Identify one issue facing hospitals today. Discuss the current state of the Affordable Care Act, and what impact changes may have on hospitals today? How might these changes to the law, impact the hospitals here in Northwest Indiana?
1. Problem: Too many avoidable patient
days.
Suggestions: When Ms. Ubbing brought in an outside
group to look at her hospital's inefficiencies, the group found
that the number one opportunity for cost-cutting was in avoidable
patient days. Patient days can add up quickly if providers aren't
focused on moving patients to other facilities or their homes once
appropriate. She says the hospital took several approaches to
decrease patient days. They worked with nursing homes and extended
care facilities to make sure patients could be transferred on
weekends, to avoid keeping a patient in the hospital until Monday
when they were ready to be moved on Saturday. The hospital also
worked with physicians on length of stay and showed data that
demonstrated how each physician stacked up compared to his or her
peers.
Ms. Ubbing says the hospital's nurse leaders also introduced a
concept called "full capacity protocol." A hospital might be at
"full capacity" for various reasons: Perhaps so many patients are
in isolation that second beds in semi-private rooms are
unavailable, or perhaps all the beds in the hospital are actually
full. Sometimes a patient waiting for discharge will occupy a bed
when there is no medical necessity — simply because it's easier to
stay in the bed than to go home. "What we do is we move the patient
awaiting discharge to a hall bed, and we put the sicker patient in
the room to begin care there," she says. "It's pretty amazing how
soon that patient awaiting discharge finds a way home."
2. Problem: Desire for physician integration but very few
employed physicians.
Suggestions: Ms. Ubbing's hospital employs around
10 percent of its physicians, meaning the vast majority of the
facility's providers are independent. This echoes the traditional
model of physician practice, but it can mean hospitals struggle to
integrate physicians in order to take advantage of bundled
payments. Ms. Ubbing says the hospital may eventually move toward a
greater percentage of employed physicians, but for now, she uses
co-management of hospital service lines to involve her independent
physicians in hospital operations. The hospital first implemented
co-management of the orthopedics service line and then moved to the
cardiovascular and thoracic service line.
When structuring the co-management of the cardiovascular line, Ms.
Ubbing says the hospital brought together diagnostic and
interventional cardiologists, thoracic surgeons and radiologists —
but also primary care physicians and nephrologists, two groups that
might seem out of place. "If you step back and think about it and
look at 30-day readmissions, the care between hospitalizations
rests in those [primary care] offices, not in the hospital," she
says. "That's where primary care comes in, and that's where
nephrology comes in with vascular cases."
She says the hospital placed its trust in the independent
physicians by saying, "If you want to run how clinical care is
delivered in our hospital, come on down." Co-management helps
integrate physicians with the system, she says. "Unlike the
independent physician, who's doing his care for his patients the
way he wants to, he [now] has the opportunity to be part of an
institute where the incentives are for the whole group to perform
at the highest level," she says.
3. Problem: Unhealthy community.
Suggestions: Under the healthcare reform law, FMC
is required as a non-profit hospital to perform an annual
healthcare needs assessment of its community. "One of our big
issues is around healthy lifestyles, and more specifically, obesity
and the disease stream it leads to," she says. Even as the
insurance coverage expands, she says community members still have
to make the effort to visit a physician and keep themselves
healthy. In 2010, the hospital targeted drug and opiate addiction
in the community, and in 2011, the hospital plans to target
obesity. To fight drug addiction issues, the hospital required
every employed physician to register with the Ohio Automated Rx
Reporting System, an Ohio database that shows physicians a
patient's prescription drug history. "There are some pretty
persuasive stories that show you don't know what you don't know,"
Ms. Ubbing says. "One surgeon got a referral from a primary care
physician for surgery, and when [he looked up the patient in
OARRS], he found the patient didn't have one doctor — he had two.
He was getting identical prescriptions from both." The hospital
also dedicated a newsletter to issues around drug abuse and
provided copies to anyone who wanted them.
In 2011, the hospital will focus on obesity, a huge problem for
many communities in the United States. The community has raised
money to sponsor local residents to ride their bicycles at
designated events where the courses run from 5-100 miles. Because
the hospital is located in a farming area, administration is trying
to bring more local, fresh produce to community members and ensure
nutritionally balanced meals in the hospital cafeteria. Ms. Ubbing
has been amazed by the willingness of community members to
participate in these initiatives: "People have come forward and
said, 'I want to be part of this,'" she says.
4. Problem: Poor communication between
providers.
Suggestions: Fairfield Medical Center recently
added a new role to its facility: clinical nurse leader. "A
clinical nurse leader is the first new role in nursing in 40 years,
and this is a post-masters trained nurse who is on track like an
advanced practice nurse, except their training puts them in the
hospital at the bedside," Ms. Ubbing says. She says the hospital
has assigned a clinical nurse leader to micro-units of around 12
beds throughout the hospital, where the CNL acts as a liaison
between physicians and patients and mentors other nurses. "[We
think] this will reduce length of stay, eliminate some rework and
get better information flowing faster for decisions to be made,"
she says. By installing a nurse leader to increase communication
between providers, she thinks patients will have a better
healthcare experience with fewer redundancies, and physicians will
have a better understanding of what happens to a patient when
another provider takes over.
5. Problem: Physician and nurse shortages.
Suggestions: Hospitals across the country are
preparing themselves for predicted provider shortages. To offset
physician and nurse shortages in southeastern Ohio, Fairfield
Medical Center has partnered with Mount Carmel Health System in
Columbus, Ohio, to bring a satellite college of nursing campus to
the Fairfield facility. "[Mount Carmel] has a college of nursing
that rewards a BSN degree, among others, and they ran out of bricks
and mortar space. The cost of that is expensive," Ms. Ubbing says.
"They came to us because of the vast majority of their students
outside Columbus come from here — Fairfield County." Together, the
hospitals installed a branch campus of Mount Carmel's nursing
school at FMC.
About two miles away from FMC, Ohio University runs a branch campus
— Ohio University Lancaster. Ms. Ubbing says the nursing students
from Mount Carmel do their first year of classroom work at OU
Lancaster and spend the next three years doing clinical work at
FMC. "There are up to 24 allowed in the class, and we're on our
third class this year," she says. "We have the benefit of
developing more nurses, and we have a three-year relationship with
those nurses [by the time they graduate]." The project benefits
everyone: Mount Carmel doesn't have to build more space, Fairfield
County students avoid a 50-mile drive and FMC has the opportunity
to "grow their own" nurses.
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