March_2010_HR.pdf - Becker's Hospital Review

BUSINESS & LEGAL ISSUES FOR HEALTH SYSTEM LEADERSHIP

Hospital ReviewMarch/April 2010Vol. 2010 No. 2

Inside: Brochure for Hospitals and Health Systems: Improving Profitability and Business and Legal Issues Conference (April 2010; Chicago) (p. 17)

14 Biggest Trends and Events for Hospitals and Health Systems in 2009By Leigh Page

1. Recession. Though conditions have im-proved in some areas, hospitals are still feeling the lasting effects of the recession.

“This recession seems to be a two-step process that we are only halfway through,” says Michael Rowan, COO and executive vice president of Catholic Health Initiatives in Denver. “The mar-kets are improving but there are still a large num-ber of unemployed out there, and that will affect hospitals’ bottom lines.” The recession has re-vealed itself in a variety of ways that are mapped out in numbers 2-7 below.

Chris Van Gorder: Working Closely With Physicians Key to Turn-ing Scripps Health AroundBy Chris Van Gorder, president and CEO, Scripps Health, and chairman-elect, Ameri-can College of Healthcare Executives

This past decade started off with a big promo-tion for me as well as a daunting challenge.

After working my way up through the ranks of healthcare administration in Southern California, starting as a police officer in suburban Los An-geles, I was named CEO in 2000 of San Diego-based Scripps Health, which currently has five hospitals and 19 outpatient centers.

20 Best Community Hospitals in America Becker’s Hospital Review has named the 20 best community hospitals, defined as hospitals with no or limited teaching programs and 325 or fewer beds, in America. Each hospital included on this list was selected using scores in a number of publicly-available indicators including patient safety, outcomes and satisfaction and by rank-ings on industry lists, including hospital rankings by Thomson Reuters, U.S. News & World Report and HealthGrades. Note: Hospitals are listed in alphabetical order.

Aspirus Wausau Hospital (Wausau, Wis.)Aspirus Wausau (Wis.) Hospital is 321-bed hospital serving residents of north central Wisconsin and the Upper Peninsula of Michigan. Aspirus Wausau Hospital is an American Nurses Association Mag-net nursing facility, is staffed by 350 physicians in 35 specialties, and was identified as one of America’s 50 Best Hospitals in 2009 by HealthGrades. Best

continued on page 7 continued on page 9 continued on page 10

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5 Publisher’s Letter By scott Becker, JD, CPA

14 Steve Ronstrom: Strategic Performance Improvement Amid Cost Cutting By steve Ronstrom, Ceo of sacred Heart Hospital, eau Claire, Wis.

15 Chuck Lauer: 8 Reasons Why Health Reform is Running out of Steam By Chuck Lauer

16 8 Top Hospital and Health System Trends of the Past Decade By Leigh Page

17 BrochureforHospitalsandHealthSystems:ImprovingProfitabilityandBusinessandLegal Issues

22 Brett Gosney: 5 Tips for Maintaining Orthopedic Implant Costs By Renée Tomcanin

24 David Fox: Transparency as the Key to Improvement By Lindsey Dunn

25 Becker’s Hospital Review Announces Hospitals and Health Systems: Improving ProfitabilityandBusinessandLegalIssuesConference(April13-14,2010,Chicago)

26 Mark Laney: Bridging the Generation Gap — the Art of Managing Multiple Generations By Mark Laney, MD, President and Ceo of Heartland Health, st. Joseph, Mo.

27 Quint Studer: Four Best Practices for Improving Emergency Department Results By Lindsey Dunn

28 Hospital and Health System Executive Moves

29 Hospital and Health System Transactions

29 Marie Sinioris Explains the Goals of the National Center for Healthcare Leadership By Leigh Page

30 CEO Robert Allen of Park City Medical Center Shares Lessons Learned in Opening a New Hospital By Lindsey Dunn

31 Advertising Index


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2. More non-paying patients. “Growth in unemployment has trans-lated into growth of the uninsured,” says Nancy M. Schlichting, president & CEO of Henry Ford Health System in Detroit. Michigan has had a longer and deeper drop in unemployment than any other state, with the jobless rate at 15 percent for the state and at 30 percent for Detroit alone. Ms. Schlichting says Henry Ford has seen a 20 percent growth in uncom-pensated care each year for the past two years.

Ms. Schlichting has been trying to find ways to cope with the influx of non-paying patients. Henry Ford is partnering with a federally qualified health center in Detroit to direct patients needing primary care from its EDs to the center. Even as the economy improves, Ms. Schlichting says the chal-lenge of non-paying patients won’t go away because unemployment will remain high. Washington has been trying to soften the blow. Dick Clarke, president of the Healthcare Financial Management Association, hopes that Congress’ extension of COBRA eligibility for group insurance coverage for laid-off workers could markedly raise the number of paying patients.

3. Cancelling or delaying capital projects. The recession forced 44-bed Community Hospital in McCook, Neb., to initially postpone a $30 million building addition, says CFO Troy Bruntz. “We had to deal with lack of credit,” he says. “Now it’s starting to loosen up and we were able to actually get the funding we needed and push it through. But it created quite a nightmare the first six months of the year.”

Hospital CFOs across the country have been laboring for months to find funds for capital projects, according to Mr. Clarke at HFMA. “As a result of bond insurance companies being downgraded, some hospitals are moving capital funds from a variable to a fixed basis,” he says. Markets for fixed rate bonds in the past three months have become favorable hospitals with an A- rating or better, but Mr. Clarke says this change requires a great deal of paperwork.

4. Restructuring investments. Many CFOs have also had to pay close attention to the asset side in the balance sheet, Mr. Clarke adds. With

investment portfolios hit hard by the stock market crash, “hospitals have been restructuring investments to make sure they have fully assessed the risks,” he says. “CFOs have been asking: What is the allocation? What per-centage of assets is in equities, what percentage is in fixed investments, what percentage is in alternatives, what are in the risky things like deriva-tives, hedge funds and real estate?”

5. end of the nursing shortage (for now). One good thing that has come out of the recession, says Thomas Dolan, president and CEO of the American College of Healthcare Executives, is that healthcare workforce shortages have eased. Nurses who had left the workforce years ago came back into it when spouses lost their jobs and had their pay cut. Although there are pockets of demand for more nurses, “my guess is that right now we have the largest percentage of licensed nurses in the workforce than ever before,” Mr. Dolan says.

Mr. Rowan at Catholic Health Initiatives thinks it will take at least a few more years for the nursing shortage to return. Employment in other sec-tors of the economy will remain weak and “we’re not going to go back to the go-go years we’ve seen,” he says.

“Healthcare has become the employer of choice in tough times,” observes Ms. Schlichting. Henry Ford hosts a healthcare retraining program for dis-placed autoworkers at a Detroit-area university. When Henry Ford West Bloomfield Hospital opened in 2009, she says 300,000 people applied for its openings.

6. stagnant interest in healthcare executive positions. Anoth-er effect of the bad economy is healthcare executives’ lack of interest in switching jobs, Mr. Dolan says. “Executive search firms say this is the worst year in their history,” he says. Rather than follow their ambitions, mov-ing the family to a new city and facing daunting administrative challenges caused by the recession, executives are staying put. “Few want to take on the risks of starting a new position in this economy,” he says.

7. Coming up with new ways to save money. Hospitals have in-stituted budget cuts, laid off employees and canceled or cut back on capi-

14 Biggest Trends and Events for Hospitals and Health Systems in 2009 (continued from page 1)

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tal projects. Many of these institutions, often to their surprise, ended this year in the black, with even higher surpluses than the year before.

“The worst of the recession may be over,” says Nicholas Wolter, MD, a former MedPAC com-missioner who is CEO of the Billings (Mont.) Clinic, which operates a 272-bed hospital. But Dr. Wolter he doesn’t think hospitals will dis-pense with the cost-cutting mentality they have learned as they enter health reform. “Both the economy and health reform are putting pressure on hospitals to look at their cost structures,” the former MedPAC commissioner says.

8. Health reform. Even though at the end of the year Congress still hadn’t passed a bill and many of its provisions require several years to take effect, preparations for reform cast a giant shadow over 2009. “Health reform is really the lead story of the year,” Dr. Wolter maintains. “What seems to be unfolding is really momen-tous.” Hospitals were affected in the following ways (numbers 9-10) as a prelude to reform.

9. Deep involvement in grassroots lob-bying. Despite the hospital industry’s deep in-volvement in health reform planning, Mr. Clarke at HFMA says the process involved many anxious moments. When the House passed a public option tied to low-paying government rates, it looked like hospitals would take a big hit, though it is now un-likely that the public option will be in the final bill. The same happened when the Senate briefly flirted with adding people ages 55-64 to Medicare.

“I have been uneasy about the bills,” says Mr. Bruntz of Community Hospital. Sitting at the

keyboard in his small Nebraska hospital, he has been fully immersed in the Washington debate, reading about 10 e-mails a day on it, sending out letters and placing phone calls. Officials at his hospital have been in close touch with Sen. Ben Nelson (D-Neb.), who grew up in the same town. After Senate leaders agreed to fully underwrite Nebraska’s share of increased Medicaid payments under the bill, Sen. Nelson cast the deciding vote in favor of reform. But Mr. Bruntz is not par-ticularly pleased with the outcome, predicting that reform will raise premiums for the middle class.

10. Taking steps to get ready for reform. Reform would usher in big changes for hospitals. Expanded coverage will deliver hospitals more paying patients, but disproportionate share hospi-tal (DSH) payments that covered uncompensated care will be phased out and many of the new pa-tients will be covered with low-paying state Med-icaid rates. Moreover, hospitals may be penalized for readmissions and be pressured to unite with doctors and other providers in integrated systems that orchestrate the entire episode of care.

HFMA’s Mr. Clarke has been urging hospitals to prepare for these radical changes. “The start of a new year is the perfect time to infuse our or-ganizations with a sense of optimism about the possibilities engendered by the imminence of reform legislation,” he wrote in a recent message to hospital CEOs.

Many hospitals have already started. Ms. Schlich-ting personally chairs a policy group at Henry Ford looking at readmissions. The group has established a 24-hour call line to support dis-charged patients so that they won’t be readmit-

ted. She says the Henry Ford system is already well on its way to becoming an integrated system through Henry Ford Medical Group, made up of a salaried physicians in multiple specialties.

11. Push for healthcare information technology. In any other year, says Chip Kahn, president of the Federation of American Hospi-tals, the new HITECH bill would have been the most important piece of legislation, but this year it was trumped by health reform. The HITECH bill, part of the American Recovery and Rein-vestment Act, the huge the economic stimulus package, will pay $30-$40 billion to hospitals, physicians and other providers that adopt elec-tronic medical records and interoperability.

Lured by the federal incentive payments, “we have been adding technology more rapidly than we would initially have done,” says Mr. Bruntz of his Nebraska hospital. But Mr. Rowan at Catholic Health Initiatives calculates that HITECH pay-ments will only cover about one-quarter of hospi-tals’ and physicians’ costs for the new technology.

12. Reauthorization of the Children’s Health insurance Program (CHiP). Mr. Kahn says another huge piece of legislation overshadowed by health reform this year was Congress’ reauthorization of CHIP. Passed in February, it is pouring $33 billion in federal funding into state coverage of children’s health-care over the next four and a half years, provid-ing coverage to 4.1 million children who would otherwise have been uninsured.

13. greater focus on fraud and billing errors. CMS’ Recovery Audit Contractor pro-gram, which got up and running this year, un-leashes private auditors to root out billions in Medicare overpayments in government-autho-rized audits. “We spent a lot of time preparing for RAC and now we are waiting for them to start asking for records,” Mr. Bruntz says. In preparation for RACs, Mr. Rowan says Catholic Health Initiatives has started centralizing its bill-ing and collections so that it can assure compli-ance with payment rules. The HHS Office of the Inspector General was also active in fraud and abuse investigations this year and will boost its budget by 50 percent in 2010.

14. growth of hospital mergers. A lot of merger activity was starting even before the re-cession got under way. For example, Ms. Schlich-ting says Henry Ford has acquired two additional hospitals in the past three years. With the reces-sion still eating away at hospitals’ bottom lines, “there will probably continue to be consolida-tion with smaller hospitals that are still indepen-dent,” she predicts. At Henry Ford, “we want to be very strategic about acquisitions, given the nature of our integrated health system.” n

Contact Leigh Page at [email protected].

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I had only been at Scripps for about six months when I took over. The or-ganization was losing $21 million a year at the time and the previous CEO had just left office after receiving votes of no confidence from Scripps’ physicians.

Bringing physicians’ voices into the C-suiteMy predecessor actually had a good strategic plan, but the problem was that he hadn’t anticipated the reaction from system physicians. I don’t think you can overemphasize the need to work closely with physicians. The ap-proximately 3,000 physicians on staff at Scripps are invaluable to our suc-cess. If we were a regular business, our physicians would be our distribu-tors. They write the orders.

I’ve learned that hospital administrators and clinical people have different kinds of education and different views, creating an information or knowl-edge gap between these two groups. I created the Physician Leadership Cabinet to fill that gap.

The Physician Leadership Cabinet is a monthly forum between elected physician leaders and hospital administrators. The goal is to share informa-tion and address controversial issues as a team, before they can become problems. It is an advisory group, but for the past 10 years we have ac-cepted 100 percent of its recommendations.

Closer ties with our physicians were key to our financial turnaround. By 2008, Scripps Health had an operating margin of $109 million.

Last year we added the Physician Business Leadership Cabinet. This new group, an offshoot of the PLC, also includes physicians and meets monthly with me. These are medical staff leaders who are elected by their medi-cal group or IPA (independent practice association). We have to have a lawyer in attendance at the BLC because we can’t talk about pricing and contracts.

Getting ready to align with doctors in accountable care organizationsMoving closer to our physicians follows a trend among hospitals across the country, as they take steps to form accountable care organizations with physicians. Regardless of what happens to healthcare reform, I believe this trend is inevitable. We are going to see more arrangements like bundled payments, where doctors and hospitals share reimbursements.

In some ways California hospitals are well prepared for these changes. Bundled payments hearken back to the capitated arrangements we’ve had in California for several decades. After a brief ascendency in the 1990s, capitation faded in the rest country. But in many ways capitated arrange-ments anticipated accountable care organizations. Both require close work-ing relationships between hospitals and physician groups through shared payments.

We at Scripps are in the middle of our own internal analysis for a possible accountable care organization. In a presentation to the Scripps Board of Trustees recently, our physician business leaders outlined ways to prepare for accountable care organizations and bundled payments. Our doctors are interested in information technology, quality initiatives and safety across the system.

While a few hospitals across the country have joined CMS pilot studies on bundling, California hospitals have not had the opportunity to join. At any rate, I would like to wait and see how the trend develops. California’s ban on the corporate practice of medicine is a barrier to fully integrating with physicians. Hospitals in this state cannot directly employ physicians, so they have to set up medical foundations, legal entities that own the practices but still do not employ the physicians in them. This makes for a fragmented healthcare system.

Our Scripps Medical Foundation encompasses about 600 physicians, as part of Scripps Clinic Medical Group, Scripps Coastal Medical Center and Scripps Cardiovascular and Thoracic Surgery Group. The founda-tion owns the buildings, IT system and everything else that the doctors use, but does not employ the physicians. Foundation physicians negoti-ate a professional services agreement with the foundation every one to three years.

Working with physicians to centralize services We are working closely with our physicians to make Scripps more efficient. We believe hospitals will eventually move away from the old model of healthcare, in which each facility tries to do everything. As trauma systems have proven, it’s better for care to be regionalized at certain hospitals. As a licensed EMT who still volunteers as an EMT on my off hours, I have witnessed the success of trauma systems first-hand.

Regionalization has worked exceptionally well for trauma. Twenty-five years ago, when six San Diego hospitals became the designated trauma centers for the region, unnecessary trauma deaths fell from 20 percent to less than 1 percent and have stayed there ever since.

However, creating designated centers for other functions will be slow. We are about to regionalize advanced cardiovascular care. Scripps is one of the largest providers of such services in Southern California. We will always of-fer some aspects of cardiovascular care at all of our hospitals, but we want to coordinate care as a system now. Our high-risk, high-cost cardiovascular procedures will be shifted into one center.

Scripps is one of the few health systems in the country that perform per-cutaneous heart valve replacements, currently a research protocol. This is done at one hospital, while less risky and more common procedures like diagnostic catheterization are still carried out at many Scripps hospitals.

We want to create this same kind of consolidation for other programs over time, as regionalization begins to take hold. For example, we have been talking about consolidation of stroke centers, diabetes centers, robotic sur-gery and neurosurgery.

All of these plans, of course, will need physician input at every step of the way. We have a strong governance system in place to make sure that happens. n

Chris Van Gorder is president and CEO of five-hospital Scripps Health in San Diego and chairman-elect of the American College of Healthcare Executives. He is a li-censed emergency medical technician whose EMT volunteer work won the Maltese Cross Award in 2006. Learn more about Scripps Health at www.scripps.org.

Chris Van Gorder: Working Closely With Physicians Key to Turning Scripps Health Around (continued from page 1)

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known for its world-class cardiovascular program, Aspirus Wausau Hospital also provides leading-edge cancer, trauma, women’s health and spine and neu-rological care. The hospital has received HealthGrades’ Outstanding Patient Experience Award, which recognizes the top 15 percent of hospitals in the nation for patient satisfaction, as well as HealthGrades’ specialty excellence awards in pulmonary care, women’s health, stroke care and general surgery. The specialty excellence awards recognize the top 10 percent of all hospitals in the nation for services in a number of medical specialties.

Aurora West Allis Memorial Hospital (West Allis, Wis.)Aurora West Allis Memorial Hospital is a 199-bed hospital located in West Allis, Wis. The hospital features comprehensive inpatient and outpa-tient medical services and surgery, emergency services, wound care, pain management, radiology services and a National Accreditation Program for Breast Centers-accredited breast cancer center. The hospital received HealthGrades’ Distinguished Hospital Award in Clinical Excellence and Patient Safety Excellence Award in 2009. The Patient Safety Excellence Award recognizes hospitals that score in the top 15 percent of all eligible hospitals in the nation for patient safety. The hospital was also named to Thomson Reuters’ list of 100 Top Hospitals in 2008 and received Health-Grades’ specialty excellence awards in general surgery and stroke care.

Aurora BayCare Medical Center (Green Bay, Wis.)Aurora BayCare Medical Center is a 167-bed community hospital in Green Bay, Wis. The hospital has received numerous accolades for its programs, in-

cluding recognition as the top performing hospital in the country as judged by quality indicators by the CMS-sponsored Premier Healthcare Alliance Quality Initiative. The hospital was recently named a Top 100 Hospital for Cardiovas-cular Care by Thomson Reuters and was recognized by The Institute for Safe Medication Practices for accomplishments in patient safety. The hospital also features an American College of Surgeons’ Commission on Cancer-approved community hospital comprehensive cancer program and is an American Nurs-es Association Magnet award winner. Aurora BayCare has also received Health-Grades’ Distinguished Hospital Award for Clinical Excellence, Outstanding Patient Experience Award and Patient Safety Excellence Award.

Bon Secours Memorial Regional Medical Center (Mechanicsville, Va.)Bon Secours Memorial Regional Medical Center opened its doors in 1998 to serve residents in suburban Hanover and Henrico Counties, rural Vir-ginia’s Northern Neck and the city of Richmond, Va. The 221-bed hospital ranks among the top 10 percent of the hospitals in the country for overall cardiac services and among the top 5 percent of all hospitals in the country for cardiac surgery according to HealthGrades. Bon Secours was named a Distinguished Hospital for Clinical Excellence by HealthGrades and re-ceived the group’s Women’s Health Excellence Award in 2009, which rec-ognizes the top five percent of hospitals in the nation for women’s services. The hospital is also home to a Commission on Cancer-approved commu-nity hospital comprehensive cancer program and features the cutting-edge da Vinci Surgical System for minimally-invasive robotic surgery.

Desert Valley Hospital (Victorville, Calif.)Desert Valley Hospital is an 83-bed acute-care hospital located in Victor-ville, Calif. The hospital is part of Prime Healthcare Services, which was

20 Best Community Hospitals in America (continued from page 1)

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founded in 2001 by Prem Reddy, MD. Desert Valley is integrated with Des-ert Valley Medical Group, one of the largest multi-specialty medical groups in the area. It was named to Thomson Reuters’ list of 100 Top Hospitals in 2008 and received HealthGrades’ Patient Safety Excellence Award in 2009. The hospital offers comprehensive state-of-the-art digital diagnostic, medical and surgical procedures including emergency care, women’s care, cardiac care and outpatient physical therapy.

Duncan Regional Hospital (Duncan, Okla.)Duncan (Okla.) Regional Hospital is a 192-bed non-profit hospital that opened in 1977. The hospital was named a Top 100 Hospital by Thom-son Reuters in 2008 and received HealthGrades’ Patient Safety Excellence Award in 2009. The hospital offers a variety of medical services including surgery, women’s services, diagnostic imaging, a comprehensive rehabili-tation unit, cardiac rehabilitation, a cancer center and home and hospice care. Duncan Regional also features a wellness center and medi-spa, which offers fitness, nutrition, massage and skin care services.

Holland Hospital (Holland, Mich.)Holland Hospital has received numerous national and regional recognitions for its services and patient care. The 171-bed hospital is a Magnet hospi-tal for excellence in nursing and is the only hospital in western Michigan to receive the honor. The hospital has been named to Thomson Reuters’ list of 100 Top Hospitals for four years running and was named to Mod-ern Healthcare’s 100 Best Places to Work in Healthcare in 2008. Holland Hospital has also been named one of the “Best and Brightest” companies in Michigan by the Michigan Business and Professional Association and received HealthGrades’ Outstanding Patient Experience Award and its Pa-tient Safety Excellence Award, both in 2009.

Meadows Regional Medical Center (Vidalia, Ga.)Meadows Regional Medical Center is an 87-bed hospital located in Vidalia, Ga. The hospital is the only Joint Commission-accredited hospital in a four county area and provides a number of services to its patients including can-cer care, critical care, heart care, orthopedics, radiology, pediatrics, urology, emergency care, women’s services and rehabilitation. Meadows Regional has been named to Thomson Reuters’ list of 100 Top Hospitals for three years in a row and received HealthGrades’ Outstanding Patient Experience Award in 2009. The hospital is also five-star rated by HealthGrades in hip fracture repair and respiratory services and received the Georgia Hospital Association’s Economic Impact Award in 2006.

Middlesex Hospital (Middletown, Conn.)Middlesex Hospital is a 168-bed non-profit hospital that has received nu-merous recognitions for its quality services. The hospital was named to Thomson Reuters’ list of 100 Top Hospitals in 2008 and received Health-Grades’ Distinguished Hospital Award for Clinical Excellence, Pulmonary Care Excellence Award, Critical Care Excellence Award and Gastrointesti-nal Care and Surgery Excellence Award. Middlesex was designated as one of only 11 demonstration sites across the country for piloting Medicare pay-for-performance. The hospital is staffed by nearly 350 active physicians from all major medical specialties and is home to a Commission on Cancer-approved community hospital comprehensive cancer program.

Newton-Wellesley Hospital (Newton, Mass.)Newton-Wellesley Hospital is a 234-bed hospital of Partners HealthCare, a network founded by Massachusetts General Hospital and Brigham and Wom-en’s Hospital in Boston. The hospital is nationally recognized for its services by


a number of organizations. It has been named a top 100 hospital by Thomson Reuters for five consecutive years and received HealthGrades’ Distinguished Hospital Award for Clinical Excellence and Outstanding Patient Experience Award in 2009. The hospital also received the Boston Business Journal’s Best Places to Work Award in 2007 and 2008. Newton-Wellesley has a full range of medi-cal, surgical and specialty services as well as intensive care, coronary care, pedi-atrics, obstetrics, psychiatric services and urgent care services.

Palm Beach Gardens Hospital (Palm Beach Gardens, Fla.)Palm Beach Gardens Hospital is a 199-bed hospital serving the healthcare needs of Palm Beach County for nearly 40 years. The hospital was named one of the best 50 hospitals in America by HealthGrades and has received HealthGrades’ award for clinical excellence for the last three years and its award for patient safety from 2007-2009. Palm Beach Gardens also earned HealthGrades’ Cardiac Excellence Award as well as the organization’s Women’s Health Excellence Award. The hospital has also received the American Heart Association’s Level Three Annual Performance Achieve-ment Award, the Association’s highest honor, and is the only hospital is Florida to earn this highest possible ranking. The hospital is currently un-dergoing a $13.6 million expansion to its emergency department, which will more than double the size of the current department and better help the hospital meet the needs of growing north Palm Beach communities

Parma Community General Hospital (Parma, Ohio)Parma Community General Hospital is a 321-bed community hospital in Par-ma, Ohio, with a medical staff of more than 500 physicians in more than 30 specialties and a comprehensive campus of services. The hospital was named to HealthGrades’ list of America’s 50 Best Hospitals in 2009 and has received the organization’s clinical excellence and women’s health excellence award. The hospital is home to a Commission on Cancer-approved community hospital comprehensive cancer program, an orthopedic center and rehabilitation pro-gram, bariatric services, a heart and vascular center and a pain center.

Parkland Health Center (Farmington, Mo.)Parkland Health Center in Farmington, Mo., part of BJC HealthCare, is a 130-bed hospital. It was named to Thomson Reuters’ list of 100 Top Hos-pitals in 2008 and received HealthGrades’ Outstanding Patient Experience Award in 2009. The hospital is five-star rated by HealthGrades for heart attack care. Parkland Health Center provides comprehensive services for maternity, pediatrics, laboratory services, radiology, cardiac rehabilitation, outpatient and inpatient surgery, physical therapy and a diabetes clinic with renal dialysis services.

Providence Regional Medical Center Everett (Everett, Wash.)Providence Regional Medical Center, part of Providence Health & Servic-es, was honored as a top 100 hospital by Thomson Reuters in 2009 and as a Distinguished Hospital for Clinical Excellence by HealthGrades for three years running. The 268-bed hospital is a 2009 recipient of HealthGrades’ Cardiac Care Excellence Award, which recognizes the top 10 percent of hospitals in the nation for cardiac care. Providence Regional was also named the 2009 employer of the year by the Everett Chamber of Com-merce. The hospital is currently in the midst of building a 680,000-square-foot, $600 million patient tower that will house an additional 368 beds, most of them in private rooms.

Poudre Valley Hospital (Fort Collins, Colo.) Poudre Valley Hospital is part of the two-hospital, non-profit Poudre Valley Health System based in Fort Collins, Colo. The 281-bed hospital features the Heart Center of the Rockies — Colorado’s third largest cardiac program — and a Commission on Cancer-approved community hospital comprehensive cancer program, Poudre Valley Cancer Treatment and Research Center. The hospital was named as one of the best 65 community hospitals in the United States in 2009 by U.S. News & World Report thanks to high-performing ser-

vice lines in endocrinology, gastrointestinal disorders, gynecology, orthope-dics, respiratory disorders and urology. Poudre Valley was also named as a Distinguished Hospital for Clinical Excellence and as a recipient of the Pa-tient Safety Excellence Award by HealthGrades in 2009.

Rio Grande Regional Hospital (McAllen, Texas)Rio Grande Regional Hospital in McAllen, Texas, an HCA-affiliated hospi-tal, was founded in 1982. The 320-bed hospital’s physicians represent more than 35 specialties. The hospital was recently named to HealthGrades’ list of America’s 50 Best Hospitals and received HealthGrades’ Distinguished Hos-pital Award for Clinical Excellence in 2009. HealthGrades also included the hospital in the top 5 percent of all hospitals in the nation for women’s services by HealthGrades. Rio Grande Regional Hospital features the only accredited diabetes management center by the American Diabetes Association in the area and the only bariatric designated center of excellence by the American Society for Metabolic and Bariatric Surgery south of San Antonio.

Rutherford Hospital (Rutherford, N.C.)Rutherford Hospital is a 143-bed acute-care hospital providing inpatient, outpatient and emergency services primarily to the residents of Rutherford County, N.C. The hospital was recently named to Thomson Reuters’ list of 100 Top Hospitals and to Cleverley & Associates’ list of 100 top hospitals based on the value they provide to their communities. Rutherford also re-ceived HealthGrades’ Gastrointestinal Surgery Excellence Award in 2009. The hospital provides comprehensive medical services to its community members including cardiology services, cardiac and pulmonary rehabilita-tion, cancer care, emergency services, women’s services, neurology, neph-rology, orthopedics, dermatology and cosmetic surgery.

Saint Elizabeth Regional Medical Center (Lincoln, Neb.)Saint Elizabeth Regional Medical Center is a 257-bed, non-profit hospi-tal in Lincoln, Neb., and was named as one of the 100 Top Hospitals in the nation by Thomson Reuters in 2007. The hospital received Health-Grades’ Outstanding Patient Experience Award and Patient Safety Excel-lence Award in 2009. The hospital has a medical staff of 475 physicians, 92 percent of whom are board certified. Saint Elizabeth is recognized as a Magnet hospital for excellence in nursing and is home to a Commission on Cancer-approved community hospital comprehensive cancer program.

St. John West Shore Hospital (Westlake, Ohio)St. John West Shore Hospital, part of Cleveland-based Sisters of Charity Health System, is a 165-bed hospital in West Lake, Ohio. The hospital has received Thomson Reuters’ (formerly Solucient’s) award for the top 100 ICUs in the nations. The hospital was also named to HealthGrades’ list of America’s 50 Best Hospitals in America. St. John West Shore has received HealthGrades’ Distinguished Hospital Award for Clinical Excellence and Patient Safety Excellence Award. The hospital has also received the organi-zation’s awards for excellence in stroke and pulmonary care. The hospital is home to a Level III trauma center and a Commission on Cancer-approved community hospital cancer program.

St. Mary’s Jefferson Memorial Hospital (Jefferson City, Tenn.)St. Mary’s Jefferson Memorial Hospital, part of Mercy Health Partners, is a 58-bed hospital in Jefferson City, Tenn. The hospital, which opened in 2001, offers advanced equipment and physicians trained in specialty ar-eas such as oncology and orthopedics as well as outpatient surgery and diagnostic testing. St. Mary’s Jefferson was honored as one of Thomson Reuters’ 100 Top Hospitals in 2008. It was selected as one of only 23 fa-cilities in the nation to receive the inaugural Everest Award for long-term improvement from Thomson Reuters and also received HealthGrades’ Outstanding Patient Experience Award in 2009. n

At LHC Group, our philosophy is simple – It’s All About Helping People.®


No matter what happens with the current health reform legislation, hospitals in the coming decade will have less money

and more demands upon them to improve effi-ciency, outcomes and safety. Since institutions will have to do more with less, strategic performance improvement will become even more important.

During more than 30 years in healthcare, I have seen how strategic performance improvement tends to be carried out. Hospitals hire an out-side consultant to take a snapshot of their op-erations and tell them how they can do it better. Then a cadre of 15 to 20 consultants march in. Their presence is felt everywhere and people get nervous and defensive. Employees are worried about layoffs, doctors get upset and administra-tors have to calm a lot of frayed nerves.

When the hospital implements the recommen-dations of these consultants, some real changes take place — these are talented, insightful profes-sionals — and we begin to see some real savings. The benefits, however, tend to be short-lived. Since employees were not part of the process, no one sees the improvisations as their impro-visations. After the consultants leave, everybody goes back to their old ways. It’s a little like yo-yo dieting. You can lose the weight quickly, but can you keep it off over the long term?

Strategic performance improvement at Sacred Heart HospitalWe didn’t want this to happen at Sacred Heart Hospital when we initiated strategic perfor-mance improvement three years ago. We wanted our improvements to become part of our culture so that the changes would be lasting. We wanted our staff to help create the improvements. And we didn’t want to spend a great deal of mon-ey. We got all three things we wished for, even though these goals might seem a little contradic-tory. How can you have fewer consultants and deliver more lasting change? It turns out that less is more in this case.

Rather than a cadre of consultants, we brought in just one single consultant — Michael Rindler, president of Integrity Hospital Company — a real professional who we value for his flexibility, open-ness and bright ideas. We then set him to work “training the trainers” — showing our managers how to do what the chain of outside consultants usually do, which is to identify the changes we wanted to make, develop strategies to carry them out and to make sure that they are really working.

The consultant was thoroughly transparent. When he met with our department managers, he said, “Here’s the kind of scrutiny we need to have, for these reasons.” Once our manag-ers understood the reasons why, they no longer thought, “Some guy told me to do this.” It be-came part of the way they — and their employ-ees — went about doing their work.

Once the consultant helped us achieve clarity on what needed to be done, we set goals in a very con-crete way, based on percentage of net revenue.

Organizing managers into teams We organized management into seven teams that would plan the process and carry it out. Rather than set up homogenous teams — clinicians teamed with clinicians, for example — we inten-tionally shook things up. So we had the head of housekeeping paired with the head of the ICU, and the head of the OR with the head of pharmacy.

These are people who wouldn’t normally have much to do with each other, which is precisely why they worked so well together. Someone who doesn’t know a lot about what the other is doing has to ask a lot of basic questions, such as “Why does such-and-such a person need to be doing this work at this particular place?” Or, “Have you thought about negotiating a better price for such-and-such a supply?”

Rather than giving our managers a list of things that needed to be cut, we wanted them to think it through and tell us what needed to be cut. Every-one had to give up something, but it couldn’t be anything that could affect the quality of patient care. Somebody asked the manager of the cardi-ology department, “Do you really need to have 10 cardiology journals?” Only a few of these publications were being read. So, with staff and physician input, he whittled the number down.

Another principle of the process was that while we wanted to evaluate the effectiveness of each position in the organization, we did not want to have layoffs. Instead, if a position is vacated, we analyze it and decide whether it is necessary to refill it. We cut positions by attrition, not layoffs.

Creating a new cultureAlthough our managers led the process, we aimed for transparency. Our entire staff knew what was happening — this was not some big secret going on behind closed doors. In fact, we engaged our staff in the process. We asked ev-

eryone, “What can we do more efficiently?” We were interested in the impact on the front line.

Getting our staff involved was, in fact, one of key reasons why we were able to sustain positive changes over a long period of time. We created a new culture among our employees, a culture of questioning. When staff members sit down with vendors, they engage in the process. “Is that the best price you can give me?” they’ll ask. “We’ve been a loyal customer for 10 years.” Because of the change in attitude, we continue to find money.

The Results The return on investment on our work was 10 times what we paid the consultant. Three years later, the changes have been sustainable. We didn’t revert to the old way of doing things after he left.

More recently, we initiated a three-month pro-cess to focus on expense reduction with defined targets. Beginning in Jan. 2009, we used the same principles and structure to eliminate nearly $1 million in expenses for the remainder of the fis-cal year (which ended in July 2009). This was a good exercise for several reasons — not just the budget savings. Our leaders were once again able to engage in the effort and leaders new to the organization were able to immerse themselves in the process to gain the skills and discipline necessary for success. While it is great to meet budget targets, it’s even more gratifying to know that people are learning and growing. n

Stephen F. Ronstrom has more than 25 years of hos-pital leadership experience, having served for the past 11 years as an executive in the Hospital Sisters Health System. He is currently president and CEO of the Hos-pital Sisters’ Western Wisconsin division, which includes 344-bed Sacred Heart Hospital in Eau Claire, Wis. Learn more about Hospital Sisters Health System at www.hshs.org.

Steve Ronstrom: Strategic Performance Improvement Amid Cost CuttingBy Steve Ronstrom, CEO of Sacred Heart Hospital, Eau Claire, Wis.


With health reform, President Obama had a great opportunity to correct some rampant flaws in the health-

care system. But for several reasons, which I’ll itemize, the reform process has become its own worst enemy. The election in Massachusetts is the latest sign that the reform process is running out of steam, although it’s not over yet.

This didn’t have to happen. When the pro-cess started, practically everyone in healthcare seemed to agree that serious reforms were need-ed. Healthcare consumes 16-17 percent of GNP. There is too much waste in the system and not enough coordination. Personally, I have been particularly bothered by insurance practices like denial of coverage based on preexisting condi-tions and the lack of portability of insurance policies across the market.

Many hospital leaders have been embracing reform, even though they have had some res-ervations about it. So why, after coming all this way, is reform in danger of imploding? Here are some of the factors.

1. in too much of a hurry. The Obama admin-istration seemed to feel that if it didn’t shove health reform through now, it wouldn’t happen. The ad-ministration was trying to create positive legisla-tion, but there have been too many compromises and too many decisions behind closed doors.

2. Too complicated. The House and Senate bills each ran on about 1,000 pages and the details kept changing. First, first health reform was go-ing to cover 47 million people, then it as going to cover 30 million. There was a lot of data and sta-tistics thrown out and not much attention to what we’re trying to resolve here. Things have gotten so complex that I think we have lost our way.

3. unclear goals. For health reform to work, everyone needed to agree on the same goals, but it’s unclear just what those goals were. Ev-ery good hospital administrator understands the importance of having a clear mission statement, but what is the mission statement for health re-form? When you have gotten lost, a good mis-sion statement is like a compass that can get you back on course, but we don’t have one.

4. Too many special interests. Instead of agreeing on common goals on behalf of the American people, each constituency seemed to be pursuing its own special interests. The man-tra was, “What’s in it for my group?” This made the American people very cynical about health reform and what it could achieve.

5. no stakeholder dialog. Bill Clinton made a lot of mistakes with his health reforms, but I think he had it right when, very early in his presidency, he brought together all of the stakeholders in health reform and had them talk through the issues. I thought Barack Obama would do this too, but the dialog seems to have been between the administration and each inter-est group, like an axel to each spoke. That broke up the debate and made it difficult to arrive at a solution that includes everyone.

6. Public left in the dark. There was a lack of transparency. President Obama would have been well served if he had initiated a public de-bate on needed reforms, but this never really happened. The public was cut out to of the dia-log. If the American people had been told the reasons why health reform needed to happen, I think they would have understood. But the ad-ministration seemed to feel this legislation was too complex for them to understand.

7. Leaves out the average American. I haven’t heard much about how health reform would affect the average patient. The administra-tion has mentioned some general things, along the lines of “people will have better care,” but no one understands what that means.

8. Too focused on financing. In the health reform debate, there was a preoccupation with how are we going to finance this legislation. Re-form would reduce Medicare by $500 billion, which makes Americans think “rationing” and they don’t like it. They are beginning to think of health reform like they did of HMOs when managed care fell out of favor in the late 1990s.

I still think some sort of health reform bill will be put through, but it will be messy. The Ameri-can people are now afraid of this thing. They seem to be turning on the reform bill and per-haps on President Obama.

Healthcare has undergone a lot of reform and it has always survived and, to a great degree, pros-pered. I think of DRGs, which were roundly hat-ed when they ere implemented in the early 1980s but are now widely accepted by hospital execu-tives. However, I don’t know where we’re headed now. I’m as mystified as the next person. n

Chuck Lauer ([email protected] ) was publisher of Modern Healthcare for more than 25 years. He is now an author, public speaker and career coach who is in demand for his motivational messages to top companies nationwide.

Chuck Lauer: 8 Reasons Why Health Reform is Running out of SteamBy Chuck Lauer

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8 Top Hospital and Health System Trends of the Past DecadeBy Leigh Page

1. Loosened cost controls. HMOs in the late 1990s had successfully slowed growth in healthcare spending, but by the end of that decade they had come to be regarded as heartless conservators of the bottom line. Managed care’s tight controls be-gan to loosen and “the negotiating power slipped back into the hands of the providers,” says Dick Clarke, president of the Healthcare Financial Man-agement Association. Healthcare costs again began increasing faster than the general rate of inflation. “It’s not clear yet how much of that will change if providers come under more pressure to contain prices,” he says.

2. Healthcare iT. Healthcare information tech-nology, still rough around the edges in 2000, be-came a major force in hospital operations by the end of the decade, says Michael Rowan, COO and executive vice president of Catholic Health Initiatives in Denver. Innovations like computer-ized physician order entry and electronic medical records have been shown to improve safety as well as efficiency. Now, thanks to billions of dollars in incentives in the 2009 HITECH legislation, health-care IT holds the promise of becoming virtually universal in the next few years. But Mr. Rowan re-ports that HITECH funds will pay for only about a quarter of the cost of the new technology.

3. Patient safety movement. At the start of the decade, hospitals were just beginning to hear word of one of the most influential reports in the history of U.S. healthcare: “To Err Is Human: Building a Safer Health System,” published in Nov. 1999 by the Institute of Medicine. It concluded that from 44,000- 98,000 people die annually—the equivalent of 10 fully loaded 757 commercial air-liners crashing each week, the report stated—due to errors in inpatient hospital treatment.

As a result, “hospitals started to get much more serious about quality and safety,” says Mr. Clarke at HFMA. The industry embraced continuous qual-

ity improvement, adds Thomas Dolan, president and CEO of the American College of Healthcare Executives. “Everybody realized that we have to constantly improve quality and it actually lowers costs because it reduces waste,” he says.

4. Physician entrepreneurialism. Many phy-sicians became entrepreneurs, investing in ASCs, imaging centers and specialty hospitals as a way to supplement declining income due to lack of increas-es in reimbursements and become more efficient. The trend, however, put physicians into conflict with hospitals, who were concerned about losing market share to the leaner, physician-run organizations. By the end of the decade, it seemed that hospitals and regulators had blunted the trend.

“The ban on physician-owned hospitals in the health reform legislation signals the decline of the entrepreneurial physician,” says Nicholas Wolter, MD, a former MedPAC commissioner and CEO of the Billings (Mont.) Clinic. How-ever, ASCs seem to have become a permanent fixture in U.S. healthcare, offering discounts too big for payors to pass up.

5. Healthcare consumerism. “The future of market-oriented health policy and practice lies in ‘managed consumerism,’ a blend of the patient-centric focus of consumer-driven health-care and the provider-centric focus of managed competition,” declared Jamie Robinson, a pro-fessor of health economics at the University of California, Berkeley, School of Public Health, in 2005 in the journal Health Affairs.

With the decline of HMOs, consumer-driven healthcare became a new way to contain costs. High deductible plans, with or without tax-free health savings accounts, would make patients cost-conscious consumers. Ratings of doctors and hospitals, from HealthGrades to CMS’ Hos-pital Compare site, would aid patients in choos-ing the best providers. Retail clinics opened to serve these new consumers. Hospitals developed a new fascination with patient satisfaction sur-veys. Brand-new hospitals lavished spending on patient-friendly design features, such as single rooms, sunlit atriums and concierge services, and these features seemed to shift market share.

6. shortages of healthcare personnel. In July 2007, the American Hospital Association reported 116,000 open positions for registered nurses in hospitals, and the existing RN work-force was aging. Mr. Rowan at Catholic Health Initiatives observes that the recession has erased the shortage for now, at least, as RNs were forced back into the workforce or into full-time work as family income fell.

Physician shortages also emerged. In a dramatic about-face at the beginning of the decade, the federal Council on Graduate Medical Education abandoned its long-held forecast of a physi-cian surplus and predicted a shortage of 85,000 physicians by 2020. Since then, medical schools have been substantially increasing class sizes, but Congress has not removed a cap on the number of Medicare-funded graduate medical education positions for physicians that has been in place since 1997.

“Current evidence suggests that the United States is headed toward an aggregate shortage of physicians,” the Association of American Medical Colleges declared in 2009. “Given the extended time required to increase U.S. medical school capacity, and to educate and train phy-sicians, the nation must begin now to increase medical school and GME capacity to meet the needs of the nation in 2015 and beyond.”

7. Accountable health organizations. While entrepreneurial physicians continued to spin off from hospitals throughout the decade, Dr. Wolter, the former MedPAC commissioner, says an opposing trend also emerged. Many young physicians were eagerly becoming em-ployees. Accountable health organizations such as Mayo Clinic, the Cleveland Clinic and Geis-inger Health System thrived by closely aligning hospitals and doctors to make care more effi-cient and effective.

Mr. Rowan at Catholic Health Initiatives says accountable health organizations seemed to be taking a lesson from the ASC playbook. Incen-tivizing physicians can make healthcare more ef-ficient. But he adds that the trend is not easy for hospitals. “Many hospitals have no expertise in running practices,” Mr. Rowan says. “We’re hos-pital people, not group management people.” Hospitals used to hire doctors merely to generate business. Now, he says, “hospitals want doctors to take financial responsibility for outcomes.”

8. Recession. “The decade will be known for the financial turmoil that came at the end,” says Mr. Clarke of HFMA. In March 2009, Thomson Reuters reported that the median profit margin of U.S. hospitals has fallen to zero percent. Hospitals tightened their belts and many of them ended the decade solidly in the black. But the numbers of non-paying patients are still high and many lead-ers like Mr. Clarke believe we are entering an era of having to do more with less. n

Contact Leigh Page at [email protected].

Hospitals and Health SystemsImproving

Profitability andBusiness and Legal Issues

April 13-14, 2010Westin Hotel • 909 North Michigan Avenue • Chicago, Illinois

Limited to 125 attendees

For more information, call ASC Communications (800) 417-2035If you would like to sponsor or exhibit at this event, please call (800) 417-2035

• Focused on Chief Executive Officers and Chief Financial Officers

• Great Speakers from CHRISTUS St. Michael Health Sys-tem, NYU Medical Center, Baylor HealthCare, LHP Hos-pital Group, Inc., Aurora Baycare Medical Center, Medical Center at St Elizabeth Place, OSF St. Joseph Medical Cen-ter, Kaufmann Hall, Sg2, Medical Facilities Corporation, HealthCare Finance Group, Sacred Heart Hospital, Wells Fargo Equipment Finance, McGuireWoods, and more

• Improve Your Profits Monday Morning• Great topics and speakers focused on key business,

financial, and legal issues facing Hospitals

and Health Systems – 37 Sessions, 45 Speakers• Immediately useful guidance plus great keynote

speakers• Joint Venture, Business and Legal Issues• Big Thoughts Combined with Practical Guidance• Great Networking• Understand the Expected Impact of Healthcare Reform• Orthopedics, Spine, Oncology, Cardiovascular,

and more• Service Line Profitablitiy, Cost Cutting, Revenue

Growth and more• Have an outstanding time in Chicago

Improving the Profitability of Your Hospital – Thrive Now and in the Future

To register, contact ASC Communications at 800-417-2035 or fax 866-678-5755 or Email: [email protected]

Register online: https://www.regonline.com/hospitalandhealthsystemconference

Improving the Profitability of Your Hospital and Health Systems –Thrive Now and in the FutureThis exclusive conference brings together hospital business and strategy leaders to discuss how to improve your Hospital and its bot-tom line in these challenging but opportunity-filled times.

The best minds in the Hospital field will discuss opportunities for Hospitals plus provide practical and immediately useful guidance on how to grow revenue, become dominant in key service line areas — orthopedic, oncology, neurosurgery, and cardiology. Improve reimbursement; manage, reduce and benchmark costs; intro-duce new specialties; work on joint-ventures and much, much more.

The Becker’s Hospital Review:1) Benefit from the efforts of Beck-

er’s Hospital Review to attract attendees and speakers that are among the smartest people in the Hospital industry today.

2) Take discussion and thinking to the highest levels.

3) Access expert views from all sides of the Hospital world.

To Subscribe to Becker’s Hospital Review, call 800-417-2035.

Conference – Tuesday, April 13, 201011:30am – 1:00pm Registration1:00pm – 5:25pm Conference5:25pm – 7:00pm Reception, Cash Raffles, Exhibit Hall

Conference – Wednesday, April 14, 20107:00am – 9:00am Registration and Continental Breakfast9:00am – 5:15pm Conference, Including Lunch and Exhibit Hall Breaks5:15pm – 7:00pm Reception, Cash Raffles, Exhibit Hall

PROgRAm SCHEduLE

Tuesday, April 13, 2010 11:30 am – 1:00 pm

Registration

1:00 pm – 1:05 pmIntroductions

1:05 pm – 1:50 pmThe Politics of Healthcare Reform

Ron Brownstein, Political Director, Atlantic Media Company

1:55 pm – 2:40 pmThe Best Ideas for Hospitals Now

Chris Karam, FACHE, President & CEO, CHRISTUS St. Michael Health System, Dan Moen, CEO, LHP Hospital Group, Inc, Paul R. Summerside, MD, Chairman of the Board, Aurora Baycare Medical Center, Alex Rintoul, CEO, Medical Center at St. Elizabeth PlaceModerated by Scott Becker, JD, CPA, Partner, McGuireWoods, LLP

2:45 pm – 3:25 pmA - The 5 Things Hospitals Should Look For In A Partner

Dan Moen, CEO, LHP Hospital Group, Inc.

B – developing a Sustainable Physician Strategy

Walter Morrissey, MD, Vice President, Kaufman Hall

3:25 pm – 3:40 pmBreak

3:45 pm – 4:15 pmA - 5 Key Concepts for growing Profits in a Challenging Economic Environment

Chris Karam, FACHE, President & CEO, CHRISTUS St. Michael Health System

B – Hospital Transactions, Current market Analysis and Valuations

Greg Koonsman, Senior Partner, and Jon O’Sullivan, Senior Partner, VMG Health

C - Key Trends and Ideas for Improving Hospital Performance and Aligning with Physicians

Bill Southwick, President & CEO, Healthmark Partners, Marc Halley, President/CEO, Halley Consulting Group, Marc E. Koch, MD, MBA, President & CEO, Somnia Anesthesia

4:20 pm – 4:50 pmA – Strategies for Competing with a dominant Hospital

Alex Rintoul, CEO, Medical Center at St. Elizabeth Place

B – A Prescription for the Free Standing Emergency department

Kimberly J. Nealon, RN, BSN, Site Director, St. Vincent Medical Center Northeast, John Marshall, Executive Director, Business Development Midwest, BrenmerDuke, Steve Mombach, VP Ambulatory Services, TriHealth

4:55 pm – 5:25 pmA – making Employed Physician models Profitable

Marc Halley, MBA, President & CEO, Halley Consulting Group

B – How doctors Think, Why doctors Are different – Suggestions, Ideas and Tips for Partnering with Physicians

Jeff Leland, Managing Director, Blue Chip Surgical Center Partners

5:25 pm – 7:00 pmCocktail Reception

To RegisTeR, call 800-417-2035 • Fax 866-678-5755 • email [email protected] https://www.regonline.com/hospitalandhealthsystemconference


Wednesday, April 14, 2010

7:00 am – 9:00 amRegistration and Continental Breakfast

9:00 am – 9:40 amPhysician Hospital Relationships – A Review of Evolving Problems and Opportunities

Paul Summerside, MD, Chairman of the Board, Aurora BayCare Medical Center

9:45 am – 10:15 amA - using metrics to Analyze Hospital Financial Performance

Zach Hafner, Vice President Strategy and Financial Planning, Kaufman Hall

B – The Evolution of Service Line Co-management Relationships with Physicians – Key Observations on Relationships and Fair market Value

Scott Safriet, MBA, AVA, Principal, Healthcare Appraisers, Kristian Werling, JD, Attorney, McGuireWoods, LLP

C – An Analysis of What Works, What doesn’t – Key Thoughts from 10 great Partnerships with management Companies and Hospitals

Joe Clark, EVP and Chief Development Officer, Surgical Care Affiliates

10:45 am – 11:15 amA – The Best Ideas for Hospital CFOs Now

Faye Deich, Chief Operating Officer, Sacred Heart Hospital, John R. Zell, CPA, MBA, CFO, OSF St. Joseph Medical Center, David Felsenthal, Senior Partner, Principle Valuation, John Thomas, EVP Healthcare REIT, Moderated by Claudia Gourdon, Senior Vice President, National Marketing Manager, Healthcare Finance Group

B – Running Your Hospital’s Orthopedic Program Smarter – Benchmarking – Improving Revenues per Case, Reducing Hours Per Case, Supply Costs per Case, Staffing and more

Larry Teuber, MD, President, Medical Facilities Corporation

C – Core Stark and Anti Kickback Issues - 5 Recent Kickback and Stark Settlements

Scott Becker, JD, Partner, McGuireWoods, LLP

11:20 am – 11:50 amA – The Cost Benefit Case for utilizing Hospitalists

Stephen Houff, MD, President, Hospitalists Management Group

B – 4 Key Ideas and Concepts to Improve Cardiovascular Program Profitability

Ted Winslow, MD, Sg2

C – Key Tips for Successful Physician Hospital Joint Ventures

Larry Taylor, President, Practice Partners in Healthcare

12:00 pm – 12:30 pmA – Key Steps to Contain Costs

Faye Deich, Chief Operating Officer, Sacred Heart Hospital, Regional Director, Hospital Sisters Health System

B – Clinical Integration models and How to Affiliate for managed Care Contracting

Brian Silverstein, MD, Senior Vice President, The Camden Group

C – Ancillary Facilities Financing Challenges

Peter Myhre, Senior Vice President, Wells Fargo Equipment Finance

12:30 pm – 1:30 pmLunch Break

1:30 pm – 2:05 pmA - monetization of Non Core Assets and Outsourcing Facility development

Michael Bryant, CEO, Methodist Medical Center and Gordon Soderland, SVP, Strategic Relationships, DASCO Companies

B – A New model in Cancer CareJohn Marshall, Executive Director, Business Development Midwest and Deeni Taylor, Regional Executive Vice President, BremnerDuke, Donna Bowers, JD, RHIA, VP, Baylor University Medical Center

C – distressed Hospital Financing IssuesShane Passarelli, Senior Vice President, Healthcare Finance Group, and Gary Samson, Partner, McGuireWoods, LLP

2:10 pm – 2:45 pmA – How to Work With Physician Owned Hospitals

Tom Michaud, Chairman/CEO, Foundation Surgical Hospital Affiliates

B – 4 Best Practices for Hospital Spine Programs

Ted Michalke, Managing Partner, NeuStrategy, Inc.

C – developing Hospital Physician gI Joint Ventures

John Poisson, Senior Vice President, Physicians Endoscopy

3:20 pm – 3:55 pmA – data Transparency and Quality in Healthcare

Holly Hampe, Director, Patient Safety and Quality, and Mary Beth Lang, Senior Vice President, Amerinet

B – moving Outpatient Surgery Out of the Hospital

Joseph Bosco, MD, Vice Chair, Clinical Affairs, Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, Moderated by Joan Dentler, MBA, Managing Partner, ASC Strategies

C – ASCs as a Physician Engagement Tool for Hospitals and Health Systems – How does a Hospital Assess the Financial Impact? How do You Ensure Physician Engagement? How Should You measure Hospital Success?

David Thoene, CEO, Medical Surgical Partners, LLC

4:00 pm – 4:35 pmA – Best Practices for Retaining Senior Level Leadership

Doug Smith, CEO, BE Smith

B – Best Practices to Reduce CostsAngie Blankinship, Director of Surgery Services, San Luis Valley Regional Center

C – The 5 most Pressing Legal and Compliance Issues Facing Hospitals Today

Scott Becker, JD, CPA, Partner, McGuireWoods, LLP

4:40 pm – 5:15 pmA – maintaining Profits, Containing Costs and Patient Care Success in a Recession

Nicola Hawkinson, MA, RN, RNFA, NP, CEO & Founder, Spine Search

B – 4 Core Ideas and Concepts to Improve Oncology Program Profitability

Lisa Slama, PhD, Director, Sg2

C - Automating procedure documentation, coding for reduced costs and increased profitability

Benjamin Krevsky, MD, MPH, Director of GI Endoscopy, Gastroenterology Section, Temple University School of Medicine

5:15 – 7:00 pmCocktail Reception

Scott Becker, JD, CPA, Partner, McGuireWoods, LLP

Angela L. Blankinship, Director of Surgery Services, San Luis Valley Regional Center

Joseph Bosco, MD, Vice Chairman Clinical Affairs, Dept of Orthopedic Surgery NYU

Donna Bowers, JD, RHIA, Vice President, Baylor University Medical Center

Ron Brownstein, Political Director, Atlantic Media Company

Michael Bryant, President & CEO, Methodist Health Services Corporation

Joe Clark, EVP and Chief Development Officer, Surgical Care Affiliates

Faye Deich, Chief Operating Officer, Sacred Heart Hospital, Regional Director, Hospital Sisters Health System

Joan Dentler, MBA, Managing Partner, ASC Strategies

David Felsenthal, Co-Founder, Principle Valuation

Claudia Stone Gourdon, SVP, National Marketing Manager, Healthcare Finance Group

Zachary Hafner, VP Strategy and Financial Planning, Kaufman Hall

Marc Halley, President/CEO, Halley Consulting Group

Holly Hampe, Director, Patient Safety & Quality, Amerinet

Nicola Hawkinson, CEO & Founder, Spine Search

Stephen Houff, MD, President, Hospitalists Management Group

Chris Karam, President/CEO, CHRISTUS St. Michael Health System

Marc E. Koch, MD, MBA, President & CEO, Somnia Anesthesia

Greg Koonsman, Senior Partner, VMG Health

Benjamin Krevsky, MD, MPH Director of GI Endoscopy Gastroenterology Section Temple University School of Medicine

Mary Beth Lang, Senior Vice President, Amerinet

Jeff Leland, Managing Director, Blue Chip Surgical Center Partners

John Marshall, Executive Director, Business Development Midwest, BremnerDuke

Theodore W. Michalke, Managing Partner, NeuStrategy, Inc.

Tom Michaud, CEO, Foundation Surgical Hospital Affiliates

Dan Moen, CEO, LHP Hospital Group, Inc.

Steve Mombach, VP Ambulatory Services, TriHealth

Walter Morrissey, MD, Vice President, Kaufman Hall

Peter S. Myhre, Senior Vice President, Wells Fargo Equipment Finance

Kimberly J. Nealon, RN, BSN, Site Director, St. Vincent Medical Center Northeast

Jon O’Sullivan, Senior Partner, VMG Health

Shane Passarelli, Senior Vice President, Healthcare Finance Group

John Poisson, Senior Vice President, Physicians Endoscopy

Alex Rintoul, CEO, Medical Center at St. Elizabeth Place

Scott Safriet, MBA, AVA, Principal, Healthcare Appraisers

Gary D. Samson, Partner, McGuireWoods, LLC

Jim Shannon, Executive Vice President, LHP Hospital Group, Inc.

Brian Silverstein, Senior Vice President, The Camden Group

Lisa Slama, Director, Sg2

Doug Smith, CEO, BE Smith

Gordon Soderland, SVP Strategic Relationships, DASCO Companies

Bill Southwick, President & CEO, Healthmark Partners

Paul R. Summerside, MD, Chairman of the Board, Aurora BayCare Medical Center

Deeni Taylor, Regional Executive Vice President, BremnerDuke

Larry Taylor, President, Practice Partners in Healthcare

Larry Teuber, MD, President, Medical Facilities Corporation

David M. Thoene, CEO, Medical Surgical Partners, LLC

John Thomas, Executive Vice President, Healthcare REIT

Kristian Werling, Attorney, McGuireWoods, LLC

Ted Winslow, MD, Sg2

John R. Zell, CPA, MBA, CFO, OSF St. Joseph Medical Center

conference speakers


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Hospitals and Health Systems ConferenceImproving Profitability and Business and Legal Issues

B E C k E R ’ S H o S P I T A L R E V I E W

april 13-14, 2010W E S T I N H o T E L • C H I C A g o , I L L I N o I S

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Implants for procedures can either make or break a hospital’s profits when it comes to orthopedic surgery. Good contracts for

these items consist of more than just a low price; other factors such as quality and payor issues are also important to success at your hospital.

Brett Gosney, CEO of Animas Surgical Hospi-tal in Durango, Colo., shares five tips for keeping orthopedic implants costs low while providing quality care.

1. include surgeons at every step of the process. Orthopedic surgeons are essential to the overall success of your hospital’s program, both on the clinical and business end of opera-tions. Since they are the ones who are going to use the implants, Mr. Gosney says it is critical to bring surgeons in early on the decision-making process.

“Leaving surgeons out of the equation often leads to senseless conflict [between administra-tion and physicians],” Mr. Gosney says. “Align-ing physician and hospital incentives is just one key to the hospital’s success.”

With a large choice for implants and manufactur-ers, it may be difficult for hospital administrators and materials managers to be certain they are get-ting the best value for their money. Surgeons can aid in the process because they will be able to evalu-ate the quality of implant as well as the knowledge and honesty of the sale representative.

“Administrators tend to look solely at cost, which is way it is important to involve physicians. If an implant is not working out the best or your sales rep is only interested in selling more products, surgeons can let you know much earlier in the process,” Mr. Gosney says.

2. sales reps should do more than just sell products. The scope of an implant sales representative’s expertise should be wider than just what his or her company makes. According to Mr. Gosney, a quality sales rep is important to a good implant contract.

“Good sales reps are essential in orthopedics, especially in total joint replacements,” Mr. Gos-ney says. “They should be well-educated on all areas of the implant, from surgical techniques to payor issues.”

Mr. Gosney says that a quality rep should pos-sess the following traits: 1) excellent clinical competence; 2) effective communication with staff and surgeons; and 3) good sales skills. He stresses that these traits should be evident in this

order. “If a rep makes sales his or her number one priority, then you probably have a subopti-mal rep,” he says.

3. Check reimbursements prior to sign-ing a contract. Hospitals can often be surprised after researching implant providers to find that par-ticular implants have low reimbursement or are not covered by payors. Consequently, hospitals should know how an implant is reimbursed in its market and other similar markets to ensure that they are receiving the best return on their investments.

“We have learned to push the burden of proof of coverage back on the vendor and the sales rep,” Mr. Gosney says. “If we like a product, we ask the sale rep to show us proof that the im-plant has been covered in other markets. They are increasingly asked to do this kind of research, so a good rep should be able to provide you with this information.”

Mr. Gosney also suggests researching reimburse-ments on some common CPT codes to make sure the procedures are covered.

“It’s a highly competitive market, and, overall, quality is similar for implants,” Mr. Gosney says. “We’ve had to be honest with a few companies. We asked them to supply proof that the implant would be covered, and they couldn’t provide us with the information. We had to say, ‘Sorry, but we have to cover costs.’”

4. schedule regular reviews of implant contracts. Animas Surgical Hospital reviews its contracts on a regular cycle. For example, total joint replacement procedures are reviewed every two years. Mr. Gosney says this review process is essential to keeping the hospital and its surgeons up to date on what is happening in the orthopedic implant market.

“We review what is currently going on in jour-nals and the literature. We then send out request for proposals to the companies we are interested in, and we bring in reps and evaluate the prod-ucts,” Mr. Gosney says.

Through this process, Animas can demo new im-plants and make sure they have the best contracts in place for the hospital and its patients. “We aren’t just looking at a price point. We want to see the new techniques and surgeries and see if they will improve our outcomes,” Mr. Gosney says.

Running regular reviews can also incentivize your current vendor to offer you the best deal. For example, Animas has returned to the same

vendor for three consecutive two-year cycles. “It has kept our current vendor honest,” Mr. Gosney says.

Another important feature to Animas’ review process is that it is closely monitored and run only by the hospital’s administration and surgeons.

5. Don’t be afraid to use similar tech-niques for other surgical products. Al-though implants tend to be the biggest expense for orthopedic surgery, similar evaluation can be performed for all types of surgical equipment, especially commonly used items such as shavers and anchors, according to Mr. Gosney.

“The key element is standardization,” he says. “Variations in big implants will get the most no-tice, but standardizing smaller pieces is critical.”

Similar to the evaluation process for implants, standardization begins with the surgeons. The first step, according to Mr. Gosney, is to ask your surgeons what kinds of equipment and sys-tems they are interested in. The administrators can then work with operating room or materials managers to narrow the field to several candi-dates, send out requests for proposals and set up trials of the equipment.

“We’ve had reps run cadaver labs for shoulder anchors. Many vendors are willing to let the sur-geons demo the products to see how they can work for them,” Mr. Gosney says.

The final step is to follow up with surgeons to see which products they liked the best, and then, based on quality, price and support from the rep, decide which vendor to choose. “It should be a collegial, collaborative experience,” Mr. Gosney says. n

Mr. Gosney is the CEO of Animas Surgical Hospital in Durango, Colo., and president of Physician Hospitals of America. Learn more about Animas Surgical Hos-pital at www.animassurgical.com.

Brett Gosney: 5 Tips for Maintaining Orthopedic Implant CostsBy Renée Tomcanin

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David Fox: Transparency as the Key to ImprovementBy Lindsey Dunn

David Fox, CEO of Good Samaritan Hospital in Downers Grove, Ill., be-lieves transparency is critical to improv-

ing the performance of any hospital. At Good Samaritan, both overall organizational and indi-vidual manager goals are shared throughout the organization, and each manager’s performance against those goals is shared across the organiza-tion on a monthly basis.

“It’s important for hospital leaders to be very open with what they’re trying to accomplish, and transparent goals are part of that openness,” says Mr. Fox. “If people don’t know what goals they are working towards, how can they align their behavior and actions to achieve that vision?”

Objective, measurable, cascading goalsThe first step to achieving transparency is set-ting organizational goals that are objective and measurable, says Mr. Fox. Aiming to be the “best hospital in the area” is certainly a goal, but it is not objective or specific enough to align be-haviors. Instead, hospitals should select crucial areas within which to set goals and measure per-formance. Good Samaritan focuses on five key outcome areas: health outcomes, employee engagement, patient satisfaction, growth and “funding our future,” which includes operating margin, expense man-agement and fundraising goals.

The hospital’s leadership begins the goal-setting process by determining the goals that will guide the organization within each area, and then these goals are cascaded down into narrower goals for directors and managers. By the end of the goal-setting process, each individual manager will have 8-10 objective, measurable goals, such as achieving a patient satisfaction rating of a cer-tain percentile, says Mr. Fox.

The goals are then weighted by relative impor-tance, and individual and organization perfor-mance against each goal is tracked monthly. Each

manager’s performance is published on the man-agement’s Intranet site, and Mr. Fox publishes what he calls his “report card” every month to the entire management team, physician leader-ship and the board of directors, he says.

Performance improvement The biggest benefit to publishing these reports on a monthly basis is that every manager is able to immediately assess areas for improvement. If performance was assessed only once per year, areas targeted for improvement could be overlooked for many months. Publishing the scorecards also allows managers of departments that many not be hitting certain goals to iden-tify managers who excel in that area and con-tact them for information on best practices and other advice, says Mr. Fox.

For example, in its most recent physician sat-isfaction survey, the hospital scored in the 97th percentile nationally, according to HealthStream. However, leaders identified two areas the hospital could improve upon: ease of scheduling inpatient surgery and ease of scheduling and performing outpatient surgery. In response to these scores, the surgical departments are currently examining ways to improve upon both inpatient and outpa-tient surgical scheduling and recently implement-ed block scheduling for 60 percent of its cases. The hospital is also recruiting an additional anes-thesiologist to expand the hospital’s OR capacity.

Consumer interest in transparencyThe hospital evaluated sharing its performance on clinical outcomes with its community on the hospital’s Web site, but surprisingly found com-munity members were, for the most part, unin-terested in accessing the data. This lack of inter-est was an important lesson for the hospital as it works to improve its transparency with its com-munity — a move that is expected to become more and more popular within the industry as

consumer consciousness regarding healthcare decisions is likely to grow.

“A key learning for us was that, as we begin to be more transparent with patient, we will have to really work hard to boil down the information in a way that it can be easily understood by our customers,” says Mr. Fox.

OutcomesTransparency has apparently paid off for Good Samaritan — the hospital met or exceeded its goals in each of its key outcome areas for 2009. Employee engagement scores reached the 98th percentile, according to Morehead Associates, tying for the best results in the hospital’s history. In core clinical measures, the hospital scored at or about the 90th percentile for all four of the following benchmark areas: acute myocardial infarction, congestive heart failure, pneumonia and surgical care infection prevention. None of these accomplishments would have been pos-sible without aligned goals and transparent per-formance evaluation, says Mr. Fox. n

Mr. Fox has served as CEO of Advocate Good Sa-maritan since 2003. He earned a graduate degree from the University of Chicago in healthcare management and previously served as president of Central DuPage Hos-pital in Winfield, Ill. Learn more about Advocate Good Samaritan at www.advocatehealth.com.


CALL 800-417-2035 or go to

www.regonline.com/ hospitalandhealthsystemconference. For the complete conference brochure, visit www.BeckersHospitalReview.com.


Hospitals and Health systems Improving Profitability

and Business and Legal issues


Becker’s Hospital Review Announces Hospitals and Health Systems: ImprovingProfitability and Business and Legal Issues Conference (April 13-14, 2010, Chicago)Chicago, IL — Becker’s Hospital Review announc-es details of the Hospitals and Health Systems: Im-proving Profitability and Business and Legal Issues Conference on April 13-14, 2010, at the Westin Hotel on North Michigan Avenue in Chicago.

HIGHLIGHTS INCLuDE:— 37 sessions and 45 speakers focused on im-mediately useful guidance for hospitals and health systems— Gain practical guidance that can be used im-mediately; topics include 5 Key Concepts for Growing Profits in a Challenging Economic Environment; Strategies for Competing with a Dominant Hospital; Key Trends and Ideas for Improving Hospital Performance and Aligning with Physicians; The Best Ideas for Hospitals Now; and Key Steps to Contain Costs— Great speakers from the following hospitals and health systems: CHRISTUS St. Michael Health System, Hospital Sisters Health System, Aurora BayCare Medical Center, San Luis Val-ley Regional Center, St. Vincent’s Medical Cen-ter, Medical Center at St. Elizabeth Place, OSF St. Joseph Medical Center, TriHealth, Baylor Health, NYU Hospital for Joint Diseases, Tem-ple University School of Medicine— Study new strategies and ideas for orthopedics, cardiovascular, oncology, neurosurgery and more— Understand the impact of healthcare reform on hospitals and health systems— Limited to 125 attendees— Outstanding keynote speakers— Early registration discounts end March 1; Additional discounts when registering 2 or more attendees

THERE ARE 4 EASY WAYS TO REGISTER:1. Online: Register through our secure Web site at www.regonline.com/ospitalandhealthsystem-conference.

2. Phone: (800) 417-2035.

3. E-mail: [email protected].

4. Fax: Print the conference brochure found at www.hospitalreviewmagazine.com/pdfs/April_Hospital_Conference_Brochure.pdf, fill out the registration on p. 5 and fax it to (866) 678-5755.

Here are just 16 of the 37 sessions:1. The Best Ideas for Hospitals Now – Chris

Karam, FACHE, President & CEO, CHRISTUS St. Michael Health System; Dan Moen, CEO, LHP Hospital Group; Paul R. Summerside, MD, Chairman of the Board, Aurora Baycare Medical Center; Alex Rintoul, CEO, Medical Center at St. Elizabeth Place; Moderated by Scott Becker, JD, CPA, Partner, McGuireWoods, LLP

2. The 5 Things Hospitals Should Look For in a Partner – Dan Moen, CEO, LHP Hospital Group, Inc.

3. Developing a Sustainable Physician Strategy – Walter Morrissey, MD, Vice President, Kauf-man Hall

4. The Politics of Healthcare Reform – Ron Brownstein, Political Director, Atlantic Media Company

5. 5 Key Concepts for Growing Profits in a Challenging Economic Environment – Chris Karam, FACHE, President & CEO, CHRISTUS St. Michael Health System

6. Physician Hospital Relationships: A Review of Evolving Problems and Opportunities – Paul Summerside, MD, Chairman of the Board, Au-rora BayCare Medical Center

7. Strategies for Competing with a Dominant Hospital – Alex Rintoul, CEO, Medical Center at St. Elizabeth Place

8. Monetization of Non Core Assets and Out-sourcing Facility Development – Michael Bry-ant, CEO, Methodist Medical Center and Gor-don Soderland, SVP, Strategic Relationships, DASCO Companies

9. Hospital Transactions, Current Market Analy-sis and Valuations – Greg Koonsman, Senior Partner, and Jon O’Sullivan, Senior Partner, VMG Health

10. An Analysis of What Works, What Doesn’t: Key Thoughts from 10 Great Partnerships With Management Companies and Hospitals – Joe Clark, EVP and Chief Development Officer, Surgical Care Affiliates

11. Key Trends and Ideas for Improving Hos-pital Performance and Aligning With Physicians – Bill Southwick, President & CEO, Healthmark Partners; Marc Halley, President/CEO, Halley Consulting Group; Marc E. Koch, MD, MBA, President & CEO, Somnia Anesthesia

12. The Best Ideas for Hospital CFOs Now – Faye Deich, Chief Operating Officer, Sacred Heart Hospital; John R. Zell, CPA, MBA, CFO, OSF St. Joseph Medical Center; David Felsenthal, Senior Partner, Principle Valuation; John Thom-as, EVP Healthcare REIT; Moderated by Claudia Gourdon, Senior Vice President, National Mar-keting Manager, Healthcare Finance Group

13. 4 Key Ideas and Concepts to Improve Car-diovascular Program Profitability – Ted Win-slow, MD, Sg2

14. 4 Core Ideas and Concepts to Improve On-cology Program Profitability – Lisa Slama, PhD, Director, Sg2

15. Key Steps to Contain Costs – Faye Deich, Chief Operating Officer, Sacred Heart Hospi-tal, Regional Director, Hospital Sisters Health System

16. Distressed Hospital Financing Issues – Shane Passarelli, Senior Vice President, Health-care Finance Group, and Gary Samson, Partner, McGuireWoods, LLP

For further information, registration and to view the complete brochure, visit www.BeckersHos-pitalReview.com.

REGISTER BEFORE MARCH 1 AND RECEIVE $100 OFF THE CONFERENCE FEECONFERENCE LOCATION:The Westin Michigan Avenue Chicago909 North Michigan AvenueChicago, IL USA 60611 (312) 943-7200

FOR MORE INFORMATION, PLEASE CONTACT:Cathy BrettBecker’s Hospital Review(800) 417-2035 [email protected]

Jessica ColeBecker’s Hospital Review(800) 417-2035 [email protected]

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Mark Laney: Bridging the Generation Gap — the Art of Managing Multiple GenerationsBy Mark Laney, MD, President and CEO of Heartland Health, St. Joseph, Mo.

One of the greatest challenges facing healthcare executives today is manag-ing physicians and employees from

different generations. When I was president of Cook Children’s Physician Network in Fort Worth, Texas, a position I held until I came to Heartland Health last year, this issue took more of my time than any other.

I managed 270 doctors at Cook Children’s with varying behaviors and values, which frustrated me very much. Then one day a young accoun-tant noticed my turmoil, pulled me aside and said that she would like to make a presentation for our administrative group about managing different generations in the workforce.

It was a beautiful presentation. She brought home the point to me that it wasn’t appropriate to judge others. I came to realize that people of different generations have varying motivations. To help people work together with less friction, I needed to gain a fuller understanding their val-ues. This was truly a breakthrough for me and I started thinking in a different way. The experience reminded me of one of the most fundamental leadership goals — to seek first to understand.

I began reading about the different generations and their attitudes. I am a baby-boomer, born between the years 1946 to 1964. This generation tends to be extremely hard-working. Boomers define them-selves by their career and a lot of their self-esteem comes from their work. That puts our lives out of balance sometimes. Physicians in my generation think nothing of working 60-80 hours a week. We baby-boomers tend to have very traditional values. We respect hierarchy and authority and seek recog-nition and promotion as our reward.

After the boomers comes Generation X, people born 1965-1981. Many of them were latchkey kids, coming home to an empty house because their par-ents were at work. This makes them generally very

independent. They don’t value hierarchy, titles or experience. Their parents were divorced in many cases, making them very family-focused. They want a balance in their life. They don’t want to work 80 hours a week and miss their children’s birthday party. They take all their vacation time. They don’t define who they are through their work. GenXers value freedom, flexible work schedules and time off to spend with family.

On the horizon is the millennial generation, born after 1980. If they are going into medicine, they are just starting residency training. Millennials are completely different from the two previous gen-erations. They are idealistic and team-oriented. They value work that has meaning above all other rewards. They demand the absolute newest tech-nology at the workplace. They may be the ideal generation for healthcare because we are going to need to be team-based and their idealism is a good fit for medicine, where incomes may not be as high they were. I have tremendous hope for the millennials. They will be a fascinating group.

Making a team out of different generations If you put a boomer physician next to a GenXer and don’t understand the differences in their basic philosophies, they can come into conflict very quickly. The millennials will enter the work-force in five to 10 years and come into contact with the other two generations. Because each group has different motivations, you can’t just treat them all the same. It’s like making a quilt: You take differently shaped pieces of cloth, sew them together and make something beautiful, but it takes a lot of work, leadership and under-standing. One of the big leadership challenges of the future will be taking individuals that look at life differently and creating a cohesive team that shares the same medical values.

How can this be done? The first step is learn-

ing to understand and overcome the conception that there is just one right or wrong. It’s a break-through moment to realize that just because I look at life in a certain way, it doesn’t mean it’s the only way. Managing multiple generations definitely takes more administrative time, but it is entirely worth it. It is very gratifying to turn anger and frustration into mutual respect by working through conflict and educating yourself about the differences. Setting expectations in orientation, recruitment and compensation plans allows organizations to put all of the pieces to-gether. Knowing what your expectations are and articulating them before a person joins the or-ganization can help both parties decide whether the relationship can be a good fit.

When you look back over time, generational dif-ferences aren’t something new. They have been cycling through history. It’s not a new phenom-enon, but I think it’s better understood today. I definitely think managing multiple generations is a skill-set any hospital executive, or anyone who manages a physician group, must be aware of because it’s not going to change.

It was that one young accountant that changed my mind about this issue, when she had the courage to step forward and give that presenta-tion about the values of her generation. She re-ally opened my eyes and helped me learn a great lesson. n

Mark Laney, MD, became president and CEO of Heartland Health in St. Joseph, Mo., in 2009. He was previously president of Cook Children’s Physician Net-work in Fort Worth, Texas. He is a pediatric neurologist who received his fellowship training at Mayo Clinic. He received his MD degree from University of Texas Medi-cal Branch and graduated from the pediatrics residency program at the University of Arkansas. Learn more about Heartland Health at www.heartland-health.com.


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Hospitals and Health systems Improving Profitability and Business and Legal Issues


Quint Studer: Four Best Practices for Improving Emergency Department ResultsBy Lindsey Dunn

The emergency department is one of the most critical departments within a hospital because a hospital’s overall per-

ception is largely dependent of the success or failure of its ED, says Quint Studer, founder of the Studer Group. As recent media reports have shown, problems in the ED can have a negative impact on the reputation of an entire institution, even if the performance of its other depart-ments are strong.

“With inpatient stays, a hospital usually has sev-eral days to rectify any problem. Providing qual-ity care and service is much more urgent in the ED,” says Mr. Studer.

In addition to improving hospital reputation, an efficient ED can also improve a hospital’s bot-tom line. Studies have shown that 45 percent of all hospital inpatient admissions come from the ED, so departments that can reduce the number of ED patients who leave without being seen can bring additional income to their facility. While most hospitals can expect at least 2 percent of patients to fit into this category, facilities that can retain two to three additional patients per day could bring in as much as $200,000-$300,000 in additional revenue over the course of a year, says Mr. Studer.

Here are four best practices for improving ED results from the Studer Group.

1. Hourly rounding on patients. One of the easiest best practices to implement to improve ED results is hourly rounding on pa-tients, says Mr. Studer. During rounding, an employee, typically a charge or triage nurse, provides status updates to patients waiting to be seen. The employee may make a general announcement to the group, and should also speak with individual patients, when appropri-ate. “A patient with sprained wrist, for example, is likely to understand if they can’t be seen right away, but if you don’t keep them updated you risk them feeling forgotten or unimportant,” says Mr. Studer.

Although rounding seems like a simple practice, it can lead to big results. When Baptist Hospi-tal of Miami implemented hourly rounding in its high-volume ED, it increased its ED patient satisfaction scores from the 6th to the 99th per-centile in one year, says Mr. Studer.

2. Key words at key times. During rounds, it is important that hospital employees provide key information to patients at key times. Doing so reduces patient anxiety and builds loyalty, says

Mr. Studer. He recommends using the acronym “AIDET,” described below, to help employees convey this information at the appropriate time.

Acknowledge — Acknowledge the patient by name. Make eye contact. Ask: “Is there anything I can do for you?”

Introduce — Introduce yourself, your skill set, your professional certification and experience.

Duration — Give an accurate time expectation for tests, physician arrival and overall treatment.

Explanation—Explain step by step what will happen, answer questions and leave a phone number where you can be reached.

Thank—Thank the patient for choosing your hospital and for their communication and co-operation. Thank the family for assistance and being there to support the patient.

3. Manage flow. Perhaps the most important practice for a successful ED is managing patient flow, says Mr. Studer. The first step to manag-ing this process is measuring patient demand by hour and matching that demand to staffing. Mr. Studer recommends hospitals use a real-time flow dashboard to analyze patient movement through each step of an ED visit at various times of the day.

Mr. Studer also suggests creating different flow pathways for different patients. “Our goal is not to put patients in back in an ED room if we don’t have to,” he says. For example, pa-tients with minor injuries can be “fast-tracked,” which means that they can be treated from the waiting area or taken back for a test and moved to a separate “results” waiting area — an area reserved for patients who can be discharged quickly once test results are reported to them, he says.

4. Follow-up phone calls. Studies by the Studer Group have found that calling patients

after their discharge from the ED greatly in-creases their satisfaction and overall percep-tion of the ED. According to a study by the Studer Group, none of the EDs studied that provided follow-up calls to patients received satisfaction rankings below the 70th percentile, and, in most cases, these hospitals reached the 90th percentile. Few hospitals that did not pro-vide such calls received rankings above the 50th percentile.

These calls are typically completed by nurses the day after a patient’s visit and are used to repeat discharge instructions and gain patient feedback on their experiences, says Mr. Studer. Repeating discharge instructions while the pa-tient is at home increases the likelihood that the patient will remember and follow the instruc-tions and can reduce readmissions, which in many cases are no longer reimbursed by payors, he says. n

Quint Studer is a recognized leader and change agent in the healthcare industry and has more than 20 years of healthcare experience. Learn more about Studer Group at www.studergroup.com.


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Hospitals and Health systems Improving Profitability and Business and Legal Issues


HEALTHY BUILDING IS...™

Harold E. Varmus, MD, president and CEO of Memorial Sloan-Kettering Cancer Center, an-nounced his retirement after 10 years at the job.

Marion (Ohio) General Hospital named Steven Brown as its new vice president of finance and CFO.

Sister Marie Castagnaro, president and CEO of St. Joseph’s Hospital in Elmira, N.Y., announced her retirement after 25 years at the hospital.

As part of its administrative takeover of Exem-pla, Sisters of Charity of Leavenworth Health Systems named Bob Ladenburger as president and CEO of Exempla, and Bain J. Farris and Grant Wicklund will lead Exempla Saint Joseph Hospital and Exempla Lutheran Medical Center, respectively.

Sacred Heart Health System in Pensacola, Fla., promoted Laura Kaiser, the hospital’s COO, to CEO.

Gregory Burfitt was named president and CEO of Allegheny General Hospital and Western

Pennsylvania Hospital in Pittsburgh. The two health systems are continuing a corporate merger.

Health Management Associates, based in Naples, Fla., named Kelly Curry as its new CFO.

Banner Ironwood Medical Center in Pinal Coun-ty, Ariz., named Deb Krmpotic, RN, as its new CEO.

Kingsport, Tenn.-based Wellmont Health Sys-tem named Bob Burgin as its interim CEO. Mr. Burgin, who was retired, will oversee the health system while a national search is conducted for a permanent replacement.

Parkridge Medical Center in Chattanooga, Tenn., named Jay St. Pierre as its new CFO.

Randy White, MBA, MS, FACHE, was named CEO of Connersville, Ind.-based Fayette Re-gional Health System.

Jackson, Tenn.-based West Tennessee Healthcare named Bobby Arnold as its new president and CEO.

San Juan Regional Medical Center in Farmington, N.M., named Rick Wallace as its new CEO.

Lincoln, Neb.’s BryanLGH Health System named Russell Gronewold as its new CFO.

Vic Dirksen, CEO of Jefferson Healthcare in Port Townsend, Wash., announced that he will retire at the end of 2010.

Clarian West Medical Center in Avon, Ind., named Matthew Bailey as its new president and CEO. n

Hospital and Health System Executive Moves


Hospital Review E-weekly,

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Marquette (Mich.) General Hospital and Bell Hospital in Ishpeming, Mich., have announced a partnership agreement in which the two hospitals would merge together to form non-profit Superior Health Partners.

Continuum Health Partners, which currently operates Long Island Col-lege Hospital in Cobble Hill, N.Y., approved an agreement that would allow the hospital to merge with SUNY Downstate Medical Center in Crown Heights, N.Y. The groups are awaiting state approval on the merger.

Memphis, Tenn.-based Baptist Memorial Health Care and NEA Clinic, based in Jonesboro, Ark., have merged into a new, non-profit health system called NEA Baptist Health System. Baptist acquired the clinic under the merger agreement for an undisclosed sum.

Rockport, Maine-based Pen Bay Healthcare has approved a merger with Portland, Maine-based MaineHealth in which Pen Bay would become a sub-sidiary of MaineHealth. The deal is currently awaiting approval from the state.

Oakbrook, Ill.-based Advocate Health Care has completed its acquisition of Normal, Ill.-based BroMenn Health. Under the deal, Advocate will take control of BroMenn’s two hospitals, which will be Advocate’s first holdings outside of the Chicago area.

Clarian Health, based in Indianapolis, and Bloomington (Ind.) Hospi-tal have officially merged, effective Jan. 1. The Bloomington acquisition will bring the number of hospitals in the state under Clarian’s ownership to 17. Union Hospital in Mayville, N.D., has finalized its merger with Fargo, N.D.-based MeritCare. Under the agreement, Union Hospital will oper-ate as part of MeritCare and will be called MeritCare Mayville Union Hospital and Clinic.

Lakeland HealthCare in St. Joseph, Mich., and Southwestern Medical Clinic in Berrien Springs, Mich., have agreed to merge. The deal would integrate the non-profit, community-owned health system and the 70-phy-sician multi-specialty medical practice. n

Marie E. Sinioris is president and CEO of the National Center for Healthcare Leadership.

Q: What is the national Center for Healthcare Leadership?

Marie sinioris: The center conducts research on global best practices and tests new models of leadership excellence. We bring together thought leaders who can help shape our forward-thinking agenda. Our goal is to ensure that high-quality, relevant and accountable leadership will be avail-able to meet the challenges of delivering health-care in the future.

Q: What is hospital leadership looking for?

Ms: Hospital leadership is trying to achieve a more efficient use of resources. They want to get to better outcomes at lower costs. That is, they don’t simply want to be more efficient; they want to be more effective. We’re going to see some creative ways of doing this. One thing we’re go-ing to see is reductions in payments for readmis-sions. We can borrow tools from other industries to improve efficiency, such as Toyota lean and Six Sigma. We can look at the literature for other industries.

Q: What’s an example of a difficult chal-lenge that hospitals face?

Ms: Embracing change. When an organization attempts to change it fails 75 percent of the time. It fails to deliver on the expected return on in-

vestment. One key reason it fails is that leader-ship hasn’t prepared its culture for change. You must have a clear vision that is transmitted to ev-eryone in the organization. If the culture hasn’t embraced the change, it is not going to happen.

Q: How do you prepare a culture to em-brace change?

Ms: You have to invest in your resources. Your most important resource is your employees, so this means providing training programs. The most effective kind of training is practice-based learning or “action learning.” This involved learning on the job. You learn best when you are doing your work. This is more effective than lectures, which engage your cognitive functions but do not help you retain what you learned. The first step is to bring outside experts into the insti-tution and have them “train the trainers.” These trainers are in-house people who will pass the knowledge on to others within the institution.

Q: What sort of skills would be taught?

Ms: A good example is health information tech-nology. This is a very important piece of train-ing, because HIT can reduce errors. But training is not limited to technical skills. It could also in-volve interpersonal skills.

Q: What sorts of changes do you see coming in healthcare?

Ms: Everyone wants better outcomes, bet-ter compliance with pharmaceuticals to reduce hospitalizations and better accountability. This

requires collaboration between doctors and hos-pitals, two groups that are used to functioning separately from each other. They would come together in accountable care organizations in which a hospital or health system works closely with a network of primary care physicians, spe-cialists and others to provide care to a defined patient population.

Q: What will be the forces that bring hospitals and physicians into integra-tive relationships?

Ms: CMS is experimenting with bundled pay-ments, which are given to the hospital and the doctors for the entire episode of illness. CMS pilot projects on bundled payments are already under way. In Massachusetts, a state commission is recommending switching to a system of global payments, under which all caregivers get a set sum of money. n

Learn more about National Center for Healthcare Lead-ership at www.nchl.org.

Hospital and Health System Transactions

Marie Sinioris Explains the Goals of the National Center for Healthcare LeadershipBy Leigh Page


Hospital Review E-weekly, go to

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Robert Allen, CEO of 26-bed Park City (Utah) Medical Center, part of Inter-mountian Healthcare, oversaw the hos-

pital’s recent opening in Feb. 2009 and has been part of the hospital’s development since becom-ing CEO in April 2008.

Q: What, specifically, has been your role in the development of Park City Medical Center?

Robert Allen: My history with the project is that I came on board a year and half before the hospital opened, but the hospital’s development had been in the works for 10 years. A local group of physicians in Park City got together to try to develop a hospital in the community. There had been no hospital in the area since the 1980s and no hospital in Park City since the 1950s. As you might imagine, the area experienced a lot of growth after the Olympics in 2002, and the area was due for expanded healthcare services. The physicians and community leaders performed a feasibility study and then began a RFP process to look for a partnering opportunity. They eventu-ally decided to bring in Intermountain to develop and operate the facility.

I was encouraged to apply for the CEO posi-tion here by Jon Hoopes [vice president of In-termountain’s Rural Region at the time] who worked closely on the project. At first blush I wasn’t sure if it was the right opportunity for me, since I had already overseen much larger facili-ties. However, the more he showed me the plans for the hospital, its history of development and its potential over time, the more I found the op-portunity extremely intriguing and was eventually selected for the position.

Q: What was the biggest challenge for you as you worked to prepare the hos-pital for its opening?

RA: Because I came in after construction was underway, my biggest challenge has been select-ing a leadership team and developing a medical staff structure, but this has also been one of the most rewarding aspects of the project. When you are building a replacement facility, you are carrying over leadership and structure, but here I was the leadership team. It’s very rare that you get to personally select every one of your key leaders so that was a very fun process for me. Once those leaders were selected we sat down and really tried to create the vision we had for the

hospital, which we tested with the hospital board to make sure it was consistent. Our focus is really on clinical excellence, and that is the platform on which we build all our services.

Developing that vision set the stage for [those leaders] to hire their staff. We had a significant amount of interest in the positions. We currently have about 230 employees and had more than 5,000 applicants for those positions. The strength of the leadership we have here at PCMC is one of my proudest accomplishments. The great team we’ve assembled amazes me every day with their commitment to each other, to patients and to the community. It’s just astounding.

Developing a medical staff structure was also challenging. Because we are a resort town, there were many physicians interested in being affili-ated with our hospital. Many of the local physi-cians had also not admitted their own patients in some time because there was not a close hospi-tal and instead referred patients to other physi-cians. We wanted to make sure that the physi-cians practicing here could be supported, so we looked at the needs of our community and the types of services it could support. We eventu-ally developed a medical staff plan that in some cases limits physicians in certain specialties. This is intended to help manage growth and create an environment that is sustainable. If we bring phy-sicians here and there is no population to sustain all of them, then we lose everyone.

Q: What is the most important lesson you have learned as part of opening a new hospital?

RA: One thing I learned through this process is that I needed a deeper history of the project be-fore coming on. I don’t know how you would get that given the situation, but it would have been tremendously helpful. There was a steep learn-ing curve for me having come in after so much development had already taken place.

Q: What has been the most rewarding part of your involvement with PCMC?

RA: When you put that much energy and time into a project and you eventually are able to see patients coming here for treatment and are able to talk to them, that is truly rewarding. When a patient here talks of the excellent care they have received and of their experiences with staff that cared for them and about them, it is really re-

warding. I sometimes think would I really want to go through all of that work again? But the reward at the end makes the time and effort worth it.

Q: What advice would you have to oth-ers involved in the development of a new hospital?

RA: Over my career, I’ve heard this advice many times, but it is the core of success in healthcare and developing or opening a new hospital. There are countless points of disagreement and chal-lenges that you will be up against, but ultimately the focus must be on the patient, the community and their needs. This is the best, most impor-tant consideration to build your decisions upon. Focusing on that will lead you very effectively toward the end goal of a successful hospital to serve the community. When our staff and lead-ership differed, this is the core point that always brought us back together. n

Learn more about Park City Medical Center at www.parkcitymedicalcenter.org.

CEO Robert Allen of Park City Medical Center Shares Lessons Learned in Opening a New HospitalBy Lindsey Dunn


Hospital Review E-weekly,

go to www.BeckersHospitalReview.com


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Hospitals and Health Systems

Improving Profitability and Business and

Legal Issues

March_2010_HR.pdf - Becker's Hospital Review

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