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Community Hospital Blog

Turn Around Efforts Start with a Look at Operations

by Wilson Weber, CHC Executive VP and COO 

 

Hospital leaders may recognize the need for improvement but may not know where to turn. Even before a hospital shows signs of financial distress, the responsible action is to take a close look at areas of operations. Since operations span the entire hospital, a head-to-toe operational assessment may be warranted to fully address financial and performance issues.

 

Taking a thorough look at operations may seem daunting. Consider starting with an evaluation of outsourced contracts; some may have been in place for years and can be renegotiated or even eliminated. Below are high-level best practice tips that serve as cost-reduction and revenue enhancement strategies, and can help redirect an ailing situation toward a partial or full turnaround.

 

Evaluate labor and its costs.

Labor costs typically account for 50 to 60 percent of a hospital’s operating revenue, so a thorough review of productivity is critical. While a productivity tool can help to set productivity targets, it also integrates a level of accountability toward helping to control labor expenses. Productivity evaluation can also indicate the right level of staffing by shift and day. Productivity standards, manager involvement, and executive oversight will move you toward your goals of greater efficiency while reducing labor costs.  

 

Analyze supply costs. 

Second only to labor costs, supply spend represents significant expense for hospitals. Often, small hospitals don’t have the negotiating power, so look to the expertise of a group purchasing organization (GPO), or evaluate whether you have the right GPO with your interests in mind. From our experience, the right GPO relationship can mean supply savings from 10 to 14 percent.

 

One key area to look at is your supply inventory. Have quantities been adjusted based on volumes, or types of procedures such as those performed in orthopedics or the cath lab? It may be possible to work with vendors to be charged for supplies when they’re needed (just-in-time delivery) versus overstocking for procedures that may be scheduled; this practice helps to free up dollars for other purposes. Also examine inventory “turns,” the number of times per year that supplies are being replaced. Based on our experience, a reasonable level of inventory turn is 9 to 12 times per year. This examination could indicate unnecessary items in your inventory.

 

Examine revenue cycle management.

Because the revenue cycle is a complex function, points in the process may be overlooked or broken. Your hospital may also face common challenges such as keeping your chargemaster current and competitively priced, and keeping up with each payer’s unique rates and payment methodology.

 

Additional areas to evaluate and address:

  • Have managed care contracts been updated or renegotiated?
  • Compare charges to reimbursement. Although you may be charging for an item at a fixed cost, it doesn’t necessarily mean that you will be reimbursed at that level. Depending on the managed care plan, or Medicare or Medicaid, reimbursement could equate to 25 cents on the dollar. 

Move ahead with greater confidence.

Your overall action plans should identify who is responsible and accountable for each area of evaluation and opportunity. The discipline of frequent review helps to ensure that you are not drifting off the plan and that progress is occurring across all areas. A new level of accountability across team members is one indication that you have arrived. Be mindful that it does take time and diligence to impact turnaround efforts.

 

Tags: Hospital Performance Improvement, Operational Assessment , Operational Improvement, Productivity Assessment, Revenue Cycle, Supply Chain, Supply Spending, Turnaround
Valuing Relationships through a Storm

by Mary W. Poole, Director of Public Relations, Baptist Hospitals of Southeast Texas

 

Proud to serve residents of Beaumont, Texas and surrounding areas, Baptist Hospitals of Southeast Texas' employees, physicians, and volunteers share a vibrant bond with our community — a heartfelt connection which became evident earlier this year in the face of Hurricane Harvey. Although hurricanes are not new to the city of Beaumont and surrounding communities on the Texas Gulf Coast, we won’t forget Harvey. We remember vividly the teamwork and community cooperation.

 

Hurricane Harvey roared ashore at the end of August 2017 becoming a tropical depression as it moved inland. Cities were underwater and Beaumont was no exception. Major roadways into Beaumont from Houston were virtually impassable due to rain and flooding. Disaster preparedness plans for area hospitals were put to the test including the BHSET Beaumont campus, a 483-bed facility.

 

This weather event crystallized the meaning of relationships in an environment where lives intersect daily, and reinforced the importance of disaster preparedness.

 

Key takeaways: a summary

 

Be prepared. The week before the hurricane’s expected arrival, BHSET’s disaster plan came into sharp focus. The plan included arrangements organizing the delivery of food, supplies, and water if needed; vendors were placed on standby. As a result, many vendors came to our aid during the storm, bringing needed supplies and support as the days passed.

 

Communication is key. Seventy-two hours before landfall we started setting up our incident command center. With food, fuel, medical supplies, linens and pharmaceutical supplies secured, our next focus turned to preparation of our employees. On any given day, everyone within our organization is aware if they are on the A, B or C storm teams.

 

Preparing your staff is as vital as preparing your facility. As Hurricane Harvey saturated Southeast Texas with over 66 inches of rain in a three day time-frame, access to clear and concise information for our employees and medical staff was a top priority before, during and after the storm. With information outlets established via website, an employee/physician app and a 1-800 number, family members, staff and physicians had access to information that they needed and to allay fears.

 

To communicate with the public, we leveraged our long-standing media relationships built on transparency and trust to share critical information.

 

Relationships matter. BHSET leaders serve on various community boards, community participation inspired by CEO David Parmer. Groups include the Rotary Club of Beaumont, the Chamber of Commerce, United Way, and the March of Dimes along with various business and industry groups such as the Texas Hospital Association and many others.

 

Partnerships like these were priceless, and with strong community involvement, we were able to weather the storm. Medical organizations and neighboring communities offered a plethora of assistance. From “duck boats” for transporting waterlogged employees to the City of Nederland providing vital drinking water, our long-lasting commitment to the community proved to be our biggest asset.

 

Expect the unexpected. No two storms are exactly the same, so learning from each one is a key to success. During Hurricane Harvey, the water came up so fast that it covered the water treatment plant in Beaumont, immediately leaving the entire City of Beaumont without “potable” water. We did not anticipate losing city water; this was a game changer. We then faced the difficult decision to discontinue services, transferring patients to nearby acute care facilities with expert assistance from the National Guard, local and neighboring air services, Black Hawk helicopters and ambulances.

 

 

The adjacent city of Nederland was a dynamic partner and friend, delivering containers of water we so desperately needed. During and after the storm, vendors brought patient care supplies, gift cards and more.

 

Give thanks. As we approach the holidays, there’s no better time to give thanks. Thank you to everyone who helped us continue to provide compassionate care and services despite Hurricane Harvey, reinforcing our commitment to making a difference in our community, one patient at a time.

Tags: Community Service, Disaster Preparation, Partnership
How LTACHs Help Local Communities

by Derek Murzyn, Market CEO, Carolinas ContinueCARE Hospitals

 

A healthy culture, local relationships, and specialty services are a winning combination for Carolinas ContinueCARE Hospitals. These distinctions are the foundation for long-term acute care hospital (LTACH) success for us locally and can help other facilities as well. LTACHs support community hospitals by extending the continuum of care, reducing acute care length of stay, and providing the best possible setting for fragile patients with complex medical needs.

 

LTACHs bridge the gap to recovery for patients often following an ICU or traditional acute care hospital stay. After admission to one of our LTACHs, teams of highly skilled doctors, nurses, pharmacists, therapists, and dietitians collaborate to develop and implement a customized medical and therapeutic recovery plan for each patient.

 

The patient is our primary focus every day at our three LTACHs in North Carolina, which include: Carolinas ContinueCARE Hospital at Kings Mountain; and two facilities in Charlotte, Carolinas ContinueCARE Hospital at Pineville and Carolinas ContinueCARE Hospital at University.

 

Thanks to a strong partnership with our host hospitals within the Carolinas Healthcare System as well as specialty physicians, we’re able to provide care continuity and leverage best practices for the benefit of patients.

 

In my leadership role, I’ve discovered that educating the medical community is paramount for an LTACH to be successful locally. Referring providers must understand the LTACH service offering and have confidence in us in order to make that referral. It’s invaluable that we share and communicate that LTACHs offer 24/7 acute care physician coverage, the availability of invasive monitoring and medical support devices, the provision of intensive and complex medical treatment, as well as our patient outcomes. Education can range from informal elevator discussions to documented communication and presentations to medical staff section meetings. We must always be flexible to the needs of our community and our host hospital in our communication and education.

 

Community and family education are also important. The general public may not be aware that an LTACH is not a nursing home, skilled nursing facility or hospice. We strive to change these common misperceptions by communicating our unique services and interdisciplinary care approach—always focused on the patient. As example of our inclusive culture, we invite family member participation in patient treatment planning.

 

We’ll continue to highlight what our LTACHs do and the services they provide — including the fact that, one-third of our LTACH patients return home. That’s a result worth sharing. And our devotion to quality is transparent and supported by key metrics documented in reports to various healthcare agencies. In April 2017, Carolinas ContinueCARE Hospital at Pineville was awarded three-year accreditation by the Center for Improvement in Healthcare Quality (CIHQ) with designation as a CIHQ Center of Excellence in long-term acute care. This achievement reflects the organization’s commitment to providing the highest level of quality healthcare to the community.

 

Above all else, we continue to foster a culture of caring; without it, nothing else matters.

 

Read more about the roadmap for LTACH success long term.

Tags: LTACH, Strategic Direction
Long-Term Acute Care Moves Forward: Moratorium ended

by April Myers, SVP Post-Acute Operations

 

It’s gratifying to see first-hand how patients with critical and complex needs improve—thanks to long-term acute care hospitals or LTACHs.

 

And now, since the Moratorium restricting LTACHs officially ended on September 30, 2017, more patients will have greater availability to be cared for in the specialized care setting of an LTACH. With the Moratorium sunset, LTACH growth opportunities are expected to blossom.

 

Patient success stories abound. One example shared with me about a patient at one of CHC’s 11 LTACHs is particularly memorable. A gentleman in his 40s experienced a fall at home. Arriving at the Emergency Department, he was placed on a ventilator and spent several days in the ICU; his prognosis was guarded. Subsequently, he was transferred to a CHC LTACH, weaned off the ventilator, and returned home with support from home health care services. Later, accompanied by family members, he returned to personally thank caregivers for the care he received.

 

Approximately 437 Medicare-certified LTACHs exist across the country, operating as a hospital within a hospital, a hospital satellite, or as a freestanding model. But over the past several years, new rules and qualifiers for admission have been imposed by the Centers for Medicare and Medicaid Services.

 

At CHC, we advocate on behalf of LTACHs and the ability to serve LTACH patients, many of whom are on ventilators, have gone through a great deal of trauma, and need extended hospitalization beyond a short-term acute-care hospital stay.

 

Our unique model and multidisciplinary approach to care for optimal recovery—all customized to the individual patient and with family input—supports the LTACH as an essential component of the patient care continuum.

  • LTACHs supplement the services provided by acute-care hospitals, extending patient care. Key characteristics of this care setting:
  • A multidisciplinary approach to care. An LTACH offers services including pulmonary and ventilator support, wound care, radiology, physical, occupational, dietary and respiratory therapy services.
  • The patient and family participate together in a personalized patient care plan.
  • A 25-day patient average length of stay
  • Acute care physician coverage 24/7
  • Availability of invasive monitoring and medical support devices

Fully-integrated LTACHs not only extend the continuum of care, hospitals and healthcare organizations benefit through cross-utilization of services and resources.

 

As part of its Post-Acute Care services, CHC currently owns 11 LTACHs in the states of North Carolina, South Carolina, Kentucky and Texas. Read more about CHC’s approach to long-term LTACH success.

 

 

Tags: Continuum of Care, LTACH
Opportunities for Critical Access Hospitals

Guest blog by Audrey Smith, Critical Access Hospital Coalition Executive Director

 

Since 2010, 81 rural hospitals have closed in the United States with another 673 at risk, endangering the health of individuals, families, and communities. Nearly 30 million people don’t live within an hour of trauma care. In fact, residents living in 16% of the mainland United States are 30 miles or more away from the nearest hospital. The rate of accidental deaths adjusted for age was nearly 50% higher in rural versus urban areas from 1999 to 2015 according to a CDC study, which also noted that long travel distances to specialty and emergency care placed residents at higher risk of death.

 

In response to rural hospital closures in the 1980s and early 1990s, the Critical Access Hospital (CAH) designation was created by Congress as part of the 1997 Balanced Budget Act, designed to reduce the financial vulnerability of rural hospitals and improve access to healthcare by keeping essential services in rural communities. Eligibility requirements for CAHs include 25 or fewer acute care inpatient beds; another hospital must be located more than 35 miles away; the facility must maintain an average length of stay of 96 hours or less for acute care patients; and the hospital must provide 24/7 emergency care services.

 

Today, Critical Access Hospitals are in 45 states. Many of these hospitals are the largest employer in their community, and each offers services and programs customized to area residents’ needs. For example, one hospital partners with their state government to provide vaccinations to children, another offers hip replacement surgery, and yet another conducts surgery for patients using the latest robotic equipment. Local rural hospitals develop very close relationships with their patients, providing hands-on care. One CAH executive shared with me how their hospital employees pushed an elderly patient in a wheelchair through the snow from a nearby clinic for care.

 

Despite having CAH designations, cuts to reimbursements and potential federal policy modifications, including proposed changes to Medicaid, intensify rural hospitals’ risk of closure. With 1 out of 5 people living in rural areas, CAHs serve a vital role in the health of their communities.

 

The Critical Access Hospital Coalition advocates on behalf of vulnerable CAHs located throughout the United States by proposing policy changes and regulatory adjustments that would benefit these essential facilities. Recently, in the wake of Hurricane Harvey, the Centers for Medicare and Medicaid Services announced that it will waive certain requirements for hospitals providing care, allowing lengths of stay beyond the capped 96-hour period and waiving the 25-bed limit for CAH designation. This type of relief is welcome to CAHs and rural communities.

 

About the Critical Access Hospital Coalition

The Critical Access Hospital Coalition (CAH Coalition) is a consortium of innovative healthcare leaders representing CAHs nationwide. Its sole purpose is to assist policy makers in understanding the unique needs of CAHs so that quality healthcare is sustained in rural communities. For more information, visit the CAH Coalition website.

 

 

Tags: Critical Access Hospitals, Healthcare Reform , Rural hospitals

CHC in the Spotlight