A WORKBOOK FOR HOSPITALS 1
introduction Using the Workbook This workbook has been designed by the Fellows of the Estes Park Institute specifically for use at hospital board meetings and retreats. It is a companion to The Top Issues in Health Care 2013 report, which sheds new light on the challenges facing hospital leaders today. The report is available at www.estespark.org/topissues. This workbook will provide you with important tools to gauge your own hospital s leadership team s opinions, and compare them to national trends. Perhaps, most important, we view this as a critical step for hospitals to begin the dialogue about how to provide the best possible care. It is our desire that this material will give you a chance to discuss today s challenges and their implications for your board, your hospital, and your community and take the first steps toward an even more successful hospital. History has shown that understanding the challenges is imperative to choosing the right path. Contents Using This Workbook... 2 Moderator Instructions... 3 Board Survey... 4 Tabulated Results Form... 5 Discussion Guide... 7 About the Estes Park Institute... 11 2
moderator instructions Ideally, the workbook exercise should be completed with the entire board in an allotted time of approximately 2 3 hours. Step 1: Conduct the Survey with Your Board Photocopy the Board Survey on page 4 and distribute a copy to all board members, asking them to complete their individual answers anonymously providing their own personal opinions. Step 2: Tabulate and Share the Survey Results After every board member has submitted his or her responses, tabulate them by totaling and averaging each one. Verbatim responses may need to be edited for conciseness. Next, use the Tabulated Results found on pages 5 6 to display/circulate the findings among your hospital board. Step 3: Compare Your Hospital s Survey Results with National Data Distribute The Top Issues in Health Care 2013 report, and note any key similarities and differences between your hospital and others. Step 4: Discussion Ask the board members to participate in a brief discussion about each issue and a deeper discussion of the most important issues. If your hospital s evaluation differs substantially from the national data, ask why that might be. Probe reactions to apparent variances between importance and ease of resolving an issue. As the moderator, you should encourage discussion that will lead to identifying specific goals, objectives, and action items for the future. You may also find the Discussion Guide on pages 7 10 helpful. Before concluding the meeting, discuss the development or continuation of an action plan to address key issues. 3
board survey Please select the title that best describes your role within the hospital: Board Member Executive / Management Physician Leader Other: Please rate each of the following health care-related issues, giving your own personal opinion. (1 means not at all important/difficult and 10 means extremely important/difficult. ) Issue Changing the health care delivery system to be more effective and less costly Improving patient safety Importance to Our Hospital Difficulty in Accomplishing Getting adequate reimbursement from Medicare Cutting costs while delivering better care Getting adequate reimbursement from Medicaid Getting adequate reimbursement from commercial insurance carriers Improving communications and trust between independent physicians and the hospital Better coordination of chronic illness Incorporating new technologies in medicine Finding ways to integrate employed physicians into the hospital organization Gaining access to new capital for expansion Resolving the on-call problem Gaining access to working capital Settling competitive issues with physicians, such as freestanding surgery centers Which of the issues above do you believe is the single most important issue facing your hospital today? Issue # Why? 4
tabulated results FORMS We asked each board member to rate each of the following health care-related issues, giving his or her own personal opinion. Ratings were based on a scale from 1 to 10. Issue Changing the health care delivery system to be more effective and less costly Improving patient safety Average Importance to Our Hospital Average Difficulty in Accomplishing Getting adequate reimbursement from Medicare Cutting costs while delivering better care Getting adequate reimbursement from Medicaid Getting adequate reimbursement from commercial insurance carriers Improving communications and trust between independent physicians and the hospital Better coordination of chronic illness Incorporating new technologies in medicine Finding ways to integrate employed physicians into the hospital organization Gaining access to new capital for expansion Resolving the on-call problem Gaining access to working capital Settling competitive issues with physicians, such as freestanding surgery centers 5
tabulated results (continued) We also asked board members which of the issues they believe is the single most important issue facing our hospital today. Issue Changing the health care delivery system to be more effective and less costly Number of Board Members who rated this the most important issue Improving patient safety Getting adequate reimbursement from Medicare Cutting costs while delivering better care Getting adequate reimbursement from Medicaid Getting adequate reimbursement from commercial insurance carriers Improving communications and trust between independent physicians and the hospital Better coordination of chronic illness Incorporating new technologies in medicine Finding ways to integrate employed physicians into the hospital organization Gaining access to new capital for expansion Resolving the on-call problem Gaining access to working capital Settling competitive issues with physicians, such as freestanding surgery centers A selection of comments: 6
discussion guide What Are Hospitals Saying About the Most Important Issues? Here s just a sample of what our attendees have to say about the top issues for 2013 and how they re affecting their health care organizations. Making the Health Care Delivery System More Effective and Less Costly says a mouthful At present, our hospital is struggling with the recently created multi-specialty/employed physician model, redefining the role of the physician/hospital, anticipating what our relationships will look like in the very near future, identifying delivery system inefficiencies, and reducing costs; all the while meeting safety/ quality standards in a collaborative and trustful environment. In the reduced reimbursement environment, and as reimbursements are more tied to continuum of care and preventive outcomes, collaboration between employed and independent medical staffs and the role of the hospital will be absolute in our efforts to be effective, efficient, fair, and profitable. All the while, we must do what is best for our stakeholders (patients). Cutting Costs while Delivering Better Care If this does not happen, we will not be around. Getting Adequate Reimbursement from Medicare So many reimbursements are based on Medicare rates. It s tough to stay in business when reimbursements don t cover expenses. Can we think of a new paradigm, such as local health care providers establishing community co-ops that provide lowest cost directly to patients and exclude insurance carriers and/or Medicare? 7
Improving Communications and Trust between Independent Physicians and the Hospital It is essential for effective integration and alignment that those being aligned and integrated do so from a basis of shared trust. Without a shared trust environment, participants will continue to act in what is perceived to be their self-interest rather than the interests of the care delivery organization. Finding Ways to Integrate Employed Physicians into the Hospital Organization Physician practices in our community all owned by external entities. Classic clinical integration just not possible. Need innovative ways to do so. Better Coordination of Chronic Illness It s a tsunami of cost coming at us. Improving Patient Safety... improving patient safety is critical because it is at the center of accountability, which is becoming the nexus for reimbursements from both government and private insurance providers. Gaining Access to New Capital for Expansion This issue, which is a direct result of health care reform, decreased reimbursement, and changes in access to health care, has impacted our daily cash on hand. We have important projects that will allow us to grow, but we need the capital to do so. 8
Incorporating New Technologies in Medicine Young physicians are trained on the latest technology, and we need to have it to attract the best and brightest. Getting Adequate Reimbursement from Commercial Insurance Carriers Reimbursement continues to decline from commercial payers as well as Medicare/Medicaid. We must have adequate reimbursement to continue [delivering] optimum care to patients. We have done a good job in cutting expenses, but there comes a time when you cannot cut anymore without jeopardizing patient care. Settling Competitive Issues with Physicians, such as Freestanding Surgery Centers In the move from production-based systems to value-based systems, physicians are motivated, more than ever, to do ALL cases that have better reimbursements to their owned-facilities, while they still can. In the 2 3 year interim, it will be very difficult for community hospitals to survive and the relationships will become very acrimonious. Resolving the On-Call Problem Paying for call is not a sustainable model for us and is considered by the physician community essential to providing coverage. Getting Adequate Reimbursement from Medicaid getting adequate compensation is taking us squarely into the no margin, no mission area when both the federal and state governments are cutting back on rates, there are more uninsured no-pay or reduced pay, and the insurance rates are following the lead of the federal rates, severely impacting the ability to stay in the black. 9
Gaining Access to Working Capital We need to upgrade our new facility. We have a strategic plan to do so by 2015, but in order to be successful we have to get our balance sheet in good shape. This means cutting costs while continuing to deliver excellent quality of care. In order to do that, we will have to find access to new working capital, access to new capital for expansion, and continue to keep technology within our organization up to date. It is almost like a domino effect. 10
A midst the chaos of daily health care management, you know that every decision, every new venture, and every new investment will impact the lives of your patients today and for generations to come. Choosing the right direction for your hospital s future has never been more difficult. Yet for America s most successful hospitals those thriving amidst the chaos a common thread is revealed: the Estes Park Institute. Since 1974, the Estes Park Institute has provided more than 75,000 physicians, health care executives, and trustees with the focused, up-to-date information, analysis, and insight they need to help guide their health care organizations toward their goals. To find out more about the Estes Park Institute conferences, call us at 1-800-727-8225 or visit EstesPark.org.