Eneida O. Roldan, MD, is the new president and CEO of Jackson Health System. Roldan is the first woman and first Hispanic to lead the hospital system. Last month, the Public Health Trust unanimously selected Roldan as the top choice for the position. The appointment became official when she was confirmed at the Public Health Trust Board of Trustees monthly meeting and her tenure began June 1.
Linda J. Porrino has been named chair of the Department of Physiology and Pharmacology at Wake Forest University School of Medicine, effective July 1. Porrino joined the medical school faculty in 1990 and has been professor of physiology and pharmacology since 1997. She was named interim chair of the department in 2008. She follows James E. Smith, now chair emeritus, who headed the department for almost 20 years.
Annmarie Hagan, 48, has been appointed executive vice president and CFO of CIGNA Corp. Hagan will be responsible for all of CIGNA's financial operations, areas in which she has held numerous leadership positions since joining CIGNA in 1987, as well as for CIGNA's Investment Management and Strategic Planning units. Hagan succeeds Michael W. Bell who has held the position since 2002 and who resigned after 25 years with CIGNA.
Thomas O'Neill III was named vice chairman and Timothy Susanin was named senior vice president, general counsel, and secretary of WellCare Health Plans, Inc. O'Neill had served as senior VP, general counsel and secretary since joining WellCare in April 2008. Susanin, who joined WellCare in November, previously was vice president and chief counsel-dispute management, and worked with O'Neill in managing government and regulator investigations.
For the last six months or so I've tried to keep track of hospital layoffs across the country. Nothing fancy, exhaustive, or scientific: I'd Google "hospital" and "layoffs" and "2009" and see what popped up.
Unfortunately, there was no shortage of hospital layoffs news in January, February, and March. In the last two months or so, however, layoffs slowed down to the point where I hadn't done a daily search for a month or so. While it was apparent that the hospital industry was now susceptible to the same financial woes that had knee-capped the economy-at-large, I was hopeful that the worst had passed.
That wishful thinking was doused by three buckets full of cold reality last Tuesday afternoon with the back-to-back-to-back announcements of layoffs at three well-established hospitals and health systems in three very different parts of the country.
Greenwich (CT) Hospital announced more than 70 layoffs as part of an effort to slash about $20 million from next year's budget.
The University of Iowa Hospitals announced that it would trim its 6,600-person workforce. The 680-bed hospital in Iowa City, with an operating budget of $860 million, had already trimmed $23 million but must cut another $45 million by June 30, 2010 to have a 1% profit margin. Hospital officials have yet to determine how many jobs will be cut.
The University of Alabama Birmingham Health System, UAB Hospital, and UAB Highlands said they would eliminate 245 positions overall, but hire back 81 staff whose positions are now held by non-UAB contract staff, for a net elimination of 164 jobs.
The sad refrain from leadership at all three hospitals was off the same sheet. They blamed declining patient volumes, a drop in elective procedures, sagging investment portfolios, increases in uninsured patients that come with the newly jobless, and anticipated reduced reimbursements from private insurers and the federal government.
Last week, the Bureau of Labor Statistics reported that hospital job growth is essentially flat this year. The nation's 5,708 or so hospitals added 300 new jobs in May. By comparison, the hospital sector added 16,800 jobs in May 2008, and 8,700 jobs in May 2007. In the first five months of 2009, the nation's hospitals increased payroll by 8,600 jobs, compared with 43,700 jobs in the first four months of 2008, and 25,300 jobs for the same period in 2007.
The May numbers are particularly disheartening because, historically, hospital hiring has up-ticked in the second quarter of each year, as hospitals get a better idea of their patient volume projections and they look to graduating nurses and other clinicians to fill jobs.
Do these numbers suggest we're on the cusp of another round of layoffs in the hospital sector?
Bill Woodson, a senior vice president at Sg2, the healthcare intelligence company, says it's important to look at the big picture. After all, the hospital sector employs about 4.7 million people.
"I'd be careful about leaping to conclusions, and I would still offer the conventional wisdom that each market is a different story," Woodson says. "In numbers terms, these layoffs are still very small percentages of the workforce. In a lot of places there have been a lot of thought and work done all year to trim wherever possible to avoid touching headcounts. Organizations have learned through the years that the cultural challenges layoffs create for them that are very hard to overcome. And they also know how in short supply the talent is."
He says more layoffs may be announced in the coming weeks as hospitals and health systems struggle to make their margins at the close of the fiscal year on June 30. "This is in a scheme of a workforce with several thousands people. If we are talking 70 or 80 people, sure it will hurt, but it's not an overwhelming number," he says. "These institutions are historically very well managed and take a very hard look at their long-term horizons."
There is some good news. The overall healthcare sector—physicians' offices, residential mental health homes, ambulatory services—reported 23,500 payroll additions in May. That's a slight increase in the average monthly gain since January but well off the average gain of 30,000 payroll additions per month in 2008. Ambulatory healthcare continued to see the fastest payroll additions in the overall healthcare sector, with 17,600 payroll additions in May, and 72,000 payroll additions since Jan. 1.
Even with the slowing payroll additions, the hospital and healthcare sectors are still outperforming the overall economy. BLS reports that nonfarm payroll employment fell by 345,000 as the nation's unemployment rate rose from 8.9% to 9.4%.
So, at this point, halfway through a very difficult year, at least we can still say that the healthcare sector is a growth industry, even if it's not at the pace to which we've been accustomed.
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Hospitals can't escape layoffs these days, and they're not exactly adding jobs anytime soon.
Bureau of Labor Statistics data released Friday say hospitals added only 300 payroll jobs across the entire nation, compared to 16,800 jobs in May 2008, and 8,700 jobs in May 2007.
So what are hospitals doing about it, especially on the front end where accurate registrations and upfront collections can mean the difference between a denial and a full return on a patient bill?
They are getting smarter, more technologically savvy, and analyzing their payer mix and what each entity requires.
Tanja Twist, director of Patient Financial Services at Methodist Hospital in Arcadia, CA, leads a team that is doing just this. She says her department has not made any major staffing adjustments.
Twist says cutting staff members in the business office may be counterproductive. A bill is a bill. It can't sit on a desk. It may mean shifting that cost savings to pay a vendor to pick up the slack.
"The accounts have to get worked – we either do it internally or we outsource it," Twist says. "In the end, we still have to get the job done. What we are trying to do is work smarter – anticipate what each payer requires."
Over the past year, Methodist went live with an EMR system – piloting it in the admitting and the business office. Twist says it allowed her to better utilize the file clerk FTEs, cross training them in scanning and document control. She was even able to transition one FTE into a much-needed position in cash collections; Methodist's self-pay population has increased significantly.
"This was a big change for my front- and back-end staff," Twist says. "We had to learn to 'let go of the paper,' which was not an easy thing to do. In admitting this meant scanning registration documents instead of copying them, and staff no longer needed to create a patient financial folder. This also required significant changes to the workflow."
Methodist has also made improvements with:
Patient flow in ED. It implemented a clinical documentation system, which ED staff members use to help with patient flow in and out of the ED.
Express unit. Methodist started 2008 by fine-tuning its pre-admission process and opened up an 'express registration unit,' which guarantees that pre-registered guests are processed in less than five minutes.
New-hire program. If it does need to rehire staff, Methodist began a "very aggressive" new-hire training program and staff re-education course, hiring a staff education coordinator to facilitate all training. It put leads in place to facilitate registration audits and found a significant decrease in registration errors and an increase in upfront collections since implementing these initiatives.
"We are just trying to optimize our time, changing the way we tackle our team mix to adjust to the changes in economy – both from a self-pay perspective and a commercial payer follow-up perspective," Twist says. "The payers seem to be hanging onto their money, and the patients are increasingly less able to pay upfront."
Editor's note: This is the first in a four-part series of stories on HealthLeaders Media talking to revenue cycle managers about coping in a tough economy.
What a difference a week makes. At the beginning of last week, it was clear that three committees in the House and two in the Senate were busy putting together health reform legislation. What was less clear was what President Barack Obama wanted—particularly in the area of a public health insurance plan option and other reform areas. But by midweek, the health reform winds seemed to change.
The President Speaks. In a meeting with key Democratic senators at the White House, the president talked Tuesday, June 2 about healthcare reform, which was followed immediately by a two-page letter sent to Senators Max Baucus (D-MT) and Sen. Edward Kennedy (D-MA), the chairmen of the two key healthcare reform committees, to clarify support for various healthcare provisions, including a public plan and requiring all individuals (under a principle of "shared responsibility") to be covered by insurance. Obama's proposed deadline for completion of healthcare reform is October.
It was a message that he took to the people Saturday, June 6 with a five-minute weekly broadcast address in which he said he would "lower costs, improve quality and coverage, and also protect consumer choice"—by letting individuals keep their plans and physicians they had if they liked them.
Obama released some details of how reform proposals would be paid for the $2.5 trillion reform package, such as cutting spending over the next 10 years through strengthening Medicare and Medicaid payment accuracy, improving care after a patient was hospitalized, and eliminating fraud, abuse, and waste. He said his estimated savings were about $309 billion. Obama's comments reflect findings from his Council of Economic Advisors on how high health costs will impact the economy.
Bill Draft Makes an Appearance. On late Friday, June 5, a draft of a reform bill emerged from the Senate Health, Education Labor and Pensions Committee, chaired by Sen. Edward Kennedy (D-MA).
The draft language, still preliminary at this point, proposes that all individuals have insurance, businesses be required to provide insurance (or pay a fee to the government), state insurance marketplaces be created where people can compare and buy plans, and subsidies be provided for low income individuals to buy coverage.
Mark-up is expected by early next week by the committee, although it is not know if Committee Chairman Kennedy, who is recovering from a brain tumor, will be making an appearance. Sen. Christopher Dodd (D-CT), a friend of Kennedy's, has been involved in moving legislation forward in Kennedy's absence.
Mark-up also is expected next week for the reform legislation completed by the Senate Finance Committee. Despite some differences between the committees noted earlier in the week, both committees agreed that they will work together to develop a bill that goes to the Senate floor.
Although it probably won't be included in the Senate Finance Committee measure, Baucus met with individuals supporting single payer interests during the week.
Health Group Proposals. After meeting at the White House last month, members of the six healthcare organizations—including the American Hospital Association and America's Health Insurance Plans—submitted proposals on Monday, June 1 on how they would decrease the annual healthcare spending growth rate by 1.5%.
In their game plan "to bend the cost curve," the groups’ projected savings would come from the following areas: utilization of care ($150 to $180 billion), chronic care ($350 to $850 billion), and administrative simplification and the cost of doing business ($500 to $700 billion). However, individualized savings are not specifically included in the sections submitted by the groups.
Access to pediatric trauma centers is often variable—and sometimes even inadequate—in many parts of the United States, according to a new study by researchers at The Children's Hospital of Philadelphia and the University of Pennsylvania. Overall, more than 17 million American children (about 30% of the population ages 1 -14) live more than an hour away by ground or air transportation from a pediatric trauma center.
In their review, the researchers were able to identify 170 pediatric trauma centers across the country, said Michael Nance, MD, the study's lead author and director of the Trauma Program at Children's Hospital.
However, even after locating the centers, large gaps in service areas were noticed. The largest holes were found mostly in rural areas: Hawaii, Maine, Montana, New Mexico, North Dakota and Wyoming provided almost no access to a verified pediatric trauma centers less than an hour away. Most children, though, living in areas such as the District of Columbia, New Jersey, Connecticut, Maryland, Massachusetts and Rhode Island were found to be within 60 minutes of pediatric trauma care.
The difficulty in coming up with the total number of pediatric trauma centers is linked to the way the centers are certified nationally: The American College of Surgeons verifies half of the trauma centers in U.S.; other facilities are verified at the state levels. However, they noticed differing standards, Nance said: "What qualifies for a trauma center in one state may not qualify in another state."
Among children ages 1 to 14, injury causes more deaths than all other causes combined so quicker access to children's pediatric trauma centers is important.
It is better to sweat more during peace and bleed less during war, according to an old Chinese proverb. The saying was invoked recently by Lisa Eddy, RN, CPHQ, CSHA, senior consultant for The Greeley Company, during her presentation at the 2009 Association of Healthcare Accreditation Professionals (AHAP) conference in Las Vegas.
Her presentation, "Continuous Survey Readiness," ran through the most-cited Joint Commission standards and methods for avoiding Requirements for Improvement (RFI) in these areas.
In healthcare accreditation, "peace is the time before the surveyors come," says Eddy. And not just the 18 month survey window. "This is all the time," she says. To prepare for that, it’s best to take a look at what The Joint Commission itself has considered the biggest challenges—by looking at the most frequently cited standards.
Approximately 5% of all standards make up 85% of all RFIs for hospitals. The number of Elements of Performance in 2009 rose to more than 2,000, Eddy noted.
"A lot of these are white noise. There is no way they would be able to look at them all," says Eddy. There are known problem areas on which The Joint Commission focuses, and these become the most frequently cited standards, which The Greeley Company calls the Frustrating 5%.
Medication reconciliation has been perennially a most-cited standard, but The Joint Commission is revisiting the concept this year.
In addition, the Provision of Care chapter has its share of challenges. Chief among them is communicating standards for history and physical exams due to recent changes. The field continues to struggle with this concept as physicians and other staff cling to previous rules for history and physicals. New standards state that a history and physical is good for up to 30 days, but there must be an update to the history and physical within 24 hours after admission or registration (as with day surgery) prior to a procedure.
This update "has to happen," said Eddy.
There are also new contenders on the scene—the Leadership chapter in particular.
"We’re seeing a lot come up surrounding the culture of safety survey," said Eddy.
Hot spots include:
Patient safety
Analyzing and assessing data
Contracted services
Policies and procedures
Patient flow
Conflict management
Surveyors are looking at how hospitals collect data about how they are working to improve the culture of safety at their facility.
"You need a statistically valid tool," said Eddy. "We see a lot of hospitals working culture of safety questions into their HCAHPS surveys."
After months of insisting he would leave the details to Congress, President Obama has concluded that he must exert greater control over the healthcare debate. He is now preparing an intense push for legislation that will include speeches, town-hall-style meetings, and much deeper engagement with lawmakers, senior White House officials say.
