St. Luke's Hospital Annual Report 2011 - Cedar Rapids, Iowa
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Report to the Community: Help for the uninsured St. Luke’s provides financial assistance to underinsured and uninsured patients. The amount of assistance provided is determined by a patient’s financial need. Besides providing charity care St. Luke’s works with the Cedar Rapids free clinics to provide support and services to uninsured and underinsured individuals in our community. Last year St. Luke’s provided over $760,000 in services such as X-rays and electrocardiograms (EKGs) to the Community Health Free Clinic (CHFC). This Cedar Rapids clinic provides free medical, dental and prescription services to more than 11,500 individuals annually. The services that St. Luke’s provides helps Clinic doctors determine the patient’s correct diagnosis and treatment. With 94 percent of Clinic patients reporting household incomes at or below 50 percent of the poverty level, the cost of these services exceeds their means. Pioneering better healthcare for all St. Luke’s recognized as a Top 100 Hospital for the fourth time the healthcare culture of more is always better. It’s something we have been working towards for some time. This is evidenced in the fact that we are a four-time winner of Thomson Reuter’s Top 100 Hospital Award. St. Luke’s has created a culture where the importance of better primary care is stressed, because we know the integration of physician and hospital services and relentless quality benchmarking are hallmarks of our future. For patients this means that for the first time ever their primary care doctor will have more detailed information about the care they have received from other providers. We will see more proactive management of chronic conditions to improve outcomes and reduce hospital admissions or complications. We will also see an emphasis on staying healthy with proac- tive encouragement for patients to obtain regular exams, immunizations and preventive programs. It’s a system where doctors lead not only in the care of patients with acute and chronic illness but also patients who are perfectly well and just need the tools to stay that way. Under the ACO structure hospitals and insurers will share accountability for ensuring the care provided is both appropri- ate and cost effective. Think about it – your doctor and insurer all on the same team, trying to do a better job. This change represents a transformation of healthcare from a system that has emphasized quantity of care to one that rewards quality of care and aims to create a patient experience less confusing and more comforting. That will be good for all of us. Sincerely, Ted Townsend President and CEO Ted Townsend President and CEO St. Luke’s, in its association as a senior member of the Iowa Health System (IHS), is blazing trails for other hos- pitals to emulate. As the nation’s highest court weighs in on healthcare reform St. Luke’s and IHS are poised for the inevitable – a new kind of healthcare. The Iowa Health System is a leader in pioneering this new direction. Our Fort Dodge affiliate was chosen in a competitive selection process as one of only 32 Pioneer Accountable Care Organization’s (ACOs) in the nation. Here in Cedar Rapids, St. Luke’s will be part of an ACO model for Medicare patients and will also introduce these concepts through a new collaboration with Wellmark, our state’s largest private insurer. We can all expect these healthcare changes in the years to come. It’s driven by new models of care that move away from paying more for the volume of services rather than focusing on the quality of a patient’s care. At St. Luke’s this isn’t a new concept. We know it is essential for changing St. Luke’s Hospital is one of only two hospitals in the state named one of the nation’s 100 Top Hospitals by Thomson Reuters, the nation’s leading source of healthcare information. The award recognizes hospitals that have achieved excellence in quality of care, operational efficiency, financial performance and growth. This is the fourth time St. Luke’s has received this distinction. According to Thomson Reuters, it is difficult to be selected as a national benchmark hospital every year. Research has shown hospitals that win this award three or more times have particularly high levels of performance over many years. The 100 Top Hospitals National Benchmarks study evaluat- ed nearly 3,000 acute care, non-federal hospitals, including St. Luke’s, in 10 areas: mortality, medical complications, patient safety, average length of stay, expenses, profitability, patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute heart attacks, heart failure and pneumonia. The study has been conducted annually since 1993. The study then compared St. Luke’s performance against similarly sized hospitals across the country. The study found if all Medicare inpatients throughout the country received the same level of care as those treated in these 100 Top Hospitals award winners, including St. Luke’s, then: • More than 186,000 additional lives could be saved. • Approximately 56,000 additional patients could be complication-free. • More than $4.3 billion could be saved. • The average patient stay would decrease by nearly half a day. Hospitals do not apply, pay for, or complete a survey to receive this designation. Donald Paynter, MD, FACP Internists, P.C. Pulmonary Medicine Community benefits are programs or activities that provide treatment or promote health and healing as a response to identified community needs. The goal is to improve residents’ access to healthcare, enhance the health of the community, advance medical or health knowledge or relieve the burden on government or other community efforts. St. Luke’s community benefits include education, charity care, subsidized health services, community health improvement activities and more. Here’s a look at a few community programs St. Luke’s offers to make Cedar Rapids a healthier community. Caring for our community St. Luke’s Cook Cancer Wellness Program With progress in diagnosing certain cancers at an earlier stage and improvements in treatment, the number of individuals who refer to themselves as cancer survivors continues to climb. These survivors need additional services to help them tackle treatment-related side effects and adjust to a new personal health altered by a diagnosis of cancer. In response to these needs, St. Luke’s Hospital launched the Cook Cancer Wellness Program in 2009. It provides multiple services to cancer survivors and addresses quality-of-life issues in an individualized way. The program is free to patients and doesn’t end when the patient stops treatment. It’s intended to be available to individuals for as long as they need it – even if that means years after their last treatment. Services offered through St. Luke’s Cook Cancer Wellness Pro- gram include: a program coordinator to help survivors identify needs post cancer, an exercise specialist who works with indi- viduals to devise an exercise and wellness plan, a dietitian to assist patients and survivors with choosing healthy foods, can- cer wellness massage for patients and survivors dealing with prolonged pain from treatment and a risk assessment advisor to work with individuals to determine additional cancer risks. Monetary value People served Wellness coordinator $ 52,161 250 Exercise specialist $ 91,282 150 Dietitian $ 2,340 52 Wellness massage $ 4,059 120 Cancer risk assessment $101,654 174 TOTAL $251,496 in FREE cancer support services to the community “Some of the testing St Luke’s provided has literally saved lives of Clinic patients,” said Darlene Schmidt, CHFC executive director and CEO. “One of our patients, Betty, was diagnosed with diabetes after receiving testing at St. Luke’s. She now has a treatment plan and is successfully managing her diabetes. Another patient, Bob, received an X-ray to determine if he had gallstones. Today, Bob is recovering following surgery. Without St. Luke’s willingness to partner with Community Health Free Clinic, these outcomes would not be as positive.” According to Schmidt, St. Luke’s is one of the clinics largest community partners. In addition to the in-kind services, St. Luke’s employees donate their time and talents enabling the Clinic to provide $11 of free healthcare services for every dollar spent. With St. Luke’s support, CHFC is able to assist the uninsured and under-served with free healthcare that improves the quality of life for the patients, their families and our community. Community benefit value: $762,667 Training tomorrow’s nurses The projected nursing shortage in the United States is expected to intensify as baby boomers age and the need for healthcare grows. Helping prepare future healthcare professionals is something St. Luke’s takes very seriously. Year round, the hospital supports education for medical and nursing students and technicians. Last year, St. Luke’s nurses mentored 138 nursing students from five area colleges and universities. St. Luke’s nurses dedicated over 17,000 hours of training. These students learn from experienced professionals how to assess patients, administer medication, eval- uate treatment and provide educational and emotional support. These students may spend anywhere from 12 to 365 hours of intense learning at St. Luke’s per semester with an experienced nurse. “We teach students how to think like a nurse,” said Joanie Copper, St. Luke’s practice development coordinator. “We have intelligent, compassionate nurses at St. Luke’s who are committed to teaching future generations of nurses to have those same qualities. We want them to think about how they will improve the patient care they will deliver in the years to come.” Students trained: 138 Training hours by St. Luke’s nurses: 17,064 Community benefit value: $1,151,690 stlukescr.org
Transcript
Report to the Community:
Help for the uninsuredSt. Luke’s provides fi nancial assistance to underinsured and uninsured patients. The amount of assistance provided is determined by a patient’s fi nancial need.
Besides providing charity care St. Luke’s works with the Cedar Rapids free clinics to provide support and services to uninsured and underinsured individuals in our community. Last year St. Luke’s provided over $760,000 in services such as X-rays and electrocardiograms (EKGs) to the Community Health Free Clinic (CHFC). This Cedar Rapids clinic provides free medical, dental and prescription services to more than 11,500 individuals annually.
The services that St. Luke’s provides helps Clinic doctors determine the patient’s correct diagnosis and treatment. With 94 percent of Clinic patients reporting household incomes at or below 50 percent of the poverty level, the cost of these services exceeds their means.
Pioneering better healthcare for all
St. Luke’s recognized as a Top 100 Hospital for the fourth time
the healthcare culture of more is always better. It’s something we have been working towards for some time.
This is evidenced in the fact that we are a four-time winner of Thomson Reuter’s Top 100 Hospital Award. St. Luke’s has created a culture where the importance of better primary care is stressed, because we know the integration of physician and hospital services and relentless quality benchmarking are hallmarks of our future.
For patients this means that for the fi rst time ever their primary care doctor will have more detailed information about the care they have received from other providers. We will see more proactive management of chronic conditions to improve outcomes and reduce hospital admissions or complications.
We will also see an emphasis on staying healthy with proac-tive encouragement for patients to obtain regular exams, immunizations and preventive programs. It’s a system where doctors lead not only in the care of patients with acute and chronic illness but also patients who are perfectly well and just need the tools to stay that way.
Under the ACO structure hospitals and insurers will share accountability for ensuring the care provided is both appropri-ate and cost effective. Think about it – your doctor and insurer all on the same team, trying to do a better job. This change represents a transformation of healthcare from a system that has emphasized quantity of care to one that rewards quality of care and aims to create a patient experience less confusing and more comforting. That will be good for all of us.
Sincerely,
Ted TownsendPresident and CEO
Ted TownsendPresident and CEO
St. Luke’s, in its association as a senior member of the Iowa Health System (IHS), is blazing trails for other hos-pitals to emulate. As the nation’s highest court weighs in on healthcare reform St. Luke’s and IHS are poised for the inevitable – a new kind of healthcare. The Iowa Health System is a leader in pioneering this new direction. Our Fort Dodge affi liate was chosen in a competitive selection process as one of only 32 Pioneer Accountable Care Organization’s (ACOs) in the nation.
Here in Cedar Rapids, St. Luke’s will be part of an ACO model for Medicare patients and will also introduce these concepts
through a new collaboration with Wellmark, our state’s
largest private insurer. We can all expect these healthcare changes in the years to come. It’s driven by new models of care that move away from paying more for
the volume of services rather than focusing
on the quality of a patient’s care. At St. Luke’s this isn’t a new concept. We know it is essential for changing
St. Luke’s Hospital is one of only two hospitals in the state named one of the nation’s 100 Top Hospitals by Thomson Reuters, the nation’s leading source of healthcare information. The award recognizes hospitals that have achieved excellence in quality of care, operational effi ciency, fi nancial performance and growth. This is the fourth time St. Luke’s has received this distinction. According to Thomson Reuters, it is diffi cult to be selected as a national benchmark hospital every year. Research has shown hospitals that win this award three or more times have particularly high levels of performance over many years.
The 100 Top Hospitals National Benchmarks study evaluat-ed nearly 3,000 acute care, non-federal hospitals, including St. Luke’s, in 10 areas: mortality, medical complications, patient safety, average length of stay, expenses, profi tability, patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute heart attacks, heart failure and pneumonia. The study has been conducted annually since 1993. The study then compared St. Luke’s performance against similarly sized hospitals across the country.
The study found if all Medicare inpatients throughout the country received the same level of care as those treated in these 100 Top Hospitals award winners, including St. Luke’s, then:
• More than 186,000 additional lives could be saved.• Approximately 56,000 additional patients could be
complication-free.• More than $4.3 billion could be saved.• The average patient stay would decrease by nearly
half a day.
Hospitals do not apply, pay for, or complete a survey to receive this designation.
Here in Cedar Rapids, St. Luke’s will be part of an ACO model for Medicare patients and will also introduce these concepts
through a new collaboration with Wellmark, our state’s
largest private insurer. We can all expect these healthcare changes in the years to come. It’s driven by new models of care that move away from paying more for
the volume of services rather than focusing
on the quality of a patient’s care. At St. Luke’s this isn’t a new concept. We know it is essential for changing
in quality of care, operational effi ciency, fi nancial performance and growth. This is the fourth time St. Luke’s has received this distinction. According to Thomson Reuters, it is diffi cult to be selected as a national benchmark hospital every year. Research has shown hospitals that win this award three or more times have particularly high levels of performance over many years.
The 100 Top Hospitals National Benchmarks study evaluat-ed nearly 3,000 acute care, non-federal hospitals, including St. Luke’s, in 10 areas: mortality, medical complications, patient safety, average length of stay, expenses, profi tability, patient satisfaction, adherence to clinical standards of care, and post-discharge mortality and readmission rates for acute heart attacks, heart failure and pneumonia. The study has been conducted annually since 1993. The study then compared St. Luke’s performance against similarly sized
The study found if all Medicare inpatients throughout the country received the same level of care as those treated in
• More than 186,000 additional lives could be saved.• Approximately 56,000 additional patients could be
• The average patient stay would decrease by nearly
Hospitals do not apply, pay for, or complete a survey to Donald Paynter, MD, FACPInternists, P.C. Pulmonary Medicine
Community benefi ts are programs or activities that provide treatment or promote health and healing as a response to identifi ed community needs. The goal is to improve residents’ access to healthcare, enhance the health of the community, advance medical or health knowledge or relieve the burden on government or other community efforts. St. Luke’s community benefi ts include education, charity care, subsidized health services, community health improvement activities and more. Here’s a look at a few community programs St. Luke’s offers to make Cedar Rapids a healthier community.
Caring for our community
St. Luke’s Cook Cancer Wellness ProgramWith progress in diagnosing certain cancers at an earlier stage and improvements in treatment, the number of individuals who refer to themselves as cancer survivors continues to climb. These survivors need additional services to help them tackle treatment-related side effects and adjust to a new personal health altered by a diagnosis of cancer.
In response to these needs, St. Luke’s Hospital launched the Cook Cancer Wellness Program in 2009. It provides multiple services to cancer survivors and addresses quality-of-life issues in an individualized way.
The program is free to patients and doesn’t end when the patient stops treatment. It’s intended to be available to individuals for as long as they need it – even if that means years after their last treatment.
Services offered through St. Luke’s Cook Cancer Wellness Pro-gram include: a program coordinator to help survivors identify needs post cancer, an exercise specialist who works with indi-viduals to devise an exercise and wellness plan, a dietitian to assist patients and survivors with choosing healthy foods, can-cer wellness massage for patients and survivors dealing with prolonged pain from treatment and a risk assessment advisor to work with individuals to determine additional cancer risks.
TOTAL $251,496 in FREE cancer support services to the community
“Some of the testing St Luke’s provided has literally saved lives of Clinic patients,” said Darlene Schmidt, CHFC executive director and CEO. “One of our patients, Betty, was diagnosed with diabetes after receiving testing at St. Luke’s. She now has a treatment plan and is successfully managing her diabetes. Another patient, Bob, received an X-ray to determine if he had gallstones. Today, Bob is recovering following surgery. Without St. Luke’s willingness to partner with Community Health Free Clinic, these outcomes would not be as positive.”
According to Schmidt, St. Luke’s is one of the clinics largest community partners. In addition to the in-kind services, St. Luke’s employees donate their time and talents enabling the Clinic to provide $11 of free healthcare services for every dollar spent. With St. Luke’s support, CHFC is able to assist the uninsured and under-served with free healthcare that improves the quality of life for the patients, their families and our community.
Community benefi t value: $762,667
Training tomorrow’s nursesThe projected nursing shortage in the United States is expected to intensify as baby boomers age and the need for healthcare grows. Helping prepare future healthcare professionals is something St. Luke’s takes very seriously. Year round, the hospital supports education for medical and nursing students and technicians.
Last year, St. Luke’s nurses mentored 138 nursing students from fi ve area colleges and universities. St. Luke’s nurses dedicated over 17,000 hours of training. These students learn from experienced professionals how to assess patients, administer medication, eval-uate treatment and provide educational and emotional support.
These students may spend anywhere from 12 to 365 hours of intense learning at St. Luke’s per semester with an experienced nurse.
“We teach students how to think like a nurse,” said Joanie Copper, St. Luke’s practice development coordinator. “We have intelligent, compassionate nurses at St. Luke’s who are committed
to teaching future generations of nurses to have those same qualities. We want them to think about how they will improve the patient care they will deliver in the years to come.”
Students trained: 138Training hours by St. Luke’s nurses: 17,064Community benefi t value: $1,151,690
stlukescr.org
Report to the Report to the Community:Community:Report to the Report to the Report to the Report to the Community:Community:Report to the Report to the Report to the Report to the Community:Community:Community:Community:
$46,773,915 in community supportCharity care............................................................... $5,520,050 Uncompensated Medicaid ...................................... $10,131,189 Community health improvement services and community benefi t operations ......................... $1,594,708 Health professions education .....................................$2,174,831 Subsidized health services ......................................... $5,574,947Cash in-kind contributions to community groups .... $4,738,091 Community building activities ......................................$175,057 Bad debt .....................................................................$3,778,392 Unreimbursed Medicare* ..........................................$1,872,974Income, property, payroll and sales taxes .................$11,213,676 Total community support .................................. $46,773,915
$335,817,000 in operating costs**Salaries & benefi ts ............................................. $165,520,000 Supplies, implants & pharmaceuticals ................ $55,744,000 Other expenses & purchased services ................. $92,847,000 Depreciation ........................................................ $17,584,000Interest ................................................................... $3,971,000Provisions for uncollectible accounts*** .................. $151,000 Total operating costs .....................................$335,817,000
$36,585,708 reinvested in the community**Facility renovation/construction in progress ......... $13,810,739 New services/equipment/clinical improvement ......$8,048,719 IT investment ....................................................... $14,726,250
Total reinvestments ..........................................$36,585,708 *2010 data**Operating costs associated with St. Luke's Physicians & Clinics not included.***Provisions for uncollectible accounts are expenses incurred when a patient is unwilling to pay. Due to an accounting method change in 2011 the majority of bad debt is netted against gross patient revenue. Total bad debt (at charges) were $11,587,000.
Physical therapy outcomes after orthopedic procedures and injuries
Decreased pain Greater motion Improved function
2009 2010 2011
2010 Accelero Health Average 2010 Accelero performers in top 20 percent
Perc
ent i
mpr
oved
Accelero Health Partners data for St. Luke's Therapy Plus from 2009 to 2011.
Physical therapy patients report greater improvements Physical therapy (PT) is a treatment individuals may need after an injury or surgery. PT's goal is to help a patient move better, relieve pain and restore physical function.
Patients who receive outpatient care at any one of St. Luke’s Therapy Plus’ three locations fi nd their experience satisfying and effective. St. Luke’s works with Accelero Health Partners to identify physical therapy outcomes and compare St. Luke’s patient results with other client results from around the country.
As the chart indicates, St. Luke’s physical therapy patients report decreased pain, greater motion and improved function. St. Luke’s is considered one of Accelero’s top performing hospitals.
Reducing avoidable readmissionsAccording to the Institute for Healthcare Improvement hospitalizations account for nearly one-third of the total $2 trillion spent on healthcare in the United States. In most of these cases, hospitalization is necessary and appropriate. However, a substantial fraction of all hospitalizations are patients returning to the hospital soon after their previous stay. These rehospitalizations are costly, potentially harmful and often avoidable.
As part of St. Luke’s ongoing work to prevent patients from returning the hospital launched a program called Transitions Home in 2006. This program aims to create an ideal transition home or to the next level of care for patients discharged from medical and surgical units at St. Luke’s.
Making customer satisfaction a priorityWhen it comes to satisfi ed patients, look no further than St. Luke’s Emergency Room (ER). Survey results from healthcare research and consulting fi rm Press Ganey place St. Luke’s ER near the top in the nation when it comes to patient satisfaction.
Patients receive a survey after a visit to St. Luke’s ER. In the survey patients are asked about their experi-ences during treatment. They evaluate the hospital on a number of factors such as wait time, courtesy of staff, employee responsiveness and attention to detail, facility cleanliness and more. Individuals who completed the questionnaire gave St. Luke’s high marks in virtually every area on the survey.
“High patient-satisfaction scores show our ER employees give a consistently high performance in the treatment of patients,” said Sandi McIntosh, St. Luke’s Emergency Services director. “This is a constant work in progress. We are always fi ne-tuning the processes and looking for ways to improve our care and have patients seen as quickly and effi ciently as possible.”
Recent efforts to improve St. Luke’s ER include a major renovation and expansion, adding guest relations employees to communicate with patients about wait times or other issues and a posted list of expected wait times for tests and procedures like X-rays, CT scans and blood work.
2011 readmissions to the hospital within 30 days of discharge
Heart attack Heart failure Pneumonia
St. Luke's US national rate
Lower is better
The graph shows how often patients are readmitted within 30 days of discharge from a previous hospital stay for heart attack, heart
failure or pneumonia. They may have been readmitted for the same condition as their recent hospital stay or for a different reason.
In particular St. Luke’s focused its efforts on heart failure because of its high readmission rate. A team of healthcare providers looked at ways to make the patient’s transition home more family-friendly and identifi ed specifi c areas that caused a break-down in communication, which often led to a patient being readmitted to the hospital. Many of the same techniques are now used with other patients who are also at risk for rehospitalizations.
Press Ganey data
Higher is better
Higher is better
St. Luke’s Healthcare provided $47 MILLION of charity care, community benefi t, other uncompensated care and taxes in 2011.
That is 14 percent of St. Luke’s annual expenses.
St. Luke’s is committed to providing the highest level medical care to improve patients’ lives, regardless of their ability to pay. We are focused on strengthening the quality of life and well-being in our communities through sponsorships, in-kind donations, volunteer activities, innovative medicine and unparalleled passion and commitment to our patients. Examples of free services and programs provided include health screenings, support groups, counseling and immunizations.
Charity care
Community health improvement services & benefi t operations
