With nearly 92% of CFOs rating the impact of uncompensated care as a drain on their revenue stream over the next three years and the majority of hospital financial leaders surveyed in the HealthLeaders Media Industry Survey 2010 expecting uncompensated care numbers to worsen in the next year, you might think that other areas such as patient experience might slip from importance—but you'd be wrong.
Interestingly, the HealthLeaders Media Survey results also indicate that healthcare leaders are placing a priority on patient experience and patient-centered care, which at first blush may seem to juxtapose the challenge hospital leaders face with uncompensated care. However, some hospitals and health systems are taking a proactive stance toward offsetting the current and future uncompensated care costs while improving their patient experience.
In part two of this two-part series, I asked CEOs how they and their teams are addressing uncompensated care in terms of patient experience at their facilities and how it's helping them survive and thrive.
Patient referrals in the 30% range would call to action most healthcare leaders, however when you are CEO of UCLA Health System, one of the largest health-science centers in the country, numbers that low called for immediate action.
Prior to becoming CEO for UCLA, Feinberg was a physician in the health system's psychiatric division. It was this experience, working in one of the older buildings in the system and with patients who were sometimes involuntarily admitted, that offered him a great education in patient experience.
"Here we had patients who may have been admitted involuntarily and yet we had found that 90% of these patients would refer to us." When he took over as CEO at UCLA, Feinberg was surprised to see how low the referral scores were for the hospital. Wanting to move the bar swiftly higher, Feinberg set out to change the culture of the hospital teams.
They started by listening to the patients. What did they need and want to make them feel more welcome? It was often simple things, such as hot meals or socks to keep their feet warm, but it was also time with the staff and the ability to contact them when needed.
"We have structured rounds here, so everyone makes patient rounds from the IT team to the CEO. We spend half of all our time meeting with patients and we give patients cards with our cell numbers," says Feinberg.
The new culture took about three years to fully set in, but once it did they saw their patient referral numbers steadily increase to 99% in some units. "That means our hospital is at full capacity and our payer mix has gotten better. Patient satisfaction is really driving our business and making a position margin allows us to keep our door open to everyone."
For the 13-plus hospitals that make up the Franciscan ministry of Hospital Sisters Health System, serving those in need of charity care is the core of their mission. But aside from helping those in need, they also want to be sure they are providing the best care to all, a feat they continue to accomplish. All 13 hospitals that make up the system have been recognized for excellence and among them is St. Joseph's Hospital in Chippewa Falls, which was awarded a 2009 Press Ganey Summit Award for achieving stellar inpatient satisfaction.
Ronstrom says the first thing you need when it comes to working those who need charity care is purity of intention and no preconceived ideas. "You need to understand from a health planning perspective who the poor are in your area of service and what exactly they need. Then it's critically important to go forward and partner with others in the community to help serve them," says Ronstrom.
Even with rising charity care numbers they are achieving that mission. From 2008 to 2009 charity care increased just more than 10% of total gross charges from $9.2 million (2008) to $10.4 million (2009).
"We've been working hard on this for years and we're hard-wired [toward patient satisfaction] now," says Ronstrom, who credits his staff with embracing the protocols and tenets of helping the patient in every way possible. "We live the mission here."
Living the mission is helping keep their patient satisfaction scores steadily in the top, ranking in the 99th percentile for 10 of 12 quarters, according to Press Ganey's database of patient satisfaction.
"When it comes to the health status of the poor the future is in prevention, wellness and chronic care management. People are very concerned about health expenses … and those in healthcare needs to be doing their fair share to help out," Ronstrom notes.
"Uncompensated care and patient experience are two issues that tug at each other, because often better patient-centered care requires more resources," says Safyer.
With uncompensated care draining hospital coffers that may not leave facilities with a lot to spend toward a better experience. It starts, Safyer says, with working with the hospital team to ensure that everyone looks at the patients and simply smiles. Then they looked at their nursing and now they have doing rounds every hour and asking the patients if they need any help.
"Some patients will just press the call button to see if anyone will come. We want the patient to know that we are paying attention to their needs before they get to that point," he says.
With nearly 1,500 beds, Montefiore sits in the heart of the Bronx, a borough of nearly 1.5 million people. The community is currently struggling with a 15% unemployment rate and the hospital is seeing growing uncompensated care rates. As the University Hospital for the Albert Einstein College of Medicine, Montefiore recognizes the need to not only fulfill the hospitals' mission to serve the community, but Safyer says they also feel a responsibility to train future physicians on their role in providing care for those who cannot afford it.
To that end, Montefiore has embraced the idea of helping its patients through the continuum of care and much of this has been accomplished through the use of technology. Montefiore developed a clinical and management information system to manage patient information, and then they took it a step further. Harnessing their electronic medical records, Montefiore partnered with all major providers in the Bronx Regional Health Information Organization to help create the infrastructure for a Bronx-wide exchange of patient information.
Next the team used technology to embrace the concept of the medical home, in which patients with chronic illnesses such as congestive heart failure, diabetes and asthma benefit from innovative disease management programs, including technology that allows home monitoring.
"The medical home is the way to feel plugged in and connected," says Safyer. "This all pays off too when the patients do better."
At St. Joseph Hospital, a 167-bed acute care hospital in Kokomo, IN, high unemployment numbers from automotive manufacturer layoffs have driven up uncompensated care. The hospital estimates that 14,820 people received uncompensated care costing them more than $3.8 million annually. The rising cost and numbers of charity care didn't deter St. Joseph's from pursuing their course to provide the best patient experience in Central Indiana.