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Rural Health Care Leadership Conference
February 7-10, 2010 | Phoenix, AZ | Sponsored by Amerinet
The 2010 Rural Health Care Leadership Conference focuses on accelerating performance excellence and improving the sustainability of rural hospitals. Follow blogs from H&HN Executive Editor Alden Solovy, Managing Editor Bill Santamour and Todd Linden, president and CEO of Grinnell Regional Medical Center, a private non-profit hospital in Grinnell, Iowa, for insights from the meeting. All comments are welcome and may be posted to the blog. Comments may be edited for clarity or length. Click here to return to the H&HN blog homepage. |
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Before I Forget
by Bill Santamour @ 12:30PM
The 23rd Annual Rural Health Care Leadership Conference draws to a close under much the same circumstances in which it started: Sunshine and 60-degree temperatures here in Phoenix; major snowstorms to the east. Like many of my fellow attendees, I’m waiting with baited breath to find out whether my flight home will be delayed (a given, let’s face it—I fly into O’Hare). In the meantime, here are some jottings from my reporter’s notebook that didn’t make it into my blogs over the last three days:
- Ever hear of a nocturnist? That’s a hospitalist who works—you guessed it—strictly nights. Kirk Mathews, CEO of Inpatient Management Inc. in St. Louis, says nocturnists make sense for some large organizations. But small hospitals will have trouble replacing them when they leave—and other physicians will be very unhappy if you try to reschedule them for hours they thought they wouldn’t have to work.
- Speaking of night duty, Mathews said the rule of thumb is that 10 percent of patient encounters happen between 10 p.m. and 4 a.m. If a physician averages 20 patient encounters a day, two of them will be at night. In most rural settings, night coverage can be accomplished just fine through on-call duty.
- In her presentation, Gail Scott cited another rule of thumb to underscore the need for service excellence: a 5 percent increase in customer retention will bring up to an 85 percent increase in profits.
- Scott also referred to the 10-10-10 equation: It takes $10,000 to get a customer, 10 seconds to lose a customer and 10 years to make the problem go away.
- Jamie Orlikoff cautioned that the pressure to slash health care costs will only intensify. The bitter irony is “these are the good old days,” he said. “There is as much money in the system today as there will ever be.”
During one session, attendees were asked what simple but useful ideas their hospitals had come up with recently to improve customer service. Three interesting ones I heard:
- A golf cart to shuttle people between the parking lot and hospital—and this time of year the driver always brings along a bucket of salt for any icy spots he sees along the way.
- An outpatient lab in a nearby building to cut the bottleneck in registration inside the hospital.
- Drive-by flu vaccinations so people don’t even have to get out of their cars.
As usual, this conference offered many opportunities to share good ideas, a chance to meet other rural health care leaders facing common problems, and, of course, a little time to thaw out. I’d like to thank my fellow bloggers Alden Solovy and Todd Linden. Todd did an excellent job as conference host, synthesizer and official cart-wheeler.
Also, thanks to my Health Forum colleagues, Laura Woodburn, who put together another terrific meeting, and to Connie Lang and Kevin Brown, who provided great support and helped make attendees feel right at home.
And one shameless plug: Hospitals & Health Networks will next be blogging from HIMSS in March and the AHA Annual Meeting in April. In the meantime, we’ll see you in the pages of the magazine and on our Web site at www.hhnmag.com.
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The Primary Care Conundrum
by Bill Santamour @ 12:00PM
Closing the payment gap between primary care physicians and specialists is by far the most important step to ease the nation’s primary care shortage. But it’s not the only step, said Mark Doescher, M.D., at this morning’s general session.
Doescher, director of the WWAMI Rural Health Research Center described what most attendees are well aware of—fewer and fewer medical students are choosing primary care because they know they’ll have to work longer hours and will earn significantly less than they would as specialists. And, he noted, while the average age of primary care docs continues to climb, the average age at which they retire is not changing despite the bad economy. If the system doesn’t react soon, the crisis will only deepen, especially in rural areas.
One suggestion: Change the training pipeline to require students and residents to spend time in rural facilities. Data show that experience in rural settings encourages some students to come back.
Second suggestion: Understand the lifestyle needs of young physicians and redesign work process to accommodate them. New doctors do not want to work nights and weekends. Hospitals need to better use hospitalists, locum tenens, nurse practitioners and physician assistants to fill in when possible.
Doescher outlined how the House and Senate reform bills address the need to boost primary care. Details are on his PowerPoint slides, available on the conference homepage.
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3 Small Hospitals Just Deal With It
by Bill Santamour @ 11:45AM
As daunting as some of the challenges facing rural communities and their health care providers are, I’m always impressed by the creative ways leaders of small hospitals find to deal with them. Three examples from this year’s conference:
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Is Everybody Happy?
by Bill Santamour @ 9:30AM
Service excellence is one of those terms guaranteed to get the cynics on your staff going. “We’ve tried it before, it didn’t work then, why should it work now?” That attitude can bring any effort to improve customer service to a screeching stop.
Gail Scott says one way to shut up the skeptics (and maybe even win them over) is to bombard them with information—post progress reports about your service initiatives on walls, write about it in your newsletters, send e-mails, talk it up in board, medical staff and general staff meetings. “If we don’t provide feedback about how we’re doing, all we do is give ammunition to the naysayers,” Scott, a health care training and development consultant, told rural conferees.
Service excellence entails any number of things, from creating a welcoming environment to anticipating patient needs to listening with empathy and concern. Scott recommends focusing the entire hospital on one specific element at a time until everybody nails it.
Once staff understands what the hospital leaders expect—and that the leaders are paying close attention—they’ll buy into the effort. “People want to feel they are making a difference,” she said. “If you let them know why this matters and that they’re doing a good job, they’ll be happy.”
And as every hospital leader knows, a happy staff makes for happier patients.
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Hospitalists: To Have or Have Not
by Bill Santamour @ 8:00AM
Starting a hospitalist program in a rural setting can bring generous rewards, but there are critical questions executives need to ask themselves first. Chief among them: How does your medical staff feel about the idea? “You don’t need consensus, but you do need a base of support,” Kirk Mathews, CEO of Inpatient Management Inc., a St. Louis-based hospitalist staffing firm, told a crowded room of rural leaders. “If you don’t have it, don’t even start.”
When considering the return on investment, look at both hard numbers and intangibles. If hospitalists can shave even one day off length of stay for a proportion of patients, the program may be well on its way to paying for itself. Hospitalists also often make more efficient use of the pharmacy and lab. Reimbursement may improve because of more accurate coding, a better case mix index and timelier medical records.
Because they are employees and work on site, hospitalists can drive quality programs, reducing readmissions, for example, and improving unexpected-mortality rates.
A common argument is that inpatients would rather see their primary care physician than a hospitalist. Not so, Mathews said. “Patients will readily trade familiarity for accessibility.”
A growing number of primary care physicians adamantly refuse to work with organizations that do not have a hospitalist program in place. “With younger doctors, especially, it’s a quality-of-life issue,” he said. “They don’t want to take call; they don’t want to come to the hospital at all if they can avoid it.”
Set your hospitalist program up for success by doing your homework first. “Know how many you’ll need to hire. Do not understaff,” Matthews stressed. “If they have too much work, they’ll leave. And if your regular physicians see a new face every three months, they’ll lose confidence.” Moreover, high turnover is prohibitively expensive because hospitals need to hire locum tenens for weekends and other off hours.
A failed program is disastrous to your medical staff relations. “Understand that it is very hard to turn back,” Mathews said. “It’s like an addiction to referring physicians.” Once they get used to coming in to the hospital less frequently and to never having to be on call, they’ll be very, very reluctant to go back to the way it was.
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Your Board and Questions of Quality
by Bill Santamour @ 3:30PM
Two former hospital leaders offered cautionary tales about what happens when the Centers for Medicare & Medicaid Services suddenly shows up and slaps you with an “immediate jeopardy” letter. CMS investigators spend days stalking staff and poring over documents. If they decide the complaint in the IJ letter is credible, the hospital has just 23 days to resolve the issue or be decertified for Medicare. If that happens, all other insurers immediately halt payments. The local media goes into a feeding frenzy. Patients leave. Physicians abandon ship. Getting recertified is next to impossible. And trustees take a bruising.
“This is happening across the country with increasing frequency,” Mac McCrary warned at a strategy session called “Is Training Your Board Worth the Expense?” “I do not flinch when I say it is coming to a hospital near you.”
McCrary, who operates a consulting firm out of Morgantown, N.C., and Alton T. Byers, a consultant from Webster, N.C., were executives at different North Carolina hospitals 90 miles apart in the 1990s when CMS staff auditors showed up unannounced in their lobbies. How prepared the two hospitals were for such an unexpected event and how each reacted—particularly how their boards of trustees reacted—is a study in contrasts.
The CMS investigation at Byers’ hospital was based on the contention that patients did not receive their medications within 30 minutes before or after physicians ordered them to be administered. Before CMS showed up, the board paid a lot of attention to financial reports and capital expenditures and almost no time on quality issues. “They accepted administration reports without question and received no reports on complaints about care and what was done to resolve those complaints,” Byers said, who was a senior executive at the time.
In an egregious failure to communicate, hospital leaders did not alert board members that CMS had launched an investigation before the agency published its pro forma announcement in the local newspaper. Stunned board members found themselves in the media crosshairs with little understanding of the situation and no training on how to behave under the circumstances.
The opposite was true at McCrary’s organization, Blue Ridge Healthcare. “One of the strategic reasons BRHC was formed in 1999 was to improve the performance of the board,” he said. “From the beginning and with the support of the CEO, the organization has regularly invested in board training and development.”
When a patient complaint triggered the CMS audit at Blue Ridge, the trustees were notified within hours and updated in daily e-mail messages from the CEO. “The board has a written policy in place that says they expect the CEO to deliver bad news more quickly than good news,” McCrary said.
Just as importantly, the board is trained to pay close attention to quality and patient safety issues, and to demand quality reports from administrators as well as unfiltered information through, among other things, confidential hotlines monitored by independent, outside parties. BRHC invests time and money in the orientation of new trustees and continuous education around those issues. Board members are even encouraged to round on patient floors with administrative and medical staff leaders. “That doesn’t mean they should get involved in operations—there’s a clear understanding of ‘no meddling,’ ” McCrary said. “But they need to get a sense of what’s going on.”
The final CMS audit for BRHC came back satisfactory; in fact, auditors cited numerous best practices and announced their intention to share them with other North Carolina hospitals.
At the other hospital, the CEO left shortly after the trouble broke and Byers was asked to step into the leadership role. The hospital lost its Medicare certification, but after many months of backbreaking effort and frustrating interaction with CMS, became one of only about a half-dozen hospitals ever to earn recertification. In the meantime, it had lost millions of dollars and drained its reserves.
But, Byers said, the experience drove home to the top leaders and trustees the need to vigorously discuss quality and patient safety with each other, physicians and staff, and to communicate continuously before, during and after such a crisis.
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So Much To Do, So Little Time
by Todd Linden @ 3:00PM
We got into the meat of the conference today. It was standing room only this morning bright and early for the Stress Management workshop that Bruce Cryer and I presented. We even had some Alaska folks attend...it was like 5:00 AM to their internal clocks!
Then on to Gail Scott with more tips about beefing up our customer (and employee) satisfaction levels than you can shake a stick at. She reminded us that it is really all about creating a “leaning organization” and that we have to tap into the “unlimited potential within our teams to make a difference for our patients, community and indeed the world”. Stories brought her primary points to life and her energy level is infectious (the good kind of infectious). Her presentation was filled with proven strategies for hospitals at all stages of customer service levels. The materials packet was also an awesome resource for taking stock of current levels of success and ideas for moving forward. She left us with a lovely story about a 50-year laundry manager from Texas who taught her employees to read and write and get a GED. When questioned about what that had to do with the laundry, she replied, “It’s really not about the laundry, it’s about life.” One final point, Gail reminded us that service excellence is a journey, not a destination!
Next John Supplitt, who heads the American Hospital Association’s small or rural hospital section, ventured out onto the “cat walk” that had been built by the Hilton staff so Gail could be very close to the audience. John’s goal in a short 45 minutes was to give us all a briefing about “The Rural Hospital Policy Roadmap.” He progressed through the political environment, the reform debate, advocacy agenda and beyond. It was fun to let the audience re-live the process AHA used to build its key principles that were used to support the drive for reform. So much politics and policy issues and so little time! We were just scratching the surface during one of the most interesting political debates in our history. However, John did remind us that we must stay engaged. As Jamie Orlikoff mentioned yesterday, whether we get a full fledged reform bill through Congress or not, is hardly the point since reform is happening now through policy and regulatory channels.
Then it was on to another robust series of strategy sessions...truly something for everyone.
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Todd's Spontaneous Cartwheel
by Alden Solovy @ 12:30PM
What hasn’t Todd Linden done here? He’s attended sessions. He’s led sessions. He’s the event moderator, opening the keynotes with his observations and insights from the conference. He’s contributing to this blog. He did a cartwheel on a catwalk.
Okay, I’ll explain. Today’s opening keynoter, Gail Scott, asked us to rearrange the room a bit for her talk. Hotel staff built a catwalk—a stage that thrust out into the ballroom from the front podium about a third of the way into the ballroom. The catwalk allowed her to create a dynamic, interactive session. She could move into the crowd and still be seen from every corner of the room. A unique idea. It worked.
At one point she called Todd up on stage to take notes for her on a flip chart. He mounted the stage and did a cartwheel on the catwalk. It was not Olympic gymnastics, but I gotta say this: the man can move!
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Watch the Details
by Alden Solovy @ 12:00PM
Try this: Take off your watch and put it in your pocket. That’s what attendees were asked to do by Gail Scott, a consultant and service excellence guru during her opening keynote today.
So, take off your watch and put it away. Quickly, without looking at it. Now, draw a picture of it with as many details as possible. I used my mobile phone. (My watch is on my dresser back home in Chicago.)
What happened? Me and everyone else at my table—and most folk in the room for that matter, judging by a show of hands for that matter—missed many details.
Why, she asked the crowd? Someone called out: “The more times you walk by something, the less you see.” Gail responded: “Good answer. The point is that service behaviors are about the details. Her advice: focus on getting really, really good at one thing at a time, like creating a welcoming environment or responsiveness. And give your employees the tools to be successful.
And you can put your watch back on.
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Finding Physicians: The Basics
by Bill Santamour @ 11:00AM
Twenty percent of Americans live in rural communities, but only 9 percent of physicians practice in rural communities. For small-town hospitals, finding doctors “is the most important thing you do and the hardest thing you do,” William P. Sexton, said at a strategy session on physician recruitment.
Sexton, CEO of Prairie du Chien Memorial Hospital in Wisconsin, and David J. Campbell, manager of Prairie du Chien’s Gundersen Lutheran Clinic, chided rural hospitals that don’t have a well-orchestrated physician recruitment strategy in place. And they delivered a primer on how to build one, from where to look for candidates (everywhere and anywhere) to how to treat them when they come in for the interview (every little detail matters).
Staffing firms, state and national hospital associations and rural health agencies are excellent sources for locating potential medical staff, Campbell said, though nothing beats a lead from one of your own physicians—those candidates are more likely to fit your culture and be readily accepted by other clinicians. Rural hospitals should even consider reaching out to physicians who might be attracted to the special attractions of your area, Sexton said. Are you near the ocean? Consider advertising in a surfing magazine. Near mountain trails? Try a hiking publication.
Once you’ve found a candidate, don’t bother bringing him or her in if they’re not willing to spend at least two days, Campbell said. They need adequate time to develop a healthy understanding of your organization and to get a feel for the community. “If they only have an afternoon, it’s not worth the visit,” Sexton declared.
Another red flag: If the candidate fails to bring his or her spouse, they’re probably not serious about the job.
The interview process should be methodically planned and consistent each time. Decide who in the organization will meet with the candidate, make sure they deliver the message you want and make sure their vibe is upbeat. “If one of your people is a frowner, the candidate will pick up on that negativity in an instant,” Campbell said. Decide ahead of time the terms of your offer and when and how you will deliver it, assuming you like the candidate. Set a deadline for when the offer must be accepted or rejected.
Ultimately, it’s the physician’s family who will decide whether or not to make the move. Be prepared to answer questions about such things as housing, schools, kids activities, social and religious organizations and job opportunities for the spouse. And, to be really nit-picky, make sure the hotel you put them up in treats them like VIPs. “Local businesses want these physicians to come to their communities almost as much as you do,” Campbell said. “They’re happy to cooperate.”
You probably will only get one chance to impress a candidate. Make every moment of the visit count.
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Guess Who's Watching What You Pay
by Bill Santamour @ 8:00AM
Hospitals are under increased scrutiny by the federal government over how they compensate top executives and other high earners—including physicians—attorney Roger D. Strode warned at a session on regulatory compliance. For one thing, he pointed out, the Internal Revenue Service revamped Form 990 to force organizations to more fully disclose their compensation policies. And in separate Department of Justice cases, a hospital system, an interim hospital CEO and the chairman of a board of trustees paid millions of dollars in settlements or fines after the government charged that certain employees had been improperly compensated. In at least one case, the organization had done what it considered due diligence with consultants, salary survey organizations and attorneys but decided it would be less expensive to settle with the government than to fight.
Strode, who’s a partner with the Chicago law firm McDermott, Will and Emery LLP, called the new 990 “really one of those drop-your-drawers documents. The IRS wants to have complete transparency in your compensation.”
He bluntly warned attendees, “Do you have conflict-of-interest policies in place and how do you enforce them? If you don’t have them in place, you have to disclose that fact—and that in itself will be a trigger for the IRS’ attention.”
When it comes to physician pay, “fair market value” is a now key, Strode said. If compensation is above the 75th percentile of applicable surveys, you better review it; if it’s above the 90 percentile, you risk compliance issues. In fact, the issue of doctor pay has become such a hot potato, Strode noted, that some hospital boards have created physician compensation committees that are separate from their regular compensation committees.
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Timing is Everything
by Alden Solovy @ 6:09PM
In his opening keynote, Jamie Orlikoff said in no uncertain terms, but not precisely this way: improve your organizations or become irrelevant. Lower costs. Improve quality. And you can’t get their alone. New partnerships, new relationships and new affiliations will rule the day.
Consolidation is on the horizon, added Brain Haapala of Stroudwater Associates in his afternoon session on affiliation. The problem is that many hospitals wait too long to make the decision to evaluate an affiliation. That reduces the number of potential partners.
“My premise is that you are in control of what you get out of an affiliation,” Haapala said. But a hospital has to do it from a position of strength, when the organization has the most leverage in negotiations and the greatest number of options for long term partners.
The trick is to start with ‘what’—asking what the organization wants from an affiliation. Too many hospitals start with the “who’—asking who’s our best affiliation partner. That, Haapala said, eliminates many good—and not immediately obvious—partners.
The key: start early, know what you want and evaluate all the options.
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Kitty Litter, Toilet Paper and EHRs?
by Todd Linden @ 3:45PM
Jeffery Daigrepont, senior VP at the Corker Group, gave a great primer for how to optimize the stimulus funding aimed at bringing the all too allusive EHR to prime time for providers across the country. He joked that we may well be seeing bumper stickers popping up proclaiming, “Honk if you paid for my EHR”. The point being that the governmental focus on providing both funding and “opportunity for integration with physicians” is here now and time is running out. After a great overview of all the vendors out there, he made mention of the fact that even Walmart is offering an EHR option for physician offices. Physicians will be shopping for their kitty litter, toilet paper and their EHR all in the same place, he quipped. Will it be that simple? Probably not, but he did emphasis there are many folks out there looking to make a buck with all the money on the table.
Jeff shifted to an excellent array of “tips” when it comes to working with IT vendors, including the Top 10 contracting mistakes. He got a big laugh when he suggested that “...you don’t want to be the Amish feller standing in the Circuit City.” He clarified that he loves the Amish, however they are not that comfortable when it comes to technology. Clearly, it can be very overwhelming and a well thought out plan is the key. He also said it was OK to slow down if the plan runs into the inevitable speed bumps. Again, another compelling presentation emphasizing that we must be thoughtful about the quest for implementing a information technology strategy in a timely manner.
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Drinking from a Fire Hose
by Todd Linden @ 3:30PM
The conference got into full swing this morning with Scott Street, CEO of Duncan (Okla.) Regional Hospital, being honored with the Shirley Ann Munroe Leadership Award. Scott and his team are doing some great things in rural Oklahoma.
Then it was on to Jamie Orlikoff and just as promised it was like drinking from a fire hose. Some of the quotes that really hit home for me included: “You’ve got to be able to think beyond your previous experience,” noting that the new normal is going to be very different than anything we have experienced in the past. He made a very compelling case for getting busy NOW with a physician integration strategy. Then there’s this quote, which got a big laugh: “If you’re going to be naked, you better be buff.” Funny yes, but Jamie was dead serious about making sure every hospital knows exactly where they are on the cost and quality continuum. You better be seeing the data and feeling comfortable with your progress toward “best 25%” of all hospitals, because the world is moving toward transparency and payment based on value. Next, he said, “No one can afford health care.” Again, he had the data to prove that very soon the only answer for corporations, the government and individuals getting access to health care is going to be for those in the delivery end of things to get all the unnecessary costs out of the system…or we are doomed. Finally, he asked all of us—and the board members in particular—to answer these questions: “Do you have a bozo in the board room” and “What you permit? What do you promote?” In this context he was suggesting that boards must not look the other way when it comes to poor clinicians on the medical staff. Get busy with setting standards, using evidence based care and setting policies that will drive both best practice in quality and reduce cost. Jamie proved once again he is the man, when it comes to making us all think and left us a clear call to action. The room was buzzing at the break!
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Can Rural Hospitals Achieve Meaningful Use?
by Alden Solovy @ 2:39PM
Cost. Expertise. Timing. Rural hospital execs are worried that the meaningful use requirements—as currently construed under the proposed regulation—are unattainable for most organizations.
That was one of the themes at a breakout lunch in the sunny South Garden. What will it cost? Where will hospitals find the expertise? Will they make the deadlines? For many hospitals, the group of about 20 agreed, the challenges are too great, especially for hospitals that have just begun the journey toward an electronic health record.
As if to put an exclamation point on the challenge, one hospital CEO asked, in effect, “Where do we get the expertise to get started?”
Another concern is the one-size-fits-all structure of the proposed definition. The lunch time discussion group agreed that the key elements that influence quality at small and rural hospitals are different than their larger urban and suburban counterparts.
One rural hospital exec put it this way: “There’s still so much to do. There isn’t enough expertise at the vendors or at the hospitals to get it all done.”
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Reform is Here
by Bill Santamour @ 2:00PM
“Health reform is not going to happen, it’s happening,” Jamie Orlikoff told 400-plus rural leaders at this morning’s opening keynote address. “Even without major reform legislation, the way you deliver care is changing.” That change is being driven as much by the marketplace—and big payers and by consumers who are increasingly responsible for how they spend their health care dollars—as by elected officials.
With health care expenditures threatening to bankrupt the nation, pressure is mounting from all sides to pull costs out of the system, Orlikoff said. Hospitals need to become more and more efficient and provide higher and higher quality as the fee-for-service system gives way to a payment system that rewards value not volume. Hospital executives and board members must keep a relentless eye on quality data and be fully transparent with the data. Government leaders, insurers and consumers all want access to the data.
“The kimono is going to be ripped off,” Orlikoff said. “You better take a look in the mirror before you present yourself to the public. If you’re going to be naked, you better be buff.”
Although much of the focus during the federal reform debate has been on what Republicans and Democrats disagree about, more telling, Orlikoff suggested, is where there is relative consensus, including the need to bundle payments for all providers involved in a patient’s care, the benefits of creating accountable care organizations and improving how hospitals and physicians work together, the need to reduce readmissions, and the need to implement evidence-based care, which means hospitals must require all physicians and nurses to follow protocols and standardize treatments shown to be the most effective—even when clinicians balk at doing so.
Although final reform legislation may sidestep many of those issues, the folks who implement policy in Washington—read: regulators—and those who pay for care will see them as imperatives. Hospitals that don’t change to meet these new demands do so at their own peril, Orlikoff said. Given the history of health reform over the last many decades, he warned, “It’s easy to convince ourselves it’s never going to happen. For hospital leaders, that would be a mistake.”
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Food for Thought
by Todd Linden @ 1:30PM
Something new for the conference this year was offering seven “Hot Topic” networking roundtable discussions over lunch. I helped lead on of these discussions and as near as I could tell, the roundtables were well attended. We had 25 in our group and it looked like all the groups had plenty of folks sharing their ideas and asking questions of one another. No doubt this addition will become part of future conferences as I heard many attendees comment on the great opportunity to meet with and discuss common issues and possible solutions.
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You and Your HR Exec
by Bill Santamour @ 11:00AM
Most top hospital leaders under-value their human resources executives, admonishes workforce expert Susan D. Douglass. “In 50 percent of hospitals, the HR executive still acts as the personnel manager, rather than a strategic partner with the CEO,” she said during a session on recruiting. “The career path for the HR executive has never been as clear as for, say, the CFO. Hospital CEOs need to work on that.”
Douglass said the head of the hospital HR department must focus less on “low-value activities” such as policy enforcement and records management, and more on such “high-value activities” as leadership development, culture, staff morale and recruiting and hiring people who share the organization’s values. That last item will help ensure people who come on board want to stay—extremely critical considering that losing and replacing staff is generally two to three times more costly than hiring somebody initially.
As workforce issues become ever more critical, hospital leaders must make sure their HR executives have the competencies necessary to meet some very complex challenges. And nothing will be more challenging than the trend toward hospitals employing physicians. “You need somebody who can go toe to toe with the physician, who can talk about compensation, performance expectations and so on,” Douglass said. “If physicians feel the HR executive doesn’t know what they’re talking about, they’ll just dismiss them.”
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Old Worries, New Worries
by Bill Santamour @ 8:00AM
With apologies to Mom back in Pennsylvania and all you other Easterners still trying to dig out from under Friday’s record-breaking blizzard, I have to report that the 23rd Annual Rural Health Care Leadership Conference opened Sunday under sunny skies and temperatures in the 60s. As if we didn’t already know why this event is held in Phoenix in February, now there can be no question.
Early arrivals were obviously tickled to escape to a balmy clime and to check out what the Pointe Hilton Squaw Peak Resort has to offer, especially the attractive grounds with amazing views of the jagged hills that spike up out of nowhere. This is my first time in the desert and it was kind of a thrill to get an up-close look at a regal, 10-foot tall saguaro cactus (not too close, of course).
As people began to filter into the conference center to register and pick up their meeting schedules and assorted giveaways, I conducted a very informal poll about what brought them out here. Though many of the concerns are familiar—payment and finances, the spike in charity care thanks to the Great Recession, recruiting physicians—the federal government’s focus on health care, both with regard to reform and with increased scrutiny of not-for-profit organizations by the Internal Revenue Service, the Office of Inspector General and Congress, is moving up the worry list. “Whenever the government is involved, you have to pay attention and wonder how it will all wash out,” one Plains state administrator told me. “The last year or so shows that you just never know how things will turn out. Could be good, could be awful.”
How do you think the reform debate will turn out? What do you think are the biggest challenges for small and rural hospitals today? Let us know.
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A Provocative Kickoff
by Todd Linden @ 10:55PM
Hi, my name is Todd Linden, CEO of Grinnell Regional Medical Center in Grinnell, Iowa. I am also a member of the Health Forum board and moderator for the 23rd Annual Rural Health Care Leadership Conference in Phoenix. I arrived this afternoon to sunny skies and a comfortable temperature in the high 60s...a welcome relief from the truly brutal winter we are having in Iowa this year! With a record-breaking attendance of more than 400, the conference got off to a great start with two pre-conference workshops. Both were very well attended and were competing with the kick off of the Super Bowl!
One of my board members and I attended the “Interactive Governance Clinic: Current Issues in Hospital Governance” session led by Jamie Orlikoff and Mac McCrary. I counted over 75 with a mix of both trustees and hospital executives. Jamie got right to his provocative self with a comment regarding his concern that support for “cost plus reimbursement for Critical Access Hospitals may be waning in Washington, D.C.” Now that will get any rural hospital audience sitting up and taking note! The give and take was excellent between the audience and these two very seasoned governance consultants. The topics ranged from conflict of interest to medical staff engagement and the new IRS 990 rules to the arcane Robert’s Rules of Order.
A couple challenges were thrown out to the trustees in the room: Ask your medical staff leadership if there were physicians practicing at the hospital whom they would not feel comfortable taking care of their own family; and, what is your proactive physician integration strategy as the market moves toward accountable care organizations and bundled payments?
Those topics are sure to get some lively discussions going back home around the old board table.
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All Rural, All the Time
by Bill Santamour @ 2:00PM
I’ve said it before: Rural health care leaders are redoubtable. OK, it’s the first time I’ve said it exactly that way, but I heard that word recently and I really wanted to use it. Considering what the last 12 months have wrought on rural hospitals and how their leaders have struggled day after day to keep their facilities fiscally viable and able to meet their communities’ needs, it’s certainly an apt description. These folks don’t wring their hands and whine, they acknowledge and act.
Which explains why a record number of CEOs, administrators, trustees and others will converge on Phoenix Sunday for the 23rd Annual Rural Health Care Leadership Conference. They’ll be there to discuss the many issues that keep them up at night—a growing Medicaid and underinsured population, facilities in need of upgrade, the pressure to implement EHRs and other technologies, physician and nurse staffing, the implications of federal health reform debate, among many, many others. Most importantly, they’ll share concrete, practical ideas for confronting and solving those problems.
I’ll be there, along with my Hospitals & Health Networks colleague Alden Solovy, to listen in on those conversations and to report on what we learn in blog postings several times a day. We’re extremely excited that Todd Linden, president and CEO of Grinnell Regional Medical Center in Iowa, will also be blogging from the conference everyday. Todd’s an outspoken advocate for rural health care and a board member of Health Forum, which will present the conference along with the American Hospital Association.
Whether or not you are able to join us in Phoenix, we hope you’ll find our blogs interesting and useful. Look for them in your inbox this coming Monday, Tuesday and Wednesday. And feel free to share your thoughts about any of our postings. We’d love to hear what you think.
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