Medical Center Barbour Prepares for the Future with Financial and Operational Assessment
Eric Shell, CPA, MBA, Principal with Stroudwater Associates, worked with Medical Center Barbour in 2013 on a Financial and Operational Assessment (FOA) Project. RHPI staff spoke with Ralph Clark, CEO, Debbie Norton, CFO, and Kathy Wilder, CCO, in January of this year concerning their progress.
Q: Why did you choose to focus on an FOA for your RHPI project?
A: Medical Center Barbour (MCB) was doing well financially, but we knew there were several reductions in Medicare and Medicaid payments that would affect our organization and we pursued the FOA to help us be proactive in assessing areas that we could improve in an effort to overcome the cuts.
Q: What is your hospital's current status with regard to implementing the recommendations made during this project?
A: The majority of Eric's recommendations have been implemented. The swing bed program is showing marked progress and a separate physical location has been created. A team consisting of a physician, social worker, case management, physical therapy and nursing meet daily to discuss patients that are appropriate for the program. Physical therapy has been an excellent partner to help market the program and with the addition of the Social Worker, we can now assess when a patient is ready to move to the next level of care. We now have a "true swing bed program". Census has grown to a consistent four/five patients a day (before was 6-7 patients per year).
The rewards program for staff was revamped so that everyone has an opportunity to participate. Measures include customer service, attendance, patient recognition, etc. Prizes are limited to the top 10% of staff to encourage "above and beyond" performance and not just "meeting expectations". Prizes offered have also improved.
Quality scores have improved. All staff are required to attend a mandatory class for customer service and it is now included in orientation. The hospital has implemented AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) and hourly rounding, whiteboards, and no- pass zone. The hospital continues to work on constant reinforcement of quality and customer expectations.
The hospital is using continuous documentation improvement and will use it with ICD-10 implementation. A biller has been hired, which means that now one person does all billing. This is proving to be more efficient. They are presently updating their chargemaster and looking at charges.
In addition to all the improvements listed above, there has also been a focus on the creation of new services. For the first time, a foundation was established. The Foundation has already pursued strong fundraising for a mammography machine, raising $120k so far. 340B was implemented in March and will be fully rolled out in May. A new rural health clinic will be opening spring 2014. A new podiatrist who will help with geri-psych started in February. The orthopedic group is expanding their time and may be doing outpatient procedures within the next few months. We are now discussing the establishment of a Urology and ENT Clinic with the help of Southeast Alabama Medical Center.
Concerning electronic medical record (EMR), qualifications for current meaningful use have been met and the hospital is waiting for reimbursement. The hospital is preparing for computerized physician order entry (CPOE) and will have EMR at their clinics to interface with lab and radiology.
Q: What were the expected outcomes of this project? Has your hospital been able to document any of these outcomes?
A: MCB was hoping to maintain a profitable margin while focusing on areas that could positively affect the bottom line other than controlling expenses. We were already doing a good job of controlling expenses and felt we could not cut expenses any further. We did end 2013 with a positive margin, although not at the level of 2012 ($2.5M). The second goal was to increase net patient revenue (NPR) by 2.5%, and as of February 2014, our NPR has increased year-to-date by 1.8%. Although our days of cash on hand has only increased by five days, we have paid our affiliate back $3M for prior year renovations to our hospital.
Q: What are the expected next steps towards adopting your consultants' recommendations? Is there a sustainability plan?
A: The hospital is presently considering the services of a nephrologist. Presently, the hospital transfers at least one patient every other day from the ER because they need dialysis.
Q: Is there anything your hospital would do differently if you were able to repeat this experience?
A: No. Our team did well in identifying the recommendations from Eric Shell that we could affect locally and through our affiliate, Southeast Alabama Medical Center. Please note that it takes more than six months to a year to recruit a family practitioner to a rural town such as Eufaula.
Q: Aside from the measurable outcomes, what has been the impact of this project on your community?
A: New services are now available for the local community so they are able to stay local when possible rather than travel to other towns. The hospital is creating and hardwiring a culture of service. The swing bed program has great potential to decrease readmissions while also keeping residents close to home for services.