I hear plenty about the roadblocks that small community hospitals face when it comes to replacing or upgrading facilities. A dwindling population base due to an aging community or scarcity of jobs, proximity to another hospital, a lack of staff physicians to increase volumes, a lack of community support—all of these factors can hinder a hospital's ability to secure financing. And as if finding access to capital wasn't already difficult enough, now these facilities are dealing with fallout from the sub-prime mortgage crisis and changes to the way nonprofits are able to borrow money in the bond markets.
When money is tight, consumers are forced to make painful choices. Should you buy baby diapers or a new pair of shoes? On the surface, that decision seems obvious. Baby diapers are a necessity; a new pair shoes may be more comfortable or stylish than what you're wearing now, but you can survive without them. They're a luxury. But the thing is, sometimes it becomes difficult to distinguish the things you truly need from the things you merely want. With the slowdown in the economy, small community hospitals will have to take a long, hard look at what products and services their communities need versus what they would like to have.
Many community hospitals will need to take a more modest approach to their construction or expansion projects. Some decisions will be easier: "Do we really need a glass atrium, waterfall wall, or healing garden at our new hospital?" Others will be more challenging: "Do we really need a 50-bed replacement facility, or will a 40-bed facility be sufficient?"
Even though the majority of community hospitals won't be able to borrow as much money as they could have a year ago and will likely have to curtail some of their plans, postponing construction projects until the economy rebounds is not in their best interest, according to industry experts. Many of these hospitals are operating in antiquated facilities that are unable to meet the needs of their community. What's more, construction has slowed up a little bit, says Arlan Dohrmann, managing director of the Stern Brothers & Co., a national healthcare finance group, so "the cost of construction is not going up at the inflationary rates that we were seeing."
Dohrmann offers these tips to community hospital executives whose facilities are in the middle of a construction project—or about to begin one:
Get a credit assessment done to determine your hospital's debt capacity.
Decide what services are really important to your community.
Analyze your current operations, demographics of your region, the size of the project, and your vision.
I would love to hear about your hospital's construction project. Please drop me a line at the below e-mail address.
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
New York Neurological specialists are now available to help stroke patients in rural areas via the Internet. Using the "REACH" (Rural Evaluation of Acute Ischemic Stroke) system, patients at Cortland Regional Medical Center and Schuyler Hospital can connect with specialists in Syracuse without having to make the trip by ambulance. The system uses a computer placed near the patient, and an on-call neurologist in Syracuse then can log on from any computer with Internet access. From the computer, the neurologist can recommend a treatment plan for the patient.
As part of a new strategy, Butler (PA) Memorial Hospital has begun offering expanded services for back and spine problems at a shopping center clinic. The Back and Neck Center of Butler Memorial Hospital opened in March at a shopping complex that also features a Target and Wal-Mart. Connected to the clinic is a medical imaging center, and the site is among 17 outpatient facilities run by the hospital.
With the strength of a San Andres Fault spasm, California officials have retaliated against managed care organizations following a number of alleged missteps.
It seems like a week doesn't go by without a negative managed care article with a California city dateline. In this past week alone, two stories perpetuated the image of managed care as heartless.
The Los Angeles city attorney sued the state's largest health insurer charging that Anthem Blue Cross unlawfully canceled the coverage of as many as 6,000 Californians. In the other case, the state Department of Managed Health Care announced an independent arbiter will review policies canceled by five major insurers over the last four years to make sure they were not wrongly canceled. If rescinded in error, the state will reinstate the individual policies and require the insurer to pay the patient's medical bills that were incurred while the person was not covered.
Many officials have taken aim at the industry because of individual coverage cancellations, also called rescissions. Officials have supported the causes of individuals who have lost coverage and face mounting health bills and declining health. Cindy Ehnes, director of the Department of Managed Health Care, called rescission "a harsh practice," and has already ordered three of the state's largest insurers to reinstate 26 patients' policies.
Health Plan Insider readers have surely followed the proceedings in California, which plays into the perception of health insurers as unfeeling bean counters. Beyond this week's news, here are four stories from the Golden State that have blackened the eyes of managed care over the past four months:
In the most widely publicized case, CIGNA initially declined a liver transplant for a 17-year-old leukemia patient named Nataline Sarkisyan at the Pediatric Liver Transplant Program at UCLA, saying it "does not cover experimental, investigational and unproven services." After protests from doctors and nurses and picketers to the company's Glendale, CA, offices, CIGNA changed its mind, but it was too late. The girl's family had already taken her off life support and she died a short time later. Sarkisyan's story became a major piece of former Sen. John Edwards' presidential campaign.
The California Department of Insurance fined PacifiCare $3.5 million after the department reportedly found the UnitedHealth Group subsidiary had more than 130,000 claims-handling violations over two years. PacifiCare could be on the hook for an additional $650 million to $1.3 billion in fines. In response to the PacifiCare case, the California insurance commissioner launched an audit of the largest health insurers to address claims-processing violations.
The Los Angeles Times reported on Blue Cross of California sending letters to physicians asking them to report pre-existing medical conditions that the insurer could use to rescind coverage. The insurer agreed to stop the practice after the story was published, but not before enduring a public relations disaster.
An arbitration judge whacked Health Net with a $9 million judgment in a case involving a breast cancer patient whose coverage was canceled during chemotherapy. Los Angeles City Attorney Rocky Delgadillo also opened an investigation into whether the company illegally rescinded the policies of at least 1,600 members.
Taken separately these articles are not pretty, but collectively they have created a climate where managed care is forced to explain itself. Elected officials are pursuing health insurers, and managed care reform could be the ultimate result.
Some of the problems are surely managed care's fault, but there are some overarching unanswered questions:
Is rescission a fair safety gauge to protect health plans (and consequently their members) from astronomical costs?
Is rescission a way to assure that people are truthful when filling out individual health plan applications?
Are the applications clear enough so people understand what they are filling out?
Are officials targeting insurers because they believe there is a better way to provide health plans to Californians or are health insurers merely an easy target to gain notoriety?
Managed care officials should keep tabs on California. The aftershocks from the Golden State could shake the industry to its core.
"The patient experience" is all the rage right now. And it makes sense: Make a good impression on patients and their visitors and they'll say good things about you. That spreads positive word of mouth to other patients and referring physicians. And that ultimately helps the bottom line. And because I care about your bottom line, I am going to share with you a three-step process guaranteed to improve patient and visitor experience, perception, satisfaction, and word of mouth:
Walk to the nearest restroom
Take a look around
Flush the toilets
A few weeks ago my father had heart surgery at a medical center that is consistently listed among the best hospitals in the nation. It is world renowned for its research and clinical excellence. It posts its quality data online for all to see. It has the top doctors, is affiliated with the top medical school, and has competent and caring nurses and attentive staff.
The hospital handles about 1.3 million inpatient and outpatient cases and performs more than 35,000 surgeries a year. It bustles like a small city and hums like a machine. The sounds of construction are a constant sign of its continued growth. The cafeteria has healthy food, the coffee shop handles long lines with amazing efficiency, and the gift shop is well-stocked with some really cute stuff.
But the bathrooms are disgusting.
Wastebaskets overflowing with paper towels, dirty floors, dirty walls, dirty ceilings, dirty mirrors, dirty everything. Unflushed toilets. Old, yellowed cigarette burns on the toilet seats. Seriously—when was the last time anyone could get away with smoking a cigarette in the bathroom of a hospital? They can afford a new building, but they haven't changed the toilet seats since the 1980s?
There was a cleaning schedule on the wall—I suspect it was forged. And when I told a staff member of the state of things down the hall, she said that she'd sent me to that bathroom because it was usually the least disgusting. "Oh," said another staffer. "I always thought that one was the worst!"
The two women debated the relative squalor of the various bathrooms for a while. Neither one of them picked up the phone to call housekeeping.
The truth is that my family and I felt confident in this well-known hospital with the trusted name that treats heads of state and crowned princes. But the state of the bathrooms really threw me. And, after telling folks that my dad is doing well, that's what I end up talking about.
And I'm not the only one. Paul Spiegelman, CEO of The Beryl Companies, talked about the patient experience at the Healthcare Strategy Institute's consumer-based marketing conference earlier this month. He pointed out that patients will spend 20 seconds talking about their clinical outcome and 30 minutes talking about poor customer service—whether the noise kept them up at night, whether the nurses answered their call button, whether the bathrooms were clean.
Dale Dauten, a Boston Globe columnist dubbed the "corporate curmudgeon," says bad restrooms are a kind of antimarketing, especially among women. "When customers and employees see your restroom, Web site, phone system, waiting room, or product-return counter, they are seeing a picture of what you think of them," he writes.
Listen, it might seem a little silly to talk about the bathrooms of a world-renowned medical center. And if you are at or near the top of the market, maybe you can get away with bathrooms that are less than stellar. But if you're in a crowded market where you have to fight for share? If your referring physicians have been sending business elsewhere lately or complaining that their patients weren't impressed with your facilities? It's the so-called little details that can make a big difference.
"If we treat our customers well, we don't have to worry so much about the competition down the street," Spielgelman said.
A chemical used to make baby bottles, water bottles and food containers is facing increasing scrutiny by health officials in Canada and the United States. The substance is bisphenol-a, or BPA, which is widely used in the making of the hard, clear plastic called polycarbonate. Studies and tests show that trace amounts of BPA are leaching from polycarbonate containers into foods and liquids. Retailers including Wal-Mart have said they are withdrawing baby products made with it.
E-mail marketing is a great way to interact with customers, and to help, Inc. Magazine breaks down all main electronic managing services and spells out which company is best for each e-mail marketing technique. The services listed include those that let marketers manage subscriber lists, comply with spam regulations, monitor bouncebacks, and track who opened and clicked on what. Some even check messages against spam filters.
In this BrandWeek article, Eric Zeitoun writes that trends have the power to sway consumer attitudes, and the marketer who detects and embraces them can respond quickly and intelligently to the latest desires of the consumer. But because product life cycles have gotten so short, innovation has become a part-time job for many marketers, and the result is one very disturbing trend: too many trends, Zeitoun writes.
In his Heath Markets Guru blog, Michael Harris asks "why is service line growth so new to hospital executives?" He says administrators at one hospital said that they are "finally ready to take this seriously" when talking about service lines. "It never ceases to amaze me how health organizations rarely applied the practices of health diagnostics and treatment to their own fiscal stealth," he says.
After a few years of consumer research and trial and error, Southern Ohio Medical Center had found that its most effective marketing centered on patient and professional testimonials. However, when they won the prestigious Magnet Award for nursing, they discovered that incorporating the awards into their plans made them a ‘magnet’ for attention.
Southern Ohio Medical Center decided to take a testimonial spin on announcing the Magnet Award to the community it serves. “Rather than having one of the hospital executives come out in a suit to talk about how great [Southern Ohio Medical Center is] we decided it would be really great to let the nurses do it—since they were the ones who earned the honor,” says Robbie Kemper, creative director and CEO of Southern Ohio Medical Center’s agency KGB Advertising, Inc located in Cincinnati.
The hospital selected community members for the TV and radio spots that were created. The ability to be featured was given out as a reward for those internal members who did the work to make the award possible for the facility. Overall, reaching beyond their normal emphasis of marketing particular service lines proved to be a positive internal communications move. “We’d hear from the community ‘enough, what about the rest of us?’ Most of what we’ve marketed has centered on the heart and cancer service lines at Southern Ohio Medical Center. This allowed us to do a campaign that was an all inclusive representation of the professional internal community,” says Kemper.
By using real nurses and professionals, and by having them speak one-on-one with the potential patient/consumer, Southern Ohio Medical Center manages to grab attention and community appeal with the simplicity and sincerity of their ‘heart to heart’ message. As Kemper said of the focus group’s reaction to the TV spots, “There has yet to be a focus group that doesn’t know someone featured in one of the spots. In one focus group a woman said, ‘that can’t be a real nurse, she looks like an actor.’ Another woman spoke up and said, ‘no, she’s real, she’s well known in our community and if she says this facility is good than that’s good enough for me.’ What could be better than that?”
Kandace McLaughlin is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kmclaughlin@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
