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Evaluate Your EHR for Improved Quality

by Amy Boykin, SVP Quality, Patient Safety and Care Management, CHC


Across the country, hospitals continue to make significant investments in the implementation, enhancement and use of electronic health records (EHRs). The use of EHRs to coordinate and share more complete patient information is widely recognized as a way to improve quality of care and patient safety. However, EHRs can also be a new source of medical errors with the potential for patient harm.


Inherent EHR challenges


A study in the Journal of the American Medical Informatics Association found that a majority of safety events identified in an earlier RAND Health study resulted from the EHR itself, rather than user error. Triggers include:


• Unmet display needs. Information presented on the screen did not address the clinical needs of the end user.


• Consequences of software modifications, including improperly configured software, upgrades and out-of-date software.


• Data exchange failures. Patient safety was compromised through poor patient-matching during data exchange or an inability to get necessary information from another hospital’s system during an emergency.


• Hidden dependencies within the EHR. For example, when an inpatient was transferred to an outpatient area temporarily, medication information was automatically deleted when the patient returned to the inpatient setting.


• Pre-populated default clinical information, such as “within normal limits,” can increase the risk of adverse events — and increase the risk of non-compliance with hospital and Medicare accreditation standards. Improper use of default function clinical information put patients and hospitals at risk. CMS surveyors finding inconsistencies may cite an immediate jeopardy finding and recommend termination from the Medicare program.


Mitigating risk: recommendations and resources


Recognizing these potential EHR risks, in March 2015 the Joint Commission released guidelines to prevent adverse events. Sentinel Event Alert #54 offered three key recommendations.

  • Safety culture. Create and maintain an organization-wide culture of safety, reliability and effective change management.
  • Process improvement. Develop a proactive approach to process improvement that includes assessing patient safety risks through tools such as Failure Mode and Effects Analysis (FMEA).
  • Leadership. Enlist multidisciplinary representation and support in providing oversight for health information technology planning, implementation and evaluation.

Additionally, the U.S. Office of the National Coordinator for Health Information Technology developed Safety Assurance Factors for EHR Resilience (SAFER) guides to help hospitals and healthcare organizations complete self-assessments to optimize quality of care and patient safety through the use of EHRs.


Put technology to good use


The EHR can improve quality of care and enhance the efficiency of documentation from physicians, nurses and members of the patient care team. Use the resources identified here to self-evaluate your EHR in order to identify and improve work processes and systems to prevent potential patient harm.


Learn more about CHC Information Technology services including technology assessment, the EHR and Meaningful Use incentives.

Tags: Electronic Health Record, Meaningful Use
Three Steps to Help Rural Hospitals Overcome Financial Distress

by Michael Morgan, Director of Due Diligence and Strategic Analysis, CHC


An array of issues – from increasing charity care, bad debt and declining reimbursement rates to negative profit margins – create financial distress for rural hospitals. Despite today’s challenging operating environment, many rural hospitals across the country are using a practical approach to grow revenues and control costs.



Know the signs and symptoms of declining financial health


How does a hospital reach the point of “no return” where closure becomes inevitable? Were there warning signs along the way? Were they missed? Would the outcome have been different if danger signals had been noted and addressed?


Discussions around performance, growth and capital stewardship are at the heart of strategic planning for most health care organizations, and even though financial indicators are a harbinger of financial health, “finance” is often considered the responsibility of the chief financial officer or other “financial” folks. Budgeting is usually department-specific.


Like car dashboard warning lights, financial warning signs mean it’s time to sit up and take notice. A regular review of the most important indicators related to an organization’s financial health should be a shared responsibility for the entire health care team. Data points to focus in on include:

  • Look at aggregate volume and provider utilization trends. This data can offer a big-picture perspective to leaders and managers across departments.
  • Share operating ratios, including expenses as a percent of net operating revenue focusing on labor, supplies, and purchased services.
  • Examine labor costs relative to volumes. Is the hospital meeting productivity goals? Look at FTE staffing per adjusted occupied bed targets.
  • Review patient revenue indicators including bad debt percentage and net to gross percentage by payor class. Are there shifts in payor mix that need to be addressed?
  • Study liquidity ratios, such as net days in patient accounts receivable and cash collections as a percentage of net revenue minus bad debts. What steps can be taken to improve cash flow?


Identify and assess significant financial indicators


Operational best practices include a monthly review by hospital leadership of key measures, many of which are listed above. Procedures should be put in place by the hospital’s finance department, with input from department managers, to produce accurate monthly stats and financial performance metrics to facilitate these periodic reviews. A closer look at financial indicators also should be part of the annual review and planning process. A key to financial improvement for hospitals is clear communication of expectations and goals across the leadership spectrum in order to accomplish desired changes.  



Connect the dots for sustainability


Once data is available to everyone, the next step is to analyze the root cause. For instance, if inpatient admission volumes are down significantly in a current month compared to the same month in the previous year, the conclusion might be, “We think it went down because there were fewer flu cases this year compared to last year.” That may be true, but speculation can be risky. Do a deep data dive and take the guesswork out of the equation. What were the primary diagnoses of the admitted patients for each time period? Were there any abnormal physician trends? How do observation days this month compare? Understanding the trends and their causes is the key to creating actionable solutions.


Regular reviews of key financial indicators can identify operational best practices, support strategic planning efforts, enhance understanding and create accountability. These reviews can confirm or redirect efforts aimed at sustainability. The most critical element of the entire process is answering “why.” Only then can the team develop solutions to improve operating margins and avoid financial distress.


Learn more about CHC's Financial Improvement services.

Tags: Affordable Care Act, Healthcare Reform , Hospital Management, Hospital Performance Improvement, Operational Improvement, Strategic Direction
CHC Supply Trust Helps Community Hospitals Achieve Greater Savings

by David Domingue, SVP Business Development, CHC


It’s an ongoing challenge for hospitals and health systems — providing quality patient care in the midst of declining reimbursements and increasing patient volumes. This predicament is particularly acute for community hospitals as they strive to maintain their financial health.


For larger providers, participating in a group purchasing organization (GPO) to help manage supply costs has been a way to hold the line on expenses. GPOs offer preferred pricing based on volume. Yet smaller community hospitals, often hit the hardest by supply costs, don’t have the purchasing power to secure the pricing discounts larger hospitals can command — until now. CHC Supply Trust is a supply chain solution designed specifically for community hospitals.


About CHC Supply Trust


An extension of Community Hospital Corporation’s supply chain support services, CHC Supply Trust offers significant supply cost savings to community hospitals through a longtime partnership with HealthTrust. By granting access to HealthTrust’s portfolio of specially priced, clinician-recommended products and services, CHC Supply Trust hospitals obtain deep discounts — savings similar to those of larger hospitals. And smaller hospitals benefit from meaningful savings even when purchasing many of the same items they secured prior to working with CHC. This offering helps community hospitals improve their bottom line with a reduction in supply costs estimated at about 10 percent savings annually — substantial savings for smaller hospitals. Program participants also benefit from additional support services.


CHC Supply Trust provides four levels of support to help hospitals reduce costs while prioritizing clinical quality and patient safety:

  • GPO Access Only
  • Supply Chain Consulting
  • Customized Support Services Agreement
  • Outsourced Materials Management

The bottom line: CHC Supply Trust hospitals are able to free up more money to dedicate to patient care or other needs. Preferred supply pricing typically reserved for large hospital systems is now available to community hospitals nationwide. Regardless of size, CHC Supply Trust hospital clients gain access to a higher tier of savings.


Savings Results


CHC has a history of helping community hospitals achieve cost savings through supply chain support services. Working with CHC, Community Hospital in McCook, Nebraska has achieved yearly savings averaging 18 percent on its supply spend since 2013. Another client, Bert Fish Medical Center in New Smyrna Beach, Florida, has recognized nearly $1.5 million in supply chain savings across several categories since 2011.

Tags: Operational Improvement, Supply Chain, Supply Spending
Giving Back to the Communities We Serve

by Mike Williams, President and CEO, CHC


It’s a privilege to serve at Community Hospital Corporation, an organization dedicated to health, help and hope. Our calling is to guide, support and enhance the mission of community hospitals and healthcare providers around the country. One of CHC's core values is stewardship, a responsibility to share our individual gifts, time and talents to care for one another.


For me, sharing with others is a legacy from my parents etched in vivid childhood memories. The Salvation Army collected donations for families in need in front of stores during the holidays. Emblematic red kettles were positioned to accept the offerings, and Salvation Army bell ringers sounded a call to give. Coins dropped in the container would help children have a Merry Christmas — kids who weren’t likely to enjoy the sort of Christmas we had come to expect, my parents explained. Today, putting money in the kettle brings back fond recollections of home and the meaning of sharing. Ringing bells signify reverberating kindness. Now you can even create your own online red kettle to raise donations.


Community Hospital Corporation has supported The Salvation Army, the largest and one of the oldest charities in the United States, for the past 18 years. They provide food for the hungry, relief for disaster victims, outreach to the elderly and ill, clothing and shelter to the homeless and much more. Through the years donations from individual employees — along with a corporate match — have exceeded $223,600. All CHC employees have the opportunity to contribute. This year, CHC’s philanthropic giving to The Salvation Army Carr P. Collins Social Service Center-Dallas totals $37,650. Employee groups will also help distribute gifts to Angel Tree families at the Center in Dallas on December 18.


In this season of giving, think about ways your health care organization could benefit the community, beyond patient care. There are countless opportunities. For example, Mother Frances Hospital in Tyler, Texas recently developed an internship program to teach high school students with disabilities how to transition from school to the workforce. These students are developing job skills leading to employment and greater self-sufficiency.


Take a close look at your community. Are there medically underserved groups in your service area? Unmet social services needs? Could new or enhanced services or programs improve the quality of life for area residents, including children and older adults? How can you reach out and help make life easier and better for others? Stewardship — partnership and service — comes into focus when you answer these questions.

Tags: Community Health Needs Assessment
Strategy and Vision Planning for Results

By Cindy Matthews, Executive VP, CHC.


Strategic planning. It’s listed at the top of meeting agendas, discussedin hallways, and generally viewed as a blueprint for organizational growth and success. It’s how businesses (should) plan for the future, after all. Although the purpose of strategic planning is to enhance an organization’s performance, growth and revenue — classic business objectives with obvious benefits – many participants say “it takes too much time,” or “it’s disconnected from the way we actually operate.” How can this be?


“Strategic planning” usually isn’t the issue. According to the Harvard Business Review, it’s how the process is developed and managed to support ongoing decision making. Here are some guidelines to restructure and facilitate the strategic planning process to make it more effective and relevant to your hospital’s daily operations.


(1) Assemble key stakeholders to create a clear vision for the future. The first step is to bring everyone to the table to discuss how the hospital can move forward effectively —board members, medical staff and hospital leadership. Explore your desired future state, asking questions such as “Where do we want to be, what’s helping or hindering us from moving forward, and how can we get there?” Talk about the hospital’s strengths and weaknesses too, internal and external. And don’t forget education as a component of the conversation. Share information on the hospital’s service area and patient demographics, market share, the Affordable Care Act and how it may be impacting patient volumes, and more. This visioning process is integral to effective planning.


(2) Identify strategies to support attainment of the vision. How will you achieve your desired outcome? Outline key operational, physician, employee, financial, technological and growth strategies for the next three years to help turn vision into reality.


(3) Develop action plans for implementation. Now that strategies are defined, the next step is to identify key tactics and measurements for each initiative. Be sure to document plans with timelines and accountability. Engage departments and staff in the strategy execution process. A disciplined approach helps everyone be accountable. A related note: make strategy development continuous, spreading strategy reviews throughout the year to focus on a single issue at a time. Don’t limit reviews to a two- or three-month time period.


(4) Align business planning with strategic planning processes. Business-unit focused plans related to service line growth, physician alignment, operational efficiency, clinical quality and patient engagement/satisfaction must be consistent with the organization’s strategic objectives. Leaders should work closely with hospital managers to ensure department and service line business plans and budgets align with hospital strategic planning efforts.


When we’re caught up in day-to-day operations, planning can become an afterthought or an exercise in futility. Reconfigure the process to clarify a shared vision, advance stakeholder collaboration, define responsibility and improve decision making.


Learn more about CHC Strategy and Vision Planning services.

Tags: Affordable Care Act, Hospital Performance Improvement, Operational Improvement, Strategic Direction

CHC in the Spotlight