BY SHIRLEY SHORES Director, Healthcare Epidemiology UTMB-Galveston Infection prevention programs must assess the risks of individual facilities and tailor the program to those needs. However, there are high-priority issues that have been identified by most hospitals and by various state and federal agencies. All infection control programs focus on hand hygiene as an important and broad- based approach to preventing infection. The nature of health care involves hand contact with patients, as well as the patient’s environment, equipment, supplies, medication and food. There are many other important measures to prevent infection, but most can be undermined by unclean hands. During patient care, hands should be clean before and after contact with a patient or their environment and equipment, before performing a sterile procedure, between a dirty and clean task, and after contact with blood or other body fluids. Most hospitals require hand hygiene upon entering the room because the patient or colleague may unexpectedly request assistance. Health care workers frequently touch surfaces in the room even when they do not touch the patient, and their hands will carry the contaminants into the next patient’s room if not cleaned upon exiting. Staff will not perceive clean-appearing hands to be contaminated, but CDC sites studies showing that hands can become colonized with significant levels of bacteria even during clean activities (e.g., checking blood pressure). Skin is colonized with different levels and INSIDE ▼ The Leading Source for Healthcare Business News February 2012 • Volume 8, Issue 11 • $3.50 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methodist Sugar Land Hospital expands surgical robotics program see page 15 INDEX ▼ Financial Perspectives.......3 Healthcare Properties Update..............................4 Legal Affairs......................5 Integrative Medicine........6 THA.................................8 Technology...................... 15 . . . . . . . . . . . . PRSRT STD US POSTAGE PAID HOUSTON TX PERMIT NO 13187 Legal Affairs: OIG tells CMS, “If you want results, clarify your expectations”, see page 5 Special Feature Infection Control: Focus for 2012 VA offers aternative for traditional heart valve replacement see page 16 On the cusp of commemorating its 40th anniversary, HCA affiliated Clear Lake Regional Medical Center (CLRMC) recently broke ground on a $92 million construction project, a significant expansion that will help meet the growing and changing healthcare needs of the Bay area Houston community. The new tower is 154,470 square feet and will feature large pre-operating rooms for patients and their families preparing for surgery; state-of-the- art operating suites; and recovery rooms with patient comfort a continuing top priority. The tower also will house a new 30-bed adult Intensive Care Breaking Ground: Clear Lake Regional Medical Center breaks ground on $92 million expansion and renovation project Please see BREAKING GROUND page 10 Please see INFECTION page 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rendering of the new Clear Lake Regional Medical Center renovation and expansion
Transcript
By Shirley ShoreSDirector, healthcare epidemiologyUTMB-Galveston
Infection prevention programs must assess the risks of individual facilities
and tailor the program to those needs. However, there are high-priority issues that have been identified by most hospitals and by various state and federal agencies.
All infection control programs focus on hand hygiene as an important and broad-based approach to preventing infection. The nature of health care involves hand contact with patients, as well as the patient’s environment, equipment, supplies, medication and food. There are many other important measures to prevent infection, but most can be undermined by unclean hands.
During patient care, hands should be clean before and after contact with a patient or their environment and equipment, before performing a sterile procedure, between a dirty and clean task, and after contact with blood or other body fluids. Most hospitals require hand hygiene upon entering the room because the patient or colleague may unexpectedly request assistance.
Health care workers frequently touch surfaces in the room even when they do not touch the patient, and their hands will carry the contaminants into the next patient’s room if not cleaned upon exiting. Staff will not perceive clean-appearing hands to be contaminated, but CDC sites
studies showing that hands can become colonized with significant levels of bacteria even during clean activities (e.g., checking blood pressure).
Skin is colonized with different levels and
INSIDE▼
The Leading Source for Healthcare Business NewsFebruary 2012 • Volume 8, Issue 11 • $3.50
legal Affairs: OIG tells CMS, “If you want results, clarify your expectations”, see page 5
Special FeatureInfection Control: Focus for 2012
VA offers aternative for traditional heart valve
replacementsee page 16
On the cusp of commemorating its 40th anniversary, HCA affiliated Clear Lake Regional Medical Center (CLRMC) recently broke ground on a $92 million construction project, a significant expansion that will help meet the growing and changing healthcare needs of the Bay area Houston community.
The new tower is 154,470 square feet and will feature large pre-operating rooms for patients and their families preparing for surgery; state-of-the- art operating suites;
and recovery rooms with patient comfort a continuing top priority. The tower also will house a new 30-bed adult Intensive Care
Breaking Ground: Clear Lake Regional Medical Center breaks ground on $92 million expansion and renovation project
With current economic instability and looming decreases in payer reimbursement, your practice needs to retain the
maximum amount of each dollar earned. But because the struggling economy is also affecting your patients, collecting payments has likely become an expensive and frustrating burden.
Patient bad debt is becoming a serious threat to profitability for healthcare providers nationwide, representing an estimated $65 billion in uncollected revenues in 2010i. While self-pay patients do account for some of this debt, insured patients who neglect to pay post-insurance balances represents the fastest growing segment of individuals with outstanding medical bills. In a 2009 McKinsey survey of retail healthcare consumers, more than 74% of insured consumers are both willing and able to pay their out-of-pocket medical expenses for liabilities of less than $1,000
a year. Yet collection rates lag well behind these levels, even for lesser charges.
On average, a staggering 50% of every dollar billed to patients goes uncollected, even after sending as many as three billing statements; a costly process to any practice that yields little in return.
What steps can your practice take to increase patient collections in light of these changing dynamics? Managing accounts receivable begins with:
Developing Written Financial Policies
The policies should strive to optimize revenue recovery and clearly outline what the practice considers acceptable in terms of patient payment timing and extended payment plans for large balances. Educate patients on your payment policies while they are making their appointments. Your payment policy should explicitly state that payments are due at the time of service. If your practice fails to establish written policies, you are jeopardizing the ability to improve cash flow and maximize your revenue.
Verifying Patients’ Insurance Coverage
Just because a patient presents an insurance card doesn’t necessarily mean coverage is effective. With people losing jobs or transitioning between jobs and forgoing COBRA coverage, and with many businesses dropping employee benefits, taking the time to verify insurance coverage can reduce claim denials and the possibility that the patient balance won’t get paid. Use an online system that verifies patient eligibility electronically in real-time.
Setting Clear Expectations
Until recently, many practices were unable to calculate a patient’s out-of-pocket financial responsibility until after the insurance company paid the claims. As patients continue to take responsibility for a larger portion of their medical bills, it becomes increasingly important that they understand their expected out-of-pocket costs. With new technologies emerging, practices now have the capability to generate an accurate estimate of the patient’s portion of the bill in just minutes. By sharing this information with patients in advance of procedures or at the time of service,
providers can minimize misunderstandings and increase the likelihood that patients will pay.
Collecting at Time of Service
Providers have a much greater chance of receiving payment from patients before they leave the office. Unfortunately, many front-office staff members are uncomfortable requesting co-pays and outstanding balances from patients, making collections both awkward and inconsistent. Employees should be committed to asking for the entire balance on the account at the time of the visit. It’s also a good idea to review the patient’s account and collect payment on any prior balances before the patient incurs additional charges.
Making It Easy and Convenient to Pay
Give your patients the ability to pay by cash, check, and credit/debit card in the office or online. Teach staff to be compassionate without letting patients walk all over them. Ask for the payment politely after handing the patient a statement with the estimated amount owed. Don’t ask if the patient
The basic tenets of a good collection strategyFiNANCiAl PerSPeCTiVeS
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Please see FINANCIAL PERSPECTIVES page 11
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By BeTh yoUNG, CCiM, leeD AP and heNry hAGeNDorF, CCiM, leeD AP, Grubb & ellis Company-healthcare Properties Group
Last month, Part I of this two-part series introduced the reader to healthy buildings – buildings that qualify for Energy Star, LEED (Leadership in Energy and Environmental Design)
or similar “green” or health-conscious designations. Reasons these buildings are growing in popularity, besides the obvious health benefits, include: • Occupants rate air quality and temperature of highest importance in terms
of tenant comfort• Green buildings boost employee’s productivity by as much as 15 percent• Employees would be more inclined to work for a “Green” company• More than two thirds of Generation Y workers wanted their employer to be environmentally friendly• Almost a third of a survey’s respondents said they would be willing to sacrifice a portion of their salary to work for an environmentally friendly firm with Generation Y workers saying they would sacrifice on average, 6.2 percent of their wages• The potential impact for buildings on overall productivity is +12.5 percent (improved performance) and -17.0 percent (hampered performance) for an overall 30 percent change in work performance in the best and worst buildings
For landlords and building owners, if those are not enough reasons to transform your building into a healthier workplace, consider this: oil and utility costs continue to fluctuate and increase. The use of fossil-fuel generated power used by medicine to
heal is having the unintended consequence of causing additional illness and disease that then must be cured. Hospitals use approximately twice the energy as office buildings of the same size. Studies show that if a nonprofit healthcare organization saves $1 on energy, it is essentially adding $20 to the bottom line if it is a hospital and $10 to the bottom line if it is a medical office building.
If building owners, particularly healthcare-property owners, want to stay competitive and profitable, they must add intelligent building initiatives that save energy while not compromising the delivery of safe healthcare services. Issues such as 24/7 operations, energy and water use intensity, chemical use, infection control requirements, formidable regulatory requirements, and the heightened need
for patient privacy are examples of design challenges unique to healthcare projects. Healthcare buildings have a head start in this area because they are designed to be long-lasting, durable buildings - a core principle of sustainable design. Also, because many healthcare facilities are typically owner-occupied, it may make the implementation of sustainable design programs easier than in many other commercial buildings.
A good place to start would be to hire a “green” consultant to work with healthcare-practice managers or administrators to establish a plan to reduce energy costs while increasing the environmental quality and infection control in the building. Begin with an energy-use assessment that explains where and how much energy is being used in the building. Local utility companies can provide a free or inexpensive energy audit to identify where improvements can be made. Numerous renovations are simple and inexpensive; and others have a quick return on the investment (ROI).
heAlThCAreProPerTieS
UPDATe
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Healthy BuildingsPart II
Please see HEALTHCARE PROPERTIES page 12
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By MAry M. BeArDeN and AlliSoN ShelToN,BroWN & ForTUNATo, P.C.
On January 5, 2012, the Office of Inspector General (OIG) released a report entitled: “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm.” This is the third report in a series of studies concerning adverse and temporary harm events in
hospitals. By reading the report, hospitals can get an idea of the changes the Centers for Medicare and Medicaid Services (CMS) intends to make for the implementation of Quality Assessment and Performance Improvement (QAPI) programs.
The OIG’s January report follows up on a study released in November of 2010 entitled: “Adverse Events in Hospitals: National Incidence among Medicare
Beneficiaries.” In the November report, the OIG revealed findings from a medical records review of Medicare beneficiaries who were discharged from participating
hospitals in October 2008. Out of the 999,645 Medicare beneficiaries discharged, the OIG, through the assistance of physicians, reviewed the medical records of 780 inpatients for the indication of an
adverse or temporary harm event. During the course of the review, the OIG identified 128 adverse events that included events listed on the National Quality Forum’s
list of serious events, hospital acquired conditions, and events that resulted in permanent harm, a prolonged hospital stay, life-sustaining intervention, or death. Also, through the medical records review,
the OIG identified 174 temporary harm events that required medical intervention but did not cause lasting harm.
Overall, the November 2010 report generalized that 13.5 percent of inpatients enrolled in Medicare experienced adverse events during their hospitalization and an additional 13.5 percent experienced a temporary harm event. Through the follow-up study detailed in the January 2012 report, the OIG assessed whether hospitals tracked these adverse and temporary harm events as required under the Medicare conditions of participation.
To participate in Medicare, hospitals must have a QAPI program through which they “track medical errors and adverse patient events, analyze their causes, and implement preventable actions and mechanisms.” CMS neither defines “adverse patient events” nor identifies the means hospitals should use to track such events. Likewise, none of three accrediting organizations with deeming authority stipulate the means for tracking events. Each accrediting organization, however, provides a list of adverse events. The accrediting organizations each have a
By ViCTor S. SierPiNA, MD, ABFP, ABihM, Distinguished Teaching Professor, Family and integrative Medicine,
UTMB health
Over the past months, we have been sharing with you book reviews of from the Weil Integrative Medicine Library in a variety of areas. These have included integrative practice in oncology, women’s health, pediatrics, gastroenterology, rheumatology, psychiatry, and cardiology. Upcoming volumes will include neurology, men’s health, and more. These are enormously helpful books in assembling the evidence and practice of integrative medicine. Whatever your specialty, you’ll find something for you. For a list of titles and ordering information, go to http://www.oup.com/us/catalog/general/series/WeilIntegrativeMedicineLibrary/?view=usa.
Or just Google Weil Integrative Medicine library, Oxford.
As much as we all like to read to further our clinical education and practice skills, let’s face it, changing our daily practice often requires the support and encouragement of other professionals. Though we only grow when we extend beyond our comfort zone, it is comforting to know others have gone before us that we aren’t out there by ourselves. New practices and new knowledge in medicine are often hard to adapt as we all are prone to be stuck in the ways we have always done things since residency or fellowship. Also, we all owe it to our patients to be sure newly proposed integrative methods are rational, safe, and effective.
One of the best ways to move from theory and knowledge to application is to attend CME conferences where we meet and greet fellow physicians, hear what they are doing in the integrative medicine space, and learn from reputable speakers about the evidence and the practice of integrative methods. These often include those we haven’t used in our own practices. Recent changes in CME rules have encouraged CME courses to follow-up and see what impact their programs have actually made on attendees. Receiving information and
applying it are two different orders of learning. Such courses are increasingly targeted to changing practice, not just increasing knowledge.
So, as I sat in a plane returning from San Diego to Houston, after both presenting and attending the annual Scripps Natural Supplements conference, it occurred to me that sharing some of the learning opportunities I had just experienced in San Diego with our Houston area physicians could be helpful to y’all.
I started by compiling a list of my favorite annual and upcoming conferences where a physician can go to a nice venue, learn something new and practical for Monday morning, and feel comfortable adding some new integrative techniques to his/her practice.
Here is a partial listing of what is available with some comments:
Scripps Integrative Medicine Natural Supplements Conference This conference, now just completing its 9th year, is one of my favorites. I have had the pleasure of attending and speaking at it for many years. It attracts well over 400 medical professionals to the San Diego and La Jolla area, most recently at the elegant
San Diego Bayfront Hilton. Speakers cover essential integrative medicine topics using an evidence- based approach. These include integrative approaches to GI health, cardiovascular disease, cancer, headache, arthritis, depression, new evidence on botanicals and dietary supplements, and many more. See the website link for details of this year’s program and plan to go next year. It is usually the third week of January in San Diego, a great time to escape the oppressive winter here in Galveston and Houston.
University of Arizona Center of Integrative Medicine Nutrition ConferenceI have attended several of these conferences and find them fun, educational, and delicious! Attendees enjoy healthful salmon, chocolate, green teas, and excellent information about cutting edge, evidence-based nutritional guidelines. You will taste delicious and healthful meals based on the latest dietary recommendations and anti-inflammatory guidelines. Meals are organic, sustainable and increasingly sourced locally. While getting credit for your professional development, you will get expert, applicable and timely information not covered at other conferences. Learn from and alongside like-minded professionals who realize the value
iNTeGrATiVe MeDiCiNe
. . . . . . . . . . . . . . . CME Opportunities in Integrative Medicine
Directions: From Hwy 288 South, exit Shadow Creek Parkway / FM 2234. Turn right on Shadow Creek Parkway.
Special to Medical Journal – houston By DAN STUlTz, M.D., President/Ceo, Texas hospital Association
Almost one thousand people gathered in Austin Feb. 1 and 2 for the Texas Hospital Association Annual Conference and Expo. The large attendance reflects hospital executives’ concerns about the changes occurring in the Texas Medicaid program, and their fear of more budget cuts from Washington, D.C. Despite their anxiety over future health care funding, hospital leaders seemed very focused on their mission of caring for their communities’ health needs, and are committed to improving quality and operating more efficiently.
Mike Leavitt: R e m a i n CompassionateThe highlight of the event was the keynote address by Mike Leavitt, former governor of Utah and a former secretary of the U.S. Department of Health and Human Services. He really set the tone for the conference when he said he feels optimistic because health care is responding to the financial crisis and is in the process of changing. He talked about the importance of remaining compassionate while being dispassionate about change. He pointed out that the move to reduce spending on health care is the “debt market saying, ‘We want our money back. You’re going to start living within your means. You’re going to start making progress’.”
Gov. Leavitt predicts “rigorous change” and already we are seeing that. He also pointed out that “health reform is not a bill, it is a process.” He explained that health reform is being driven by “global economic dispassion.” He encouraged everyone attending to not lose the compassion that motivated them to work in health care, and he stressed that as providers, we’ve got to do better. He said, “This is not a stratification of care but a stratification of how we deliver it.”
Medicaid Budget Situation Looks DireTexas Health and Human Services Executive Commissioner Tom Suehs echoed Gov. Leavitt’s message about health care costs and financing. He noted that the 2011 Legislature left a $4.5 billion hole in Medicaid, and with the greater-than-budgeted growth in caseload, Suehs projects a $15-17 billion shortfall in Medicaid when legislators convene in January 2013. If federal health care reform is implemented, then in 2014, current health care financing will “implode.” While many see a disaster looming, Suehs urged hospital leaders to “look for the opportunities.”
Suehs sees the recently approved Medicaid 1115 waiver as a real opportunity to transform the Texas Medicaid program.
He believes that the waiver will encourage innovation, and lead to a better, more affordable M e d i c a i d program. He emphasized “it’s not business as usual. It’s a new day. The old programs are out the window.”
P o i n t /C o u n t e r p o i n t
Produced Lively DiscussionFormer Judge F. Scott McCown, executive director of the Center for Public Policy Priorities, and former state Rep. Arlene Wohlgemuth, executive director of the Texas Public Policy Foundation, squared off on the state’s role in funding health care programs for low-income Texans. As expected, the two disagreed on key fundamentals. McGown believes in health care coverage for all, which he says is “the right thing to do. Otherwise the two-headed monster of higher costs and shrinking care will eat you.” Wohlgemuth emphasized that “It’s not what you want to do; it’s what you can do.” She does not believe the Patient Protection and Affordable Care Act is “the panacea for taking care of the uninsured.”
In a preview of the 2013 session, McGown advocated for a balanced approach to budgeting with new revenue plus cuts. He told the THA conference attendees,
THA conference focuses on future, honors Houston hospital
Unit as part of the dedication of CLRMC to provide healthcare with the patients’ needs as its chief priority.
Patient rooms and all expanded services are geared toward continuing the healing environment for which CLRMC is renowned. Private patient rooms enhance patients’ sleep and personal recovery time with family. The same high tech, patient-centered care that the hospital staff and physicians have always provided now will include the most modern, serene aesthetics designed with comfort and efficiency in mind.
In addition to new construction, the project also features renovations to other areas of the facility, which will result in 79,000 square feet of remodeled space. CLRMC’s busy Women’s and Children’s Services Departments will experience exciting changes – including all-new, state-of-the-art birthing suites and two additional Labor and Delivery Rooms. The hospital continues its dedication to the safest and most expedited care for women and infants with three dedicated caesarean section operating rooms.
CLRMC delivers more than 4,000 babies annually, and the hospital will continue its commitment of offering women the highest quality medical services with individualized attention. A newly expanded newborn nursery also is part of the plan for renovations. It will provide the best in aesthetics and comfort, with work stations and accessibility to staff and physicians that allows ease of access to physicians, staff and newborn parents.
“An expansion of this size is important on many levels. Primarily, it greatly enhances the services of an already remarkable medical center, which is a very valuable asset to the quality of life for the people who live in Bay Area Houston,” said Bob Mitchell, President, Bay Area Houston Economic Partnership. “Additionally, it indicates to businesses and site selectors who are considering this area for growth or relocation that our economy is more than capable of supporting this kind of expansion not only for the medical center but for them, as well. This is very positive for the continued economic vitality of the region.”
The largest employer in Webster, CLRMC currently employs more than 2,000 people and serves more than 1.5 million people in surrounding communities. As a result of the expansion, hospital administration anticipates some additional jobs in various
clinical and ancillary service areas.
CLRMC will remain fully operational during construction; free valet and general parking continue to be provided to visitors. A free shuttle services also is available to visitors during the construction phase.
Perkins+Will in Dallas is the architect for the project and the construction will be completed by DPR Construction in Houston.
Public invited to celebrate opening of UTMB’s new Comprehensive Maternity Center
After delivering nearly 20,000 babies in the three years since Hurricane Ike, the department of obstetrics and gynecology at the University of Texas Medical Branch will open a new, state-of-the-art Comprehensive Maternity Center at UTMB’s John Sealy Hospital.
The new center boasts 16 private, spacious labor-delivery and recovery suites, five triage rooms, four prolonged observation rooms, a maternal intensive monitoring bay, and an obstetric post-surgical recovery area. The facilities are supported by five operating rooms and one fetal surgery room. The center is on the same floor as UTMB’s Neonatal Intensive Care Unit, making it ideally suited for high-risk maternity patients.
Families who choose UTMB’s new center will be supported by health-care professionals with the expertise to respond immediately to the most complicated pregnancies, including obstetrician gynecologists, neonatologists, obstetric anesthesiology specialists and highly skilled obstetric nurses.
Mothers at lower risk for complications have access to UTMB’s certified nurse midwives, who are available 24 hours a day to attend births and provide woman-centered care in UTMB’s Ob/Gyn clinics. The midwives and physicians work closely together to provide the individualized birth experiences many families request.
The Comprehensive Maternity Center is a part of the larger John Sealy Hospital Modernization Project for which the Sealy & Smith Foundation has provided the majority of funding. The cost of the modernization project is $36 million and includes, in addition to the new maternity center, improvements to the two medical-surgical wings (now completed), the Blocker Burn Unit, the pediatric intensive care unit (in construction) and hospital infrastructure (in construction), according to Mike Shriner, UTMB’s vice president for business operations and facilities. t
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would like to pay today; ask how the patient would like to pay.
Offering Flexible Payment Options
Use a system that allows you to set up plans using a credit or debit card or direct debit from a patient’s bank account that runs automatically. Clearly define what payment plans are acceptable for large balances, but require the entire balance paid within six months.
Creating Team Responsibility and Incentive to Collect
To garner participation from office-staff in committing to asking patients for payment at the time of visit, establish graduated expectations for improvement over a specific period of time. Provide staff with sample scripts and/or talking points on how to collect. Well trained staff may be your biggest asset toward improved collections. Monitor staff’s performance each week
and share the results. Some practices offer bonuses when staff hit certain targets as an incentive to improve collections. Depending on the practice, the reward might be a set dollar amount, salary percentage or portion of above-goal collections.
By taking steps to collect patient payments at the time of the visit, you can significantly reduce your practice’s billing and collection efforts. When front office staff is careful to verify insurance before the visit, inform patients of collection procedures ahead of time, and collect payments at the time of service consistently, then your practice’s billing staff has a lighter work load and can focus on other areas of billing and collections.
Remember, a patient-friendly experience begins the moment the patient walks into your practice. Do not miss the opportunity to create a favorable, patient-centered experience. By making adjustments to the manner in which your practice interacts with patients, your practice can build a more positive patient experience, ultimately establishing a more cost-effective workflow within your office.
Get the most out of your banking relationship
By SPeNCer SoCkWell, National healthcare Banking executive, BBVA Compass
Health care providers rely on their banks to help them
with everything from paying their employees to financing their business expansion. So it stands to reason that medical providers should evaluate banking services like those of any long-term partnership.
Those decision makers tend to repeat the mantra “Know me, know my company, know my industry.” But health care providers don’t have time to educate their business partners, including banks, about the nature of their business. Rather, healthcare bankers need to know the industry.
Spending in the health care industry increased 93 percent between 1999 and 2009 and is expected to increase another 75 percent in the next decade, according to the most recent Centers for Medicare and Medicaid Services’ National Health Estimates.
In 2009, the U.S. spent $2.5 trillion on health care, a growing market from the perspective of banks. But while banks want to cater to this growing market, it is up to health care providers to make sure they are receiving the right attention and service from their bankers so they can focus on offering the best service to their patients.
The banker and bank must know what keeps providers up at night. Bankers should know the external and internal challenges healthcare providers face. They must know about legislative changes and how a growing and aging population drives the need for more health care services.
Clients must feel the banker is listening to their needs and prepared to offer ideas and create solutions. Too often, banks fall into the trap of ‘pitching product’ instead of taking the time to listen, evaluate, discuss, and solve.
For example, almost any bank can fulfill a request for a working capital line of credit, but a good banker who is knowledgeable and listens would also then probe into the causes of the need for this request. Are there revenue cycle issues impacting cash flow and what solutions can be created to address this?
A good relationship should be more than providing and consuming banking services, it should also be about collaboration. t
The greatest energy wastes are in air conditioning, heating and ventilation (HVAC), the thermal envelope of the building, lighting and water use. In older buildings, electrical systems are run on a manual basis. Upgrading to a web-based system will control the zones. The reduction in electricity use and labor hours (since it can be accessed offsite) can typically reduce overall cost by 30 percent. Landlords can make simple renovations to the building’s envelope that result in fast savings. Upgrading insulation, weather stripping and sealing improve the building’s resistance to the elements. Installing window film on exterior windows to block the sun’s rays in the summer will reduce heat gain, and window film will also help prevent heat loss in the winter, reducing energy consumption by 10 percent or more. For a larger up-front cost, but a bigger effect on the bottom line and potentially a more appealing look, replace the old windows and doors with new high-performance versions.
Attractive lighting system upgrades can range from simple to a complete replacement. Inexpensive and easy changes include reducing the power where areas have excessive or unneeded lighting. One building owner replaced metal halide and other incandescent light fixtures with fluorescent and compact fluorescent lighting technologies and saw a return on investment in 1.8 years. Install lighting controls and motion sensors to make sure areas that aren’t in use aren’t lit. Solutions such as low-mercury fluorescent systems or even LED options are somewhat expensive, but the energy savings and reduced maintenance provides as much as 70 percent energy savings.
Another easy way to reduce energy costs includes deregulated purchasing of electricity at lower rates. With the assistance of utility consulting firms, one company called USSCO purchased electricity in deregulated states, saving them $865,000. Grubb & Ellis Company was hired to make recommendations for Sony’s New York building that included it in a pooled bid for electricity. Along with
some related changes, Sony saw a savings of over $1 million a year. Additionally, they completed an attractive lighting retrofit which resulted in more savings.
Potable (drinkable) water reduction saves money fast. Changing to modern, efficient water faucets and plumbing fixtures helped update the appearance at 200 Market Street in Portland, Oregon while demonstrating a 67 percent ROI in as little as 1.5 years. Elaine Aye of Green Building Services said “The 17-story building achieved a 31 percent water use re¬duction beyond the Uniform Plumbing Code.” Decorative changes that reduce the use and cost of potable water can be accomplished with efficient landscaping. Recycled water may be used on the plants; and plants that are native to the area may receive all the water they need from rain.
To help some building owners get started or further improve their bottom lines, the federal, state, and local authorities offer incentives and other policies. Sony earned a local tax rebate of $400,000 for its efforts at the New York building. One state-by-state database Web site of tax credits, grants, financial incentives and other opportunities for funding related to energy efficiency upgrades can be found at www.dsireusa.org.
We are just touching on the possible ways to reduce energy consumption and improve environmental design. The ways are countless, and some of them are really fun. One landlord placed a large glass bowl in the lobby of their buildings to collect and recycle used wine corks. The tenants love the idea and support it so much that the bowl must be emptied several times a week. Another landlord renovated a sorely neglected park that was attached to his building. After re-landscaping, repairing the sprinkler system and fountain, and installing security cameras and a rover, employees from surrounding buildings come to sit and enjoy fresh air and a beautiful green setting. Maybe eventually they will move to his building.
Other good sources for information and advice include the EPA which has also developed an energy conservation program specifically for the healthcare industry, and the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) at www.ashrae.org. t
HEALTHCARE PROPERTIES continued from page 4. . . . . . . . . . . . . . .
Preventative Medicine…
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While no governmental or accrediting organization prescribes a tracking method for adverse events, health care experts encourage the use of incident reporting systems. In 1999, the Institute of Medicine recommended the use of incident reporting systems in hospitals, and today, many hospitals, including all the hospitals used in the January 2012 study, employ such systems. Incident reporting systems are limited, however. First, the reliability of the evidence generated by such systems for generalized trends is questionable due to the inconsistency in reports and reporting methods. Another limitation of incident reporting systems is that they tend to capture only a small percentage of events. Correspondingly, certain categories of events may be underrepresented in data generated by incident reporting systems. These limitations were confirmed through the study detailed in the OIG’s January 2012 report.
According to the January 2012 report, incident reporting systems utilized by hospitals captured only 14 percent of the 302 adverse and temporary harm events identified for the November 2010 report. To conduct the study, the OIG obtained information from (1) 189 of the 195 hospitals in which the adverse or temporary harm
events occurred; (2) follow-up interviews with administrators in 34 of these hospitals; and (3) interviews with staff from the three accrediting organizations.
In the study, all administrators reported that staff at their hospitals received general instructions to report adverse events, but that these instructions did not define or list reportable events. As a result, administrators reported that staff would not have recognized certain events identified by the OIG to be reportable. Administrators also reported that staff members often misconstrue the reporting
obligation to apply only to events involving medical errors. For example, the November 2010 study identified 17 temporary harm events involving the use of catheters (e.g., infections and urinary retention). Because these events did not involve any medical errors and are common side effects frequently dealt with in hospitals, only one of the 17 events identified by the OIG was reported. The OIG also found that none of the three accrediting organizations with
deeming authority assessed the effectiveness of incident reporting systems in hospitals.
The OIG admits that the report’s findings may be skewed as a result of (1) the time lapse since October 2008 when the hospitals treated the patients, (2) issues with recordkeeping procedures, and (3) decisions to not disclose due to confidentiality and liability concerns. Even though the report may have underestimated the percentage of incident tracking in hospitals, the study highlighted the uncertainty and perplexity in the requirement for incident tracking and reporting. As a result, the
OIG recommended that the Agency for Healthcare Research and Quality (AHRQ) and CMS should collaborate to define a list of reportable events, including “near-miss” events. CMS and AHRQ both agreed with the OIG’s recommendations and are in the process of drafting a list of reportable events. According to the OIG’s recommendation and CMS’ response, when the list is released, hospitals will be encouraged to use the list to design a system for internal reporting and
tracking of adverse events.
The OIG also recommended that CMS develop guidance for accrediting organizations and other surveying authorities to assess the effectiveness of incident reporting systems. In response, CMS stated that it is currently testing such guidance for surveyors. CMS agreed that surveyors must determine whether hospitals have clear and unambiguous reporting requirements and that hospitals should use both the list of reportable events and the AHRQ’s Common Formats to develop a tracking system for the QAPI program.
Hospitals can, therefore, expect to see changes to the Medicare State Operations Manual that implements the OIG’s recommendations. In the meantime, hospital administrators may take steps to assess whether the OIG’s reported findings are true in their hospitals and to improve their incident reporting systems. For example, administrators may survey staff to determine whether members recognize reportable events and to identify common misconceptions about the reporting obligation. By identifying misunderstandings among staff, administrators may determine the amendments needed for their QAPI policies and procedures. Administrators should also compare their policies and procedures to the AHRQ Common Formats and the list of adverse events used by the OIG in the November 2010 and January 2012 reports. This comparison will likewise reveal amendments hospitals may need to make to their QAPI programs. t
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types of bacteria depending on body site, from 100 to one million colony forming units per square centimeter. The environment becomes contaminated as patients shed skin that is laden with bacteria. Gloves are often perceived to be a replacement for hand hygiene, but hands may become contaminated from small defects in the gloves or during glove removal.
The Joint C o m m i s s i o n requires hospitals to measure and improve compliance. In order to focus i m p r o v e m e n t activities, the facility should identify barriers to compliance. Knowledge and attitudes should be assessed and addressed by education. Education and marketing will not address all barriers. Hand hygiene products must be acceptable to the staff. The location of alcohol hand sanitizer and handwashing sinks must support work flow and dispensers must be refilled on a timely basis. There should be a skin care product that is compatible with the soap and gloves in use.
Because there are many distractions in health care, creating a culture in which colleagues remind one another to clean their hands when they neglect to do so is extremely important. Patients can participate if we teach them about the importance of clean hands and encourage them to ask staff and visitors if their hands
are clean. Finally, attending physicians and leadership must be role models and hold themselves and others accountable for high compliance.
Other common focus areas nationally include prevention of device-associated and procedure-associated infections. Device-associated infections include central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI) and ventilator associated-pneumonia (VAP).
In Texas, hospitals are required to publicly
report CLABSI for all ICUs via the National Healthcare Safety Network (NHSN). CMS retrieves CLABSI and CAUTI data from NHSN. A number of regional and national projects have demonstrated effectiveness of the prevention bundle approach, which is the use of several prevention strategies together. Although each device has a very specific set of measures, a commonality is a daily review by physicians of the necessity for the device and discontinuing the device when no longer necessary. The involvement of clinicians in planning and implementing prevention initiatives is imperative: they
must agree to adopt and support evidence-based measure. The Keystone and CUSP projects have demonstrated the power of learning from each infection to continually refine risk reduction.
Preventing procedure-associated infections is typically focused on surgical procedures in hospitals. Surgical procedures can be followed for development of surgical site infections. Other invasive procedures also create risk for the patient, but it can be difficult to associate subsequent infections with the procedure. Even when outcome data is available, the processes to
prevent infection should be assessed and may include SCIP measures, compliance with aseptic practice, or compliance with e n v i r o n m e n t a l controls such as air exchanges or air flow direction.
Increasingly of interest to regulatory agencies is assuring best practices are followed for sterilization and high-level disinfection of equipment used for critical (sterile) and semi-critical (mucous membrane
contact) procedures. Manufacturer’s instructions for use for the equipment must be followed, including all the quality control checks required for the process.
These are only a few of the focus areas for today’s hospital infection prevention program. To be effective, it is imperative that clinicians and leadership be engaged in all aspects of the program, including planning, implementation and evaluation of preventive measures and the infection prevention program. t
“Folks, we’re gonna have to raise taxes.” Wohlgemuth disagreed, and thinks “there is plenty of money; we’re just not spending it wisely.” The 2012 elections provide an opportunity for all Texans to think about the type of government and health care they want. To use Gov. Leavitt’s expression, will Texans want to continue to show compassion for the poor and disenfranchised by supporting funding for Medicaid and the Children’s Health Insurance Program? Or, do Texans take a dispassionate approach, and agree “no new taxes,” regardless of the consequences?
In my Annual Report to the membership, I asked hospital leaders to step up to the plate, to get involved in shaping health policy and in educating their communities. All Texans – especially those with health insurance – must understand the impact
of the uninsured on access to vital health care services for everyone. Health and health care are too important to let partisan politics drive policy decisions that hurt people in the long run. A little knowledge can be dangerous, and Texans need all the facts to make informed decisions. Health care finance is extremely complicated, but our communities and our elected leaders need to understand the basics so that wise choices are made. Hospitals have a responsibility to help educate them.
Memorial Hermann Health Care System HonoredHospitals also have a responsibility to continuously improve patient safety and quality. At the THA Awards Luncheon, Houston’s Memorial Hermann Health Care System received the prestigious Bill Aston Award for Quality in the Academic/Large Teaching Hospital category. Over five years, Memorial Hermann has significantly reduced the rate of central-line associated blood stream infections and ventilator-associated pneumonia across its 12-hospital
system. The award recognizes hospitals/health systems that demonstrate improved outcomes in patient care related to a national or state evidence-based standard.
For a health care system providing 732,000 days of care to 135,000 patients annually, that was no small task. The initiative required an organizational culture change to make error prevention fundamental to business operations. Memorial Hermann is a role model for other large systems, and this prestigious award recognizes the system for its discipline and commitment to improving patient care.
South Texas Health System in Edinburg was honored in the Non-Research/Non-Academic Hospital/System category for similar work.
If you didn’t attend the 2012 conference, you missed a great opportunity to learn and network with your peers. But there is always next year – Feb. 13-14 in Austin. t
Methodist Sugar land hospital expands Surgical robotics Program
In 2010 Methodist Sugar Land Hospital (MSLH) was the first to bring robotic surgery to Fort Bend County and recently MSLH expanded on that technology with an upgrade to the da Vinci® SI Surgical Robot which includes fluorescence imaging technology. The da Vinci SI Surgical Robot allows surgeons to see and assess anatomy better than the naked eye, further enhancing the unmatched vision, precision and control of surgical robotics.
The robotic system is guided by a surgeon
and uses a minimally invasive technique, which entails smaller incisions and less damage to surrounding tissue compared to traditional surgery. Surgeons are able to perform major surgeries through dime-sized incisions, which require only one or two stitches to close. As a result, patients can return to their normal activities in one to two weeks and are at much lower risk of developing infection.
This new upgrade is instrumental in the treatment of renal tumors which may spare kidney cancer patients an increased risk of life-long dialysis. Using the recently acquired da Vinci SI Surgical System, Dr. John Boon and Dr. Henry Pham, board certified urologists on staff at Methodist Sugar Land Hospital, can remove the tumor affecting the kidney and leave the healthy tissue. Patients can then often avoid the increased risk of organ failure that results from having a single healthy kidney.
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of an integrative approach to medicine and nutrition. This one is coming up in April, 2012 in Boston. Go if you can, and if not this year, look for it next spring.
ABHIM review courseThis review course is a wonderful week of learning covering the waterfront on integrative and holistic practices preceding the ABIHM Board exam. Lectures and experiential learning provide the attendee with pragmatic skills and knowledge to not only take a test but to apply such principles in practice. Healthful meals, morning yoga, meditation, and tai chi set the tone for a time to retool and reinvent yourself and your practice.
Application for certification as a Diplomate of the ABIHM is for MD or DO physicians who choose to incorporate integrative holistic principles into their practices, and to demonstrate to their colleagues and patients that they have undergone the only comprehensive, peer-reviewed, psychometrically validated examination process in integrative holistic medicine. The certification enables physicians to obtain a credential that attests to their knowledge in the field and affords them the recognition of having met a recognized standard of achievement.
Taking this test will provide Diplomate status until 2013 after which it is expected that a fellowship in integrative medicine will be required for board certification by the American Board of Physician Specialties. Tests will be offered in May and November of 2012) and in January of 2013. (with next review course in San Diego in November).
International Research Congress on Integrative Medicine and HealthThis is the premier meeting on research in the field. Co-sponsored by the Consortium
of Academic Health Centers for Integrative Medicine (CAHCIM) and the International Society for Complementary Medicine Research (ISCMR), this international event starts May 15, 2012 in Portland, Oregon. It brings together the best international researchers in the field to present exciting new findings applicable to clinical practice and future research. Over 600 abstracts are under review and we are expecting over 800 attendees from more than two dozen countries to be present. It will be a high quality, benchmark conference with lots of opportunities to network, share new ideas, and learn about the cutting edge research in integrative medicine.
Helms Medical Institute Acupuncture TrainingFor those of you who wish to learn how to incorporate acupuncture into your practice for pain management and more, this is the premier program. Helms Medical Institute educates physicians in the science and art of medical acupuncture. HMI sponsors the oldest ongoing medical acupuncture training program in North America. It is the only training that offers a comprehensive foundation in all dimensions of acupuncture. Ninety percent of physicians practicing acupuncture in the United States have been trained through Helms Medical Institute’s Medical Acupuncture for Physicians courses. HMI has been chosen by the US military to teach this discipline to its physicians.
There are a number of other annual courses such as the Integrative Healthcare Symposium in New York City which you could attend this year or next. Get on their mailing lists.
All of these and more are opportunities to sit elbow to elbow with other holistic practitioners and to learn how to transform your practice and enhance the care of your patients. t
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imaging and high definition monitors, surgeons in many specialties can perform major surgeries with the most accuracy possible. The surgeon’s skill, complemented by the robot’s precision, offers benefits to patients undergoing surgery in a growing number of specialties.
Too risky for surgery, houston VA offers Army veteran catheter-based alternative for traditional heart valve replacement
The Michael E. DeBakey VA Medical Center (MEDVAMC) is the first VA to implant an innovative artificial heart valve recently approved for commercial use by the Food and Drug Administration.
The Sapien heart valve made by Edwards Lifesciences is implanted through a catheter as an alternative to open heart surgery for patients with inoperable aortic valve stenosis disease. Army Veteran Cottrell McGowan, 81, of Nacogdoches,TX., received this transcatheter aortic valve on December 21, 2011.
“In addition to his advanced age, Mr. McGowan had chronic lung and renal disease, and a heavily calcified aorta so he was not a candidate for open surgery,” said Biswajit Kar, M.D., F.A.C.C., Interventional Cardiology director and an associate
professor of Medicine-Cardiology at Baylor College of Medicine (BCM). “We were able to offer him this life-saving device and he was ready to go home two days later.”
Many older or sicker patients suffering from aortic valve stenosis are considered poor candidates for conventional surgery, which requires cutting open the chest and temporarily stopping the heart.
“With the aging population, the potential impact of this procedure is enormous,” said Faisal Bakaeen, M.D., chief of Cardiothoracic Surgery and associate professor of Surgery at BCM. “People can literally gain a new lease on life overnight.” The valve, made of bovine tissue and stainless steel, is about the width of a pencil when it is deployed through a catheter in the femoral artery in the groin. Once it arrives at the correct spot, the valve is released, replacing the diseased one. Patients generally stay in the hospital for an average of three days, compared to seven days with open heart surgery, Kar said. Besides Kar and Bakaeen, the MEDVAMC Heart Valve Team is a multidisciplinary team that includes cardiothoracic surgeons, cardiologists, vascular surgeons, anesthesiologists, radiologists, nursing and auxiliary staff superbly trained to take care of this unique and complex patient population.
St. luke’s episcopal hospital offers bronchial thermoplasty treating severe asthma patients
St. Luke’s Episcopal Hospital is the first hospital in Houston to offer bronchial thermoplasty, an innovative procedure for the treatment of severe asthma. Affecting almost 25 million Americans, asthma is one of the top five chronic diseases globally, along with heart disease, stroke, cancer and diabetes. Patients treated with this minimally invasive, outpatient procedure have shown a decrease in severe asthma attacks and improved quality of life. On October 20, 2011, Robert Pakebusch became St. Luke’s first patient to undergo the bronchial thermoplasty. He has suffered with difficulty breathing for more than 15 years and was diagnosed with asthma two years ago. Since his diagnosis, Pakebusch’s pulmonologist has addressed the constant exacerbations in his lungs with ongoing steroid and antibiotic treatments. Living everyday with the inhibiting disease and after being hospitalized at St. Luke’s last year with double pneumonia and asthma exacerbations, Pakebusch thought there would be no relief from his constant battle when his pulmonologist, Clinton H. Doerr, MD, recommended he research a new treatment option, bronchial thermoplasty. “As I have been on steroids everyday for the last ten months, I was immediately interested because any improvement would be fantastic at this point,” said Pakebusch.
Bronchial thermoplasty is an outpatient procedure that treats severe asthma by going to the source. The lungs consist of multiple airway passages that are surrounded by
airway smooth muscle. For patients with asthma, this smooth airway muscle is more susceptible to triggers and irritants that can cause it to constrict and reduce the amount of airflow through the lungs. Bronchial thermoplasty uses radiofrequency waves to shrink the smooth muscle reducing the muscle’s ability to constrict, thereby creating a larger airway. This increased airflow results in a decreased frequency of asthma attacks.
Bronchial thermoplasty with the Alair® System is approved by the FDA for adults with severe asthma who are not well controlled on current medications, and is expected to complement asthma medications by providing long-lasting asthma control. The procedure typically takes less than an hour to complete, with the patient returning home the same day. To treat the entire lung, the complete bronchial thermoplasty procedure is performed in three separate outpatient treatment sessions, each treating a different area of the lung and scheduled approximately three weeks apart.
In clinical studies, the benefits of the bronchial thermoplasty included reduced severe asthma attacks, decreased visits to the ER and hospital for respiratory symptoms, and less time lost from work or school due to asthma. t
