The South Carolina Supreme Court has ruled that state law does not guarantee uninsured hospital patients the same discounts offered insured patients. The court overturned a decision that had said a loophole in state law gave all patients the same discounts through 2004. These discounts could shave 50 percent or more off a typical hospital bill, said the attorney representing uninsured patients before the Supreme Court.
Visiting the bustling United Arab Emirates, you can see the world's tallest building and the world's grandest shopping mall. These are testaments to the commitment of the UAE's leaders to recreating the region into one of the globe's financial powers. About two-thirds of its population is made up of expatriates, brought in to help expand the UAE's economic infrastructure.
These non-nationals work in retail, construction, hospitality, and--increasingly--healthcare. Smartly, the leaders of the UAE realize that dazzling skyscrapers and a robust financial exchange isn't enough. So they've focused on enhancing the healthcare system as a cornerstone of the region's economic development. Initially, the region's healthcare system will support other industries. But as plans for world-class facilities in Abu Dhabi and Dubai come to fruition, the region might someday compete for the world's medical travel dollars.
American expatriate David L. Printy, president and CEO of Oasis Hospital in the city of Al Ain and the emirate of Abu Dhabi, has seen much of the healthcare system's expansion in the region first-hand. When Printy was visiting the States last week, I had a chance to talk with him about some of the top challenges hospital leaders in the UAE face.
Compliance with quality standards: Like many hospitals in the West, UAE hospitals must meet increasingly stringent quality regulations. These standards are set UAE-wide and within individual emirates, the strictest being Abu Dhabi and Dubai. Many of these regulations relate to the quality of clinical staff. For instance, Abu Dhabi requires that nurses have two years of professional experience before they could be licensed in the emirate. And physicians must practice five years past certification and undergo a peer-led interview process. These extra barriers are meant to weed out fraudulent clinicians, which traditionally have been a known problem for many developing nations.
Increased healthcare utilization: Last year, Abu Dhabi mandated that employers provide health insurance. That effort, combined with the state-provided coverage, has led to a swelling of emergency room patients for Oasis and other facilities. "That has increased the utilization of healthcare dramatically," says Printy. "[It's] one of the highest [increases] I've experienced in my over 30 years of healthcare leadership."
Clinical staff recruitment and retention: There just aren't enough good doctors and nurses to go around. Printy recruits physicians from around the globe--from the Philippines to Chicago. It might not seem easy to woo expats, but he says there's a budding interest in international healthcare that's helping him attract high-quality clinicians. But, just like hospitals everywhere, it still takes a lot of effort and partnerships with organizations near and far to maintain the clinical staff. Part of that effort is dedicated to building the supply of local healthcare workers. "I am a firm believer that the quality of healthcare in any nation cannot be sustained without nationals taking leadership roles," says Printy.
Healthcare as a business sector: While the UAE works to address healthcare quality and coverage for its citizens, Printy and other healthcare leaders in the region continue to promote the advancement of professional healthcare management. Recently the American College of Healthcare Executives has given approval for a Middle East/North Africa chapter based in Dubai. "So now we're providing a framework for healthcare executives, and we have members from Egypt and Lebanon and all over the region," says Printy.
The UAE's ongoing investment into healthcare infrastructure and leadership is a sign of things to come for the region. "Leaders see a business opportunity in healthcare that supports the development of the country," says Printy. "They believe that over time they are going to compete with Singapore and other regions of the world for tourism healthcare."
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Rick Johnson is senior online editor of HealthLeaders Media. He may be reached at rjohnson@healthleadersmedia.com. View Rick Johnson's profile
Six years ago, the California Legislature passed a law requiring the state to adopt regulations to ensure HMO patients have timely access to needed medical services. But there are still no requirements that spell out how soon primary care doctors must schedule an appointment for an urgent healthcare matter or provide referrals to a specialist if necessary. The state Office of Administrative Law rejected draft regulations because the state Department of Managed Health Care did not provide enough time for public comment after the proposal was altered, and now regulators have four months to come up with the next proposal.
Debbie Laughery, vice president of public relations for WakeMed Health Systems, describes the organization's "Listen to Your Heart" campaign, a winner at the 2007 HealthLeaders Media Marketing Awards. Laughery will talk about the planning and strategy that went into this successful campaign during the March 19 Webcast, Marketing Cardiology: Strategy for Service Line Campaigns.
"Mission" and "vision" are words that I hear a lot from healthcare leaders. But, as I heard yesterday at the American College for Healthcare Executive's annual conference, a leader's ability (or inability) to give the organizational mission meaning for all employees is what will make or break an organization's success during times of adversity.
George Masi, executive vice president and COO of Harris County Hospital District in Houston, TX, knows adversity first-hand.
In the days following Hurricane Katrina, his organization treated more than 17,000 misplaced patients in a virtual hospital in Houston's Astrodome. Their rescue efforts tested hospital resources and staff like no other event in the organization's history, Masi said. And it was Harris County's "quiet leaders"--staff not in official leadership roles--who made the effort successful.
Hospital executives don't really know who their true leaders are until they are faced with adversity, Masi told ACHE attendees; leaders will be pleased, surprised, and disappointed by who rises to the top at those times. So, as leaders prepare their staffs and organizations for everyday challenges, they must ensure the mission has meaning for each and every employee.
But how do you make 30 or so words that sound good on paper matter to your shipping staff, billers, and housekeepers?
"Chunk down the vision," Masi said; that is, rework and reword the mission for each employee so it has meaning for them and their jobs. This may sound almost sacrilegious to leaders who have spent months word-smithing their mission statements, but, as Masi said, it's not. "You have the right and prerogative to retool the vision so that it has relevance to the people working with you," Masi said.
Organizations spend so much time crafting the perfect mission statement they often lose sight of what the words in that statement actually mean. Part of your job as leaders is to make the vision something everyone can relate to on an ongoing basis. How well you do that will determine how well your organization fares during times of adversity.
Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at mrowe@healthleadersmedia.com.
Carol Westfall, president of Cejka Search, talks about the growing number of part-time physicians and other findings from the Cejka Search/AMGA 2007 Physician Retention Survey.
Looking back on the massive HIMSS exhibition, I am struck by the enormity of change under way in the industry. I had multiple encounters with CIOs describing how their health systems are undertaking ambitious projects. These are invariably wrapped in a patient safety initiative, one that is being driven by the clinical staff, not the CIO. Following are a few highlights of the people I met in Orlando.
Deborah Gash, the CIO at St. Luke's Health System in Kansas City, told me how her hospital is really promoting patient connectivity. They're using Relay Health (now owned by McKesson) to facilitate online bill payment and clinical messaging. St. Luke's has some 4,300 patients enrolled thus far, all at the behest of physicians. Patients can see their lab results and medical records through a secure connection. St. Luke's has the potential to offer "e-visits" as well, although few physicians are taking advantage of it to date. Only recently have payers begun to ante up for the service.
Michael Krouse, CIO at Columbus-based OhioHealth, is leading the charge at the 16-hospital system for increased patient safety. Speaking at a McKesson press event, Krouse described how OhioHealth is deploying "closed loop" medication management technology. The goal is to automate the entire medication administration chain, from the initial order to dispensation on the floor. OhioHealth recently opened a new "digital hospital," Dublin Methodist, in which no paper charts are to be found.
Michael Kramer, MD, serves at CMIO at Michigan-based Trinity Health. Trinity has one of the industry's largest IT overhauls under way, as it is standardizing on Cerner clinical documentation tools across 31 hospitals. According to Kramer, Trinity has completed the staged deployment at 11 hospitals thus far, and is on track to have 11 more complete by the end of this year. It's a big undertaking with big numbers: Trinity has compiled some 3,600 order sets to date. It's also seeing reduced malpractice pay-outs at its automated facilities.
Melissa Foster, RN, is manager of nursing informatics at Homestead (FL) Hospital, where she is overseeing a project to capture documentation from fetal surveillance monitors directly into an electronic chart, from CliniComp. The setup enables centralized monitoring of up to 13 patient beds at once. Homestead has 11 nursing informatics specialists, says Foster, who reports to the chief nursing officer.
Jamie Welch is CIO of the Rural Hospital Coalition, based in Pride, LA. The coalition is supporting a state-wide data exchange that includes 24 rural hospitals. Funded by an $11 million state grant, the RHIO is just getting off the ground. I asked Welch about the exchange's odds for long-term survival, and she conceded that it may take five years to answer that question.
During a medical emergency--or even during the most planned courses of treatment--there always exists the chance for unexpected procedures, complications and longer-than-anticipated hospital stays. When a patient is finally released from care, the recovery process can cause both physical and emotional stress. All too often, this stress is multiplied for patients and their families when insurance companies deny coverage for the patient's treatment or days spent in the hospital.
Stifling hospital bills that are not covered by insurance can quickly devastate a family's financial security. As a result, patients are unable to cover their bills, thus affecting the financial status of the hospital that provided the treatment.
A few years ago, West Virginia University (WVU) Hospitals administration realized the need to revitalize operational procedures, in order to reduce patient length of stay and improve the quality of care delivered. Reducing denied coverage, improving coordination of care and improving the bottom line became the goals.
Finding the right solution was a daunting task for our large health system, which is based in Morgantown, West Virginia. WVU has an annual inpatient discharge rate of more than 22,000 patients per month. WVU Hospitals had quite a list of operational goals --streamlining and coordinating the utilization of services, improving case and discharge management processes, as well as incorporating a new, coordinated denial management practice with financial services.
A team consisting of senior management, physicians and care management professionals researched numerous companies within the industry to find technology that would most effectively manage patient throughput. Recognizing the burden denials management created for case managers and other hospital staff, as well as the trend towards paperless, wireless solutions, WVU Hospitals decided to look to a case management system to streamline operations and organize an effective appeals process. After extensive research into various case management options, WVU Hospitals decided to implement Allscripts' Case Management system in 2001.
Reducing denials by reducing length of stay Implementation of a case management system greatly affected the denials management process at WVU Hospitals by decreasing the patient's length of stay. Before the implementation of the case management system, a patient's medical team would depend on the bedside nurse to keep everyone updated on patient needs, plan of care and discharge status.
But now, the case management system streamlines communications so that all members of a patient's care team--doctors, nurses, social workers and case managers--are up-to-date on a patient's progress and anticipated discharge. In fact, the case management system keeps the team informed of the exact barriers keeping the patient from safely returning home, such as missing lab results, consultations, and family needs. Today, case managers can more efficiently and effectively orchestrate a patient's discharge with the help of this system.
In retrospect, case managers use the reporting capabilities of the system to produce concurrent medical service line reports for the medical services lines and senior management team evaluating length of stay compared to their benchmarks and analyzing avoidable day reports. As a result of this implementation, WVU Hospitals were able to reduce their actual length of stay by a half day in the first 12 months.
By 2003, WVU Hospitals were performing well below our average length of stay goal of 5.5 days. In addition, WVU Hospitals reduced length of stay and patient days for high-risk, complex patients who stay in the hospital for over 15 days.
Alerts, reports and appeals--fighting denied days After implementation of the case management system, managing the process of preventing and appealing insurance company payment denials also improved. Before automation, utilization review nurses spent a large portion of their work week filling out endless paper work, searching for proper coding, and awaiting signatures from doctors in order to start the process of appealing a denied claim. Now, the process is proactive and seamless. While the patient is still in the hospital, the payer specialist sends a review to the insurance company--communication that documents the patient's acuity level according to established criteria.
Establishing how sick the patient is allows for the payer to authorize treatment and prevents them from claiming at a later date that the care was not necessary. Automation also allows more proactive census management as we know with more precision how many in-patient days authorized by payer--called "certified days"--we have in the system.
Proper coding is available to the specialists directly on the workstations, cutting back on small errors that can make a big difference. If a denial is reported to the facility after filing with the insurance company, the payer specialist can document the denial and alert the appeal coordinator to initiate the appeal process. This process happens while the patient is still in the hospital, and continues after discharge, as needed.
The reporting capabilities of the system keep all members of the team up to date on the specific needs of the denials management team from the initial threat of denied coverage, and through the entire appeals process. For example, an e-mail is sent to all members of a patient's care team, as well as various members of the hospital administration, to inform the team the patient's insurance has threatened a denied day.
In addition, the reports are used to track for trends and assist with workflow prioritization--a process which includes physician reporting, tracking and logging necessary documentation, and preparing for necessary hearings. Although this can be a complex process, the capabilities of the case management system have made the denials process at WVU Hospitals more efficient and has yielded positive results for both patients and the hospital.
Looking ahead Due to the reduction in patient length of stay and increased effectiveness in denials management, WVU Hospitals have greatly improved operational efficiencies and financial security. The hospital has noticed greater success rates in winning denied day appeals. This success rate has made a significant fiscal contribution. By reducing excess days by about 400 per month and improving the facility wide appeals process, WVU Hospitals have been able to add an estimated $140,000 per month and $1.5 million per year to the hospital's bottom line.
With the comforts of a more controllable denials management process and a stronger bottom line, WVU Hospitals are prepared to continue their standard of excellence in patient safety, as well as look towards a future of steady growth. And most importantly, patients and their families can return home to continue recovery with the confidence in the organized, highly successful denials management system and care team working to protect them.
Hospitals have long been seen as one of the top waste-producing industries, and in 1998 the American Hospital Association and the Environmental Protection Agency agreed on goals to reduce the effect of healthcare facilities on the environment. Now Evergreen Medical Center in Kirkland, WA, and other hospitals in the Seattle area are taking steps to not only protect the environment, but cut costs, as well.
Union-represented registered nurses will strike at Sutter Health-affiliated hospitals in Northern California for 10 days beginning March 21, according to the California Nurses Association. The latest strike will mark the third strike at Sutter facilities in less than six months. The union said the strike is intended to call attention to "serious problems with patient care," and a "pattern of patient safety risks caused by Sutter's refusal to schedule RNs to care for patients when nurses are on legally mandated meal or rest breaks."
