Issues : Real Solutions


Illinois Bone & Joint Institute A Renewed Commitment


Real Issues : Real Solutions


06 Illinois Bone & Joint Institute

IN-FOCUS STORIES 10 Fremont-Rideout Health Group 14 Riverwood Healthcare Center 18 Rush Foundation Hospital 22 Indiana University Health 26 Riverside Medical Center 30 The Iowa Clinic 34 America’s Healthcare at Home 37 Chillicothe VA Medical Center 40 Columbus Regional Hospital

David Wold, Chief Operating Officer

42 Coulee Medical Center 44 Methodist Hospital 47 St. Rita’s Medical Center 50 Wyoming Medical Center 52 Decatur County Memorial Hospital 54 Yuma District Hospital and Clinics 56 Lincoln Community Hospital and Nursing Home 58 Arkansas Hospital Association 60 Virtual Care Provider, Inc. (VCPI)




Debb-Kosich LLC

Illinois Bone & Joint Institute

The Illinois Bone & Joint Institute was founded 20 years ago. The vision of its physician leader, Dr. Wayne Goldstein, was strength in numbers, recognizing that together orthopedic surgeons could control their destiny. Since its founding, IBJI has evolved through a series of nine practice mergers into one of the largest fully integrated orthopedic practices in the Midwest. With 89 physician, 33 physician assistants, seven residents, and 671 employees, IBJI has 17 offices located strategically along the North Shore, starting in downtown Chicago up through Gurnee, Ill.

Doctors today need an experienced real estate provider along with a partner that they can trust to represent their best interests. Debb-Kosich LLC has a longstanding commitment to excellence in the medical real estate services industry and understands the many challenges that doctors face. That is why providing innovative solutions to medical real estate problems has been a hallmark of our work for over a decade, and we have a proven plan for converting leasing expenses into real estate assets.

A renewed commitment A few days prior to the interview with HCE, David Wold, chief operating officer, had held a member meeting with IBJI’s physicians, leaders, and administrative team. He said that everyone left the meeting with a renewed commitment to providing exceptional service and the realization that the postwar generation, who had tolerated unexceptional service, had past. Healthcare’s primary customers are now baby boomers whose demands are higher and more taxing than their parents’ demands ever were. IBJI’s team recognizes that they must be committed to patients, to referring doctors, and to everyone who interacts and does business with them. Chicagoland area is one of the most-recognized

Integrated within the organization are 14 rehab centers that IBJI owns and operates, making it the third-largest provider of rehab services in the Chicagoland area. IBJI also owns and operates eight MRI facilities.

areas for orthopedic leaders in orthopedic care and has built its name on superior clinical services and excellent outcomes. Wold said that IBJI is committed to recruiting the best young talent out there.



tory, combined with the uncertainty of healthcare reform, volumes are down across-the-board because patients don’t want to go to the doctor unless they absolutely must. Even more profound is that IBJI is now dealing with competition greater than a five-doctor orthopedic practice down the street. Instead, it’s multimillion-dollar hospital systems that are flexing muscles and buying up IBJI’s competition. Wold said that his leadership finds themselves making decisions today based on what they know while trying to be prepared for change based on the uncertainties of tomorrow. He believes that IBJI is a relatively sophisticated organization and can be a player in such areas as bundled payments and pay for performance. “We hope to be that orthopedic group that is partnering with hospitals, not being acquired by hospitals, but ultimately having an impact in terms of helping reduce costs on the hospital side and

“When I realized a guy like me could actually learn

on Saturdays. This way, patients don’t have to go

sharing in the upside associated with that,” he

the functionality of it in 20 minutes, I thought that

into the ER and can see an ortho surgeon almost


this is the perfect solution, and it’s truly an unbe-

immediately and at any time.

Improving quality of service Of course, going forward, IBJI’s chief goal is to

lievable success story,” Wold said. The implementation has not affected physician

“It has been a fabulous success,” Wold said. “Our patients love it because it’s a lot less of a

workflow, nor has it seen a reduction in productiv-

hassle, much more convenient than going to an ER



“If you look at the most successful medical prac-

improve its level of service. Wold said his organiza-

tices or businesses, essentially great companies

tion was ahead of the curve about five years ago

our physicians who are not technically savvy,” he

cantly less than the expenses incurred in going to

are built around one’s ability to recruit, retain, and

in terms of dollars it has invested in compliance


an ER room.

attract great people,” Wold said. “It starts with the

and risk-management programs. He added that

owners, which is difficult because the docs are

this also encompasses dollars invested in patient

The next few years

Wold wants to make IBJI an increasingly more at-

often busy, but at least my guys get it.”


Wold tidily summed up IBJI’s three-to-five-year

tractive option for younger recruits.

Simply put, IBJI wants to make it a more com-

Wold said that IBJI has a strong administrative

“It is so easy to use that it was not a barrier for

strategic plan when he said, “From a market-

And the cost to see an IBJI doc is also signifi-

With all of these initiatives and commitments,

“We’re able to offer a competitive and secure

team who makes his staff feel recognized and ap-

fortable experience for when patients come into

ing perspective, our goal 2013 is focusing more

offer to these young guys and so can a large hos-

preciated. He said they cultivate loyalty and dedica-

the office. Two years ago, IBJI implemented digital

on internal marketing and implementation of the

pital system, but the difference is we’re physician-

tion through communication and encouragement of

X-ray in its offices. Wold said the implementation

customer-satisfaction plan. We want to continue

owned and physician-driven. We have a bunch of

all employees.

was a tremendous success.

to be the best. We want to continue to be known as

entrepreneurs, so it’s an attractive program and

leaders in orthopedic care.”

our challenge will be to remain that way as we

Competing against a multimillion-dollar system

“I’ve never seen our doctors so excited,” he stated. Electronic medical records (EMRs) are also

To reach these goals, IBJI has been implementing a plan known as OrthoAccess, which consists

well on the way toward implementation. It took IBJI

of its member clinics seeing patients from 4 until 9

Most of IBJI’s challenges are no different from any

seven years to find the right solution, but it settled

and in a couple of offices until 10 and being opened

other medical practice out there, Wold said. Faced

on SRSsoft, which is similar to a hybrid document

with one of the worst economic recessions in his-


move into the future.” By Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


02 | Fremont-Rideout Health Group





Fremont-Rideout Health Group The Fremont-Rideout Health Group (FRHG) is an independent, non-profit, community-based health system located in Northern California that serves Yuba and Sutter counties with primary and specialty care and also offers specialty-care services to the Nevada, Butte, and Colusa counties. FRHG is made up of two acute-care hospitals, a Level III trauma center, an urgent-care center, an ambulatory-surgery center, a cancer center (in partnership with UC Davis Medical Center), an outpatient lab and imaging centers, and a senior living campus that features facilities for skilled nursing, dementia and Alzheimer’s care, and assisted living.

Theresa Hamilton, Chief Executive Officer

The system also has a home healthcare and hospice service and a durable medical-equipment company. In its bi-county area, it is the largest private employer, with 1,800 people on staff and 260 physicians. FRHG prides itself on having a high level of regard and respect for all of its clinicians and employees. Theresa Hamilton, chief executive officer, first joined FRHG in 2000 as vice president and was appointed CEO in 2007. Since her appointment, she has overseen an unprecedented period of growth and development at FRHG.

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Broadening the system’s scope For several years, Hamilton said that FRHG has been making significant gains in all quality outcomes and metrics. Financially, FRHG is on a strong footing, especially compared to four years ago when the global and national economies went into a tailspin. The communities FRHG serves were

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heavily impacted by this collapse. Hamilton said FRHG was forced to make some very difficult decisions to “right-size� the organization in order to continue providing high-quality, yet financially viable care for the volume of patients it was receiving. “We took some very bold steps during that process,� she stated, “but the result of that was that we accomplished our financial goals and did not forsake quality in the process.�



for a concurrent expansion of FRHG’s emergency department and cancer center. In spite of the pressing economic challenges, FRHG is accomplishing these goals. The cancercenter expansion will be completed this fall, and ground was broken in March on the new six-story addition to Rideout Memorial, on schedule to be completed in December 2014.

In spite of all its successes, FRHG is like other healthcare systems throughout the country and trying to juggle progress with potential setbacks. Chief among these challenges is the continuing decline in reimbursement from the largest payer that most hospitals have—Medicare and for the

Working on efficiency and wellness

state of California, Medi-Cal.

Hamilton said that FRHG is continuing to work on

hospitals and ours included,” Hamilton said. “Try-

operational efficiencies with the goal of modeling a cost structure that can deliver cost-efficient care, while still delivering high-quality outcomes and eliminating unnecessary costs and wastes from the system. In preparation for healthcare reform’s rollout in 2014 and the new people that will be joining the system, FRHG is also seeking to expand its These steps included FRHG stepping up its recruit-

outpatient network by opening its own urgent-care

ment efforts, successfully attracting more spe-

center and starting up a clinic system that partners

cialists to the organization; increasing advanced

with doctors and other providers in the commu-

training of staff; improving quality outcomes; and

nity so that there are additional access points for

proceeding with a $250-million building project to

outpatient care. Hamilton emphasized that FRHG does not want

expand Rideout Memorial Hospital into a regional medical center, capable of providing advanced

the only location for outpatient to be in a crowded

medicine to its service areas.

and costly emergency room. FRHG is also in its last two years of a seven-

“We wanted to broaden our scope of services and our ability to take care of more acute patients

year strategic plan for the implementation of elec-

in the community,” Hamilton said.

tronic medical records (EMRs). Hamilton said she

There were two reasons for the new building.

expects that in the next 24 months or so, FRHG will

First, FRHG needed a state-of-the-art facility that

be completely electronic with medical documenta-

matched its desire to expand its specialty services.

tion for doctors, nurses, and testing, with the great

Second, it would enable FRHG to consolidate inpa-

hope being that FRHG will be able to offer schedul-

tient hospital care into one location.

ing online.

“The continuing decline in reimbursements countrywide and statewide is of great concern to all ing to plan for reinvesting in our staff and reinvesting in our facilities for our community is made more difficult if we don’t have very constant, predictable revenue streams.” Hamilton foresees this problem becoming even more profound going forward and said this is why it’s so important for FRHG to achieve efficiency with its cost structure. “There’s nothing more important in our day than the care we deliver to our patients because that’s the only business we’re in,” Hamilton stated. “The only reason we exist is to take care of sick people, and the more dedicated and focused we are on that mission and the more we truly grasp that as being the essence of what we are, the better we’re going to be.” by Pete Fernbaugh

FRHG is also on track to meet all of meaningful

This expansion was a very expensive proposition, especially since the strategic plan also called

Confronting the reimbursement challenge

use’s standards.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


03 | Riverwood Healthcare Center

The importance of partnerships

that trickle down, but not having enough resources

said he is concerned that the political rhetoric

left to proactively prepare for what the future

related to healthcare reform is trending toward re-


“Some elected officials seem to believe that

Preparing for a new compensation model

small hospitals should not provide higher-level

Generating $70 million a year in gross revenue,

services, but our communities really need these

Riverwood Healthcare Center is a 25-bed critical-

services available locally,” he said. “Patients are

access hospital with three primary-care clinics. The

not keen on driving hundreds of miles for knee or

facility includes a Level III Trauma Center, Level I

hip replacement or chemotherapy, and in some

heart-attack program protocol, and is a Compre-

cases, it is simply not possible for these patients to

hensive Advanced Life Support hospital.

surgery, and trauma from rural hospitals.

commute for the services.” However, these services are expensive and

Aitkin County’s population is 16,200, but in the sum-

resources available when affiliated with a larger

mer, the area’s population can reach 75,000 or even

regional health system. Delfs said it’s important

125,000. As expected, the emergency room and

to Riverwood, as it is to most rural hospitals, to

urgent care see the most increase in volume. To account for the seasonality, Delfs said the

center has developed strategic partnerships with

hospital uses flex staffing to adjust with volume.

Minnesota Oncology; the Virginia Piper Institute at

The staff is offered a day off during the slow times,

Abbott Northwestern Hospital, Minneapolis; and

and the hospital maintains a schedule to follow at

even a competitor health system in the area.

times when there are no volunteers.

Working with the Virginia Piper Cancer Institute

Looking toward a pay-for-performance fee

and a neighboring hospital to drive numbers, River-

schedule, Riverwood has already formed a group of

wood is able to provide oncology services, including

physicians and administrative members to evaluate

genetic counseling and stereotactic biopsy, respec-

what a physician-compensation model looks like in

tively. The health system is also working toward

that environment.

becoming a fully accredited community cancer cen-

“We don’t want to jump the gun, but we do need

ter by the Commission on Cancer of the American

to start working to align the way physicians see

College of Surgeons. In addition, the collaborative

patients with how the system gets paid,” Delfs said.

partnership allows the community’s lone oncologist

“Health systems, both large and small, will be in

to consult with more than 90 partners in the state.

trouble if we continue a pay structure based solely

“To remain independent as long as possible, it

Michael Delfs, Chief Operation Officer

The service area is populated by numerous lakes and attracts a large seasonal population.

difficult for a small hospital to provide without the

remain independent. And to do that, the healthcare

Rural health systems are getting hit hard in today’s healthcare market. Proactively looking at partnerships with larger facilities or institutions is key to the future success of these organizations. In north-central Minnesota, Riverwood Healthcare Center is finding ways to remain independent through strategic partnerships with local institutions.

is the time spent reacting to regulatory standards

Riverwood Chief Operating Officer Michael Delfs

moving higher-level services such as orthopedics,

Riverwood Healthcare Center

Delfs said one concern he has about rural facilities

on volume.”

is vital for rural facilities to partner with other organizations,” Delfs said. “It is much better to do it now proactively, rather than later reactively.”

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


Shifting the focus to quality Quality reporting is becoming more and more important to all healthcare organizations and not just in relation to future payments. In addition to core measures and HCAHPS, Riverwood has implemented initiatives for hand hygiene and state-based measures. Minnesota Community Measurement asks for quality reporting in areas such as diabetes care and congestive heart failure. Riverwood has applied those measures internally to begin evaluating processes and improving care for chronic conditions.

The building project also added a new and larger

Other areas of focus include falls and medica-

infusion center with five patient bays and a private

tion safety. Committees regularly walk the halls to

entrance so that immunocompromised patients

evaluate potential fall hazards and make recommendations on how to improve patient safety. Medication safety is reviewed through an evaluation of process, equipment, and workflows. To help improve quality and patient care, Riverwood has implemented the Transforming Care at the Bedside program. The goal of the program is to engage front-line nursing staff who spend the most time with patients with implementing changes in how the organization cares for those patients. “We are empowering our nurses to make changes to improve care,” Delfs said. “We introduced the program, but let the nurses run with it to ensure it is not an administrative-driven initiative.” To help improve patient satisfaction, the facility is undergoing a $21-million building project to convert all hospital patient rooms to private. Delfs expects this to also make patient care and staff workflows more efficient. With the former con-

“Our hospital thinks about innovation and partnerships and this is where our focus will be in the future.”

do not have to enter the hospital with the risk of exposure to germs. The birthing suites will now provide more features that new moms want in terms of the overall birthing environment, look of the room, and comfort for family members. The orthopedic care area will also follow a new model, where patients will be examined by orthopedic specialists in the rehab area where their pain and mobility issues can be closely monitored with physical therapists, nurses, and surgeons working together as a team. Delfs said. “Although rural health may only represent a small total of the country’s population, 100 percent of the population served by these centers needs healthcare services delivered locally. For everyone who chooses to live in rural areas, these services are vitally important.” by Patricia Chaney

figuration of single and semi-private rooms, the hospital was essentially at capacity with about 17 or 18 patients because of gender, infection control, and other issues.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


04 | Rush Foundation Hospital

Expanding within rural areas Rush Foundation Hospital also has a 49-bed longterm acute-care facility on the first floor, and the health system operates rural-health clinics, a physician-management company, two multispecialty physician entities, and five critical-access hospitals. Rush Health Systems recently added a 25-bed critical-access hospital in Mississippi and another 25-bed critical-access hospital in Alabama. “It is a tough time to be in a period of growth, but we are trying to take care out to rural communities,” said Christopher Rush, hospital administrator and executive vice president of the health system. “Patients in these areas often have transportation issues, and we are trying to have a network of facilities solidly in place throughout our service area.” In addition to new hospitals, Rush is also implementing an electronic health record (EHR) throughout the system. The organization is in its second year of a three-year plan to bring all Rush Health Systems entities, including clinics and physician

Rush Foundation Hospital

practices, online with the EHR. “Ultimately, we want a patient to be able to come into any facility and be able to send information seamlessly to other hospitals, clinics,

Rush Foundation Hospital, a rural acute-care facility in Mississippi, is in a period of growth, a factor that is uncommon for many community-based hospitals. The 215-bed hospital is part of Rush Health Systems, which serves communities in East Central Mississippi and West Central Alabama. The patients seen at Rush are from rural communities with limited access to care outside of the facilities Rush Health Systems provides, and about 50 percent of the hospital’s payer mix is Medicare and Medicaid. Despite challenges in reimbursement, the health system’s growth is enabling it to better service the surrounding counties.

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emergency departments, or physicians within our system,” Rush said. Rush Hospital was founded by surgeons and still remains largely a surgical hospital, accounting for about 60-70 percent of its services. During the

have begun some heart surgery and are looking to

past three years, the hospital has built its minimally

add urological surgery with the robot.”

invasive surgical program and invested in two of the latest da Vinci Si Surgical Systems. The hospital has already performed more than 1,000 cases. “Our robotics program began with a gynecologic

Christopher Rush, Administrator


Managing challenges along with growth As with all healthcare facilities, Rush Hospital is

surgeon, but has encouraged our entire surgical

looking at ways to provide lower-cost care. Rush

department to look at capabilities for minimally

said the health system is looking at ways to position

invasive surgery in other areas,” Rush said. “We

patients in the proper facilities to get quality care

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


cian shortage. The nation is facing this physician

patient, being prompt, being professional, and help-

shortage in all specialties, and rural hospitals have

ing others. The main driving force of these rules is

always faced even greater struggles in recruit-

the hospital’s mission, penned by the Rush family,

ment. Rush said using nurse practitioners more

to be their “Brother’s Keeper” in providing care.

and establishing a team of nurse practitioners with

Continuing this in light of reform, Rush is fo-

physician oversight is a future initiative.

cused on improving patient-satisfaction scores.

Keeping it in the family

Keeper is proving true in our patient-satisfaction

Many community-based hospitals have close

scores, which will be very positive under the new

relationships with staff and the communities they

reimbursement models in healthcare reform,”

serve, and Rush is unique in its family history. The

Rush said.

hospital was founded in 1915 by Dr. J.H. Rush,

“Focusing on our mission to be our Brother’s

In all of this, Rush continues to implement

at the lowest cost. For example, some patients may

Christopher Rush’s great-grandfather. Dr. Rush’s

growth strategies and evaluate the most cost-effec-

be treated in a smaller hospital in a swing-bed pro-

sons joined the staff shortly thereafter, and Chris-

tive way to provide care while not losing sight of the

gram at a lower cost than at the flagship hospital.

topher’s father was also a surgeon at the hospital.

patients in the communities it serves.

“We are coordinating as a system to make

Today, the hospital is a nonprofit facility with no

sure patients move from a higher-cost setting into

family ownership, but the Rush family has always

a lower-cost setting and receive the appropriate

remained involved. Christopher Rush’s brother

care,” he said. “We are also working on cost control

serves as a surgeon at the flagship hospital.

in terms of length of stay.” Rush is employing other methods as well. With

“Having the hospital carry your name does have meaning on a personal level in terms of your view

more people coming into Medicare and Medicaid,

of how you think about providing care and whether

Rush said managing length of stay and capacity

you are fulfilling the mission to the community,”

will become even more important. The system is

Rush said. “I am constantly aware of a higher stan-

also working on ways to link clinics and physician

dard than just being the administrator of a hospital.

practices to ensure patients are receiving care

There is a history of my family’s values and life

once discharged from the hospital in order to avoid

work that I carry forward every day in guiding the

readmissions. Rush said the system is evaluating

hospital. It is the biggest privilege of my career so

ways to provide as much care as possible on an


outpatient basis to limit readmissions and maintain the surgical volume at Rush Foundation Hospital. Another important area that Rush is evaluating is using mid-level practitioners in light of a physi-

by Patricia Chaney

“Focusing on our mission to be our Brother’s Keeper is proving true in our patient-satisfaction scores.”

The values or “House Rules” at Rush Hospital also reflect a family atmosphere. These values include guidance on how to treat others, such as showing respect, addressing people by name, being

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


05 | Indiana University Health

Creating a healing environment While not involved in direct patient care, the design,

To develop standards, reduce costs, and increase value, Shayda Bradley, executive direc-

example, a seemingly small change that can have a

tor over design and construction, said IU Health is

big impact on patient-satisfaction scores is replac-

considering a partnership with a limited number

ing the wheels of the carts in hospitals.

of architectural firms and general contractors that IU Health to educate firms and contractors about

said. “As a patient trying to sleep, if you hear a cart

the healthcare environment and have those part-

in the evening, it can be disturbing. Even replacing

ners brainstorm ways to achieve further efficiencies

the wheels to provide a quieter environment allows

on their end.

general contractors focused on the patient versus

facilities tried to incorporate luxury hotel-style

focusing on the single project.” Bradley said her department has also recruited

the patient and affects all the senses--aroma, paint

an employee in design and construction to focus

colors, natural light, and noise.

specifically on the customer experience. This em-

Furniture for patients and families is another

Joe Arruda, vice president of design, construction, and supplychain operations, is responsible for managing costs related to the supply chain as well as standardizing design and construction. His team is focused more on ways to improve the patient experience in order to meet the needs of patients and the requirements of payers instituting value-based purchasing.

“Construction is more stringent in healthcare,” Bradley said. “It is a challenge to get architects and

focus from previous years of hospital design, when features. Now, the trend is to look at what heals

Shayda Bradley, Executive Director of Design and Construction

embrace this approach. This strategy would allow

design facilities from a healing perspective,” Arruda

Creating a healing environment is a shifting

Joe Arruda, Vice President of Design, Construction, and Supply Chain Operations

Health facility.

ute to patient satisfaction in significant ways. For

for better healing.”

Indiana University Health is the Indiana’s most comprehensive healthcare system and is comprised of over 20 hospitals. It also has health centers, partners, affiliates, and joint-venture operations. The system has more than 2.2 million admissions and outpatient visits annually. Overseeing supply-chain management and facilities construction of a system this size is a daunting challenge.

patients will feel comfortable and familiar in any IU

construction, and supply-chain team can contrib-

“We challenge our staff to look at how to better

Indiana University Health

a building standard with specific features so that

ployee connects with IU Health patients and fami-

contributor to satisfaction, and IU Health has

lies, bringing back suggestions that can be incorpo-

partnered with Kimball Office Furniture, based in

rated into future designs with the goal of improving

Indiana, to develop furniture solutions that create a

healing and patient-satisfaction scores.

better environment. Kimball designers have toured

“We cannot assume that our historical percep-

the hospitals with executives, talking to staff and

tions are correct without talking to patients and

patients about value-added features and needs for

families,” Arruda said. “We need to pause and

family members and patients in order to identify

listen, check and validate, and retool independent

ways to increase comfort.

of cost. We can find creative ways to design and

Standardizing design and construction

control costs.” Furthermore, since it is such a large system, IU Health is beginning to directly negotiate contracts

In the future, to help manage costs and consistency

with manufacturers of building materials on items

across the facilities, IU Health is looking at ways to

such as flooring, lighting, air handling units, and

standardize construction and design across all enti-

services for multiple facilities.

ties and new projects. This includes implementing

As many health systems have found, Lean Six

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


Kimball® Office Kimball® Office understands the importance of providing patients, visitors and employees with a safe, comfortable and easy to maintain environment. With a wide selection of seating and office solutions that meet the furniture industry’s most rigorous sustainability standards, we offer organizations the ability to design spaces that encourage collaboration or privacy, help organize the busiest hubs within the building and offer unparalleled flexibility and mobility. Healthcare environments are designed to help people of all ages feel comfortable, and with years of research at hospitals across the country, Kimball Office is confident it can provide solutions that meet workplace goals and fit within the budget.

Sigma creates standardized processes, measur-

The first phase of the tower opened in Janu-

able returns on investments, and cost reductions. IU

ary 2012, and the entire project is scheduled for

Health is implementing the Lean process manage-

completion in 2013. The tower is working toward

ment philosophy and Building Information Modeling

attaining Leed silver certification.

(BIM) in the design of new construction projects. Given the economic times, Arruda said that

“By having our facilities Leed-certified, we are creating a healthier environment for our patients,

future investments will be more closely examined to

more productive employee work spaces, and

evaluate community benefit and improved outcomes

reducing environmental impact to our community,”

for their patients. The health system may proceed a

Bradley said.

little more cautiously and re-examine investments in its 10-year strategic plan.

Embracing sustainability

However, even without pursuing certification, IU Health achieved approximately 40 credits for sustainable features in the IU Health Saxony hospital that opened in December of 2011.

IU Health is looking for ways to implement more

With the future moving toward value-based

green initiatives both in new building projects as

purchasing, all design and construction initiatives

well as existing facilities. One recent project is the

keep patients and their families in “top of mind.”

Riley Hospital for Children at IU Health’s Simon

Arruda’s team works with nurses, physicians, and

Family Tower, a 10-story inpatient building. The

staff to interview patients and to spend 24 hours

$475-million expansion will increase access to chil-

with them and understand their experience.

dren’s care at IU Health and is part of a $500-million 10-year strategic plan for the children’s hospital.

“We try to determine what the patient goes through and design accordingly,” he said. by Patricia Chaney



06 | Riverside Medical Center

About six years ago, Dr. John Jurica, senior vice

Jurica also said having the proper measurement

president and chief medical officer, oversaw an

tools and electronic tools in place is key to provid-

initiative to restructure the case-management pro-

ing quality care and improving patient safety. He

cess to reduce length of stay. Focusing on length of

also noted that as payments for medical care con-

stay addresses quality and cost.

tinue to be reduced, electronic tools will become

“We believe that excessive length of stay leads to poor quality, and in turn, poor quality leads to

During the past few years, Riverside has

a multidisciplinary approach to reduce length of

implemented a number of tools to become more

stay through a variety of processes including case

electronic and improve quality care and reporting.

management and patient throughput, and we found

In 2011, Riverside rolled out computerized physi-

that our patient safety and quality metrics improved

cian order entry (CPOE) throughout the Riverside

along with length of stay.”

hospital using McKesson software. documentation specialists a few years ago to assist

by half a day. Jurica said to be a top hospital, you

with physician documentation and risk adjustment

have to look at not only quality metrics, but also

and reporting quality measures to CMS.

Having the right tools in place

Dr. John Jurica, Senior Vice President and Chief Medical Officer

The hospital also hired two full-time nurse

said the hospital was able to reduce length of stay

processes, productivity, and efficiency.

Riverside Medical Center, a 325-bed hospital serving counties south of Chicago, Ill., has made patient safety and quality an integral part of its future strategy through documentation, process evaluation, and electronic tracking tools.

lower cost with less staff.

excessive length of stay,” Jurica said. “We took

By addressing case management alone, Jurica

Riverside Medical Center

more important to achieve better efficiency and

Another recent tool the hospital began using is the Crimson Continuum of Care. This tool helps facilities manage total cost and quality for defined populations and informs risk-based contract nego-

Riverside Medical Center has been named a 100

tiations with payers. Physicians can view their risk-

Top Hospital by Thomson Reuters for four years in

adjusted outcomes anytime in a web-based format.

a row. It has also achieved Magnet ® recognition

Jurica said the Crimson tool is the next phase in

and received the Distinguished Hospital Award for

monitoring and improving outcomes. It was put

Clinical Excellence from HealthGrades. In addi-

into use late last year and has initially been used to

tion to being recognized for quality of care, Jurica

support the hospital’s length-of-stay initiatives.

said Riverside is one of the lowest cost providers in Illinois. Jurica said the hospital uses awards such as

Future directions and expansion

those from Thomson Reuters and HealthGrades as

To address current and future models of care and

a benchmark to help verify the effectiveness of its

patient expectations, Riverside Medical Center

quality and safety initiatives. It gives the hospital

recently underwent a $60-million renovation

a way to measure itself currently and to develop a

and expansion project. The project added a new

strategy for improvement.

160,000-square-foot tower with 12 operating

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


The future is ours to shape.

rooms; seven labor, delivery, and recovery rooms; a C-section operating room; 18 high-tech private McKesson Corporation

ICU rooms; and 23 family-centered private patient

McKesson Corporation, ranked 15th on the FORTUNE 500, is a healthcare services and IT company dedicated to making the business of healthcare run better. We partner with payers, hospitals, physician offices, pharmacies, pharmaceutical companies and others across the spectrum of care to build healthier organizations that deliver better care to patients in every setting.

was also renovated to upgrade surgery areas and

We are proud to count Riverside Medical Center among our partners, and we look forward to helping Riverside set its course for excellence as we evolve healthcare together.

rooms. About 45,000 square feet of existing space cardiac cath labs. Riverside Medical Center is part of Riverside HealthCare, a regional health system that includes a multispecialty physician practice and specialty clinics throughout a four-county area. As with most healthcare facilities, Riverside is trying to adapt to and prepare for an uncertain future. “We know that focusing on safety and quality are going to be important, and we are trying to determine how much of our resources we devote outside the hospital to prevent readmissions,” Jurica noted. Most community hospitals are looking at new models of care, and Riverside is evaluating models that have been successful elsewhere. The hospital’s strategic plan focuses on three primary areas--stakeholder experience, which includes patient and physician satisfaction; growth; and quality and patient safety. “We have teams addressing ICU quality, long-stay cases, the implementation of a clinicaldecision unit, and physician-specific quality data,” Jurica said. “It is a juggling act trying to optimize care in all these areas. Ensuring that we have good documentation, engaged teams, and cohesive leadership is necessary to continue being a high-quality provider.” by Patricia Chaney

Better Health 2020 sets the stage for excellence as we evolve healthcare together. You’re at an extraordinary crossroads, experiencing challenges like never before. To help you take on the here and now and what’s to come, McKesson proudly introduces Better Health 2020, our initiative that positions you to use IT more strategically — for better business, better care and better connectivity. Over the next two years alone, McKesson will invest $1 billion in technology R&D to address your critical success factors: maximizing the value of your core systems, improving financial performance and quality, coordinating and connecting care, and managing advanced payment models. All for better health, through 2020 and beyond. Explore the future of better health at © 2012 McKesson Corporation. All rights reserved. HCE EXCHANGE MAGAZINE


07 | The Iowa Clinic

The Iowa Clinic

From paper to technology Throughout the last six years, The Iowa Clinic has transformed from a paper-based organization to a

The Iowa Clinic is a $120-million, fully integrated multispecialty clinic with more than 140 physicians and healthcare providers practicing in 32 specialties. The group has about 500,000 patient visits each year, 167,000 of whom are unique patients. The Iowa Clinic also enjoys national influence thanks to its involvement with the American Medical Group Association (AMGA). Its chief executive officer, C. Edward Brown, has served as a past chair of AMGA and has been a member of the board for 10 years.

C. Edward Brown, FACHE, Chief Executive Officer

The Iowa Clinic continues to be involved in public policy on both state and federal levels. From a clinical standpoint, the organization works hard to establish areas of clinical excellence and remain active in medical education and in research. “Those are the various venues by which we try to establish ourselves professionally on a regional and maybe even on a national basis,” Brown said.

technology-based organization. The biggest step in this transition was converting every department to a fully integrated electronic medical record (EMR). This was a massive project that took about 18 months to complete. Despite the challenges associated with this transition, the benefits of the EMR were quickly realized. The Iowa Clinic continues to embrace technolo-

Bankers Trust Based in Des Moines, Iowa, Bankers Trust is Iowa’s largest independently owned bank, grounded in the Midwestern principles of stability, integrity and prudence. Founded in 1917, we understand the importance of being flexible to meet the needs of our customers, in order to help them grow. Bankers Trust has locations in Iowa, South Dakota, Nebraska and Arizona.

gy, not only in the clinic setting, but also throughout the organization. For example, when patients check in at The Iowa Clinic, it’s done on an electronic clipboard known as a kiosk. The entire process is now completely paperless. Brown pointed out that only a few organizations in the country are able to say that.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


“Those reports were presented to the board first,

strategic relationships that much more. I will pre-

and then, they were presented to the entire physi-

dict that we will have close strategic partnerships

cian membership of the organization,” Brown said.

with larger organizations that culturally fit with our

“That whole program has had a dramatic change


on the participants, and at a board level, we believe

He added, “While we’re in a position of change

that it will have a positive cultural change on the

and uncertainty, we should never lose sight that our


primary interest is the patient, and we should never

A more conservative time With the economic and federal restraints being

let the political winds or the economic debates allow us to lose sight of that. And we must maintain the position of being the patient’s advocate.”

imposed upon healthcare institutions, Brown said The Iowa Clinic has been focused on paying down

by Pete Fernbaugh

any debt it has and on being more conservative in capital acquisition. He admits to some trepidation about the future, saying that the Clinic will continue to evaluate its strategic position. “There’s no paper when you come to The Iowa

ment and bonus program focused on performance.

Clinic,” he said. “You check in electronically, and if

The endgame is improved efficiencies and improved

you don’t feel comfortable checking in electroni-

quality patient outcomes.”

cally because of your skill sets, we’ll do it for you.”

Another example of physician leadership is

When a new patient checks in for the first time,

demonstrated through a collaboration with the

the process might take 10 to 15 minutes, but for

University of South Florida. The Iowa Clinic was

visits after that, check-in will only take one-and-

the first in Iowa to establish a physician-leadership

a-half to two minutes. The clinic also promotes

institute. A cohort of 16 physicians and administra-

electronic payment.

tors participate in a one-year program on-site at

“Moving to a kiosk has had a positive business influence on the organization because we’ve improved the effectiveness of the data that we’ve

access to capital will cause organizations to look at

Participants in the program are placed in situations that force them to examine what leadership means to them; who they are as individuals; what

ficiency of our operations.”

their personal skill sets are; and what they need to improve personally in order to be a more effective leader. The students are divided into three groups and

Brown said expanding quality measurements and

given meaningful corporate projects that have a

operational feedback in terms of quality perfor-

return on investment to the organization. Upon

mance has become a physician-driven priority for

completion, these projects are delivered as formal

The Iowa Clinic.

reports to the board of directors and then imple-

“The entire organization is involved when it

of collateral one needs to have in order to have

learning in leadership development.

improved our collections, and it’s improved the ef-

comes to quality,” he said. “Each department

in the banking and lending markets, the amount

The Iowa Clinic. The emphasis is on experiential

received,” Brown said. “It’s standardized. We’ve

Letting physicians take the lead

“That has become more important now than ever before,” he explained. “With the uncertainty

mented. The first class focused on the following proj-

establishes its measures. We are working with our

ects: cardiovascular services, customer service,

local payers through a collaborative contract agree-

and defining the healthcare organization of the future.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


08 | America’s Healthcare at Home

A full-service company

Coping with minutia

America’s Healthcare at Home is a full-service

“We’re in an industry where the person who is or-

home medical-equipment company, offering

dering the product is not paying for it, nor are they

everything from walkers to ventilators and CPAP

using it,” Kassir explained. “And the person who’s

machines. The company will even go so far as to set

using it didn’t order it and is paying some of it, but

up intensive-care units in the home if the patient

not all of it. And the person who is paying for it isn’t

is stable, and it will provide babies suffering from

using it nor did they order it.”

sleep apnea with apnea monitors. America’s Healthcare at Home employs several respiratory therapists and deals often with respiratory issues. Business is currently good and growing, Kas-

As a result, the reimbursement process has never been harder or more complex. Kassir said when he first got into the business, a doctor would order, for example, oxygen from America’s Healthcare, Kassir’s people would get

sir said, adding that hospitals want to discharge

the prescription and the insurance information, and

people. They’re incentivized financially to do so.

issue the oxygen almost immediately.

The biggest obstacle for the company right now is reimbursements.

Now, they have to call to verify the insurance and get an authorization from the insurance company, which can mean getting labs and reports and studies to prove that the patient genuinely needs the device. Usually, authorizations are only for 30

America’s Healthcare at Home

days, so when the 30 days is completed, should the patient still need the device, the process starts all over again. America’s Healthcare confronts these ob-

Mark Kassir, chief executive officer of America’s Healthcare at Home, recalls the mid-80s, when he was working as a respiratory therapist at Children’s National Medical Center in Washington, D.C. He noticed that children were often staying at the hospital weeks, if not months, after they could have been discharged to receive home care. The insurance companies were not paying for a large percentage of the expenses incurred, and discussing home care was not an option in spite of the American Association for Respiratory Care (AARC) advancing a study that asserted it was cheaper to take care of patients at home than in an institution.

Mark Kassir, Chief Executive Officer

stacles by developing solid partnerships with physician’s offices and educating patients on the paperwork, doctors’ appointments, and the equipment use that is expected of them. But the difficulties go beyond even this.

The Medicare conundrum

and awards it, they can still pull out. They could

For America’s Healthcare at Home and for most

mess up the number for everyone else and not even

companies like them, Medicare comprises a signifi-

take it.”

As Kassir’s career progressed, he worked with many start-up companies who were geared for home care, but their equipment wasn’t tailored for children. After his last position as president at a company that went from $1 million to $30 million in annual revenue, he decided to branch out on his own. Kassir started America’s Healthcare at Home with the mission of providing customized home-care services to all ages.

cant percentage of its business.

“In home care, my opinion is that you can be a big corporation, but you’ve got to be able to work within the region and be able to tailor your services to what that region wants, and a lot of these big corporations, they just want to McDonaldize everything,” Kassir said. “Their attitude is, ‘This is how we’re doing it, and it’s going to work for everybody,’ but it doesn’t.” America’s Healthcare at Home is located in the Baltimore, D.C., and Northern Virginia markets. And even in those localized markets, Kassir said individual doctors want different services.

Kassir said Medicare is now doing competi-

Originally, Medicare said the bidding regions would be individual cities, but the end result found

tive bidding. As a part of the program, all of those

it to be a combination of cities. Therefore, Kassir

who provide medical-equipment services will have

would have to bid on two regions—one made up of

to bid on different product lines in oddly defined

D.C. and Northern Virginia and the other Maryland,


Delaware, Philadelphia, and other parts of Pennsyl-

“The problem with that is there are a lot of guys who have no idea what they’ll be bidding,

vania—to get the kind of Medicare business he was receiving before competitive bidding.

they’re smaller companies, not knowing what true

Therein lies another negative, Kassir said.

costs are to do business, which will keep that price

Winning one bid doesn’t mean a company has won

below-cost in some cases,” he explained. “But they

the entire service line for that region. Kassir may

don’t hold those bids. After Medicare comes out

win oxygen and wheelchairs, but he could lose out

”Everybody can buy the same equipment. It’s not an equipment issue. It’s what can we do. Can we do a little bit more to help the patient in the home to keep them from being readmitted into the hospital and make their quality of life a little better?” HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


09 | Chillicothe VA Medical Center

on beds and hospital chairs. And Medicare doesn’t always factor in the service component when accepting bids. “For a patient who needs a hospital bed, a wheelchair, and oxygen, they’re going to call two different companies to service them,” he said. “So it’s the government getting involved, not really knowing what they’re doing, don’t understand it. They refuse to accept the fact that there’s a service part to this industry. They look at what the cost of the actual equipment is and base the bid on that.”

Everyone gets hurt It’s important, Kassir asserted, to realize that everybody will get hurt by this. “They’re either not going to have the availability of the services or the services are going to be strongly scaled down,” he stated, adding that

Chillicothe VA Medical Center

his company has found that sending a respiratory therapist out to a home every few weeks can

Chillicothe VA Medical Center in Chillicothe, Ohio, places a great emphasis not just on primary care and basic acute care, but also on mental-health services and geriatrics. The latter has a robust program with 162 nursinghome beds.

actually be preventive care. But with scaled-down services, patients will end up getting sick before they go to a doctor. Then, Medicare will have to pay five-fold. “People are being shortsighted out there, and people are making decisions in the government, in the insurance industry, who have no idea what real life is.” by Pete Fernbaugh

Jeffrey T. Gering, Medical Center Director

Even though Chillicothe VA is a federally funded institution, Jeffrey T. Gering, medical center director, said the organization measures itself according to private institutions, especially when it comes to benchmarking quality metrics and patient-satisfaction scores. In fact, most of its measures equal or surpass the private sector, and Gering said that Chillicothe VA is equal with the private sector on patient preference for a healthcare facility.

Expansion and improvement initiatives

Chillicothe is also pursuing a biomass energy plan that involves taking the main boilers and supple-

Currently, Chillicothe is spending over $150 mil-

menting them with other boilers that will be run-

lion on upgrading its facility. This includes infra-

ning off wood chips. When the project is completed

structure improvements and total renovation of

this June, most of the facility’s heat and some of its

the patient-care building. The organization is also

electricity, through co-generation, will be powered

devoting $20 million each in renovation dollars for

via wood chips harvested from south central Ohio.

its nursing-home units. The goal is to bring them

Gering said that after talking with the American

more in line with a neighborhood community living

Hospital Association, he discovered that Chillicothe

center similar to the Planetree model. Gering said

will only be the second facility or hospital in the

this project is about 50-percent complete.

country to implement this kind of a program, especially on this scale.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


munity partnership in housing homeless veterans. This includes transitional living with nonprofits and

Chillicothe VA has also made a significant invest-

collaborating with the HUDfast program, a partner-

ment in technology and a program called Vocera,

ship between the Department of Housing and Urban

which is a person-to-person rapid communication

Development and the VA.

system that each staff member wears, enabling

In this program, landlords are found who are willing to house veterans in apartments in their

computerized operator that can find a person and

community. Once the veterans are housed, the

prompt them to respond.

program provides case-management assistance to

Gering said the center is in the process of

the veterans to make sure they transition effectively

implementing the Real Time Location System

from an unstable living environment into a stable

(RTLS) for tracking equipment and implementing


other applications appropriate to its mission.

Always looking ahead

ship between Chillicothe and Cincinnati VA Medical

Gering has been with the Chillicothe VA for four

Center. An intensivist in Cincinnati can log on or be

years. Prior to this position, he was associate

logged on and remotely consult with the attending

director and COO of Edward Hines Jr. Va and Jesse

staff and the patient at Chillicothe. As Gering noted,

Brown VA, both in Chicago.

this allows an intensivist expert to be available 24/7

He realizes the obstacles inherent in being a smaller rural facility. For example, if one specialist

Additionally, there’s the electronic ICU partner-

at the medical center. Gering added that the center is also a beta-test

leaves, it is difficult to get a replacement imme-

site examining physician use of iPads for remotely

diately. He also cited the need for employee unity

tapping into medical records.

as a challenge, especially when it comes to taking

Being proactive with homelessness

them to communicate with each other through a

Future plans are based on the federal map for

Chillicothe VA outside its comfort zone and stretch-

transforming the VA into a 21st-century leading or-

ing it to a higher level.

ganization. Large initiatives include moving toward

“I’m always looking out on the horizon about

a model of patient-centered care; patient-centered

When President Obama and the Honorable Eric

the possibilities and stretching the organization to

medical homes; primary care using kiosks for pa-

K. Shinseki, secretary of veterans affairs, adopted

strive to achieve excellence in healthcare services

tients to log into and/or check into the center; and

a goal of eliminating homelessness among the

as defined by our patients, our veterans,” he said.

more reliance on telehealth.

veteran populations, Chillicothe also heard the

“That kind of dovetails into being very patient-fo-

call and has been actively pursuing a program to

cused and trying to design our services and operate

care leader in many respects,” Gering said. “We’re

achieve this goal.

our programs so that they truly do meet the needs

always looking on the horizon of opportunities and

of our veterans as defined by our veterans.”

advancing the level of quality and services for our

The Housing First Initiative is a program that houses a homeless veteran first, thus providing some stabilization, then seeks to get them the medical care and social treatment they need.

Significant future investments

“The VA and Chillicothe in particular is a health-

patients and that includes taking advantage of the latest technology and applying it here. Even though we may be more rural, we still like to be considered

Meeting the needs of veterans often involves

a leader in adapting and effectively using the tech-

gram successful is doing a better job in preventing

upgrading equipment and facilities. With the new

nology that’s available to us.”

homelessness and screening for those who are at

radiology suite came a new MRI, two CT Scans, as

risk for homelessness, as well as doing more com-

well as two nuclear-medicine cameras.

Gering said one of the keys to making this pro-

by Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


10 | Columbus Regional Hospital

Implementing disasterrecovery solutions Although Columbus Regional was in the midst of implementing a disaster-recovery plan when the

Disaster of network proportions

flood hit, the disaster revealed many other areas where the hospital could implement safeguards. For example, power switches, custom-made for the

In 2008, the hospital had just purchased a new data

hospital, had been previously located in the base-

center and was just a few weeks away from moving

ment and were moved to their present location on

all of the existing hardware out of the hospital’s

the main floor.

basement when a devastating flood hit the region

Furthermore, Columbus now has two data

and flooded the entire basement of the hospital.

centers, one off-site and one on the main floor of

The flood caused $171 million in losses, includ-

the hospital. The hospital also opted for IP phones

ing the data center, radiology, pharmacy, and food

in the recovery, which offer cheaper and quicker

services. But the organization was committed to


reopening as soon as possible. Executives worked

FEMA funding helped to hasten the reopen-

in a house behind the hospital to determine what

ing, and GE opened a plant to build switches for

systems needed to come online first and assigned

Columbus and another hospital in Iowa that had

internal information technology staff to the job of

experienced a similar loss around the same time.

restoring those systems.

Boyer said without GE making the effort, it could

“We had planning meetings every morning and talked about business priorities to determine what

have taken a year to get new power switches.

a commitment to pay our employees during the clo-

Returning to business and moving forward

sure, so we had the finance system back up within

Now that the hospital is back to business, Colum-

four days. We also didn’t have to contract out any

bus Regional is implementing a number of Lean Six

IT services because we had retained all expertise

Sigma and IT initiatives.

systems were needed first,” Boyer said. “We made

Before the flood, Columbus was budgeting to

internally.” Within five months, the hospital reopened.

build a new patient tower that would have all pri-

Columbus Regional Hospital

vate rooms, but with the immense loss, the hospital needed to get creative with its existing space. The hospital had been using Lean processes for some time and began a project to get more private rooms out of the existing space. Lowering readmissions was one step in reducing the census, allowing the hospital to make 85 to 90 percent of the rooms single occupancy with the flexibility to increase that as the census changes. Boyer said Lean has been a big push for the organization overall during the past few years and sprung from the encouragement of Cummins, a major employer in the area. Cummins had implemented Lean initiatives within its company and was interested in using Lean to reduce healthcare costs as well. Columbus developed a Lean Six Sigma department to lead initiatives and has six black belts currently employed. Boyer said every department has done a Lean process-improvement project that has helped make the transition to electronic medical records (EMRs) smoother. Columbus was on track to meet Meaningful-Use standards by 2010, but after the damage, the hospital decided to begin a new vendor-selection process. Columbus chose Cerner and is on track to meet Stage 1 Meaningful Use this fall and Stage 2 not long after. Columbus has purchased the Cerner physician

Innovation Center that has taken over the restored

EMR software and will be offering it to private-prac-

basement. The area brings together multiple

tice physicians interested in joining with a shared

disciplines to help adopt best practices faster and

product. The hospital is also looking at databases

inspire creative thinking.

to share information with physicians who use a different tool. “When preparing for a new way to manage

Diana Boyer, Vice President and Chief Information Officer

One way the hospital is doing that is through its new

Lean projects are brainstormed in the center, and there is a simulation lab to test out new processes or ideas. CPOE scripts will run through the

patients, we need the whole picture,” Boyer said.

simulation lab as the EMR implementation takes

Chief Information Officers at any hospital have an ever-increasing presence in today’s healthcare environment. As CIO and vice president of Columbus Regional Hospital in Indiana, Diana Boyer has faced daunting challenges over the past four years in order to get her hospital prepared for healthcare’s electronic future.

“Getting on the same database will do that. We also


Columbus Regional Hospital is a 225-bed facility with emergency services, surgical services, a primary-stroke center, chest-pain center, lung center, heart center, cancer center, and other specialties. The hospital has been named to Thomson Reuters’ 100 Top Hospitals Award list.

patient-care and end-user perspective to IT initia-

need to data-mine for those who don’t join us.”

Encouraging innovation and collaboration With a background as a nurse, Boyer brings a tives.

“The Innovation Center has a unique set up,” Boyer said. “It’s something we would not have had the space or ability to do if it weren’t for the flood.” Which is, of course, one of many silver lining to the disaster. by Patricia Chaney

“There is a huge appetite for technology right now,” she said. “You have to be able to pull the right people together and prioritize.” HCE EXCHANGE MAGAZINE


11 | Coulee Medical Center

The first six months and beyond

In response to this, Graham has jumpstarted

J. Scott Graham, chief executive officer, said the

employees what the executive team is doing and fa-

first six months after the move were consumed

cilitate communication back to them with ideas the

with becoming acclimated to Coulee’s new sur-

staff has for improving the hospital. Graham said


they’ve also started holding open forums with the

“Before, we really had the task of working from

several initiatives to better communicate to the

staff on a quarterly basis and have what they call a

the build-up to the new building and all that was

CEO Roadshow where they go to every department

going to mean,” he explained. “Now, it’s ‘What do

meeting on a rotating basis and essentially conduct

we do with the rest of our lives in the new build-

an open Q&A period.

ing?,’ especially in sustaining a culture of continuous improvement.”

Lately, these sessions have been centering around Coulee’s mission and vision. The team

Since the move, Graham said Coulee has expe-

asks those at the forum to grade how they feel the

rienced a few leadership changes, further refining

executive branch is doing in meeting the vision,

the executive and leadership team. Consultants

mission, and goals of the organization.

have been brought in from Virginia Mason Institute

So far, they haven’t received any Fs or Ds, Gra-

to train the staff in Lean Management. Graham

ham said, adding, “Everybody generally says they’re

noted that this was Virginia Mason’s first experi-

seeing a lot of good improvement, so we feel we’re

ence in training at a critical-access hospital.

going in the direction that we should.”

This training led to the hiring of a Lean consultant from Joan Wellman and Associates, a firm

Bringing IT home

that specializes in applying Lean principles to rural

In May 2011, Coulee took the step of hiring an IT

healthcare environments. Coulee’s goal is to go

director for the facility. It had previously contracted

through the entire facility over the next several

these services out to an organization in Spokane,

years and make sure that everything is being run as

Wash. Graham stated that the hiring was somewhat

efficiently and effectively as possible.

of a departure for Coulee, but the director, Doug

Coulee also conducted a comprehensive employee-engagement survey and received mostly positive feedback.

McLeod, comes with extensive healthcare and management experience. Graham said McLeod’s strategic capacity,

“We were actually quite taken aback by that, es-

maturity, and technical expertise is a real find for

pecially considering all the upheaval we have been

Coulee, and he has been well-received by the hos-

in with the move,” Graham said.

pital’s staff.

Nevertheless, a few areas of improvement were identified, mainly in communication.

Coulee has also been a member of the Critical Access Hospital Network, a group of critical-access

Coulee Medical Center When HCE last covered Coulee Medical Center of Grand Coulee, Wash., (Editor’s Note to Production Staff: Please insert story link http://www.healthcareix. com/2011/04/coulee-medical-center-scott-graham-ceo/ here. Thanks!-Pete), the organization had just moved into its brand-new facility and was looking forward with great optimism. One year later, that optimism is still intact.

hospitals in the region that collaborate on IT needs. As part of this collaboration, Coulee will lend McLeod out to the other hospitals in the network as their CIO. So far, Graham said some innovative measures have been accomplished thanks to this partnership. Coulee also signed on with Clarity Medical Systems in an effort to conduct rural health-clinic case management better. Clarity uses a web portal that streamlines an organization’s ability to refer patients elsewhere, but also to find out what happens to them, keep track of outcomes, and bring them back to the hospital when the time is right.

Working with the community and legislature Graham said it is part of Coulee’s corporate philosophy to help the community not just by providing healthcare services, but also by promoting wellness. To this end, Coulee has been working with its local government to construct a community wellness center. So far, the hospital has secured grant money, signed a consultant with experience in building these facilities around the country, and is actively fundraising for the center. The hospital has also been dealing with legislative issues that affect critical-access care, especially with regards to Medicare and Medicaid reimbursements. Critical-access hospitals are reimbursed on a cost basis through both programs, the end of 2011 would have eliminated cost-based

Bringing business and healthcare together

reimbursements for critical-access hospitals.

With the healthcare paradigm changing, Graham

and a Washington-state initiative introduced at

Graham said that Coulee has been working with

feels that it is increasingly important for organiza-

legislators to try to reverse that and was grateful

tions to balance business principles with caregiving

that the legislative session came to an end without


any of the cuts being enacted. Coulee continues to

“My impression is that healthcare is rapidly

work on keeping the community informed should

becoming an arena where we have to be solid

this measure ever reenter the discussion and is

business people as well as caregivers,” he stated.

grateful for the added time to prepare for the inevi-

“And the technology, the tools, and the methods

table tightening up of resources in the future.

that make a business viable and well-run need to

Additionally, Coulee has opposed and will

be applied to healthcare. Technology and IT is one

continue to oppose legislative attempts to mandate

of those fundamental tools. We just think you have

nurse-patient ratios.

to be looking forward all the time and positioning

“We’ve seen concerns about breaks and meals for nurses that have gone into the legislature, so

yourself to remain efficient, effective, and competitive.”

we’ve had to be very active and in fact very proactive in making sure that the folks that represent us

by Pete Fernbaugh

understand what’s at stake should these measures

J. Scott Graham, Chief Executive Officer

go into effect,” Graham explained. HCE EXCHANGE MAGAZINE


12 | Methodist Hospital

Focusing on the positive aspects of change All healthcare organizations are concerned about having enough money to continue providing services to their communities. But, Begley reminds us that there are positive changes coming from reform, primarily in terms of moving from a corrective-care model to a preventive-care model. “It’s positive to move toward being more involved on the front end and helping people live a healthier life,” he said. “Very few people get to be part of such change, and it’s exciting to work with people in the community to bring about that change.” Methodist Hospital operates 28 healthcare facilities in three counties of western Kentucky. This includes a 209-bed hospital, a critical-access hospital, nine family-practice clinics, six specialty offices, and 13 affiliated services such as Home Medical Equipment and the Advanced Wound Healing Clinic. Methodist has been a part of the community for more than 60 years and values its role in providing care for people locally. In fiscal year 2011, the hospital expended $1.9 million in charity care, $6.9 million on bad debt, and $21.8 million in com-

Methodist Hospital

munity-benefit activities that are provided by the Methodist system. During the same fiscal year, the hospital also

Bruce D. Begley, Chief Executive Officer

served 88,000 people across western Kentucky,

free health screenings at over 40 local fairs, festi-

With uncertainty and instability in healthcare, the experience of leadership can make a difference in how a healthcare organization addresses the future. At Methodist Hospital in Henderson, Ky., Bruce Begley has held the role of chief executive officer for 19 years and been with the organization for 27 years. His experience has given him a unique perspective on healthcare reform, and he approaches organizational change with a view of the positive.

southern Illinois, and southern Indiana through a

vals, senior centers, and annual meetings.

babies with its lactation and breastfeeding ser-

Three areas that need to change

“My first endeavor into healthcare was in 1975, and adequate reimbursement was one of the main concerns,” he said. “Here we are, more than 30 years later, and it’s still the main concern.”

vices; sponsored and provided physician speakers

Looking toward the future, Begley said whether re-

for the 350 people in attendance at heart disease,

form comes about or not, the three goals Methodist

breast cancer, colon cancer, and stroke prevention

and most hospitals are focusing on will not change-

“Lunch and Learn” events; screened 101 men for

-increased quality of care, improved patient experi-

prostate cancer at the second annual “Know Your

ence, and decreasing or bending the cost curve.

He recognizes that there is only a limited amount of money in the system, but part of the problem is that the money is viewed from two completely different perspectives. “The first is that there is a sense of entitlement,” he said. “We live in one of the greatest countries in the world, and we feel we should be able to get healthcare with no questions asked. Most people feel as though healthcare is a right; however, it is financed like a privilege. We have to bring those two views more in line before we can reach some of the goals we’re aiming for as a whole.”

variety of screenings and educational activities. It

This community involvement is what drives

served 2,715 patients of limited financial means

Methodist’s future initiatives regardless of what

and chronic conditions in its Continuity Care Clinic;

reform holds.

treated 1,718 children with medical needs through its CATCH Program; helped 122 women and their

Stats” event; provided free diabetes screenings

“There is no way to continue to pay for health-

and counseling to 80 people on Diabetes Alert Day;

care and keep doing what we’re doing for the next

sponsored 70 local youth sports teams, non-profit

15 years,” he said. “There have to be different ways

events, and community fundraisers; and provided

of doing things.”



13 | St. Rita’s Medical Center

Methodist is working on getting medical staff on

continue to attack them with a can-do attitude. If

board to ensure that everyone has the same goals

you only focus on the financial piece, it will discour-

and objectives, with everyone taking accountability

age you too much.”

for quality, patient experience, and cost contain-

But any change takes time, especially culture

ment. Part of the values Begley encourages in his

changes in healthcare. Begley encourages small

staff is to put themselves in the patient and care-

changes over time to improve cooperation with

giver’s shoes.

staff. It may not feel as though the organization is

“It’s important to understand that we deal

making a lot of progress, but five or 10 years later,

with people’s lives every day,” Begley said. “It’s

looking back, one finds that the organization has

not always life or death, but we should try to put

come a long way.

ourselves in our patients’ shoes and those of their caregivers. Staff should say, ‘If it were me on the

St. Rita’s Medical Center

by Patricia Chaney

Serving a 10-county area of mostly rural communities in westcentral Ohio, St. Rita’s Medical Center has placed a large focus on sharing information through electronic medical records. The 425bed acute-care hospital went live with a new Epic electronic medical records (EMRs) system in June, linking inpatient and outpatient services, as well as affiliated physician offices.

receiving end, what would I expect?’ If my staff can confidently say they did for a patient what they would want done for themselves, then they have probably followed every policy we could dream up.” Despite challenges and fear over reimbursement, Begley continues to maintain a positive attitude about the future and encourages other organizations to do the same. “If we aren’t going to be positively involved in change, then who is?” he said. “We know our com-

Herbert Schumm, MD, Vice President of Medical Affairs

munities better than people in Washington, and I encourage everyone to look at the positive things we do to provide services to our community and

“The electronic medical records system provides us with a new level of being able to share not only with providers, but also with patients,” said Dr. Herbert Schumm, vice president of medical affairs.

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


Dr. Schumm said this is an important step in the

encourage individual leaders to do what needs to

future management of patients. As with most

be done in their areas, rather than taking a dictato-

health systems looking toward a value-based pay-

rial approach.”

ment system and Medicare regulations related to

St. Rita’s Medical Center is part of Catholic

readmissions, St. Rita’s is exploring better ways

Health Partners, which helps the facility grow and

in which it can manage the community’s wellness,

learn from other organizations across the state.

rather than just treating illness.

“By being part of Catholic Health Partners, we can look at the bigger pictures, look at other com-

“We need to move from an acute-care mindset to looking more at the continuum of care,” he

munities and learn from what they are doing,” Dr.

said. “How do we better partner with other entities,

Schumm said. Looking toward the next three to five years in

agencies, extended-care facilities, and physicians to make sure transitions are smoother and to prevent

In 2011, the medical center centralized all billing

healthcare, he sees more integration and com-


and service-center operations for affiliated physi-

munication of electronic health records across

cian practices. All calls for appointments or billing

multiple providers and more focus on community

share those records across different systems will

inquiries go through a centralized service center,

wellness. St. Rita’s has already taken steps to ac-

be a key part of the future of managing patients

freeing up office employees to focus on patients

complish both of these through participation in the

across the continuum of care.

coming through the doors. Implementing Epic in

HIE and through initiatives to improve the health of

the offices has aided this effort by placing all neces-


Electronic records and tools such as the HIE to

Gaining efficiencies through electronic tools During the past couple of years, St. Rita’s has

Linking the region

sary information in one place and further allowing the billing and scheduling to be done off site. In addition to waste-reduction initiatives, St.

placed increasing focus on improving efficiencies

Rita’s also works to streamline other areas of

throughout the organization. Dr. Schumm said St.

investment and capital management. One employee

Rita’s is the largest employer in the community.

at the hospital oversees all equipment, evaluating

This creates a special responsibility for the organi-

life expectancy and usage to make data-based rec-

zation to be fiscally responsible and reinvest in the

ommendations for capital-equipment investments.


statewide health information exchange (HIE) called

Dr. Schumm said St. Rita’s is working to reduce

Embracing change for the future

Clinisync. This allows providers to share patient

waste in clinical services through managing length

St. Rita’s has a well-established leadership team,

information between the hospital and Health Part-

of stay, reducing harm, eliminating unnecessary

with many members having been part of the center

ners of Western Ohio, a federally qualified health

tests, and avoiding duplication of tests.

for more than 20 years. However, leaders at the

St. Rita’s was the first hospital to go live with a

To prepare for a value-based payment system,

center. The health center serves 14,000 under-

St. Rita’s has a strong Operational Excellence

served patients, providing primary medical, dental,

Lean Six Sigma management program to achieve

behavioral health, and pharmacy services.

its efficiency goals. Some initiatives include a

by Patricia Chaney

organization embrace change and look toward ways to meet the coming challenges of reform. “We are facing a lot of change really fast in an

The HIE is part of Ohio’s vision to connect

clinical-integration project, working with physicians

industry that tends not to embrace change,” Dr.

hospitals, physicians, labs, and others so they can

to reduce waste in inpatient and outpatient care and

Schumm said.

exchange patient health records electronically. The

standardize care according to evidence-based pro-

venture will eventually include five other acute-care

tocols, and a collaborative-care unit being piloted in

hospitals, a long-term acute-care hospital, and two

one area to bring together pharmacy, nurses, and

independent labs.

physicians to eliminate waste.

But, in physician surveys, engagement has remained high­­—about 85 percent. “We have a culture that is willing to take chances, learn, and try new things,” he said. “We

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


14 | Wyoming Medical Center “I come at [healthcare leadership] from a different

Wyoming Medical Center

perspective,” she stated. “I think it really helps me know how care’s delivered, and it’s really holding people accountable, working well with medical staff to raise the level of quality in the organization and

With 192 beds and a service-catchment area of over 100,000 people in five surrounding counties, Wyoming Medical Center, located in Casper, Wyo., carries a great deal of the healthcare load for its sparsely populated state. Some of the surrounding towns have critical-access hospitals, but many do not, making WMC the regional health center for the state, primarily because of its central location. WMC also handles a majority of Wyoming’s trauma cases, plus it has the only CAMTS-accredited flight program that is headquartered in the state.

Vickie Diamond, Chief Executive Officer

When HCE last spoke with WMC, (, the organization was focusing on safety initiatives and capital investments. WMC has experienced great success in those areas, and along the way, it has discovered a renewed commitment to the health and wellness of its employees and by extension, its community.

actually producing data that they can believe.” It’s a challenge to be a standalone entity in the current healthcare environment. Diamond said WMC is always wondering if they should affiliate with a larger organization. Plus, there’s the need to maximize on the current reimbursement system, while preparing for its next iteration. “I think the challenges are having one foot on the dock and one in the boat as this system transforms,” she said. Diamond has helped to form the Wyoming Integrated Care Network, a group of hospitals and other organizations that have come together in an effort to unite Wyoming hospitals in the smaller communities in working toward commonly held goals. This has been dubbed the Wyoming Solution.

Making personal health a premium

Assisting its employees To motivate and encourage WMC employees to

ming’s unique in the sense that we have low

Vickie Diamond, in her fifth year as chief execu-

achieve their health goals, WMC has constructed

population and we’re geographically spread apart,”

tive officer of WMC, said the hospital is working

a weight-loss center, promoted an ideal-protein

Diamond said. “And it’s hard having one primary-

diligently to be a community leader in promoting

program, and established a wellness committee

care physician out in those small communities day

health prevention and wellness. This starts with its

that promotes walks, challenges, and massages for

after day, so we’re addressing what we can do to


employees. WMC also provides information about

help support that.”

Two years ago, WMC conducted a mandatory

healthy eating, including the placement of nutri-

health assessment that helped employees set

tional information on all of the food in the cafeteria

personal health goals based on the feedback from

so employees can make wise and healthy choices.

“We’ve been working on that, because Wyo-

Making great strides in patient care

During the month of March, the hospital held

WMC is in the midst of a two-year journey to make

“The problem is our distances factor into that,” she

those goals, and if an employee did meet them, they

No Fried Fridays, in an effort to get away from fried

the hospital safer, and to accomplish this, the lead-

explained. “We fly people in from all over.”

would not experience an increase in their insurance


ership has engaged every employee and physician

the assessment. Employees had a year to meet

premiums. If the goals were not met, they would receive

“We’re starting out slowly, but it’s a big satisfier for particularly the families, and so we are trying to

Still, it’s this forward progress that Diamond

in achieving these goals. As a result, WMC has seen

continues to cultivate at WMC, regardless of what

some amazing results.

happens in Washington. She’s quick to clarify that

another year to do case management. As long as

work on healthier eating and actually just making

“Serious safety events are down,” Diamond

she’s not nervous about the future. She’s ready.

they stayed in the case-management program, the

healthy choices available in the cafeteria,” Diamond

said. “We analyze anything that puts the patient

“I wish we had more information about how

premiums would not go up. Once they dropped out,

said. “By just putting the calories and how many

at risk that was preventable and put an immedi-

long reform is going to play out. If we could have

the premiums would increase.

grams of protein and fat and carbohydrates on

ate process in place. We have a staff briefing every

those answers, we could plan better, so it’s not a

every food item, it makes it a lot easier for people to

morning to talk about the past 24 hours and any

sense of nervousness, it’s a sense of readiness and

make good choices.”

safety issues that occurred and follow up on them.”

knowing what the right thing is to do to position

Diamond said this program is especially significant since WMC is self-insured, and she was pleased to report that out of 1500 people in the health plan, only about 100 would be paying extra. “We’ve done just a tremendous job with that,

Passion for safety and quality

Its heart center has also seen an incredible reduction in door-to-balloon time. The national average is 90 minutes, and WMC has a mean of 47

with case management, and our employees that

As Diamond enters her fifth year as president,

minutes. Diamond said the hospital is also trying to

need more help,” she stated. “We’ve done a really

her background as a nurse and nurse practitioner

shorten the door-to-balloon time for patients who

good job with trying to keep our health expenses

becomes even more valuable, and her passion for

are transported to the hospital from remote areas.


safety and quality has never been stronger.

your organization so you could flip the switch when that reimbursement system comes into play.” by Patricia Chaney and Pete Fernbaugh

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


15 | Decatur County Memorial Hospital

Officer Linda Simmons said that this project is nec-

relegates it to being a triage center, then care is

essary as more hospitals are moving services to the

delayed for rural patients.

outpatient environment. Younger patients coming in

To help strengthen the hospital’s position,

are also conscious of time and are looking for more

Simmons said Indiana has a strong network of

of a “one-stop shop.” The office building will house

hospitals, including a rural-hospital association that

oncology services, physical therapy, and physician

provides support to critical-access hospitals.

specialists. “Even if the facility has nicely renovated areas,

Renovating for change

Decatur has also established a telestroke program with Indiana University Medical Center. The

but the services are scattered and inefficient, it’s

hospital has a 128-slice CT scanner, which, through

hard for patients to come in for care and get back

PACS, allows a neurologist at the medical center to

to work quickly,” Simmons said. “We want to get

help diagnose and determine whether to bring the

our outpatient services together and accommodate

tissue plasminogen activator (tPA) to Decatur or to

patients efficiently.”

immediately transfer the patient. Decatur is also looking to partner with a tertiary

Despite its small size, Decatur County Memorial

A future of partnerships

center for cardiology. With the diagnostic equip-

has managed to stay technologically advanced, with

As with many rural hospitals, Decatur’s goal is to

ment available at the hospital combined with the

state-of-the-art imaging equipment, electronic

remain independent as long as possible, but part-

expertise of specialists at a tertiary center, many

medical records, and a telestroke program. The

nerships with larger organizations are necessary to

patients can be treated close to home without being

hospital has upgraded most of its facility and is be-

continue providing services to the community.


ginning a construction project to enhance the med/

“I want to make sure that what we do positions

surg department, which is the final renovation area

us to stay financially feasible,” Simmons said. “We

is a shared-employment agreement with another

of the existing hospital.

are strengthening ourselves and making partner-

critical-access hospital about 15 miles away for five

Decatur is adding two floors to the building,

ships. If the landscape changes because of reform,

physicians. One hospital employs the physicians, but

creating all private rooms, universal rooms, and an

we have leverage in who we can go to and how they

half of the salary and benefits are underwritten by

acute-care unit. The ACU will be plumbed for dialy-

handle us.”

the other facility. Simmons said this poses unique

sis to allow for more patients to remain at Decatur rather than being transferred to a tertiary center.

Simmons is working to grow necessary service lines, including telemedicine links and diagnostic

Another unique partnership the hospital has

challenges that the hospital is working through.

in transfers to a tertiary center. She said if Decatur

Rallying around rural care

“We need to rally around the rural healthcare

becomes a partner with another organization that

Despite the success of partnerships, rural hospitals

need to balance the budget, but not on the back of

The next construction project will be the

imaging, to prevent patient care from being delayed

construction of a medical-office building and the consolidation of outpatient services. Chief Executive

face particular threats related to funding, which affects the strategic plans for the coming years.

Decatur County Memorial Hospital

“When I look out three years, I think about what service lines it makes sense to grow, particularly in light of if we become affiliated with another hospital, what services they would see value in and allow us

Rural hospitals provide a critical service in small communities throughout the United States, and most are finding that partnerships are vital to their survival. Decatur County Memorial Hospital in Greensburg, Ind., is an independent 25-bed critical-access hospital.

to maintain a strong presence within our commu-

Greensburg is located less than an hour’s drive from Indianapolis and Cincinnati and is home to more than 11,000 people. Decatur County Memorial has been named one of the Top 20 Critical Access Hospitals in the Nation by the Health Strong Index.

an Acura plant, bringing in many new jobs to the

nity,” Simmons said. Decatur County is a growing community and

that’s out there,” she said. “I understand politicians undermining and doing away with rural healthcare. Our patients shouldn’t be penalized or have delayed care because they choose to live in a rural community. We have elderly and others in our communities as well who struggle to find transportation and traveling 20 or 30 miles from home can be challenging.” by Patricia Chaney

likely will be able to sustain the hospital for years to come. Honda has a plant in the county and is adding community. Simmons emphasized the importance of maintaining strong rural hospitals throughout the country.

Linda Simmons, Chief Executive Officer HCE EXCHANGE MAGAZINE


16 | Yuma District Hospital and Clinics

Gardner said it’s very stressful for patients to drive two to three hours to see a specialist for 15 minutes, so one of his ongoing initiatives is to partner with the urban hospital to get specialists out in his

INDUSTRY PARTNERS Davis Partnership Architects

service area once or twice a month. Yuma also struggles with OB, Gardner said. There aren’t many births in the area, so the hospital doesn’t offer surgical OB or epidurals for women

He is moved by the number of people the hospital

in labor. In actuality, most women leave the area to

sees who struggle to find the resources to pay for

have babies, and this is a problem Gardner wants to

care. He is hoping that these financial barriers will


go away with healthcare reform’s implementation,

Two of Yuma’s physician providers have already agreed to be trained in surgical OB, but looking at

New to rural healthcar Gardner himself is relatively new to the rural

other rural communities. Physicians see a diversity

setting, but he has been surprised at the nursing

of patients with a variety of chronic conditions. “We have primarily family practitioners in our

manpower in the Yuma area. “This community has done a great job of grow-

clinic,” Gardner said. “Sometimes they feel like

ing their own in terms of nurses with lots of women

they’re practicing internal medicine rather than

who start out as nursing assistants, got their LPNs

family practice. The patient is bringing much more

at local junior college, and moved on to get their

to the table in terms of medical challenges for

RNs,” he said.


As a result, Yuma has a very stable pool of

And because it’s rural, Yuma has to look harder

nurses. This is fortunate, since the area is afflicted

to find specialists who will trek into the rural setting

with many health challenges.

to help take care of these patients. It’s even more

Yuma is a retirement area for farmers and ranchers, and thus, has a larger Medicare load than

difficult since the hospital is located two to three hours away from the nearest urban hospital.

Yuma District Hospital in Yuma, Colo., opened the doors of its new 15-licensed bed facility in June of 2007, offering acute inpatient and outpatient health services, as well as home health. It also has an integrated clinic, the Yuma Clinic that has a Rural Health Clinic designation from the Centers for Medicare & Medicaid Services as does its Akron Clinic, located 30 miles to the west. Both clinics specialize in rural healthcare.

John Gardner, Chief Executive Officer

“The facility has been great for us, because it’s new,” John Gardner, chief executive officer, said. “It’s got current technology, and we’ve been very successful in recruiting and retaining physicians, which is always a huge challenge for rural facilities.”

“I see my role in the next five years as position-

the volume of births in the area, Gardner has to

ing the hospital for dramatic changes in how we get

wonder if he’d be able to use their skills at a level

compensated for our services,” he said.

that would assure patient safety.

Resource management comes into play, of

“We are really wrestling with that,” he said.

course, especially revenue-cycle management.

“What’s the best thing for the community in terms

Gardner is constantly asking himself if there are

of OB?”

more efficient ways for Yuma to be doing things.

Then, there’s the issue of reimbursements.

He said he’d be the first to admit whether or not

Right now, Yuma is enjoying the benefits of cost-

Lean was a worthwhile process after seeing CQI

based reimbursement.

and other “initiatives-of-the-month.” But he’s been

“We need to start positioning ourselves for the eventuality that that will probably go away and we’ll have to live just like the PPS (prospective-payment

impressed with how it works, because the process has been very inclusive. “I’m impressed with how effective it’s been,”

system) hospitals in terms of reimbursements,”

he said. “I’m very hopeful that it’s going to get us a

Gardner stated. “It’s trying to figure out how to

long way.”

better manage our resources so that we can live in that new environment.”

Out of the urban jungle

Yuma District Hospital and Clinics

even if accounts receivable drop.

As it stands now, Yuma is financially secure, and Gardner senses that the community would like to remain independent of a larger system, even if establishing such a partnership is Gardner’s first

Gardner is in his fifth year as CEO and has been

inclination. He’s not sure that Yuma can go another

with Yuma since it opened. He came from larger

10 years without addressing that option, and he

urban systems with more of a planning background

urges those around him to keep an open mind to

and had spent three to four years as a consultant


and doing interim hospital management. He was

“I think we all get so focused on the way we’ve

brought to Yuma as an interim CEO and accepted

always done stuff, and I think this is a great time for

the role on a permanent basis because he saw an

creativity,” he said. “I encourage people to avoid the

interesting opportunity.

textbook solutions and to look for creative solutions

“I think compared to a lot of my rural peers,

that will help the organization thrive.”

because I’ve had kind of the integrated-system experience, tertiary center, I just bring a much dif-

by Pete Fernbaugh

ferent perspective to rural hospital management than many folks have,” he observed.



17 | Lincoln Community Hospital and Nursing Home

Knowing who they are

and Schreivogel is hoping to have it opened no later

Herman Schreivogel, chief executive officer, places

than Sept. 1 of this year.

great emphasis on Lincoln being aware of who it is

The hospital itself is in the process of installing

and the purpose for its existence in Hugo. In an era

digital mammography, which will enable Lincoln

when so many rural hospitals are trying to keep up

to perform diagnostic mammograms. This instal-

with the urban hospitals, Schreivogel advocates a

lation also has a purpose that has nothing to do

steady approach, maintaining what Lincoln has and

with “keeping up” with larger facilities. Schreivogel

expanding discriminately and wisely.

wants to ensure that his patients, most of whom

For example, Lincoln is currently in the process of building a new clinic in Limon, Colo., which is 15

depend on Medicare, won’t have to drive to the city. However, Lincoln still won’t be able to do biop-

miles to the west. Schreivogel has clearly outlined

sies. And that’s a limitation it is willing to have at

its purpose—it is a family-practice clinic. Initially,

this time.

there will be a medical doctor and a nurse practitioner on staff. “We’ll see how things go to see if that’s going to be adequate as far as care providers,” he said. Beyond that, his sole concern is getting the clinic up and running. The groundbreaking was in April,

“Money’s always a challenge” By now, it’s no shock to hear an executive lament the state of reimbursements and expenditures in modern healthcare. Perhaps it’s the fact that he’s

nearing retirement and has much experience to reflect upon, but Schreivogel doesn’t panic over the impending changes or cuts. After all, when hasn’t money been a challenge for virtually any healthcare institution? Schreivogel chooses to focus on other positives instead. “We’re very fortunate that we’re well-staffed and we maintain staff well and we haven’t used pool nurses for over six years,” he stated. “That’s a big benefit in having a stable staff.” As he looks down the road, he prefers to not get overly excited. When it comes to electronic medical records, he simply says, “We’re working on it.” Beyond the clinic and digital mammography, Schreivogel is also not making any additional equipment investments. In fact, he’s more inclined to rent or lease equipment if possible, because most healthcare technology outdates so quickly. Lincoln leases its MRI, and its four-slice CT scan, also leased, is in the process of being upgraded to a 16-slice CT scan. Rather than having

Lincoln Community Hospital and Nursing Home

Herman Schreivogel, Chief Executive Officer

to purchase it, though, Lincoln extended the lease contract for another three years.

With Medicare cuts and rising gas prices, Lincoln and Schreivogel are all too aware of the financial burdens many of its patients bear. As a result, Schreivogel wants to make as many services local as possible, bringing in specialists from the city to assist. His goal is to continue on the current trajectory,

Everyone’s involved

doing what Lincoln is already doing, while watching

Lincoln Community Hospital and Nursing Home is a 25-bed critical-access hospital in the small town of Hugo, Colo. With a service area of 5,000, it is the only hospital conveniently located for local residents. The nearest hospital to the north is 80 miles away, the nearest hospital to the east 70 miles away, the nearest hospital to the south 80 miles away, and the nearest hospital to the west is 100 miles away.

When it comes to infection control and quality

sible out of its dollars.

Lincoln has an attached skilled-nursing home that is licensed for 35 beds. It also offers home health, hospice, cataract surgery, and an ambulance service.

of nowhere and our objective is to do everything

Being 10 miles off the Interstate and next to a major truck route between Texas and Canada, it also picks up a tremendous amount of volume from truckers and other passersby. Incredibly, four semitrucks pass through Hugo every three minutes.

care, Schreivogel said that he has delegated those tasks to a few RNs, but really, the entire facility is responsible for these initiatives. “The whole facility is involved in quality care,” he observed. “We’re a little town out in the middle local that we possibly can so our residents around here don’t have to go to the city.”

the back-end and squeezing every cent that is pos“Everything’s going to change, but I really don’t know how,” he said. “We’re in such a position that we don’t really need to worry because of our location. It’s my plan to continue getting things done here and providing the best care we can on a local basis.” by Pete Fernbaugh



18 | Arkansas Hospital Association

Arkansas Hospital Association

Acording to Tom Harbuck, executive vice president of Jefferson Regional Medical Center in Pine Bluff, AHA played a vital role in implementing the Arkan-

For over 80 years, the Arkansas Hospital Association (AHA) has viewed the healthiness of Arkansas’ hospitals as being vital to having a healthier state. On its website,, AHA lists its overall mission as being one that will work “for the betterment of hospitals by instituting spirited programs in education, government relations, research, and communication.” By establishing this as its vision, AHA hopes to improve Arkansas’ healthcare system by promoting unity among its hospitals and by helping to make each hospital’s footprint in its service area more effective.

sas Health Information Exchange. “One of the exciting features of the exchange is it’s going to really eliminate some of the barriers that had existed before between hospitals in sharing information,” Harbuck explained prior to the implementation. “We’re going to be able to use technology and move patient-centric information from one hospital to another in a secure environment and really stay centric to our goal of a better patient experience, improved quality of care, and gained efficiencies.” Kristy Estrem, president of Mercy Hospital Berryville (formerly known as St. John’s Hospital), said

Through many fires and storms

The soda-pop tax has provided a long-term, stable

“Since it was founded in 1929, AHA has acted as the

enabled this reduction to happen, Dr. Thompson

eyes, ears, and voice of Arkansas hospitals, mak-


source of revenue for the Medicaid program that

ing a significant impact on our healthcare quality

Additionally, AHA was instrumental in es-

and status,” noted Phil E. Matthews, former chief

tablishing a program that enhanced Medicaid

executive officer, in a video produced for AHA’s 80th

reimbursements, and it fought for legislation that

anniversary in 2009.

established a statewide trauma system in 2009. “I think what we’re seeing is hospitals begin to

AHA has achieved much within the last few years. For example, the association was instrumen-

develop and become trauma centers,” Robert “Bo”

tal in getting the $1.6 billion allocated to Arkansas

Ryall Jr., current CEO, said. “[This is] very impor-

from the 1998 Tobacco Master Settlement Agree-

tant for Arkansas, because we lead the nation in

ment earmarked for health-related purposes.

highway fatalities. We’ve seen that number de-

“With the Tobacco Settlement Act, we actu-

crease already and as we move to the future, we’re

ally became the only state to put all of our tobacco

going to see more hospitals become involved, more

funds for new health programs,” Dr. Joe Thomp-

lives saved, and we’re going to have a bright future

son, Arkansas surgeon general, said in the video.

for the state of Arkansas.”

“And the Hospital Association was critical as we went around to the cities to host the team that was

Strength of leadership

advocating for those funds.”

AHA’s leadership is well-respected and highly

At the time, Dr. Thompson noted that 2009 sta-

praised by its member providers. “When I look back on the history, at least dur-

tistics had shown a 45-percent reduction in youth smoking and a 20-percent reduction in adult smok-

ing my time, the history with the association, I’ve

ing for Arkansas, and he largely credits AHA for

always had great respect for the leadership that we

this success. Furthermore, AHA was instrumental

had, the top person, and the team that that person

in implementing a new law that made all hospital

put together to make a strong leadership group

campuses smoke-free.

for the association,” stated Russell D. Harrington

By trumpeting a tax on soda pop, AHA also led

Jr., president and CEO of Baptist Health System in

the charge in reducing the number of uninsured

Little Rock. “That’s the most important thing that

children in the state, a statistic that had dropped

an association can have, great leadership, and we

from 20 percent to less than seven percent in 2009.

really enjoy that in Arkansas.”

the AHA leads the way in quality. “Working and networking with the Arkansas Foundation for Medical Care,also Medicaid, they were able to have a program that provided incentives to hospitals who met certain quality thresholds and to be incentivized and have that availability to us is not only helpful to the hospitals, but it’s good for the patient,” she stated. Estrem added that AHA provides a unified core for the voices of rural and urban hospitals, helping them to join together to affect change statewide.

Involving membership in the future

cians that work in our environment and utilize this

In the video, Ryall candidly noted, “The rules and

technology in a very mobile environment, in a very

regulations are coming. And the devil is in the

meaningful environment, and exchange information

details. It will be over the next 10 years that the

so that they have it at their hand, at their fingertips,

details will come out on healthcare reform and its

at the time they need to care for that patient, at the

true effect on hospitals.”

time they need to make that decision, at the time

As a result, he feels that it’s important for the association to have good relations with the state’s congressional delegation in order to shape the regulations so they’re favorable to hospitals. “The public is going to play an important role

that it’s most important. “ Matthews said AHA is no stronger than its membership as a whole. “It is absolutely essential that every member hospital be involved and take part in AHA activities,

in healthcare reform,” Harbuck stated. “It’s going

have their say-so about what’s going on in the busi-

to play an important role in how we utilize technol-

ness, because we need every hospital to remain

ogy. The advent of the smartphone is giving people


access to information they’ve never had before, but likewise, we’re able to take these devices and put them in the hands of physicians, put them in the hands of nurses, and put them in the hands of clini-

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions


19 | Virtual Care Provider, Inc.

technology-hosting solutions, VCPI can prepare data-center configuration, redundant-network configurations, and the high availability of EMR for its clients. Since EMR really implies point-of-care technology interaction, which really implies mobile computing and wireless networks, VCPI also offers solutions with design and installation for these secure and redundant wireless networks and the proliferation of a variety of mobile computing devices. The second step revolves around the actual implementation of the EMR. Since selecting an EMR partner is tricky, Claypool said VCPI can assist or-

From the mundane to the sophisticated

completely outsource their IT to us, which many do,

ganizations in going through a very disciplined and

but also we have the solutions unbuttoned so we

robust RFP and application-selection process.

Loren Claypool, vice president and managing direc-

can solve a very particular problem or create a very

“Implementation of an EMR is not insignifi-

tor of VCPI, said his company can provide expertise

particular advantage for a client within our service

cant,” he stated. “It’s the single most challenging IT

on everything for a long-term/post-acute organiza-

offerings as well,” he explained.

implementation a long-term/post-acute company

tion, whether it’s basic blocking and tackling, such

Unlike hospitals, long-term/post-acute provid-

will have ever faced. We work with our clients on

as cabling or device installation in buildings, or the

ers aren’t as focused on meaningful use yet, as they

the project-management implementation pieces of

more complex, such as hosting applications, man-

are still getting the fundamental electronic medical

these projects.”

aging networks, or 24/7 service-desk capabilities.

records (EMRs) in place. VCPI divides EMR imple-

“We cover the end-to-end IT space, including professional services and consultative services, and do so in a way that allows a company to either

mentation into three steps for providers. First, Claypool said an organization must have in place the basic infrastructure for EMR. With its

VCPI will also assist facilities in training its front-line caregivers on EMR technology. A problem commonly encountered, however, is that many frontline caregivers are not comfortable with the basic uses of technology. “One of the things we help our clients do is pro-

Virtual Care Provider, Inc.

vide basic technology training so caregivers can be prepared to learn the utilization of the application itself,” Claypool said. VCPI is a big proponent of the Savage-Gutkind EMR Adoption Model, and Janine Savage, one of the

Virtual Care Provider, Inc., commonly known as VCPI, is a national company whose primary mission is to partner with longterm/post-acute healthcare providers, helping them improve their financial performance and quality of care through technology and technology-related products and services. VCPI is currently in over 2,250 long-term/post-acute care locations in 46 states.

model’s authors, is a Healthcare Analytics Consultant with VCPI. With seven of the 10 stages already on the market, VCPI will help organizations work through each stage of the implementation. Finally, VCPI will assist post-acute providers in optimizing their clinical workflow. VCPI will make sure that caregivers are using the technology as they provide care instead of capturing data for input at the end of the day. Claypool said that VCPI will

Loren Claypool, Vice President and Managing Director

“One of the things we help our clients do is provide basic technology training so caregivers can be prepared to learn the utilization of the application itself.”

make sure an organization is working with EMR in a very efficient and patient-centric way.



Maintaining the right culture As a company in rapid growth mode, Claypool wants to ensure that VCPI’s culture remains intact and doesn’t dilute as they bring new partners in. “Our culture is really built around a maniacal commitment to client service and a very intimate understanding that at the end of the work we do are real people that are either going through some interruption to their life or they’re having their endof life experience,” he explained. “It’s critically important that we all understand that this isn’t about technology. Technology is the tool we use to help our clients take care of people and their families.” With the market and technology changing rapidly, Claypool said the company is constantly asking, “How do we rethink yesterday’s decisions in the light of tomorrow’s reality?” Two years ago, VCPI could have made a decision that was appropriate then, but with the technology innovations available now, the same decision might require a fresh approach.

Not a time to hunker down Claypool fights the idea that healthcare is currently weathering a storm. He thinks those organizations that believe all they have to do is “hunker down” and endure until this storm passes are missing the point. “We’re at the front end of a tectonic plate shift

“It’s critically important that we all understand that this isn’t about technology. Technology is the tool we use to help our clients take care of people and their families.”

“We have the advantage at VCPI of scale, which lets us hire brilliant people to focus on these challenges.”

who came to them from two different networks or hospitals with different clinical protocols.” With hospitals under challenge to reduce readmissions, Claypool has noticed that organizations are becoming much more active in seeking partners in the long-term/post-acute space. And with the speed of change that the industry is faced with and the speed of change in technology innovation, Claypool stresses that long-term/post-acute care has key decisions to make and key projects to execute that they must get right the first time. “The question I would ask myself if I were the CEO of a provider is, ‘Do I have the IT talent that I need?’” he said. “In almost every case, the answer is no, because the follow-up question is, ‘Can I afford it?’ And in almost every case the answer is no. The economics don’t work for a standalone provider to assemble the depth and breadth of talent needed to effectively drive these decisions and execute them. You need a partner. We have the advantage at VCPI of scale, which lets us hire brilliant people to focus on these challenges.” by Pete Fernbaugh

around the industry,” he asserted. “Rates aren’t going to improve. The regulatory environment isn’t going to become less intrusive. Competition for the resident or the patient is going to do nothing but rise. Other players/partners in the healthcare space are going to be more demanding. The frontline caregivers’ jobs are going to be more complicated and really intertwine with that point-of-care technology. In tomorrow’s world, a frontline caregiver could have two patients in rooms side-by-side

HCE EXCHANGE MAGAZINE Real Issues : Real Solutions




Real Issues : Real Solutions

HCE Exchange Magazine EDITORIAL Editor-in-Chief Tiffany Ford Editor: In-Focus Pete Fernbaugh Contributing Writers Teresa Pecoraro Jacqueline Rupp David Winterstein Meghan White Tracy Simmons Kathy Knaub-Hardy Editorial Associates Levent Nebi Deepa Bhatia Lori Ryan Anami Mittal ART DEPARTMENT


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