Does McHenry County, Illinois need a new hospital?
The Illinois Health Facilities and Services Review Board is expected to address the question this month when it considers certificate-of-need (CON) applications submitted by Mercy Crystal Lake Hospital & Medical Center and Centegra Health System.
Mercy proposes to construct a hospital in the community of Crystal Lake, while Centegra plans to build in Huntley. Meanwhile, the Review Board’s data indicates that McHenry County may need a new hospital soon, but not this year.
Moreover, the Board’s data suggests McHenry County will need, at most, one new hospital in the coming years. Therefore, the race is on as Mercy and Centegra vie to be the first to cross the finish line and obtain the coveted CON. Many factors could determine the outcome of this race.
1.The Odds The odds of either hospital receiving a CON are not favorable. Historically, the Board has been reluctant to approve new hospitals. Since 1976, the Board has granted only one CON for a new hospital. However, Adventist Bolingbrook Hospital, approved in 2004, obtained its CON with much less favorable Board data when compared with the need data applicable to the McHenry County projects.
Adventist’s planning area had a surplus of 263 medical/surgical (M/S) beds. McHenry County, in comparison, needs 83 M/S beds. Despite this stated need, each Hospital proposes 100 M/S beds, which is 17 beds over the projected need. Board regulations provide that proposals for new hospitals within metropolitan statistical areas must be for no fewer than 100 M/S beds. As a result of this rule, Board staff will likely conclude that a need for the project does not exist at this time.
2.Timing
Because two hospitals cannot be justified, the order of Board consideration could be critical. Generally, the Board considers CON applications in the order they are received, although the Board may not follow this rule when competing applications aim to satisfy the same projected need. The main problem in this situation is that once one project is approved, the other is essentially unnecessary. Expect the Board to address this concern before it considers these two applications. 3.Construction Timeline
The average amount of time to construct a new hospital is five years. Both hospitals could argue that failing to start construction now may create patient access issues in the near future, especially if a hospital is not operational when patient need surpasses the 100 bed benchmark. The hospitals have a good point here—McHenry County’s M/S bed need could exceed 100 in just one or two years.
4.Population Growth
The Hospitals may need to explain how new population information released by the U.S. Census Bureau in March 2011 affects their CON applications. The key question is whether McHenry County’s population growth will continue at a rapid pace.
5.The Economy
A slow economy creates public policy considerations that support approval of at least one CON. Hospital construction projects will create good-paying jobs now and in the future, and greatly benefit the local economy. Furthermore, construction costs and interest rates are down and securing labor contracts and loans at today’s rates could save millions of dollars and reduce project costs.
6.Access to Care
A recent applicant was granted a CON even though the Board’s need data indicated the project was unnecessary. The applicant provided evidence that the project would improve access to care for underserved populations. Mercy or Centegra may find similar success if they can demonstrate that their hospital will enhance access to care.
Although Mercy and Centegra cannot justify all 100 M/S beds, several other factors support a decision for CON approval now. CON observers will have a great race to watch if the Board determines that McHenry County needs only one hospital. Only time will tell if Mercy or Centegra end up in the winner’s circle.
Joseph Hylak-Reinholtz is an Attorney, McGuireWoods LLP in Chicago. He formerly served as an ex-officio member on the Illinois Health Facilities and Services Review Board and can be reached at jhreinholtz@mcguirewoods.com.
The HealthLeaders Media 2011 Annual Survey identified a perceptible disparity in thinking between CEOs and nurse executives. The data collected distinguished the priorities of the two groups, with the c-suite respondents claiming cost reduction as their most important concern and nurse executives ranking patient satisfaction as first. But are they so different?
The apparent fork in the road is the result of competing demands and internal organizational perspectives. Hospital leadership is forced to face a new reality in order to effectively deploy resources to continue and improve operations as a result of skyrocketing costs; unpredictable reimbursement, including pay for performance; work force shortages; the public outcry for improved quality and safety; and the demand for increased transparency.
Positive financial and clinical successes do not occur in isolation from one another. Proven process-driven improvements, implemented concurrently with staffing and facility improvements, are crucial to a facility's ability to prosper. Fiduciary responsibility and providing a notable healing environment can and do co-exist.
The process of presenting a business case for any major expenditure should start with some basic questions:
Does it meet the facility's mission, organizational structure, and vision of the project?
Are the associated costs prudent in light of other alternatives that might achieve the same goal?
What is the financial impact of any project?
For example, if the facility is considering a building renovation project, consider the following:
Will it result in increased admission capacity?
Will it increase the hospital's bond rating as a result of capital improvements?
Will it help avoid hospital-acquired conditions or never events that result in decreased reimbursement?
One should look at cost savings by cost avoidance as well. For example, will it reduce litigation, malpractice settlements, or worker's compensation cases?
Assemble a multi-disciplinary team to research projects. Financial managers should be determining the operating impact-paralysis of first cost, ongoing cost effectiveness of the investment, and a multiyear return on the investment. The results may surprise you. Those responsible for clinical oversight should help define how it will improve patient satisfaction and safety. Advocating clean design, environmental risk management, standardization, and innovative design, materials, and equipment choices that create positive, empirically measureable outcomes can be "sold" to the c-suite. How will the project optimize work flow and organizational structure? Can the hospital market the system improvements to remain competitive, increase their market share, and encourage philanthropic donations? How can these benchmarks be documented?
What financial analysis can support a clinical decision? How can the nurse executive argue the clinical imperative and value of a functional program on a business decision? Safety, satisfaction, and costs go hand in hand. Present the facts. Consider the following examples:
Consumer Reports National Research Center published a report on March 31, 2011 that showed that 77% of those surveyed reported a "high level" of public concern that they would be harmed during treatment as a hospital patient.
Indeed, the 2010 U.S. Department of Health and Human Services Office of Inspector General report showed that one in seven Medicare patients or 13.5% of hospital patients experienced serious or long-term medical harm (including infections) or death while undergoing treatment in hospital; an additional 13% experienced temporary harm. The researchers estimated that hospital infections and medical errors involving Medicare patients contributed to approximately 180,000 deaths and $4.4 billion in additional hospital care costs each year.
A health system that does not have patient safety reports that encourage patient confidence will not only have trouble enticing patients but will now be penalized with reduced revenues resulting from never events and hospital-acquired conditions. With the advent of never-events and hospital-acquired conditions impacting healthcare reimbursement, facilities are driven by both the financial and legal impact of medical errors.
Thirty-three percent of all reported incidents to NPSA were "slips and falls" at a cost of approximately $24,962 per case. Define the savings of risk mitigation by analyzing and documenting incidents and safety improvements through progressive clinical processes. The following steps can reduce patient slip and fall incidents dramatically: Shorter distances between the bed and bath; limiting travel in open spaces and providing resting points; increasing opportunities for staff observation; careful selection of flooring choices; consideration for dementia conceptualization; improved way finding.
Hospital-acquired infections translate into $21.3 billion dollars per year, according to data from CMS. Post-op sepsis alone costs an estimated $9,000 per case. This problem can be approached by adding hand washing and hand sanitizing stations, HEPA filters, anti-microbial finishes including floors, counter tops, furniture, and fabrics.
One organization replaced all of its counter surfaces with a solid surface that had anti-microbial properties after a high-price lawsuit following the unfortunate death of a patient from a hospital-acquired infection. The plaintiff's attorney had established evidence that the bacteria that had stricken the patient was traced to the work surfaces in the patient's room.
Two out of every hundred patients experience an adverse drug event at a cost of $4,700 per case. Research has revealed that medication errors can be reduced by 30% by increasing the size of medication rooms, reorganizing supplies, improving lighting, and controlling noise and distraction thereby preventing misinterpretation of verbal orders.
The average medical-surgical nurse walks 5 to7 miles per shift, lifts 1.8 tons cumulatively over an 8-hour shift, and spends 80% of his or her time fetching supplies. Eighty-one percent of nurses have back pain, which is a higher rate than construction workers. Considering it costs $65,000-$75,000 per head to train and replace a nurse, a business case can certainly be made to make a safer and more efficient work environment that will result in improved staff morale, recruitment, and retention.
About 65% of the hospitals in this country are more than 40 years old. Buildings can be barriers to progress when they are not designed for future flexibility and growth. By the year 2020, when it is estimated that more than16% of the population will be older than 65, the need for healthcare will increase exponentially. Healthcare in the future will move from the inpatient environment to more than 90% being delivered in ambulatory care or specialized short stay facilities. Organizations need to start anticipating the needs and changes this will bring now.
Most of the shortcomings in design and process planning occur because of a lack of vision and communication. Projects that are rushed forward without a detailed review of the functional program and available financial resources are the ones that are at risk of failure. By collectively focusing on the lifecycle perspective, strategic planning, consumer satisfaction, and life and safety elements of the project, success can be achieved by all.
Sandie Colatrella, RN, BSN, CLNC, is VP Healthcare Planning & Research at Avanti Architecture.
While patients and doctors often worry about medical records being hacked by cybercriminals and Internet snoops, the most common cause of health data breaches is physical theft of computing gear, according to reports by the U.S. Dept of Health and Human Services. Under the HITECH Act, HHS is required to post a list of incidents involving breaches and unsecured protected health information affecting 500 or more people. The HHS listing of the incidents reveals the top causes of breaches to be theft, not hacking of data. Of the 288 HIPAA breaches listed on the HHS site, physical theft is at the root of more than 49% of the violations, according to analysis by software research and consulting firm, Software Advisor. Meanwhile, human error and careless or accidental physical losses -- such as losing a laptop with patient data -- accounted for 14% of the incidents; unauthorized access and disclosure was involved in 16% of the casesp; and improper disposal was the root of 5% of the incidents.
Oregon and Illinois are two states that will launch their initial health information exchange core services in early 2012. Both states will shortly publish contractor proposals to help them develop the systems and databases they will need to support their health information exchanges. For Oregon, a vendor will set up a provider directory at the individual and entity level, which will also include a certificate authority, and a statewide health information service provider to offer Direct Project addresses to any state provider or consumer for free, said Carol Robinson, state coordinator for health IT, Oregon Health Authority. Oregon will onramp its exchange participants with messaging services using Direct protocols, which are secure email designed for simple exchanges between providers or between a provider and a patient. In Illinois, state officials anticipate putting its initial services in production in April 2012. These core HIE services will include a master patient index, which will be comprised of multiple repositories in the state starting with the Medicaid database, said Ivan Handler, CTO of the Illinois Office of Health IT.
The Illinois Attorney General's office filed a lawsuit Thursday accusing the owner and manager of Heart Check America, a medical imaging company, of pressuring patients into purchasing pricey body scans that many did not need. Last month, ProPublica published an investigation of Heart Check America, describing its marketing and sales techniques. In our story, medical experts called the company's tactics unethical and said its scans were inappropriate for many patients, exposing them to unnecessary expense and treatment. Health regulators in Colorado and Nevada have cited the company for performing medical scans without doctors' orders. Now Illinois officials say Sheila Haddad and her son, David Haddad, the owner and manager of the company, used "unfair and deceptive business practices" to manipulate consumers, possibly numbering in the thousands, into 10-year screening contracts costing up to $7,000, plus additional annual dues.
Franciscan St. Francis Health on Thursday defended its commitment to provide needy patients with financial assistance, one day after a report slammed its charity care practice. The Hospital Accountability Project, a joint effort of the Citizens Action Coalition Education Fund and Indiana Legal Services, said all four Marion County nonprofit hospitals need to do more to make patients aware of their charity care provisions. But the project strongly criticized St. Francis Health, calling upon the state attorney general to launch an investigation. In a statement released Thursday, St. Francis expressed confidence in its financial assistance programs and said it hopes to meet with the report's authors. The hospital makes information about its financial assistance program available on patients' bills and its website, and has financial counselors available to help patients with questions.